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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 42 to 66 of 66. Go back in thread:
Posted by linkadge on August 1, 2021, at 17:57:08
In reply to Re: Am I Lou Pildering you guys?, posted by Lamdage22 on August 1, 2021, at 13:49:30
>How do you mean that?
Not sure what you are asking..
I just mean that Lou was very annoying. I'm not going to literally punch somebody.
Linkadge
Posted by Phillipa on August 1, 2021, at 18:04:16
In reply to Re: Am I Lou Pildering you guys? » Lamdage22, posted by linkadge on August 1, 2021, at 17:57:08
What happened to Lou? I have his email address but he does not respond to it. Hope he is okay for real. Phillipa
Posted by linkadge on August 1, 2021, at 18:14:03
In reply to Re: GABAergic hypofunction in psychosis?, posted by Lamdage22 on August 1, 2021, at 14:51:47
>i dont know how commonly, but it is conceivable >that sometimes patients are errenously considered >to have bad genes and that way dont get the most >appropriate treatment for them.
Just because you have bad genes doesn't mean you can't get effective treatment. Bad genes just means you have a genetic predisposition. That genetic load could be mild (in which case a variety of treatments could work) or it could be severe, in which case a patient may be treatment resistant, or require multiple treatments.
For example, variations in sodium channel genes could predispose to neuronal overactivity. Variations in HPA could predispose to elevated cortisol responses to stressors. Variations in BDNF genes could result in impaired synaptic plasticity. Variations in PER2 genes (circadian rhythm genes) could predispose to being out of sync with typical sleep wake cycles. Variations in AANT or TPH2 genes can predispose to altered metabolism of tryptophan. Alterations in BH4 genes can predispose to reduced monoamine synthesis. Alterations in immune related genes can predispose to elevated immune responses and / or inflammatory responses. The list can go on and on.
Bottom line there are a gazillion different variations that, alone likely do little, but in combination can predispose to mental illness.
For example. I CANNOT gain weight. This sounds completely absurd to many people I tell. Even when I eat a typical 'western diet' I cannot gain a pound. What could explain this other than genetics? This is not bragging because I have lost the genetic lottery when it comes to mental health.
Linkadge
Posted by Lamdage22 on August 1, 2021, at 23:42:58
In reply to Re: GABAergic hypofunction in psychosis?, posted by linkadge on August 1, 2021, at 18:14:03
Well if my boundaries are respected enough so that I am not speaking of abuse anymore for a few years in a row, and I still have symptoms, I am willing to consider genetics.
It hasnt been proven yet like down syndrome etc. Obviously I dont know anything about your genes.
Posted by Lamdage22 on August 2, 2021, at 0:11:08
In reply to Re: GABAergic hypofunction in psychosis?, posted by Lamdage22 on August 1, 2021, at 23:42:58
It is now the case that to my abuser my every problem in life and with him is genetic. It is being used because it is disempowering. So this notion of genes and its overestimation can be used to cause harm. I am pretty certain Id enjoy life without this BS much more. Completely healthy or not.
Posted by Lamdage22 on August 2, 2021, at 2:33:02
In reply to Re: GABAergic hypofunction in psychosis?, posted by Lamdage22 on August 2, 2021, at 0:11:08
I don't have a problem with psychiatry as much, but my abuser has successfully used it against me. $$$ I have a problem that they happily allowed that to happen. If the notion that you genes are the culprit is helping you, I have no problem with that. But if it isn't helping me, I have a problem when people think I have to be converted.
I was a bit missionary, sorry for that. What helps is good. I'm not sure that the genes notion does, but I don't know you and thus I shall not judge.
Posted by undopaminergic on August 2, 2021, at 7:14:30
In reply to Re: GABAergic hypofunction in psychosis? » undopaminergic, posted by linkadge on August 1, 2021, at 13:30:26
> >Yes, but when pain is present, painkilling is >rewarding, relatively to baseline, and is one >reason you'd want to use the drug again. I agree >that "addictive" is perhaps not the right term, >but I don't know one that fits better.
>
> Yes, but if you had a painkiller that did not cause reward (in and of itself), then yes one might feel better after taking it (if in pain) but it's not the drug producing the reward. It's simply the desirability of less pain.
>
> For example. If you take an aspirin, and it relieves a headache, you wouldn't bother take a second. However, if you took some morphine for that same headache, you might ask for more 10 minutes later.
>I agree. However, I wonder a) how much the time to onset from taking the drug, and b) prior knowledge of the nature of the drug play a role. If you *thought* aspirin was like morphine, and the speed of onset was the same, would you ask for a second dose? Or would that depend only on whether the pain was gone? Of course, the lack of the secondary psychotropic effects of morphine would probably make a second dose seem less interesting. But morphine, especially the first dose, has adverse effects too, including nausea and drowsiness.
-undopaminergic
Posted by undopaminergic on August 2, 2021, at 7:28:26
In reply to Re: GABAergic hypofunction in psychosis?, posted by linkadge on August 1, 2021, at 18:14:03
>
> For example. I CANNOT gain weight. This sounds completely absurd to many people I tell. Even when I eat a typical 'western diet' I cannot gain a pound. What could explain this other than genetics? This is not bragging because I have lost the genetic lottery when it comes to mental health.
>I'm currently, for some reason, in a condition where I can pretty much eat how much I want without gaining weight. My goal has been 70-75 kgs, and now I seem to be staying 67-68. This is despite antihistamines clozapine and trimipramine.
So, I understand what you mean, but I'm still wondering whether you *could* gain weight if you put your mind to it? I'm sure I could.
-undopaminergic
Posted by linkadge on August 2, 2021, at 9:27:28
In reply to Re: GABAergic hypofunction in psychosis?, posted by Lamdage22 on August 1, 2021, at 23:42:58
>Well if my boundaries are respected enough so >that I am not speaking of abuse anymore for a few >years in a row, and I still have symptoms, I am >willing to consider genetics.
I don't know your exact situation. However, it is common for people with mental illness to blame a whole host of factors which would not cause most healthy people to become clinically mentally ill.
>It hasnt been proven yet like down syndrome >etc. Obviously I dont know anything about your >genes.
I would not say that it hasn't been proven. It's that the genetic findings are somewhat diverse. However when you combine the genetic profile of hundreds of thousands of patients with (say) depression, or schizophrenia, or bipolar you DO find genetic differences compared to similar sized samples of patients without depression.
Also there are many studies of twins separated at birth which show a very high rate of concordance. For example, in twins separated at birth with schizophrenia, there is roughly a 50% concordance. This is WAY higher than you would expect by chance. Hence the only explanation is genetics (as the environmental factors are stripped away).
There are genetic influences AND epigenetic influences. Epigentics factors can be altered (to some extent). Although some epigenetic factors become very difficult to alter.
To say that there is no proof of genetics influences in depression is completely false. However, it is false to say that they have found the exact genes that influence everybody's depression.
They are also finding that many of the lines between various mental illnesses are blurred. For example, there is a high degree of overlap between the genes that influence bipolar and schizophrenia. This is no surprise given the overlap in efficacy in treatments with these two disorders. Similarly, there are overlaps in the genes for OCD, ADHD and Autism. Sleep disorders / anxiety disorders and depression also share some common gene clusters. The genetics are starting to prove what we've known for some time.
They can genetically engineer mice that respond to antidepressants. They can also genetically engineer 'treatment resistant' mice that have extra f*ck*d up genes that mean they don't respond to antidepressants.
You see the genetic argument as a negative. You see that suggestion that you might have a few bad genes as a negative. I see this as very liberating. The idea that one day I might be able to analyze me genes to guide treatment, or that they might be able to develop more specific targets, or gene therapy etc. as extremely liberating.
Linkadge
Posted by linkadge on August 2, 2021, at 9:33:35
In reply to Re: GABAergic hypofunction in psychosis? » linkadge, posted by undopaminergic on August 2, 2021, at 7:28:26
>So, I understand what you mean, but I'm still >wondering whether you *could* gain weight if you >put your mind to it? I'm sure I could.
Because I am underweight (6'2" 125lbs) my doctor told me to gain weight. I strictly followed a recommended protocol for about 6 months and didn't gain a single pound.
What could prevent this, other than genetics?
Linkadge
Posted by undopaminergic on August 2, 2021, at 9:51:46
In reply to Re: GABAergic hypofunction in psychosis? » Lamdage22, posted by linkadge on August 2, 2021, at 9:27:28
>
> They are also finding that many of the lines between various mental illnesses are blurred. For example, there is a high degree of overlap between the genes that influence bipolar and schizophrenia. This is no surprise given the overlap in efficacy in treatments with these two disorders.
>I'm accused of having schizophrenia. Funny that I'm not accused of having bipolar, even though there is more evidence for the latter. The former is harder to diagnose with certainty; eg. you need to know how long a psychotic episode has lasted, and you have to find delusions and differentiate them from other theories and beliefs. However, the fact that negative symptoms are a factor does make it easier to diagnose someone with depression as schizophrenic. With bipolar disorder, just one episode of (hypo)mania is enough for diagnosis, although I do not necessarily agree it should be.
> You see the genetic argument as a negative. You see that suggestion that you might have a few bad genes as a negative. I see this as very liberating. The idea that one day I might be able to analyze me genes to guide treatment, or that they might be able to develop more specific targets, or gene therapy etc. as extremely liberating.
>I see both perspectives. For the time being, having the wrong genes is a difficult thing to do anything about, but it won't be all that long before it's easier to address the genetic component than the environmental.
-undopaminergic
Posted by undopaminergic on August 2, 2021, at 9:55:21
In reply to Re: GABAergic hypofunction in psychosis?, posted by linkadge on August 2, 2021, at 9:33:35
> >So, I understand what you mean, but I'm still >wondering whether you *could* gain weight if you >put your mind to it? I'm sure I could.
>
> Because I am underweight (6'2" 125lbs) my doctor told me to gain weight. I strictly followed a recommended protocol for about 6 months and didn't gain a single pound.
>
> What could prevent this, other than genetics?
>The psyche comes to mind (ie. think psychosomatic). I'm not saying it's likely.
-undopaminergic
Posted by Lamdage22 on August 2, 2021, at 9:55:43
In reply to Re: GABAergic hypofunction in psychosis? » Lamdage22, posted by linkadge on August 2, 2021, at 9:27:28
If anything there is a predisposition and then triggers. Being overwhelmed with triggers could make many many people sick that never would otherwise have had a diagnosis in their lives and whose genes are slightly problematic but mostly okay. Fewer triggers -> no disease
But with an extreme disposition, minor triggers that would have caused healthy people no trouble at all are enough. Then I would talk of a genetic problem.
It is important that not all are the same here.
Posted by Lamdage22 on August 2, 2021, at 10:17:28
In reply to Re: GABAergic hypofunction in psychosis?, posted by undopaminergic on August 2, 2021, at 9:51:46
Right, if there are in fact genes that are not ideal and they can test which ones they are and do something about it, Id be listening. Listening, not mindlessly agreeing to the treatment. Needs to be reasonably safe.
> I see both perspectives. For the time being, having the wrong genes is a difficult thing to do anything about, but it won't be all that long before it's easier to address the genetic component than the environmental.
>
> -undopaminergic
>
Posted by linkadge on August 3, 2021, at 6:27:26
In reply to Re: GABAergic hypofunction in psychosis?, posted by undopaminergic on August 2, 2021, at 9:51:46
>I'm accused of having schizophrenia. Funny that >I'm not accused of having bipolar, even though >there is more evidence for the latter.
Cognition in schizophrenia is usually more impaired (on an ongoing basis) whereas in bipolar impairment usually more state dependent. Although, cognitive issues in bipolar can accumulate over time if symptoms do not remit.
I think (don't quote me) that substance abuse history is more common in bipolar. Substance use can muddle the diagnosis however, depending on the proximity between last drug use and diagnosis.
Linkadge
Posted by linkadge on August 3, 2021, at 6:35:52
In reply to Re: GABAergic hypofunction in psychosis?, posted by Lamdage22 on August 2, 2021, at 9:55:43
>It is important that not all are the same here.
Absolutely. None of us here has the exact same disorder.
Linkadge
Posted by undopaminergic on August 3, 2021, at 12:01:57
In reply to Re: GABAergic hypofunction in psychosis?, posted by linkadge on August 3, 2021, at 6:27:26
>
> Cognition in schizophrenia is usually more impaired (on an ongoing basis) whereas in bipolar impairment usually more state dependent.
>That rhymes with my experience. The cognitive impairment began as part of my burnout syndrome and it only went away during my first manic episode. It is interesting to note that the only thing that went wrong with this first and most intense manic episode is that it came to an end and I went back into my usual depressive state. For that reason, you may consider it "hypo"-mania, but it was a full blown mania in terms of intensity. I've had other, less intense episodes, but they did not feature a resolution of the cognitive impairment, and they ended in the hospital.
> Although, cognitive issues in bipolar can accumulate over time if symptoms do not remit.
>I do not really feel they have accumulated, except insofar as taking anticholinergics and the natural consequences of aging probably play more of a role than I easily notice. I find that my short term memory is pretty good, but working memory and long term memory are not.
> I think (don't quote me) that substance abuse history is more common in bipolar. Substance use can muddle the diagnosis however, depending on the proximity between last drug use and diagnosis.
>Substance abuse (psychostimulants) probably played a greater role than I'd like to admit in my first episode of psychosis. I like to attribute it to the consequences of accumulating sleep deficit, but this was in turn largely secondary to the use of (cocaine-like ie. reuptake inhibitor) stimulants. The first episode featured auditory hallucinations, the further episodes have not so far.
-undopaminergic
Posted by linkadge on August 3, 2021, at 18:52:34
In reply to Re: GABAergic hypofunction in psychosis?, posted by undopaminergic on August 3, 2021, at 12:01:57
So have you ever taken mood stabilizers (i.e. lithium) or just antipsychotics?
You might ask your doctor for a trial of a mood stabilizer just to see if it has any therapeutic effects.
I've taken a few antipsychotics (olanzapine, seroquel and risperdal) and while there was some benefit, I found lithium seemed to address my issues more directly and with less collateral damage.
If you stopped taking antipsychotics would you have any psychotic symptoms or would it just be mood symptoms that return?
Personally, I feel that I am some mixture of unipolar, bipolar and ADHD. I know it is not currently believed that you can have unipolar and bipolar but I think it is possible. Mood stabilizers help me, but alone they are simply not enough. They bring down the volume in my brain but they don't change the color of my mood. Small doses of antidepressants help change the color of my mood. Yet, even with these, I can't concentrate. A bit of ritalin helps, but I'm finding that PEA seems to be (fingers crossed) helping mood and concentration. I'm still adjusting things so I can't make any conclusions.
Linkadge
Posted by undopaminergic on August 4, 2021, at 14:32:35
In reply to Re: GABAergic hypofunction in psychosis? » undopaminergic, posted by linkadge on August 3, 2021, at 18:52:34
> So have you ever taken mood stabilizers (i.e. lithium) or just antipsychotics?
>I have extensive experience with lamotrigine. I've tried lithium orotate a few times. At first, it seemed to help, but the other doses did not seem to do anything. I'm not sure about the doses, as I did not measure the amount I took. I'm currently on 200 mg of lamotrigine.
> You might ask your doctor for a trial of a mood stabilizer just to see if it has any therapeutic effects.
>I'm going to discuss lithium at some point.
> If you stopped taking antipsychotics would you have any psychotic symptoms or would it just be mood symptoms that return?
>I find the current antipsychotics don't do much, other than clozapine which produces side effects. It's been over 10 years since I had auditory hallucinations. I've had delusions, but antipsychotics don't seem to do anything about it; it's not like they make me stop believing things that I would otherwise believe.
> Personally, I feel that I am some mixture of unipolar, bipolar and ADHD. I know it is not currently believed that you can have unipolar and bipolar but I think it is possible. Mood stabilizers help me, but alone they are simply not enough. They bring down the volume in my brain but they don't change the color of my mood. Small doses of antidepressants help change the color of my mood. Yet, even with these, I can't concentrate. A bit of ritalin helps, but I'm finding that PEA seems to be (fingers crossed) helping mood and concentration. I'm still adjusting things so I can't make any conclusions.
>You say "volume" in your brain. Is that like a kind of silent "buzz" that PEA can squelch? I mean the "paradoxical calming effect" of stimulants in ADD.
-undopaminergic
Posted by linkadge on August 5, 2021, at 7:04:00
In reply to Re: GABAergic hypofunction in psychosis?, posted by undopaminergic on August 4, 2021, at 14:32:35
>You say "volume" in your brain. Is that like a >kind of silent "buzz" that PEA can squelch? I >mean the "paradoxical calming effect" of >stimulants in ADD.
It feels like everything is just too intense (mood, sensory, noise inside head, speed of thoughts etc). Monoamine modulators don't fix this but mood stabilizers help this to some extent. Once I am able to turn down that volume some of the monoamine modulators work better.
Linkadge
Posted by undopaminergic on August 5, 2021, at 12:32:11
In reply to Re: GABAergic hypofunction in psychosis?, posted by linkadge on August 5, 2021, at 7:04:00
> >You say "volume" in your brain. Is that like a >kind of silent "buzz" that PEA can squelch? I >mean the "paradoxical calming effect" of >stimulants in ADD.
>
> It feels like everything is just too intense (mood, sensory, noise inside head, speed of thoughts etc).
>For me things are too dull, not too intense.
So, do you get a calming effect from any of the stimulants?
-undopaminergic
Posted by jay2112 on August 5, 2021, at 18:44:19
In reply to GABAergic hypofunction in psychosis?, posted by Lamdage22 on July 26, 2021, at 21:19:05
> Does increasing GABAergic neurotransmission lessen psychotic symptoms?
There have been studies which suggest a co-relation. Just go to pubmed and search. GABA seems to fall with an increase in l-arginine in psychosis. As well, GABA is decreased by an increase in NDMA agonism associated with an increase in l-glutamine.
Regular "GABA" you find in health food stores does not cross the blood-brain barrier. Lyrica (pregablin) and Neurontin (gabapentin) do, put I am not sure about their use in preventing or treating psychosis. Depakote/Epival also has a pro-GABA effect, and all of those meds are used highly in Bipolar, and quite effective in reducing agitation and mania.Jay
Posted by Hugh on August 8, 2021, at 14:08:11
In reply to Am I Lou Pildering you guys?, posted by Lamdage22 on August 1, 2021, at 3:09:10
Don't worry about it. You're nothing like Lou.
Posted by SLS on August 9, 2021, at 13:03:38
In reply to Am I Lou Pildering you guys?, posted by Lamdage22 on August 1, 2021, at 3:09:10
Hi, Lambdage.
This is what Hugh wrote:
"Don't worry about it. You're nothing like Lou."
I agree. Actually, I see you as being a good man whose posts I look forward to reading.
Never give up, my friend.
- Scott
Posted by Lamdage22 on August 12, 2021, at 12:27:01
In reply to Re: Am I Lou Pildering you guys? » Lamdage22, posted by SLS on August 9, 2021, at 13:03:38
You neither!
> Never give up, my friend.
>
>
> - Scott
>
This is the end of the thread.
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