Posted by Elizabeth on July 27, 2001, at 19:51:20
In reply to Re: Handholding » Elizabeth, posted by Lorraine on July 27, 2001, at 11:19:35
> > I think that, relatively speaking, that's a good sign. To me it indicates a reactive mood, and the possibility that you have the potential to be cheered up temporarily.
>
> And so I was last night by my wonderful husband.Good for him. :-)
> Stahl talks about the "end-stage" of depressive illness as one where the lows are so low but the ability to "feel" generally has been severely blunted.
That's what I experience. I don't think of it as an "end stage," but perhaps it does have something to do with the fact that my depression first manifested when I was quite young. I would like to see more research on childhood-onset depression. I think my depression is probably not similar to most early-onset mood disorders, though.
> > > > Interesting about panic and hypothyroidism. All my TSH tests have been pretty normal, and T3/4 augmentation is something I've never tried.
>
> It might be worth a try.What do you think it might help with besides panic? Have you ever tried it?
> Also, the notion of "estrogen dominance" causing panic symptoms is interesting. Apparently, estrogen dominance is not just a problem associated with menopause, but can be a woman's normal state throughout her lifetime. Another avenue to explore.
That is interesting. Tell me, can you make anything out of my experience with the pill? (fairly sudden relapse of depression while taking Parnate)
> > > > Buprenorphine seems to make my periods irregular. I've been wondering about the mechanism there.
>
> Isn't that odd?Yes. I've heard of female opioid addicts (who, interestingly, are outnumbered 4:1 by male addicts) having irregular periods, but I assumed that was just due to the junkie lifestyle (where self-care tends to take a second chair to obtaining drugs).
> When I had endometriosis and would have great pain on starting my period, I was given a drug that is now sold over the counter (maybe it's advil?).
Ibuprofen and other nonsteroidal anti-inflammatory drugs are definitely effective for menstrual cramps. (I use Relafen -- easier on the stomach.)
> If I was successful, then my period would start and I would not be in pain. But if I missed the very very beginning, what happened was my period would be delayed. I explained this to my doctor, who dismissed it out of hand. Point is there was something operating there that might be similar to your situation.
How do you mean? I'm a little confused.
> > > > You know, any effective antidepressant has the potential to trigger mania. When I started taking buprenorphine, it seemed to cause activation, psychomotor agitation, etc., rather than the calming effect that opioids seem to have on a lot of people.
>
> Really? I have adverse reactions to drugs at times, like getting wired from decongestants.That's not too unusual. Decongestants are basically bad speed. (Ephedrine or "ma huang" is a step down from bad speed: it's bad Sudafed.)
> But is agitation and activation considered mania?
Not necessarily. They're symptoms of mania, though.
> I once (for a couple of days in the weeks just before the last stock market crash), had incredibly racing thoughts, could hardly contain my excitement and so forth, but was still able to sleep. From my reading of the DSM categories, that would not qualify as mania--although I was euphoric and felt a bit invincible.
Hypomania, perhaps?
> > > > We work with the information we have, and count on the research folks to accumulate more information. I don't think that we should feel we have to wait for more research to be done before we can be comfortable treating mood & anxiety disorders.
>
> Absolutely. We just need to recognize the limitations.Yes! I don't think it's a good idea to pretend that we have a decent understanding of the causes of depression, mania, psychosis, anxiety, etc. -- attributing them to a vague "chemical imbalance" (I wince whenever I hear that expression). For now, I think (as I mentioned before) the most reasonable approach to clinical practise is the empirical-descriptive approach (identifying symptom clusters that respond to particular treatments, and using this information to try to predict which treatments will be most likely to work for any particular patient). Our knowledge about the biology is still in its infancy and should be reserved mainly for research at this time.
> The problem is that we have an entire conceptual framework that is premised on presentation rather than on physiology.
That's not what I'm talking about: I just don't think we have enough information about the physiology of these disorders.
> I think the old system just has to be gutted. I think it gets in the way of determining what works and doesn't work because we test drugs on "depressed" people. Well, if the category "depressed" is not meaningful--that is if in fact very different physiological processes are occurring in different people with depression--then we are barking up the wrong tree.
We have to identify symptoms and symptom clusters in order to say which treatments are most effective for what. This is because known physiological markers are not reliable predictors of response, for the most part.
> It may be that the med that is tested as effective in reducing symptoms by 50% in 51% of the subjects is actually 85% effective in 90% of the subjects with a specified physiology and that is the direction we need to be heading in in terms of research.
Yes: in research. At this time, we have no way of
I think more research is needed in regards to the descriptive approach, too. As you say, the categories are very fuzzy, and it would be nice to make them more specific (which is something that we *can* do with current knowledge).
> So to the extent that the old paradigm henders rather than helps progress, it should be rethought and possibly abandoned.
That's where we disagree. I think that we can simultaneously examine psychiatric illness on both levels (behavioural signs and symptoms, and physiologic ones). Both types of information are useful.
I do like the way that your doctor does it, basing treatment decisions on statistics and not simply on his impressions of what works for whom. The guy in my town who's known for using EEGs and functional imaging doesn't seem to be doing it that way; he also makes some assumptions that are based on flawed logic.
The statistical approach can also be applied to descriptive psychiatry, although it hasn't been used nearly enough IMO.
> His believes that my QEEG indicates that a combination of stimulants (he includes MAOs here) and anticonvulsants should work.
I agree with him that MAOIs are a lot like psychostimulants in their effects on people.
> Complicated stuff. But if it is "insulin sensitivity" or "insensitivity?", then low carb should help.
I dunno, thinking about insulin always gets me confused for some reason.
> > > > Ask the pharmacist if it's okay to cut Parnate pills in half.
>
> Very good question. I will do that.They seem to have some coating on them (not a crunchy shell like Nardil -- the M&M of antidepressants), and it might be there for a reason (other than cosmetic reasons, that is).
> Actually, I think it was your suggestion that I look into DMDA.
Yes, it was. I'm glad to hear that your experience was a good one.
-elizabeth
poster:Elizabeth
thread:67742
URL: http://www.dr-bob.org/babble/20010725/msgs/72128.html