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Re: ****Survey****: T.C.A. Drug Use » SLS

Posted by Elizabeth on November 7, 2001, at 11:48:22

In reply to Re: ****Survey****: T.C.A. Drug Use » Elizabeth, posted by SLS on November 6, 2001, at 20:10:26

> I really don't have much of an impression of Gabitril. I have seen a few people here try it. At least one person reported good things about it. I don't remember any details, but I guess doing a PB search would find the posts.

Okay. It's a GABA reuptake inhibitor, and I've been interested in trying it. (For some reason I have an aversion to taking benzos on a daily basis.)

> > A lot of doctors have questioned whether I might be "a little bit" bipolar, but I think that's pretty much been ruled out.
>
> On what basis was it was ruled-out?

Nonresponse to various pharmacotherapies for bipolar disorder. Lack of spontaneous (non-med-induced) hypomania or mania. Except for the one associated with serotonin syndrome, the med-induced episodes have not been clear-cut hypomania or mania. When Nardil pooped out, I suffered what was then thought to be dysphoric hypomania or mania. It resolved after I'd been off the Nardil for a while, but it didn't improve with various mood stabilizers (Depakote, Lamictal, Neurontin, lithium). Really it was more a case of extreme mood reactivity than of hypomania. It's now thought that the irritability/moodiness was something like a withdrawal symptom (lots of people have very bad reactions when MAOIs poop out).

> I asked you this question along another thread: What features of your depression, if any, deviate from the classic melancholic profile? I know you have suffered with insomnia for a long time, but is it limited to early morning awakenings (after 4:00am)?

Well, my sleep has been disturbed all my life, not just during major depressions. I'm told that even when I was a baby I had trouble maintaining a consistent circadian rhythm -- it was like I didn't care what the sun did. I also slept irregularly -- a few hours here, a few hours there -- and this has happened at other times in my life too. When I was a kid I would sometimes have trouble getting to sleep due to anxious rumination ("can't shut down my thoughts," is how I tried to describe it). The early-morning insomnia is something that started when I was first seriously depressed. I also sometimes have middle insomnia (waking after 2-4 hours, say). The frequent irregularity of my sleep makes it hard to characterize the insomnia completely. It is also hard to characterize the diurnal variation in mood, although I definitely think it's there.

Some other "deviant" features:
* early onset
* presence of dysthymia or residual symptoms between episodes
* attention-deficit, panic, and social phobia symptoms
* anergia
* chronic musculoskeletal pain; the ADs that work best for me (Nardil, while it was working, and buprenorphine) also eliminate the pain (not sure if this means anything or not)

It's possible that some of the symptoms (such as the chronicity and some of the anxiety problems) are secondary to the depression and may be accounted for by early onset. However, it's clear that there's something else going on in addition to depression. One suggestion has been that since both my parents have depression (mother atypical, father "typical" dysthymia), I might have two different but overlapping syndromes.

> > (It has been starting to seem like I'm "a little bit" epileptic these days, though!)
>
> I'm sorry.

Hey, you didn't cause it. (did you??? :-) )

> How's the rocket-fuel?

Not on rocket fuel yet.

> What do you think of trimipramine?

I think it could be very good, especially if you have sleep continuity problems. I like the idea of a sedating tricyclic, but I've never tried it myself.

-elizabeth


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poster:Elizabeth thread:82743
URL: http://www.dr-bob.org/babble/20011104/msgs/83434.html