![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 57 to 81 of 434. Go back in thread:
Posted by Elizabeth on July 19, 2001, at 22:49:31
In reply to Re: I'll hold your hand if you'll hold mine » Elizabeth, posted by Lorraine on July 19, 2001, at 20:29:44
> > > > You have a much better memory than I do. I agree, then. I wonder what Stadol or ReVia would do for her, though.
>
> So these are opiate antagonists?Revia is naltrexone, an antagonist. Stadol is a mixed agonist-antagonist with a different profile than buprenorphine.
-elizabeth
Posted by Elizabeth on July 19, 2001, at 22:57:43
In reply to Re: hand holding » Elizabeth, posted by Lorraine on July 19, 2001, at 20:20:06
> [re mechanism of action Stabilium]
> > > > Of course I'd ask it! Seriously, I'm planning on looking it up myself at some point (it's right at the bottom of my things-to-do list < g >).
>
> Well, unless you are a skin picker, you must have lots of extra time on your hands.Sort of. I'm also a compulsive procrastinator.
> When I was in school--they kept us too busy to think.< vbg >
I went to a school that's considered very tough academically, but I found time to party too.
> > > > Isn't temperature intolerance tied to thyroid function?
>
> Did you do the armpit test? (No, it's not a sniff test!)Uhh...what is it, then?
> I think the bad news was that the drugs that treat anxiety aren't energizing and the drugs that are energizing are terrible for anxiety.
Ahh, ok. That's where antidepressants come in; they can be simultaneously activating and anxiolytic. (Nardil is probably the most extreme example of this.)
> [re inderal and depression]
> > > > That's interesting. What I've read has suggested that the "beta blockers cause depression" thing has been greatly exaggerated (because people with cardiac disease are at increased risk of depression to start with).
>
> Who knows? My mood really spiraled down and I have to blame it on something--although it could just be cyclical. I am now charting my moods.That might not be a bad idea; see if there're any patterns (seasonal, circadian, etc.).
> My pdoc decided that trying another beta-blocker didn't make sense given my reaction to Inderal (although cause and effect are never clear).
I think that the cardioselective beta blockers would be fine if your reaction was strictly an "above the neck" one.
> He put me on Valium 1 mg a day staying the course with my regular meds (Selegiline, Nardill and Adderal), but dropping the Inderal. We'll see, it's just day 2.
1 mg??? That's a *really* small amount (it's half of the smallest strength pill). Valium is much less potent than Klonopin and Xanax are.
I take Klonopin sometimes to counteract the jitters from buprenorphine. It really helps. Inderal helps too but isn't as thorough.
> > > Well, that's funny because I think I thought I'd jump out of my skin on them.
> >
> > On opioids? Why?
>
> I don't know, they just make me aggitated, shakey, edgy, weepy and so forth.Oh, I see. Which one(s) have you taken that caused this reaction? It's true that some people (perhaps up to a third of the population) feel dysphoric on opioids.
> > Leaden paralysis is specifically supposed to mean a feeling of heaviness in the arms and legs.
>
> That's too bad, about the definition. It really sounded like my mental state.Feeling so lethargic that you can't move is how some people describe it.
> > > > > > Huh. In what sense is it a Pandora's box?
> > >
> > > You can't close it.
> >
> > Wait -- what was "it" again? < g >
>
> I did laugh when I read this.Good, it's nice to know I can still be entertaining. :-)
> But in case this was one of those senior moments, the it was anxiety.
"senior moments?"
> It sounds like once you have the motor running, it becomes a perpetual machine that can be controlled with meds but never really turned off.
Huh. I don't get the analogy -- in what sense is your anxiety like the contents of a box that you opened?
-elizabeth
Posted by Lorraine on July 20, 2001, at 10:29:50
In reply to Re: hand holding » Lorraine, posted by Elizabeth on July 19, 2001, at 22:57:43
> > > I went to a school that's considered very tough academically, but I found time to party too.
That's great, elizabeth. It shows that you have great confidence in your intellectual abilities. I did all my heavy partying in high school and managed to miss attending most of it. I had no idea that I was smart until I started performing well in college ( a local state school), but I don't think I was always a bit insecure about it and so didn't tempt fate by partying at school.
> > > Did you do the armpit test? (No, it's not a sniff test!)You test your basil temperature by putting a thermometer under you armpit for 15 minutes upon awaking but before leaving the bed. If you temperature is below 98 degrees consistently, then it suggests that there is a thyroid deficiency notwithstanding the results on the standardized thyroid tests.
> > > I think the bad news was that the drugs that treat anxiety aren't energizing and the drugs that are energizing are terrible for anxiety.
>
> Ahh, ok. That's where antidepressants come in; they can be simultaneously activating and anxiolytic. (Nardil is probably the most extreme example of this.)I'm confused. Doesn't the weight gain associated with Nardil indicate that it is not activating? I do wish that weight gain and sexual dysfunction were not part of the Nardil profile. I also wonder if I am more likely to have these side effects given the fact that I have had them on SSRIs.
[re charting moods]
> That might not be a bad idea; see if there're any patterns (seasonal, circadian, etc.).You know the pathetic piece is this--I need to track them in part because I don't "trust" my reactions to drugs. I mean when my pdoc says how is it going with ___, my reaction may very well depend on how things are going that day. The mood clouds everything. So the mood charts help keep me honest, so to speak, and provide me with some information as to triggers etc.
> > > I think that the cardioselective beta blockers would be fine if your reaction was strictly an "above the neck" one.
Well, I wasn't wild about my pulse rate fluctuations on it either. One day (early on), my pulse ranged from 120 to 58 during the day. And, I didn't like the amount of exertion I felt on running up the stairs.
> > > He put me on Valium 1 mg a day staying the course with my regular meds (Selegiline, Nardill and Adderal), but dropping the Inderal. We'll see, it's just day 2.
>
> 1 mg??? That's a *really* small amount (it's half of the smallest strength pill). Valium is much less potent than Klonopin and Xanax are.I know, but I'm very sensitive to drugs. (When I go into a new store, the first place I go is to the pill crushers to see if they have a better one than I use. By the way, the one at Kmart seems to be the best). I can go up on the Valium to 2 mg if I need to. I am just trying to control the physical anxiety. I have felt the hyperventilating decrease pretty significantly on it--but we'll see. Initial reactions don't alway pan out for me. I'm also concerned about the withdrawal issues. My pdoc's response to this concern was: "Lorraine, you take so little of these drugs I just don't think it will be a major issue for you." I'm wondering if this is true or whether the addiction issues are not absolute dose dependent but rather dose dependent relative to the amount that works for that person.
>
> > > I take Klonopin sometimes to counteract the jitters from buprenorphine. It really helps. Inderal helps too but isn't as thorough.I suggested Klonopin to my pdoc. His thought was that it was sedating and that Valium has a very long half life. By the way, I did take Xanax for about a week once. I hated it because I felt so drugged even at low doses.
[re: opiates reaction]
> > I don't know, they just make me aggitated, shakey, edgy, weepy and so forth.
>
> Oh, I see. Which one(s) have you taken that caused this reaction? It's true that some people (perhaps up to a third of the population) feel dysphoric on opioids.Codeine is the only legal one I have tried. Dysphoric may be too strong a word. My reaction to the drug was immediate (within an hour of taking it) and, of course, I took no more. It was prescribed for a root canal. I had thought I could go back to my staid law firm and work the rest of the day. Talk about a bad place to feel unsafe and vulnerable.
> > > Leaden paralysis is specifically supposed to mean a feeling of heaviness in the arms and legs.
> >
> > That's too bad, about the definition. It really sounded like my mental state.
>
> Feeling so lethargic that you can't move is how some people describe it.OK, now we're cooking with gas! That's the feeling all right.
> > > > > > > Huh. In what sense is it a Pandora's box?
> > > > You can't close it.
> > > Wait -- what was "it" again? < g >
> > But in case this was one of those senior moments, the it was anxiety.
>
> "senior moments?"If you don't know what they are, then you are young and lucky.
> > > Huh. I don't get the analogy -- in what sense is your anxiety like the contents of a box that you opened?
OK, elizabeth, but don't say you didn't ask. It's like the bell that can't be unrung.
Lorraine
Posted by Lorraine on July 20, 2001, at 10:31:02
In reply to Re: I'll hold your hand if you'll hold mine » Elizabeth, posted by shelliR on July 16, 2001, at 23:09:41
Shelli: How are you doing with your meds? Are they finally treating you right?
Posted by Lorraine on July 20, 2001, at 15:24:31
In reply to Re: I'll hold your hand if you'll hold mine » shelliR, posted by Lorraine on July 20, 2001, at 10:31:02
I really don't understand this. I feel like I am going to panic on the Valium. I've been flying off the handle--very aggitated, feel like I'm crawling out of my skin. Does that make any sense at all?
Posted by Elizabeth on July 20, 2001, at 15:36:26
In reply to Re: hand holding » Elizabeth, posted by Lorraine on July 20, 2001, at 10:29:50
> > > > I went to a school that's considered very tough academically, but I found time to party too.
>
> That's great, elizabeth. It shows that you have great confidence in your intellectual abilities.No, it shows that I was really stressed out and needed to chill sometimes!
> I did all my heavy partying in high school and managed to miss attending most of it. I had no idea that I was smart until I started performing well in college ( a local state school), but I don't think I was always a bit insecure about it and so didn't tempt fate by partying at school.
I didn't party much in high school at all. My high school experience was pretty dull.
> You test your basil temperature by putting a thermometer under you armpit for 15 minutes upon awaking but before leaving the bed. If you temperature is below 98 degrees consistently, then it suggests that there is a thyroid deficiency notwithstanding the results on the standardized thyroid tests.
Buprenorphine probably screws up my body temperature. But I could do the armpit test before taking my morning dose of buprenorphine. Thanks, I think I will try that. (Hmm, do I even have a thermometer?)
> I'm confused. Doesn't the weight gain associated with Nardil indicate that it is not activating?
The weight gain is due to appetite stimulation. Nardil is activating, especially for people who are very tired and slowed-down when depressed. It generally reduces your need for sleep, but some people who take it do get really tired in the afternoon, for some reason.
> I do wish that weight gain and sexual dysfunction were not part of the Nardil profile.
I didn't have any sexual problems on it. But then again, I didn't have sexual problems on Prozac, either. I have encountered a lot of people who say they didn't gain weight on Nardil -- it's clearly not a universal thing.
> I also wonder if I am more likely to have these side effects given the fact that I have had them on SSRIs.
I don't know about the weight gain; sexual dysfunction seems to be almost universal with SSRIs, though.
> [re charting moods]
> You know the pathetic piece is this--I need to track them in part because I don't "trust" my reactions to drugs. I mean when my pdoc says how is it going with ___, my reaction may very well depend on how things are going that day. The mood clouds everything. So the mood charts help keep me honest, so to speak, and provide me with some information as to triggers etc.That's not pathetic; of course how you feel about the drug depends to some degree on how you're feeling about life in general at that moment. But you're right, that is another good reason for keeping a "mood diary."
> Well, I wasn't wild about my pulse rate fluctuations on it either. One day (early on), my pulse ranged from 120 to 58 during the day.
Your pulse always fluctuates widely over the span of a day. Did you check your blood pressure at all?
> And, I didn't like the amount of exertion I felt on running up the stairs.
Propranolol did that to me a little bit, too; I got winded more easily when I was on it (I only use it occasionally, when I need my hands to be very steady, although I used it more often on Nardil because Nardil made my essential tremor worse). I also remember that I would get dizzy when I was working out.
> I know, but I'm very sensitive to drugs. (When I go into a new store, the first place I go is to the pill crushers to see if they have a better one than I use. By the way, the one at Kmart seems to be the best).
< g > I'll keep that in mind!
Do you think you metabolise some drugs poorly, or is your drug sensitivity more of an anxiety thing?
> I can go up on the Valium to 2 mg if I need to.
That's something. Although I've taken as much as 40 mg of Valium and it didn't do *anything*. (I take 2 mg of *Xanax*. < g >)
> I have felt the hyperventilating decrease pretty significantly on it--but we'll see. Initial reactions don't alway pan out for me.
That's not so surprising. Sometimes you might have a nonspecific ("placebo") response, or you might become tolerant. Beta blockers do help with hyperventilation and other sympethetic nervous system effects. I've used Inderal successfully for hyperventilation with MAOIs, stimulants, and opioids (that last one is pretty weird, I know).
> I'm also concerned about the withdrawal issues. My pdoc's response to this concern was: "Lorraine, you take so little of these drugs I just don't think it will be a major issue for you." I'm wondering if this is true or whether the addiction issues are not absolute dose dependent but rather dose dependent relative to the amount that works for that person.
I wouldn't use the word "addiction" to describe what you're talking about. But yes, I think that withdrawal symptoms can have something to do with how effective the dose you're taking is; for example, a large person may need a higher dose than a smaller person (or an extensive metaboliser may need more than a poor metaboliser), but they both may experience similar withdrawal symptoms upon discontinuing the drug.
> I suggested Klonopin to my pdoc. His thought was that it was sedating and that Valium has a very long half life.
That's sort of misleading, IMO. Valium is very rapidly taken up into the CNS, but it's then redistributed throughout the body. It does have a long-lived metabolite (nordazepam), but the anxiolytic effects can only be expected to last a few hours. It shouldn't be used once a day (unless you're just using it for sleep, of course).
> By the way, I did take Xanax for about a week once. I hated it because I felt so drugged even at low doses.
It's just as well; Xanax is a pain to use if you're going to take it regularly. (Then again, so is Valium.)
[re: opiates reaction]
> Codeine is the only legal one I have tried. Dysphoric may be too strong a word.It just means "crappy." :-)
> My reaction to the drug was immediate (within an hour of taking it) and, of course, I took no more. It was prescribed for a root canal. I had thought I could go back to my staid law firm and work the rest of the day. Talk about a bad place to feel unsafe and vulnerable.
That still seems really weird and alien to me, even though I know it's not all that uncommon.
> > "senior moments?"
>
> If you don't know what they are, then you are young and lucky.Uhh...okay.
> > > > Huh. I don't get the analogy -- in what sense is your anxiety like the contents of a box that you opened?
>
> OK, elizabeth, but don't say you didn't ask. It's like the bell that can't be unrung.I think I understand.
-elizabeth
Posted by Elizabeth on July 20, 2001, at 16:40:46
In reply to Re: I'll hold your hand elizabeth shelli, posted by Lorraine on July 20, 2001, at 15:24:31
> I really don't understand this. I feel like I am going to panic on the Valium. I've been flying off the handle--very aggitated, feel like I'm crawling out of my skin. Does that make any sense at all?
How much did you take, and when?
-elizabeth
Posted by Lorraine on July 20, 2001, at 17:38:36
In reply to Re: hand holding » Lorraine, posted by Elizabeth on July 20, 2001, at 15:36:26
> > > The weight gain is due to appetite stimulation. Nardil is activating, especially for people who are very tired and slowed-down when depressed. It generally reduces your need for sleep, but some people who take it do get really tired in the afternoon, for some reason.Do you know if it is specifically carb craving? I had that on Effexor, but I wasn't doing low carb at the time.
>
> > Well, I wasn't wild about my pulse rate fluctuations on it either. One day (early on), my pulse ranged from 120 to 58 during the day.
>
> Your pulse always fluctuates widely over the span of a day. Did you check your blood pressure at all?I checked my blood pressure a couple of times, but not when things were racing. I'm pretty aware of a revved up heart though. I think I would be aware of that much variation on a daily basis.
> > And, I didn't like the amount of exertion I felt on running up the stairs.
>
> Propranolol did that to me a little bit, too; I got winded more easily when I was on it (I only use it occasionally, when I need my hands to be very steady, although I used it more often on Nardil because Nardil made my essential tremor worse). I also remember that I would get dizzy when I was working out.On an as needed basis, it would be great. The problem is my physical anxiety is constant.
> Do you think you metabolise some drugs poorly, or is your drug sensitivity more of an anxiety thing?Well, this is a very good question. I find I can't really tolerate more than a glass of wine occassionally anymore. I generally am at the low doses of drugs. I really don't know. The Wellbutrin and Moclobemide had me crawling out of my skin (which sounds like anxiety). But then other drugs immediately make me feel druggy or sedated (like Depokote). I might try to track it through my drug usage and side effects and liver metabolism mechanism.
>
> > I can go up on the Valium to 2 mg if I need to.
>
> That's something. Although I've taken as much as 40 mg of Valium and it didn't do *anything*. (I take 2 mg of *Xanax*. < g >)I really can't imagine.
> > > I have felt the hyperventilating decrease pretty significantly on it--but we'll see. Initial reactions don't alway pan out for me.
> > > That's not so surprising. Sometimes you might have a nonspecific ("placebo") response, or you might become tolerant.Well, I try to figure out if I'm just being hopeful and you know I do get pretty hopeful generally, and, then, of course, the disappointment is just enormous. But a lot of drugs that I take have immediate bad effects--so then I wonder, where's my placebo effect here?
> > > I wouldn't use the word "addiction" to describe what you're talking about. But yes, I think that withdrawal symptoms can have something to do with how effective the dose you're taking is; for example, a large person may need a higher dose than a smaller person (or an extensive metaboliser may need more than a poor metaboliser), but they both may experience similar withdrawal symptoms upon discontinuing the drug.> > > I suggested Klonopin to my pdoc. His thought was that it was sedating and that Valium has a very long half life.
>
> That's sort of misleading, IMO. Valium is very rapidly taken up into the CNS, but it's then redistributed throughout the body. It does have a long-lived metabolite (nordazepam), but the anxiolytic effects can only be expected to last a few hours. It shouldn't be used once a day (unless you're just using it for sleep, of course).Well, it's "physical" effect--eg muscle relaxant etc last longer? Remember my anxiety is pretty physical in nature. I really just feel like my autonomic system is haywire.
> > > "senior moments?"
> > If you don't know what they are, then you are young and lucky.
> Uhh...okay.Wait, you did get it? Senior as in senior discounts at the movie theater?
Sounds like our metabolism and nature of illness may be very different given our reactions to drugs. Well, the race is on to find stabilization (although I feel hopelessly behind). I hope your Desipramine does the trick for you and your quest comes to a successful end.
Posted by Lorraine on July 20, 2001, at 17:42:29
In reply to jitters on Valium? » Lorraine, posted by Elizabeth on July 20, 2001, at 16:40:46
> > I really don't understand this. I feel like I am going to panic on the Valium. I've been flying off the handle--very aggitated, feel like I'm crawling out of my skin. Does that make any sense at all?
>
> How much did you take, and when?
I've been taking 1 mg a day for 4 days. I'm going to check Dr. Koop and see if there might be a drug interaction. I seem to be spiralling down and can't really locate the brake handle. Called my pdoc. Gone for the weekend. So there we have it. I'm sure I'm beginning to sound a bit daft, but I assure you I'm not--just on a very rocky boat at the moment.
Posted by shelliR on July 20, 2001, at 22:42:39
In reply to Re: I'll hold your hand if you'll hold mine » shelliR, posted by Lorraine on July 20, 2001, at 10:31:02
> Shelli: How are you doing with your meds? Are they finally treating you right?
Hi Lorraine,
Right now I am still taking just oxycontin and then klonopin before I go to bed or as a prn. I actually have not had much depression. I more on an anxiety cycle now. I am premenstrual also, so I took klonopin before I went out to dinner with a friend, and had a glass of wine with dinner. So everything is feeling pretty good right at this moment. I am going to add estradiol (proscribed by my pdoc) when I get around to filling the presciption, either tomorrow or Sunday. Then when I see my gyn in August, she will add progesterone, definitely natural progesterone.
The big question will come when my waiting period is over and I have to decide whether to go back on nardil, try parnate, or just keep going with the oxycontin. I'm leaning toward nardil because I don't really want to try something new (and deal with new side effects), and I'm worried with the oxy alone, if I become habituated to it, my pdoc will not be willing to raise it and I'll be in trouble. So far though, I am still getting the full effect, but it's only been six weeks.
I read your post about your reaction to valium. That sounds really strange. Were you able to figure anything out about it. You were doing okay on the valium until today, right? By the way, I find valium much more potent and helpful for use as a prn than klonopin. If I'm really anxious, I can take 3 mg of klonopin and feel nothing. 5-10mg of valium always kicks in for me, but it does make me more tired than klonopin.
Hope you are feeling better now, Shelli
Posted by Lorraine on July 21, 2001, at 10:47:46
In reply to Re: I'll hold your hand if you'll hold mine » Lorraine, posted by shelliR on July 20, 2001, at 22:42:39
> > >I am going to add estradiol (proscribed by my pdoc) when I get around to filling the presciption, either tomorrow or Sunday. Then when I see my gyn in August, she will add progesterone, definitely natural progesterone.
Good luck with the estrodiol. Stahl is high on estrogen therapy during perimenopausal transitions.
> > > The big question will come when my waiting period is over and I have to decide whether to go back on nardil, try parnate, or just keep going with the oxycontin.I was just reading an article on anxiety that said that the MAOs are 60-85% effective with anxiety and, surprisingly, said that a their clinic at least, the preference was Parnate over Nardil. www.anxietynetwork.com/pdmed.html This is encouraging to me because the sexual dysfunction and weight gain has me shying away from Nardil from now. It's great that you did not have these side effects.
> > >I'm leaning toward nardil because I don't really want to try something new (and deal with new side effects), and I'm worried with the oxy alone, if I become habituated to it, my pdoc will not be willing to raise it and I'll be in trouble. So far though, I am still getting the full effect, but it's only been six weeks.Jeez, how long is your washout? If you have a med that works (sort of), I understand your reluctance to try something completely new.
> > > I read your post about your reaction to valium. That sounds really strange. Were you able to figure anything out about it. You were doing okay on the valium until today, right? By the way, I find valium much more potent and helpful for use as a prn than klonopin. If I'm really anxious, I can take 3 mg of klonopin and feel nothing. 5-10mg of valium always kicks in for me, but it does make me more tired than klonopin.It's interesting how we all respond differently to meds. No, I haven't figured out what's going on, and I think I will take it today and see how I do. I hate to just jump on and off the train without giving the med it's full shot at working, but then again, I am not in a great place so I may have to bail prematurely. We'll see--thanx for your concern.
Lorraine
Posted by Elizabeth on July 21, 2001, at 22:01:39
In reply to Re: hand holding » Elizabeth, posted by Lorraine on July 20, 2001, at 17:38:36
> > > > The weight gain is due to appetite stimulation.
>
> Do you know if it is specifically carb craving? I had that on Effexor, but I wasn't doing low carb at the time.For me it was cravings for sweets.
> I checked my blood pressure a couple of times, but not when things were racing. I'm pretty aware of a revved up heart though. I think I would be aware of that much variation on a daily basis.
Your pulse and blood pressure fluctuate depending on the time of day, your level of arousal and activity, and various other factors. The variation really can be huge.
> > Do you think you metabolise some drugs poorly, or is your drug sensitivity more of an anxiety thing?
>
> Well, this is a very good question. I find I can't really tolerate more than a glass of wine occassionally anymore. I generally am at the low doses of drugs. I really don't know.Have you had liver function tests recently?
Consider the possibility that you're just extra-sensitive to feelings in your body. A lot of people who have panic attacks are that way.
> > That's something. Although I've taken as much as 40 mg of Valium and it didn't do *anything*. (I take 2 mg of *Xanax*. < g >)
>
> I really can't imagine.What, taking 2 mg of Xanax?
> But a lot of drugs that I take have immediate bad effects--so then I wonder, where's my placebo effect here?
Perhaps you're experiencing placebo side effects? It does happen, especially if a person is nervous about taking medication or obsesses about side effects. The placebo effect doesn't always work in your favour.
Of course, it could easily be that with time you simply adjust to the side effects.
> Well, it's "physical" effect--eg muscle relaxant etc last longer? Remember my anxiety is pretty physical in nature. I really just feel like my autonomic system is haywire.
That's misleading, I think. (There's a reason it's called the autonomic *nervous* system.) Many "physical" effects can be mediated by the CNS. Anyway, the recommended dosing schedule when it's used to treat muscle spasm is 3-4 times a day.
> Wait, you did get it? Senior as in senior discounts at the movie theater?
I think I sort of get it, yeah.
> Sounds like our metabolism and nature of illness may be very different given our reactions to drugs. Well, the race is on to find stabilization (although I feel hopelessly behind). I hope your Desipramine does the trick for you and your quest comes to a successful end.
Thank you. I hope so too.
-elizabeth
Posted by Elizabeth on July 21, 2001, at 22:07:27
In reply to Re: jitters on Valium? » Elizabeth, posted by Lorraine on July 20, 2001, at 17:42:29
> > How much did you take, and when?
>
> I've been taking 1 mg a day for 4 days.Only once a day, right? Is the jitteriness worse at some times of the day than others?
> I'm going to check Dr. Koop and see if there might be a drug interaction.
I don't think that's it. Although did I read that you're taking Nardil, selegiline, and Adderall at the same time???
> I'm sure I'm beginning to sound a bit daft, but I assure you I'm not--just on a very rocky boat at the moment.
You sound fine to me, especially given how bad your anxiety must be. I wish you well.
-elizabeth
Posted by Elizabeth on July 21, 2001, at 22:10:05
In reply to Re: I'll hold your hand if you'll hold mine » Lorraine, posted by shelliR on July 20, 2001, at 22:42:39
> By the way, I find valium much more potent and helpful for use as a prn than klonopin. If I'm really anxious, I can take 3 mg of klonopin and feel nothing. 5-10mg of valium always kicks in for me, but it does make me more tired than klonopin.
Klonopin is more potent: the effective dose of Klonopin is much lower. Valium may seem to work better because it works fast. Klonopin is better if you're taking something around-the-clock and not just as-needed, though.
-elizabeth
Posted by Elizabeth on July 21, 2001, at 22:14:36
In reply to Re: I'll hold your hand if you'll hold mine » shelliR, posted by Lorraine on July 21, 2001, at 10:47:46
> I was just reading an article on anxiety that said that the MAOs are 60-85% effective with anxiety and, surprisingly, said that a their clinic at least, the preference was Parnate over Nardil.
That's a little odd. I think that Nardil is probably a more effective anxiolytic, but a lot of people can't deal with the side effects, so compliance can be expected to be better with Parnate. Parnate does work for anxiety too, though.
-elizabeth
Posted by Lorraine on July 21, 2001, at 23:27:48
In reply to Re: hand holding » Lorraine, posted by Elizabeth on July 21, 2001, at 22:01:39
> > > Do you know if it is specifically carb craving? I had that on Effexor, but I wasn't doing low carb at the time.
>
> For me it was cravings for sweets.Yeah, that's pretty much what it was for me on Effexor. But once I got on low carb, I found my craving for sweets pretty much went away. Of course, this was after I was off the Effexor anyway. So I am real curious whether low carb would stay the course of the cravings for sweets while on Effexor or Nardil. Something interesting though, at one time I was seeing an endocrinologist (who put me on Estrotest and Cytomel--T3). Anyway, he advocated Nardil and said that sometimes he put his overweight patients on it to help them get over there carb cravings. Isn't that odd?
> > > Have you had liver function tests recently?
I think so as part of a general physical--nothing out of range. Although I am going to see a preventative medicine doctor in August and am going to ask her about doing a more in depth test than the normal stuff. I think Great Smokies Diagnostic Laboratories does a more thorough test.
> > > Consider the possibility that you're just extra-sensitive to feelings in your body. A lot of people who have panic attacks are that way.It's alway possible, but it doesn't ring true at first blush.
> > > That's something. Although I've taken as much as 40 mg of Valium and it didn't do *anything*. (I take 2 mg of *Xanax*. < g >)
> >
> > I really can't imagine.
>
> What, taking 2 mg of Xanax?Ok, let me try to imagine it. What is the lowest dose of Xanax? Whatever it is, I took that once and once only, it made me almost drunk, I mean slurring my words and so forth. What I was really reacting to was the 40 mg of Valium. I think they'd have to call 911 if I got anywhere near that dose.
> > > But a lot of drugs that I take have immediate bad effects--so then I wonder, where's my placebo effect here?
>
> Perhaps you're experiencing placebo side effects? It does happen, especially if a person is nervous about taking medication or obsesses about side effects. The placebo effect doesn't always work in your favour.'I'd really hate to second guess myself that much. I feel lucky that I'm not too insecure this way though. I remember having doctors tell me that my endometriosis was "all in my head". Each month I would pass out with pain; once at a supermarket and an ambulance was called. Neither my pain nor my symptoms were in my head--the medical knowledge just hadn't caught up with the concept of endometriosis. Old hat now. I suppose the worst part about panic attacks (which I thankfully don't have) is that you have to learn to distrust what your body is telling you. But then have you ever had an emotion that just occurred without an approriate stimulus for it? (what woman hasn't < vbg >) I remember I used to have a rage waiting for an excuse to explode periodically. It was so odd to just watch it, know it was there and wait for the match to be lit that would ignite the inferno. Even when I knew there wasn't a reason for it--just some chemical coursing through my brain and having its way with me (like this depression come to think of it).
> > > Of course, it could easily be that with time you simply adjust to the side effects.
That happens sometimes and sometimes not. I had a rough 3 or 4 weeks when I first got on Effexor, but then I adjusted and went on to a different set of side effects. You know, it is awfully difficult to know when to pull the plug on a med. On the one hand, you want to give it time to work. One the other hand, you are literally watching the time that makes up your life slip through your fingers when you linger with an ineffective med. I have not been stabilized on a med for a year and a half. It just gets exhausting at some point.
> > >Many "physical" effects can be mediated by the CNS.Most, I would think. Yeah, I think the mind/brain stuff is a bit whacko. But what I mean is that ruminating thoughts of fear and such might require a different treatment.
> > >Anyway, the recommended dosing schedule when it's used to treat muscle spasm is 3-4 times a day.That's good to know. Do you would think that the jitters could have been a rebound anxiety response? I take my dose in the morning and started having trouble around 2pm.
elizabeth, once again, thank-you for your kind and generous counsel.
Lorraine
Posted by Lorraine on July 21, 2001, at 23:30:53
In reply to Re: jitters on Valium? » Lorraine, posted by Elizabeth on July 21, 2001, at 22:07:27
[re drug interaction]
> I don't think that's it. Although did I read that you're taking Nardil, selegiline, and Adderall at the same time???Mercy, no! It's selegiline, adderall, neurontin and valium.
>
> > I'm sure I'm beginning to sound a bit daft, but I assure you I'm not--just on a very rocky boat at the moment.
>
> You sound fine to me, especially given how bad your anxiety must be.
That's quite kind of you.Lorraine
Posted by Lorraine on July 21, 2001, at 23:35:57
In reply to Nardil vs. Parnate » Lorraine, posted by Elizabeth on July 21, 2001, at 22:14:36
> > I was just reading an article on anxiety that said that the MAOs are 60-85% effective with anxiety and, surprisingly, said that a their clinic at least, the preference was Parnate over Nardil.
>
> > > That's a little odd. I think that Nardil is probably a more effective anxiolytic, but a lot of people can't deal with the side effects, so compliance can be expected to be better with Parnate. Parnate does work for anxiety too, though.Certainly Nardil has the reputation of being more effective as an anxiolytic. The place that said this (www.anxietynetwork.com/pdmed.html) was actually addressing panic attacks. I don't know if that makes a difference though.
Lorraine
Posted by Lorraine on July 21, 2001, at 23:42:03
In reply to Nardil vs. Parnate » Lorraine, posted by Elizabeth on July 21, 2001, at 22:14:36
Shelli: I found two articles by stephen stahl that may interest you: Sex Therapy in Psychiatric Treatment Has a New Partner: Reproductive Hormones (www.psychiatrist.com/pcc/brainstorm/br5811.htm) and Estrogen Makes the Brain a Sex Organ (www.psychiatrist.com/pcc/brainstorm/br5810). I found them pretty interesting. He says he thinks that women are at particular risk of developing mental illness during times of great hormonal change, like puberty, post-partum and perimenopause.
Posted by shelliR on July 22, 2001, at 0:45:54
In reply to Re: hand holding and estrogen shelli, posted by Lorraine on July 21, 2001, at 23:42:03
> Shelli: I found two articles by stephen stahl that may interest you: Sex Therapy in Psychiatric Treatment Has a New Partner: Reproductive Hormones (www.psychiatrist.com/pcc/brainstorm/br5811.htm) and Estrogen Makes the Brain a Sex Organ (www.psychiatrist.com/pcc/brainstorm/br5810). I found them pretty interesting. He says he thinks that women are at particular risk of developing mental illness during times of great hormonal change, like puberty, post-partum and perimenopause.
Lorraine, it's really late (east coast time) and I've just finished responding to a bunch of posts on the social-babble board , but thanks so much. I'll take a look at them tomorrow and try to post back.
Sweet dreams zzzzzzzzzzzzz, Shelli
Posted by MB on July 22, 2001, at 1:41:35
In reply to Re: I'll hold your hand elizabeth shelli, posted by Lorraine on July 20, 2001, at 15:24:31
> I really don't understand this. I feel like I am going to panic on the Valium. I've been flying off the handle--very aggitated, feel like I'm crawling out of my skin. Does that make any sense at all?
I got akathisia when I was on Librium and Xanax (not at the same time). I thought it was strange, but it happened. I didn't feel panicky, but I did feel agitated...well, "restless" lets say, like I had to keep wiggling my legs.
Posted by shelliR on July 22, 2001, at 13:02:16
In reply to Re: I'll hold your hand if you'll hold mine » shelliR, posted by Lorraine on July 21, 2001, at 10:47:46
> > > > > > > > > > > > > >
> I was just reading an article on anxiety that said that the MAOs are 60-85% effective with anxiety and, surprisingly, said that a their clinic at least, the preference was Parnate over Nardil. www.anxietynetwork.com/pdmed.html This is encouraging to me because the sexual dysfunction and weight gain has me shying away from Nardil from now. It's great that you did not have these side effects.
> > > > > > > > > > > > > > >This is the statement from the article sited, concerning nardil vs. parnate:
"We have found that, in general, Parnate, as opposed to Nardil, is more effective with many of the anxiety disorders, provided there are no other anxiety or mental health care complications. "
That's a bit confusing to me. I think what they are saying is that they have found that parnate is more effective for agoraphobia /panic disorder, I don't think they are saying one way or the other about generalized anxiety, which I assume they mean by "other anxiety". At least that's my take, but I could be misunderstanding what they meant.
I don't remember whether you have panic. (?) In any case, I think starting with parnate is a reasonable choice, and if it turns out ineffective, there is only a ten day waiting period to then try nardil.
Thanks for the pointing me to the Stahl articles on estrogen. When I was still seeing my last pdoc, she steered me away from trying birth control pills for premenstral symptoms, both physical and psychological. In retrospect, because of my age, and the definite worsening of my depression in a fairly stable period of my life, I think it was negligent to not explore the hormonal aspect of my depression. We talked about it, but she wanted to approach the depression in other ways. By the end of our relationship, she was threatening me to drop me as a patient because of my use of vicidin and she was heavily pushing any and all of the atypical APs.
Luckily, she didn't have the same reluctance that other doctors do about my use of valium or klonopin. However, both her objection to my use of vicidin and her refusal to accept my stance against a large weight gain still annoy me. I tried dozens of drugs for the depression, none worked, and a very small bit of vicidin worked and I did not increase it for three years. I felt that she could afford to be smug and righteous about my use of oxycodone and my refusal to take meds causing me large weight gains, because it was not her life that was passing by, and not her body that was changing. My belief is that if doctors have panic attacks they quickly change their mind about benzos , and if they were as depressed as I was and had tried as many drugs unsuccessfully, they would be more willing to try opiates, especially buprenorphine. She wouldn't even read the literature on it (I brought in copies and she wouldn't even take them). That remains beyond my comprehension. Ah, yes, if the tables were turned. . . . Anyway, enough of my rant.
How long to you have to wait to try parnate? I'm really doing pretty well, so I think unless I start to spiral down, I may put off trying another MAOI and see what the estrogen does. I'll let you test parnate before I decide < g >. I think you have a lot of reason to be very optimistic about MAOIs. I think the nardil would still be working for me if I had not entered into my perimenapausal years.
Thanks again for the info on estrogen; I'm getting a little more psyched now, after reading those.
How's was the valium yesterday?
Take care,
Shelli
Posted by shelliR on July 22, 2001, at 14:01:37
In reply to Re: I'll hold your hand if you'll hold mine » shelliR, posted by Elizabeth on July 19, 2001, at 11:59:19
> Is Sheppard Pratt affiliated with Johns Hopkins, by any chance? It sounds like a teaching hospital. >No, JH has its own hospital and psych units.
> > As far as the TCAs working, I never got past the first day on two different ones.
> Which two? >have no clue, it was so long ago.
> > > I was there for a month (which is what my insurance covered), but there were people in there up to a year.
> I don't know about Maryland, but Medicaid in Massachusetts will cover a lot, probably more than most private insurance. I've encountered people who had MassHealth and spent a year or more in the hospital.
> > I was not really part of that era, and never part of the federal government at all.
> What era was that? (chronologically, I mean)< < <Probably up through the 70s.
> > > > > > > > > > > > > > > > > > > > > > > >
>That's pretty funny. I didn't know anything about Roseanne being in "the bin." If what you heard is true, I agree that she's probably not experiencing dissociation. MPD is a sort of fad diagnosis in some hospitals (just as borderline personality is at McLean), and some people who crave attention or are very suggestible probably pretend to have it, or are convinced by their therapists that they actually do have it. I think it's probably a real condition, but not nearly as common as some people seem to think.
> > > > > > > > > > > > > > > > > > > > > > > > > > > >There is no question that it is a real condition; I've spent a lot of time with multiples in the hospital since I go on the dissociative disorders unit (I have a DDNOS diagnosis). My last roommate had suffered torture by her father and in a prison in Saudi Arabia (because she told her father she *might* be gay at age 17 and he had her incarcerated ) and she had three very strong adult personalities that I related to at different times. They were all pretty down to earth, just had different ideas of life and had played different roles in her development. The personality that was the one who was conscious during the torture, was angry that my roommate didn't just get on with her life. But this girl had only learned about these inside personalities weeks before and it is an overwhelming and scary experience when someone first realizes that horrible things have happened to them that they have no knowledge of, and that there are different personalities inside which account for things that they haven't understood. e.g., when they suddenly find themselves in a different city and have no clue why. The book I like the most on DID (MPD) is The Magic Daughter. It is the well written and not histrionic at all. Mostly what I see in the hospital are people with a central personality and short periods of breakthroughs of other personalities that I meet in a more fleeting way. I think at Sheppard Pratt they tend to disagnosis most people with dissociative disorders as multiple. Lowenstein (head pdoc there) has much looser criteria for a DID diagnosis than Putnam (at NIMH) and the latest DSM is somewhat ambiguous.
I think that overall (Sheppard Pratt and other like institutions, withstanding), DID is actually under diagnosed in the population.
Have you gotten your serum levels tested yet. You think that you are taking more desiprimine than you are absorbing?We are having pretty decent weather here, for July in the swamp. Hope you are also.
Shelli
Posted by Lorraine on July 22, 2001, at 14:37:27
In reply to Re: I'll hold your hand if you'll hold mine » Lorraine, posted by shelliR on July 22, 2001, at 13:02:16
> > > I don't remember whether you have panic. (?) In any case, I think starting with parnate is a reasonable choice, and if it turns out ineffective, there is only a ten day waiting period to then try nardil.
I hyperventilate. I have read the diagnostic criterian for GAD and for Panic. I don't fall in the Panic column, because my condition is constant rather than discrete episode (and I don't think they reach the level of impending doom, fear of death etc) nor GAD, which requires "Excessive anxiety and worry (apprehensive expectation), occuring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)." I'm not worried about anything. It's like dysautonomia. Just a system glich that causes me to hyperventilate and feel some of those shivers that run from your neck to your stomach when you feel extreme stess. I think it's more like panic than anxiety but I don't really fall in either category. (by the way, I think these categories are bunk anyway because they are not pinned to physiology.)
> Thanks for the pointing me to the Stahl articles on estrogen. When I was still seeing my last pdoc, she steered me away from trying birth control pills for premenstral symptoms, both physical and psychological. In retrospect, because of my age, and the definite worsening of my depression in a fairly stable period of my life, I think it was negligent to not explore the hormonal aspect of my depression.Well, I pleaded with my ob/gyn to explore perimenopause issues but he refused saying I was "not" perimenopausal--I was too young (42) despite the fact that I was having hot flashes and missing periods for 4-5 months at a go. It still steams my glasses.
> > > Luckily, she didn't have the same reluctance that other doctors do about my use of valium or klonopin. However, both her objection to my use of vicidin and her refusal to accept my stance against a large weight gain still annoy me. I tried dozens of drugs for the depression, none worked, and a very small bit of vicidin worked and I did not increase it for three years.I think that doctors worry about drugs of posible abuse. I think it is a malpractice concern. But I also believe that the correct way to look at addiction is that it is a physical condition caused by some abnormality in the brain. So, there are a lot of drugs that could help people with mental illnesses and people with addiction that aren't used because of the stigma associated with these drugs. It's all nonsense in my book. If addiction concern is an issue, then monitor that possibility, don't refuse to treat the patient according to their needs.
> >I felt that she could afford to be smug and righteous about my use of oxycodone and my refusal to take meds causing me large weight gains, because it was not her life that was passing by, and not her body that was changing.
This stuff really drives me nuts. I understand your anger completely.
> > > My belief is that if doctors have panic attacks they quickly change their mind about benzos , and if they were as depressed as I was and had tried as many drugs unsuccessfully, they would be more willing to try opiates, especially buprenorphine.
Some doctors don't have a clue. Walk a mile in my shoe would really help some of them. I saw a woman on Booknotes last night who had written a book on political correctness and medicine. She said she decided to go into psychiatry after she had an infection that required treatment with a drug that induced depression in her. She was able to come out of the depression by weaning off the drug, but she felt compelled to go into the field because of how devastating her time limited depression was. This might be part of training for the job, if we were sure it could be reversed.
> > >She wouldn't even read the literature on it (I brought in copies and she wouldn't even take them).
Of course not, education wasn't an option in her book. She had a frame of mind that was immovable.
> > > How long to you have to wait to try parnate? I'm really doing pretty well, so I think unless I start to spiral down, I may put off trying another MAOI and see what the estrogen does.I'm going to set an appointment next week, assuming the Valium doesn't do the trick.
> > >I'll let you test parnate before I decide < g
Now, you first. Really, I insist.
> > > I think you have a lot of reason to be very optimistic about MAOIs. I think the nardil would still be working for me if I had not entered into my perimenapausal years.I wonder if estrogen and Nardil might be your holy grail.
> How's was the valium yesterday?OK, not so much aggravation, although I am still weepy and my breathing is not completely under control. I could up the dose, but I don't like sedation.
Good to hear from you, Shelli
Posted by Elizabeth on July 22, 2001, at 14:54:36
In reply to Re: hand holding » Elizabeth, posted by Lorraine on July 21, 2001, at 23:27:48
> Yeah, that's pretty much what it was for me on Effexor. But once I got on low carb, I found my craving for sweets pretty much went away.
I think a low-carb diet might help with Nardil. But that would be very difficult for me, for a variety of reasons (plus Nardil never worked for me in the long term).
> Anyway, he advocated Nardil and said that sometimes he put his overweight patients on it to help them get over there carb cravings. Isn't that odd?
Yes. I have no idea why that might work. I went from being a little bit underweight to very overweight for my size. I'd never had problems with my weight being too high before I took Nardil.
> > > > Have you had liver function tests recently?
>
> I think so as part of a general physical--nothing out of range.I don't know if that would be part of a general physical (it's been so long since I've had one < g >).
> Although I am going to see a preventative medicine doctor in August and am going to ask her about doing a more in depth test than the normal stuff.
What's a preventative medicine doctor? I mean, I've heard of preventative medicine, but I didn't know it was a recognised subspecialty.
> > > > Consider the possibility that you're just extra-sensitive to feelings in your body. A lot of people who have panic attacks are that way.
>
> It's alway possible, but it doesn't ring true at first blush.It may not be the case. Just keep in mind that it *could* be. Sometimes our intuition is mistaken.
> > > I really can't imagine.
> >
> > What, taking 2 mg of Xanax?
>
> Ok, let me try to imagine it. What is the lowest dose of Xanax?The lowest strength pill is 0.25 mg.
> Whatever it is, I took that once and once only, it made me almost drunk, I mean slurring my words and so forth.
I only take 2 mg for panic attacks (infrequently, although I need more when I'm switching ADs). It's not sedating at all; it just cuts through the anxiety.
> What I was really reacting to was the 40 mg of Valium. I think they'd have to call 911 if I got anywhere near that dose.
I have a high intrinsic tolerance. Benzos at usual doses don't do much to me, and it's not due to acquired tolerance -- for a long time I thought that benzos were useless because the usual doses just didn't have any noticeable effect.
> I remember having doctors tell me that my endometriosis was "all in my head".
I hate that! I mean, in a situation like that, I'd call it malpractise, not just unprofessionalism (and perhaps more than a little bit of sexism).
Placebo side effects are quite possible, though. Consider this: in clinical trials, the rate of occurrence of various "side effects" is usually lower in the placebo group, but most often it's more than zero.
> I suppose the worst part about panic attacks (which I thankfully don't have) is that you have to learn to distrust what your body is telling you.
Not so much for me. Just figuring out that I was having panic attacks made it a lot easier to deal with them. The panic became a problem that I could manage, not a scary and mysterious thing.
> But then have you ever had an emotion that just occurred without an approriate stimulus for it? (what woman hasn't < vbg >)
I'm nowhere near menopause, and I don't get PMS, just cramps. I have spontaneous depressions -- for the most part, my depression is not related to stressful events or circumstances (or the change of seasons or my menstrual cycle). I think that people who haven't been depressed have trouble relating to that, because the only thing they have to compare it to is sadness as a normal response to events.
> Yeah, I think the mind/brain stuff is a bit whacko. But what I mean is that ruminating thoughts of fear and such might require a different treatment.
"Somatic symptoms" is a non-dualistic term for the "physical" symptoms such as palpitations, sweating, hyperventilating, etc.
> Do you would think that the jitters could have been a rebound anxiety response?
Yes, that's exactly what I was getting at.
> I take my dose in the morning and started having trouble around 2pm.
Yup! You just need to take it more regularly.
About Nardil vs. Parnate:
> Certainly Nardil has the reputation of being more effective as an anxiolytic. The place that said this (www.anxietynetwork.com/pdmed.html) was actually addressing panic attacks. I don't know if that makes a difference though.It does. And my experience has been that Parnate is effective in preventing panic attacks, although I wouldn't say it's *more* effective than Nardil.
-elizabeth
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