![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 81 to 105 of 434. Go back in thread:
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
Posted by Elizabeth on July 22, 2001, at 15:00:31
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
> 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.
I think that benzophobic doctors should be required to take inverse benzodiazepine agonists, and opiophobic doctors should be made dependent on morphine and then forced into naloxone-precipitated withdrawal. And if they think weight gain is no big deal, they should have no problem taking Clozaril for a few years!
> 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.
It's called "intellectual laziness."
-elizabeth
Posted by Lorraine on July 23, 2001, at 10:40:03
In reply to Re: hand holding » Lorraine, posted by Elizabeth on July 22, 2001, at 14:54:36
> > > > > 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 >).tsk. tsk!
> > > What's a preventative medicine doctor? I mean, I've heard of preventative medicine, but I didn't know it was a recognised subspecialty.I don't know if it is a recognised subspecialty. It represents an approach where the doctor will explore a possible functional deficiency that hasn't yet risen to the level of pathology. When you have a disease of unknown etiology (like depression or chronic fatigue syndrome or fibromylagia), this type of doctor will look at the various functional system that might be involved with the disorder to ascertain and shore up problem areas. For instance, in depression the rate of osteoporosis is significantly higher than it is in the normal population. You can have a bone scan done periodically, but by the time it detects loss of bone mass, the amount lost is high. A functional approach would be to try to measure calcium loss by looking at urine, saliva and hair sample analysis to nip it in the bud before it is detectable by bone scan. Just an example. I want this person to look at my liver function, adrenal function, thyroid function, and estrogen/progesteron levels, among other things. It took me a year to find a doctor in this area that I was confident in (because you do have to watch out for quacks). This one came highly recommended by two people I know and respect. In addition, the doctor had either cfs or fms about 5 years ago, retired from practice for a couple of years and when she got her own body back on track, reestablished her practice--all of which makes me feel good about going to see her. She has a waiting list, but I go in next month.
> > > It may not be the case. Just keep in mind that it *could* be. Sometimes our intuition is mistaken.
I'm open to possibilities. Discounting my physical feelings is just not something that I would do casually. When I was a child, a lot of my physical and emotional reality was discounted. Learning not to discount my feelings has taken time.
> > > I have a high intrinsic tolerance. Benzos at usual doses don't do much to me, and it's not due to acquired tolerance
That was my assumption. Are you then, a fast metabolizer?
> > 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).It gets worse. I once went in for surgery--plastic surgery to remove some burn scar tissue--and the doctors gave me an experimental anethetic that didn't really knock you out but was supposed to make you forget what had happened in the surgery. They then gave me a local for pain. When they started to make the incision, I told them I could feel it. They insisted that I could not, maybe I could feel the pressure only, they said. I was strapped down on the operating table and they proceeded. It wasn't until I absolutely started freaking out, that they relented and gave me a general.
> > > 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.Yes, but if you keep a mood diary and track meds and supplements and so forth on a day-to-day basis you have different effects that happen. The difference is that when you are in a trial you "attribute" these effects to something when they may actually just be random actual occurences that are not attributable to the med. It's not that the effects aren't real.
> > > "Somatic symptoms" is a non-dualistic term for the "physical" symptoms such as palpitations, sweating, hyperventilating, etc.This is good to know. You increase my vocabulary daily < vbg >
> > > 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.I'll try this. Thanx.
> > >. And my experience has been that Parnate is effective in preventing panic attacks, although I wouldn't say it's *more* effective than Nardil.It's not clear "what" I have. I don't fall in either GAD or panic attack diagnostic categories.
Do take care of yourself. How the despramine going?
Lorraine
Posted by Elizabeth on July 23, 2001, at 16:08:30
In reply to Re: hand holding, posted by Lorraine on July 23, 2001, at 10:40:03
> I don't know if it is a recognised subspecialty.
Ahh, okay. I only knew of the expression as a sort of approach, as you described.
> I'm open to possibilities. Discounting my physical feelings is just not something that I would do casually. When I was a child, a lot of my physical and emotional reality was discounted. Learning not to discount my feelings has taken time.
I understand; I've met a number of people who were treated the same way in childhood.
> > > > I have a high intrinsic tolerance. Benzos at usual doses don't do much to me, and it's not due to acquired tolerance
>
> That was my assumption. Are you then, a fast metabolizer?Not that I know of. (The primary enzyme involved in metabolism of Xanax is cytochrome p450 3a4, incidentally. It's inhibited by some ADs, such as Serzone and Luvox, as well as various other types of drugs. 3a4 deficiency isn't as common as 2d6 deficiency, I believe.)
> It gets worse. I once went in for surgery--plastic surgery to remove some burn scar tissue--and the doctors gave me an experimental anethetic that didn't really knock you out but was supposed to make you forget what had happened in the surgery.
Was it ketamine, by any chance?
> They then gave me a local for pain. When they started to make the incision, I told them I could feel it. They insisted that I could not, maybe I could feel the pressure only, they said. I was strapped down on the operating table and they proceeded. It wasn't until I absolutely started freaking out, that they relented and gave me a general.
Jeez. Bastards. If I were mistreated to that extent, I'd consider finding a lawyer. Operating on someone who's withdrawn her consent is a big no-no.
> Yes, but if you keep a mood diary and track meds and supplements and so forth on a day-to-day basis you have different effects that happen. The difference is that when you are in a trial you "attribute" these effects to something when they may actually just be random actual occurences that are not attributable to the med. It's not that the effects aren't real.
I think that misattribution is one source of "placebo side effects." I don't think that it accounts for all of them, though.
> > Yup! You just need to take it more regularly.
>
> I'll try this. Thanx.Get permission from your doctor (who really ought to know that Valium doesn't last a whole day).
> It's not clear "what" I have. I don't fall in either GAD or panic attack diagnostic categories.
So you said. It sounds like constant, low-level panic. I've met a couple other people who had the same experience. (For me, Parnate withdrawal was like that.) I think the most prudent thing to do would be to treat it like panic, GAD, or perhaps PTSD.
> Do take care of yourself. How the despramine going?
Pretty well. I started taking 250 mg yesterday and will be bumping it up to 300 sometime later this week. My pdoc is going on vacation for two weeks in August (don't they all do that?), and I'd like to be sure that I will be able to function reasonably well while he's gone.
-elizabeth
Posted by shelliR on July 23, 2001, at 19:16:11
In reply to Re: I'll hold your hand if you'll hold mine » shelliR, posted by Elizabeth on July 22, 2001, at 15:00:31
Hi Elizabeth> > 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.
>
> It's called "intellectual laziness."Actually, I think it has more to do with close-mindedness re opitates. She was not usually that way; in fact on somethings, she was eager to see what was written.
Hi Elizabeth
You wrote to Lorraine that the despamine was going pretty well.
What is your dosage goal ? Does doing "pretty well" mean you are feeling some benefit, or tolerating side effects? BTW, what are the side effects? And do you feel anything in relation to your depression yet?
I started estrogen today and I am euphoric ( < g >, just felt like using the word). No, but actually I have really bad PMS and now I wonder if I should have waited until I got my period to start the estrogen. Like I don't want to throw things off so the PMS lasts longer than usual. Oh well, too late.
BTW, there's a message to you from me yesterday, re Shappard Pratt, MPD, etc.later, Shelli
Posted by Lorraine on July 23, 2001, at 21:39:13
In reply to Re: hand holding » Lorraine, posted by Elizabeth on July 23, 2001, at 16:08:30
> > > It gets worse. I once went in for surgery--plastic surgery to remove some burn scar tissue--and the doctors gave me an experimental anethetic that didn't really knock you out but was supposed to make you forget what had happened in the surgery.
>
> Was it ketamine, by any chance?I don't remember. It was in 1977 approximately, a long time ago. You know, a lot of brash insensitive intern types--which at teaching hospitals sometimes you get.
> > > They then gave me a local for pain. When they started to make the incision, I told them I could feel it. They insisted that I could not, maybe I could feel the pressure only, they said. I was strapped down on the operating table and they proceeded. It wasn't until I absolutely started freaking out, that they relented and gave me a general.
>
> Jeez. Bastards. If I were mistreated to that extent, I'd consider finding a lawyer. Operating on someone who's withdrawn her consent is a big no-no.It's interesting. I was outraged, but noone I related the story to at the time was. My mother and boyfriend acted like this was all normal and at the time my sense of reality was borrowed from others so I figured the problem was my perception.
> > > I think that misattribution is one source of "placebo side effects." I don't think that it accounts for all of them, though.No, not all of them. But the way people commonly use the concept of placebo it sounds like just having someone give you a sugar pills makes things happen. It makes people's reactions appear more strange than they are. Now in a controlled experiment you still care about the random associations that are made because theoretically those same random associations may occur in the treatment group.
> > > Get permission from your doctor (who really ought to know that Valium doesn't last a whole day).You sound like you would be pretty outraged at this lapse in your doctor. Would you? I find they are have failings. When I was on Wellbutrin and experiencing visual trails (like on LSD), I asked my pdoc if it was a side effect. She swore it wasn't and suggested perhaps it was the ginko that I was taking or small strokes (TIAs). Then she suggested I see an eye doctor. I did. The eye doctor found nothing wrong, then looked up Wellbutrin in the PDR and noted that visual trails were indeed a known side effect of Wellbutrin.
> > > It's not clear "what" I have. I don't fall in either GAD or panic attack diagnostic categories.
>
> > > So you said. It sounds like constant, low-level panic.I think this assessment is dead one. Pat yourself on the back please< vbg >
> > >I've met a couple other people who had the same experience. (For me, Parnate withdrawal was like that.) I think the most prudent thing to do would be to treat it like panic, GAD, or perhaps PTSD.
Yes, but the treatment seems to be different for these three conditions. My plan is to treat it like panic and assume the drugs that are effective with panic (e.g. Parnate) will be helpful.
> > >I started taking 250 mg yesterday and will be bumping it up to 300 sometime later this week. My pdoc is going on vacation for two weeks in August (don't they all do that?), and I'd like to be sure that I will be able to function reasonably well while he's gone.Well, can you get an authorization from him to increase your dosage at regular increments until you reach his "max"? It sure would help while he is gone. Are you getting any mood support from the Desipramine currently?
By the way, Stephan Stahl in an article on different meds noted that desipramine was not effective against panic--which also helps steer me towards Parnate. What type of a washout period would you expect me to have going from selegiline to Parnate? Can it be done in less than a week if you monitor your blood pressure? My selegiline is 5 mg a day.Nice chatting with you, elizabeth, as always
Lorraine
Posted by lawrence s. on July 24, 2001, at 1:29:58
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.
>
> -elizabeth
>
> > >Nardil for me was a social lubricant/personality amplifier. A miricale drug for my S.P. I Had the best results with 90mg. a day.
Parnate seemed better geared for deppresion. Also seemed to react to amines much more than Nardil. Hope this helps.
>Lawrence S.
Posted by Lorraine on July 24, 2001, at 9:35:51
In reply to Re: Nardil vs. Parnate, posted by lawrence s. on July 24, 2001, at 1:29:58
> > > >Nardil for me was a social lubricant/personality amplifier. A miricale drug for my S.P. I Had the best results with 90mg. a day.
> Parnate seemed better geared for deppresion. Also seemed to react to amines much more than Nardil. Hope this helps.Lawrence: Thank you for your response. What do you mean by "seemed to react to amines much more than Nardil"? There seem to be a lot of Nardil fans out there and not as many Parnate fans. The difficulty with Nardil is the weight gain and sexual dysfunction side effects that are prevalent. Were these a problem for you?
> >Lawrence S.
Posted by lawrence s. on July 25, 2001, at 1:15:41
In reply to Re: Nardil vs. Parnate » lawrence s., posted by Lorraine on July 24, 2001, at 9:35:51
> > > > >Nardil for me was a social lubricant/personality amplifier. A miricale drug for my S.P. I Had the best results with 90mg. a day.
> > Parnate seemed better geared for deppresion. Also seemed to react to amines much more than Nardil. Hope this helps.
>
> Lawrence: Thank you for your response. What do you mean by "seemed to react to amines much more than Nardil"? There seem to be a lot of Nardil fans out there and not as many Parnate fans. The difficulty with Nardil is the weight gain and sexual dysfunction side effects that are prevalent. Were these a problem for you?
>
> > >When I was on Parnate I noticed my blood pressure increasing while eating certain foods that I used to eat all the time on Nardil. For instance: chocolate, caffeine, bacon to name a few. Maybe because of Parnate being more stimulating it caused the problem.
Sex was a problem for me on Nardil, but not impossible. Just thought Iwas going to have a heart attack before ejaculation. I also gained about 30lbs while on it. It was amazing the amount of sweets I could eat!
>LARRY
> > >Lawrence S.
Posted by Lorraine on July 25, 2001, at 10:32:46
In reply to Re: Handholding Elizabeth, posted by Lorraine on July 25, 2001, at 10:26:21
> elizabeth: Wanted you to know that you missed a message from me--the last one on 7/15. In case it was an oversight, here's the link. http://www.dr-bob.org/babble/20010720/msgs/71555.html
Sorry, meant 7/23
Posted by Lorraine on July 26, 2001, at 10:00:19
In reply to Re: Handholding Elizabeth, posted by Lorraine on July 25, 2001, at 10:32:46
Shelli:
Have you heard from Elizabeth? I'm concerned. I haven't seen her posting lately and I know her doctor was going out of town and she's new to desipramine. Just wondered if you had heard anything from her.
How are you doing with your meds? I'm in to see my pdoc today. Probably discuss Parnate, Nardil and so forth. You were thinking about going back on Nardil as I recall. Any movement there?
> > elizabeth: Wanted you to know that you missed a message from me--the last one on 7/15. In case it was an oversight, here's the link. http://www.dr-bob.org/babble/20010720/msgs/71555.html
>
> Sorry, meant 7/23
Posted by shelliR on July 26, 2001, at 15:44:31
In reply to Re: Handholding Shelli, posted by Lorraine on July 26, 2001, at 10:00:19
Hi Lorraine.
> > > > > Have you heard from Elizabeth? I'm concerned. I haven't seen her posting lately and I know her doctor was going out of town and she's new to desipramine. Just wondered if you had heard anything from her.< < < < < < <I don't think you need to worry about Elizabeth. I looked back and her pdoc is not leaving unti August. Maybe she just went away for a few days.
> > > > >How are you doing with your meds? I'm in to see my pdoc today. Probably discuss Parnate, Nardil and so forth. You were thinking about going back on Nardil as I recall. Any movement there?< < < < < < < <
I'm doing well with the meds, although I have felt physically sick, migraines etc. all week; finally today I just started my period, so my body hopefully will demand less of my attention. The only thing about the oxycontin is that I am still on the original dose and the feeling of a little bit of high has never left. It's not a big problem, just better to decide when I want to get high, not start out my day that way.My doctor sort of has this attitude that you mix a bunch of stuff together and if it works there's no need to dissect it. I sort of disagree because I would rather put less than more into my body. (BTW, I didn't have this attitude when I was feeling suicidally depressed; I started segeligine and oxycontin at the same time.) But now I think I'll do the oxycontin and estradiol, add natural progesterone and see what happens. I've just done the estradiol for a couple of days now. I had two pretty bad migraines this week and I couldn't have taken the pill I took for them (forget the name, dissolves under the tongue) if I was on an MAOI.
Anyway, I'm feeling stable enough to wait, if a bit drugged. Maybe the estradiol will be my miracle and I could drop the oxy. Probably not though, since I have a long history of depression. But maybe estradiol and nardil, oxy prn. I'll see.
Has your pdoc been encouraging you to take nardil over parnate or vice-versa. Let me know what he said and which you've choosen.
Shelli
Posted by Lorraine on July 26, 2001, at 18:45:59
In reply to Re: Handholding Shelli » Lorraine, posted by shelliR on July 26, 2001, at 15:44:31
> > > I don't think you need to worry about Elizabeth. I looked back and her pdoc is not leaving unti August. Maybe she just went away for a few days.
I'm sure you're right. I don't think I so much worry about her ability to handle things (because she really seems to be an old hand at this). I suppose I wish that I could be more helpful to her. She does a ton of giving on this board. I'd like to be able to reciprocate on some meaningful level.
By the way, looking back over some old posts, I see that you have been very helpful in responding to my posts. I don't know how to describe it, but when I first went on psychobabble--all the names were a blur. It is only recently that the names have separated for me and I've come to identify posts with names. Anyway, I want to thank you for all the support you have given me in the past when I didn't know who you were. It really did help.
(Lord, can you see where I am in this depression? Slipping down--I become all soppy even though the sentiment is true. I tear up with gratitude--which I guess is one of the good things--that I can still feel "touched".)
> > > I'm doing well with the meds, although I have felt physically sick, migraines etc. all week;I did tell you that they now believe that migraine are associated with seizure like activity in the brain and that intestinal migrains also exist? I had migraines for years. They left when I went through menopause, and, like yours, were hormonally related. I'm now on unopposed estrogen and no migraines so my hunch is that they are related to progesterin changes. I have also read (and my pdoc confirmed to me today) that panic attacks can be associated with estrogen dominance--which given my unopposed estrogen is certainly my situation. So when I go see my functional med doctor at the end of this month a full hormone level panel is in order. Also, apparently panic attacks can be associated with hypothyroidism. Turns out I quit taking T3 augmentation around the time the panic attacks started--so who knows. New avenues to explore.
> > >Finally today I just started my period, so my body hopefully will demand less of my attention.
Well, I know what you mean about "finally"--it's like waiting for the other shoe to drop, isn't it and for me at least was such a physical feeling-a prenumbra?
> > > The only thing about the oxycontin is that I am still on the original dose and the feeling of a little bit of high has never left. It's not a big problem, just better to decide when I want to get high, not start out my day that way.
The feeling of being "high" is very unsettling to me as well. You've been on this med long enough that you would think that side effect would have evaporated if that's what its intent was. That's unfortunate.
> > > My doctor sort of has this attitude that you mix a bunch of stuff together and if it works there's no need to dissect it.
The lack of a scientific basis makes me uneasy too. Though my hunch is that nobody really knows what they are doing with these meds--it's all trial and error with a bit of hunch thrown into it. (elizabeth would disagree I think.) But I have this fantasy that one day I'll walk into someone's office and they will say "let's see here--there's a pattern of dopamine responsiveness and it appears to be D2 rather than D3---let's try such and such. It just fits the bill."
> > >I sort of disagree because I would rather put less than more into my body. (BTW, I didn't have this attitude when I was feeling suicidally depressed; I started segeligine and oxycontin at the same time.)
Yeah, but, don't you think that first you manage the depression, then you worry about simplifying?
> > >But now I think I'll do the oxycontin and estradiol, add natural progesterone and see what happens.
You know they say to do the progesterone on a constant basis as opposed to following the menstrual cycle when you have depression?
> > >I've just done the estradiol for a couple of days now. I had two pretty bad migraines this week and I couldn't have taken the pill I took for them (forget the name, dissolves under the tongue) if I was on an MAOI.
That's unfortunate that you can't take this pill when you are on an MAO. An there is no substitute? (There was never anything that I could take that helped at all.)
> > > Anyway, I'm feeling stable enough to wait, if a bit drugged. Maybe the estradiol will be my miracle and I could drop the oxy.Wouldn't that be lovely? Let's hope.
> > >Probably not though, since I have a long history of depression. But maybe estradiol and nardil, oxy prn. I'll see.
Let me know.
> > > Has your pdoc been encouraging you to take nardil over parnate or vice-versa. Let me know what he said and which you've choosen.Well, we decided to go with parnate. My guy is an odd duck--he bases everything pretty much on your QEEG. So when I say, Nardil is associated with weight gain and sexual dysfunction, he says "I've never had anyone with your QEEG gain weight or have sexual dsyfunction on Nardil". The problem is I only half (or less than half) believe in his methodology--so I believe the weight gain has to do with histamine receptors and so forth. Anyway, I'm officially off selegiline and start a very low dose (5mg) of Parnate in 3 days--which I know is a short wash-out period, but he bases these things of my QEEG (and, of course, I'll be very careful to look for problems).
I also asked him if I have temporal lobe epilepsy that didn't manifest itself in physical seizures. He looked at my chart, explained that these things are continuums and then said that I did have temporal lobe epilepsy. Well, one more thing to think about. I think that I remember reading that Tegretal has a very high rate of success with depressed people who have temporal lobe epilepsy. Another option, anyway.
I went to my first DMDA meeting on Tuesday. I went with Neal, another psychobabbler who happens to live in Los Angeles. It was helpful to me to see how others cope. I may go back. I'm still thinking it through.
All my best to you Shelli. You are a jewel, truly.
>
> Shelli
Posted by Elizabeth on July 26, 2001, at 22:05:44
In reply to Re: I'll hold your hand if you'll hold mine » Elizabeth, posted by shelliR on July 23, 2001, at 19:16:11
> Hi Elizabeth
Hi there.
> > It's called "intellectual laziness."
>
> Actually, I think it has more to do with close-mindedness re opitates. She was not usually that way; in fact on somethings, she was eager to see what was written.I'd categorise closed-mindedness under "intellectual laziness."
> You wrote to Lorraine that the despamine was going pretty well.
Yes. I'm pleasantly surprised.
> What is your dosage goal ?
300 mg/day (which I reached a couple days ago).
> Does doing "pretty well" mean you are feeling some benefit, or tolerating side effects?
The former: it seems to be working about as well as Parnate, and there could be further improvement. The side effects are noticeable at this dose (mainly dry mouth), but tolerable. It doesn't seem to work so great for panic, so I've been taking clonazepam (4 mg/day) too.
> I started estrogen today and I am euphoric ( < g >, just felt like using the word). No, but actually I have really bad PMS and now I wonder if I should have waited until I got my period to start the estrogen. Like I don't want to throw things off so the PMS lasts longer than usual. Oh well, too late.
FWIW, when I tried taking the pill last year, my depression returned (while I was taking Parnate and lithium), and when I discontinued the BCP, I rapidly returned to normal. Hormones aren't for everybody.
> BTW, there's a message to you from me yesterday, re Shappard Pratt, MPD, etc.
Ahh. I should check my mail, then! (I took an exhausting road trip Tuesday and have been feeling very wiped since then.)
-elizabeth
Posted by Elizabeth on July 26, 2001, at 22:34:55
In reply to Re: hand holding, posted by Lorraine on July 23, 2001, at 21:39:13
> > > > I once went in for surgery--plastic surgery to remove some burn scar tissue--and the doctors gave me an experimental anethetic that didn't really knock you out but was supposed to make you forget what had happened in the surgery.
> >
> > Was it ketamine, by any chance?
>
> I don't remember. It was in 1977 approximately, a long time ago. You know, a lot of brash insensitive intern types--which at teaching hospitals sometimes you get.They're like that because they don't have the self-confidence to just chill. Anyway, the effect you described sounds like the way people sometimes describe ketamine anaesthesia, which was why I asked.
> It's interesting.
As in the ancient curse, "May you live in interesting times?"
> I was outraged, but noone I related the story to at the time was. My mother and boyfriend acted like this was all normal and at the time my sense of reality was borrowed from others so I figured the problem was my perception.
Not feeling like it's okay to trust your own perceptions is one of the many negative consequences of being mentally ill, I think. But nobody can tell you what your subjective experience was: if you were in pain, you and only you would know it for sure.
> > > > Get permission from your doctor (who really ought to know that Valium doesn't last a whole day).
>
> You sound like you would be pretty outraged at this lapse in your doctor. Would you?I wouldn't allow it to happen. I'd make him get out the PDR and look at the recommended dosing schedule; if necessary, I'd find a standard, reputable textbook and read the passage about the distribution and clinical duration of action of diazepam.
> I find they are have failings.
Of course. Some people seem to expect doctors to be omniscient and omnipotent (and yet still get angry at them for "playing god"). But they're only human, and they can have moral weaknesses like we all do.
> When I was on Wellbutrin and experiencing visual trails (like on LSD), I asked my pdoc if it was a side effect. She swore it wasn't and suggested perhaps it was the ginko that I was taking or small strokes (TIAs). Then she suggested I see an eye doctor. I did. The eye doctor found nothing wrong, then looked up Wellbutrin in the PDR and noted that visual trails were indeed a known side effect of Wellbutrin.
That sounds like what happened when I tried taking Cylert with Nardil: the psychiatrist at the medical centre at my school insisted that my compulsive scratching and skin-picking was due to "anxiety;" when I spoke to my own doctor, he said that was a common side effect of stimulants, especially in overdose (MAOIs can be expected to potentiate psychomotor stimulants).
> > > > It sounds like constant, low-level panic.
>
> I think this assessment is dead one. Pat yourself on the back please< vbg >< pat >
I would expect benzodiazepines or perhaps Neurontin to be helpful for this sort of anxiety. I mentioned that I experienced something similar upon discontinuing Parnate; the Klonopin came in very handy.
> > > > I think the most prudent thing to do would be to treat it like panic, GAD, or perhaps PTSD.
>
> Yes, but the treatment seems to be different for these three conditions.Well, you have a lot of choices. Benzodiazepines seem to make the most sense, though. MAOIs could be helpful also (thinking back, again, to my Parnate withdrawal experience).
> Well, can you get an authorization from him to increase your dosage at regular increments until you reach his "max"?
300 mg is the target dose, and I'm already there. Because of some weird reactions I've had in the past (intolerance of low doses of other TCAs, several episodes of the "serotonin syndrome" with very little cause (e.g., during Effexor monotherapy)), I had blood drawn for a serum level test today.
> By the way, Stephan Stahl in an article on different meds noted that desipramine was not effective against panic--which also helps steer me towards Parnate.
Oh yeah, for primary anxiety, MAOIs are great. Desipramine does help with panic, but it's significantly less effective than the serotonergic ADs such as clomipramine.
> What type of a washout period would you expect me to have going from selegiline to Parnate? Can it be done in less than a week if you monitor your blood pressure?
That's for you and your doctor to decide. I did once switch from Marplan to Parnate with a washout of only two days. (Kids, don't try this at home!) I think a week or so is pretty standard.
> Nice chatting with you, elizabeth, as alwaysThank you. Same here.
-elizabeth
Posted by Elizabeth on July 26, 2001, at 22:36:23
In reply to Re: Nardil vs. Parnate, posted by lawrence s. on July 24, 2001, at 1:29:58
> Parnate seemed better geared for deppresion. Also seemed to react to amines much more than Nardil. Hope this helps.
That's true: Parnate potentiates vasoconstricting biogenic amines more than Nardil does at equivalent doses.
-e
Posted by Elizabeth on July 26, 2001, at 22:59:22
In reply to Re: Handholding Shelli » shelliR, posted by Lorraine on July 26, 2001, at 18:45:59
> (Lord, can you see where I am in this depression? Slipping down--I become all soppy even though the sentiment is true. I tear up with gratitude--which I guess is one of the good things--that I can still feel "touched".)
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.
Interesting about panic and hypothyroidism. All my TSH tests have been pretty normal, and T3/4 augmentation is something I've never tried.
> Well, I know what you mean about "finally"--it's like waiting for the other shoe to drop, isn't it and for me at least was such a physical feeling-a prenumbra?
Buprenorphine seems to make my periods irregular. I've been wondering about the mechanism there.
> The feeling of being "high" is very unsettling to me as well. You've been on this med long enough that you would think that side effect would have evaporated if that's what its intent was. That's unfortunate.
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.
> The lack of a scientific basis makes me uneasy too.
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.
> Though my hunch is that nobody really knows what they are doing with these meds--it's all trial and error with a bit of hunch thrown into it. (elizabeth would disagree I think.)
Only partially. I think that lately, research has focussed mainly on biology, and the empirical-descriptive school of thought has become passe'. This is unfortunate in a way, because despite technological and scientific advances, psychiatrists still mainly have to go on the clinical presentation.
> Yeah, but, don't you think that first you manage the depression, then you worry about simplifying?
I agree here.
> That's unfortunate that you can't take this pill when you are on an MAO.
It must be one of the -triptans (e.g., Imitrex).
> An there is no substitute?
No, the triptans are all serotonin agonists.
> Well, we decided to go with parnate. My guy is an odd duck--he bases everything pretty much on your QEEG. So when I say, Nardil is associated with weight gain and sexual dysfunction, he says "I've never had anyone with your QEEG gain weight or have sexual dsyfunction on Nardil".
That is so wacky! There's a doctor here who's known for similar approaches (using EEGs and functional imaging to treat depression, mania, fibromyalgia, CFS, etc., and believing that these conditions are very often caused by seizure disorders). Some people seem to respect him quite a bit, while others think he's loopy. I'm not sure what to think (although I have met him and he does seem like a bit of a flake).
> The problem is I only half (or less than half) believe in his methodology--so I believe the weight gain has to do with histamine receptors and so forth.
It's not clear how Nardil would affect that. I think it could be related to serotonin and happens at the level of the hypothalamus. The effects of Nardil on insulin sensitivity probably play a role.
> Anyway, I'm officially off selegiline and start a very low dose (5mg) of Parnate in 3 days--which I know is a short wash-out period, but he bases these things of my QEEG (and, of course, I'll be very careful to look for problems).
Ask the pharmacist if it's okay to cut Parnate pills in half.
> I think that I remember reading that Tegretal has a very high rate of success with depressed people who have temporal lobe epilepsy. Another option, anyway.
Consider Trileptal (oxcarbazepine), Tegretol's newer, gentler cousin.
> I went to my first DMDA meeting on Tuesday. I went with Neal, another psychobabbler who happens to live in Los Angeles. It was helpful to me to see how others cope. I may go back. I'm still thinking it through.
That's great to hear. I hope you can continue going; support groups can be of help in a number of ways.
-elizabeth
Posted by Cindylou on July 27, 2001, at 7:14:06
In reply to Re: Handholding Shelli » shelliR, posted by Lorraine on July 26, 2001, at 18:45:59
Hi,
I don't mean to sidetrack this thread, but was wondering what a DMDA meeting was -- I've been looking for a depression support group -- Sorry for my ignorance! But appreciate your reply,
-cindy
> I went to my first DMDA meeting on Tuesday. I went with Neal, another psychobabbler who happens to live in Los Angeles. It was helpful to me to see how others cope. I may go back. I'm still thinking it through.
>
> All my best to you Shelli. You are a jewel, truly.
> >
> > Shelli
Posted by shelliR on July 27, 2001, at 9:07:19
In reply to Re: Handholding Shelli - DMDA?, posted by Cindylou on July 27, 2001, at 7:14:06
> Hi,
> I don't mean to sidetrack this thread, but was wondering what a DMDA meeting was -- I've been looking for a depression support group -- Sorry for my ignorance! But appreciate your reply,
> -cindy
>
>
> > I went to my first DMDA meeting on Tuesday. I went with Neal, another psychobabbler who happens to live in Los Angeles. It was helpful to me to see how others cope. I may go back. I'm still thinking it through.
> >
> > All my best to you Shelli. You are a jewel, truly.
> > >
> > > ShelliHi Cindylou. Sorry, these messages tend to get all mixed up because older messages are quoted in them. Anyway, it is Lorraine that went to a DMDA meeting, but somehow my signoff got in there, and it appears that I'm telling myself I am a jewel! I think that Lorraine did talk about this on the social babble board; you might try seeing if you can find it there, or posting to her over there about it (non-med issue!). Shelli
Posted by Lorraine on July 27, 2001, at 10:02:38
In reply to Re: Nardil vs. Parnate » lawrence s., posted by Elizabeth on July 26, 2001, at 22:36:23
> > Parnate seemed better geared for deppresion. Also seemed to react to amines much more than Nardil. Hope this helps.
>
> That's true: Parnate potentiates vasoconstricting biogenic amines more than Nardil does at equivalent doses.elizabeth--what does that mean "vasoconsticting"--constriction of the veins--but what is the importance of this or the importance of reacting to "amines". Does this just mean that it is more difficult to guage individual reaction because the method of action is less clear?
>
> -e
Posted by Lorraine on July 27, 2001, at 10:09:38
In reply to Re: Handholding Shelli - DMDA?, posted by Cindylou on July 27, 2001, at 7:14:06
> > >I don't mean to sidetrack this thread, but was wondering what a DMDA meeting was -- I've been looking for a depression support group -- Sorry for my ignorance! But appreciate your reply,
> -cindycindy: DMDA stands for Depression and Manic Depression support group. There is a whole thread on this over at psychobabble social. I did a lot of research on all the different groups available so you might want to check it out. Me and Phil each are checking out a group this week and reporting back on our findings.
>
Posted by Lorraine on July 27, 2001, at 10:36:23
In reply to Re: hand holding » Lorraine, posted by Elizabeth on July 26, 2001, at 22:34:55
Hooray! You're back. Welcome.
> > >You know, a lot of brash insensitive intern types--which at teaching hospitals sometimes you get.
>
> > > They're like that because they don't have the self-confidence to just chill.It's the same with lawyers, actually. The "chill" part takes a long time to achieve for many.
> > > Anyway, the effect you described sounds like the way people sometimes describe ketamine anaesthesia, which was why I asked.
I'm wondering if ketamine also makes you vaguely paranoid? Because even though I don't doubt the reality, I had a very heightened sense of fear. I remember coming out of wisdom teeth surgery and believing that I was in a mental ward or prison of some sort and had to act a certain way to get released--the anesthesia's effect I'm sure.
> > > Not feeling like it's okay to trust your own perceptions is one of the many negative consequences of being mentally ill, I think.Well, now, that's an interesting way of looking at it. I didn't at the time think I was mentally ill (this was maybe 20 years before I was diagnosed). I knew that I had more than my fair share of "past" issues to resolve in talk therapy as a result of family dynamics that "discounted" pain and moved on.
> > > I wouldn't allow it to happen. I'd make him get out the PDR and look at the recommended dosing schedule; if necessary, I'd find a standard, reputable textbook and read the passage about the distribution and clinical duration of action of diazepam.Now you've motivated me to buy the PDR. I do find myself educating him from time to time. But, I find I do this with all doctors (and architects and landscapers and consultants generally). It doesn't bother me much because I am willing to look things up myself and am grateful when someone like you steer me in the right direction. It bothers me greatly though when I see someone who just blindly accepts their doctors word as gospel.
> > > That sounds like what happened when I tried taking Cylert with Nardil: the psychiatrist at the medical centre at my school insisted that my compulsive scratching and skin-picking was due to "anxiety;" when I spoke to my own doctor, he said that was a common side effect of stimulants, especially in overdose (MAOIs can be expected to potentiate psychomotor stimulants).
Course, it gets a bit humorous when you add a drug and a side effect occurs and their response is that it's not a side effect, but something else larger and unrelated--"anxiety" in your case. You have to chuckle sometimes when the obvious is dismissed for something less likely. This has to be a "frame of reference" issue--ie that's not what I expected, therefore it is not.
> > > I would expect benzodiazepines or perhaps Neurontin to be helpful for this sort of anxiety.Well, I'm not happy with the concept of benzos as a long term solution to what appears to be an on-going problem. But, I may not get to "choose". I did try the Valium and found it increased my depression and, at the dose I was on (1-2mg) did not completely wipe out the panic. Increasing the dose, increased the depression. My pdoc prescribed Ativan for me to try next. But I will start on the Parnate with just the Neurontin and see how it goes.
> > >I mentioned that I experienced something similar upon discontinuing Parnate; the Klonopin came in very handy.
Yeah, sounds like "rebound" anxiety? I did decide that I need a benzo in my emergency kit generally. So finding one that I am comfortable with is important.
> > >Benzodiazepines seem to make the most sense, though. MAOIs could be helpful also (thinking back, again, to my Parnate withdrawal experience).Your Parnate withdrawal makes me a bit hopeful.
> > > 300 mg is the target dose, and I'm already there. Because of some weird reactions I've had in the past (intolerance of low doses of other TCAs, several episodes of the "serotonin syndrome" with very little cause (e.g., during Effexor monotherapy)), I had blood drawn for a serum level test today.Sounds like you need to be very careful. Your theraputic dose range is quite narrow?
> > > What type of a washout period would you expect me to have going from selegiline to Parnate? Can it be done in less than a week if you monitor your blood pressure?
I'm lucky. It's 3 days.
Welcome home. Hope the desipramine holds.
Lorraine
Posted by Lorraine on July 27, 2001, at 11:19:35
In reply to Re: Handholding » Lorraine, posted by Elizabeth on July 26, 2001, at 22:59:22
[re: can still be touched]
> 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. 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 scared the putty out of me. At least now I can see the rose, smell it and delight in it.
> > > 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. 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.
> > > Buprenorphine seems to make my periods irregular. I've been wondering about the mechanism there.
Isn't that odd? 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?). Anyway, the trick was to catch the very wisp of the beginning of my period and take the pill at that time. 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.
> > > 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. But is agitation and activation considered mania? 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.
> > > 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. Sort of like when I read a fairly compelling article on Darwinism and viral evolution which proposed that many of our chronic illness may ultimately be linked to viral conditions where the viruses have adapted so that they are much more difficult to detect. They started with the ulcer situation--where they first said diet and environment were the underlying causes and ultimately determined that it was a bacteria that was responsible for the condition--and moved on to heart disease, diabetes, depression and OCD. All speculative at this point, but it does sort of blow the lid off of current thinking. And I wouldn't be surprised... But does that change how we need to approach treating these conditions now? Probably not. (except maybe Amantadine should be tried as a low odds possibility).
> > > Only partially. I think that lately, research has focussed mainly on biology, and the empirical-descriptive school of thought has become passe'. This is unfortunate in a way, because despite technological and scientific advances, psychiatrists still mainly have to go on the clinical presentation.
The problem is that we have an entire conceptual framework that is premised on presentation rather than on physiology. 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. 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. So to the extent that the old paradigm henders rather than helps progress, it should be rethought and possibly abandoned. That doctors have been taught an incorrect frame of reference just makes the process of transition that much harder. It's like a legacy computer system at an old corporation--much easier to throw the whole thing out than to try to change it bit by bit.
> > > Well, we decided to go with parnate. My guy is an odd duck--he bases everything pretty much on your QEEG. So when I say, Nardil is associated with weight gain and sexual dysfunction, he says "I've never had anyone with your QEEG gain weight or have sexual dsyfunction on Nardil".
> > >That is so wacky!Yeah, I agree it sounds wacky. If I really believed that there was another paradigm that offered a better result I would be concerned. But as it stands now, I don't think that the treatment I am receiving suffers. I am after all progressing on to MAOs just when you would think that I would. And, he would be quick to point out, that at least his approach is rooted in physiology--there is some measure of physical activity that is used to determine treatment. Just so you know he's not completely out there--what he does is run a QEEG and then perform a covariance analysis of your data against a data base of 8000 other people in terms of what meds were effective for them. He then prescribes based on that. His believes that my QEEG indicates that a combination of stimulants (he includes MAOs here) and anticonvulsants should work.
> > >There's a doctor here who's known for similar approaches (using EEGs and functional imaging to treat depression, mania, fibromyalgia, CFS, etc., and believing that these conditions are very often caused by seizure disorders). Some people seem to respect him quite a bit, while others think he's loopy. I'm not sure what to think (although I have met him and he does seem like a bit of a flake).
It's really too early in any of these approaches to determine whether they will ultimately prove to be worthwhile.
> > > It's not clear how Nardil would affect that. I think it could be related to serotonin and happens at the level of the hypothalamus. The effects of Nardil on insulin sensitivity probably play a role.
Complicated stuff. But if it is "insulin sensitivity" or "insensitivity?", then low carb should help.
> > > Ask the pharmacist if it's okay to cut Parnate pills in half.Very good question. I will do that.
> > > I think that I remember reading that Tegretal has a very high rate of success with depressed people who have temporal lobe epilepsy. Another option, anyway.
>
> Consider Trileptal (oxcarbazepine), Tegretol's newer, gentler cousin.Thanx again. Good suggestion.
> > > That's great to hear. I hope you can continue going; support groups can be of help in a number of ways.
Actually, I think it was your suggestion that I look into DMDA. I think it may be useful as well.
Lorraine
Posted by Cindylou on July 27, 2001, at 13:02:11
In reply to Re: Handholding Shelli - DMDA? » Cindylou, posted by Lorraine on July 27, 2001, at 10:09:38
Thank you so much for your help!
>
> > > >I don't mean to sidetrack this thread, but was wondering what a DMDA meeting was -- I've been looking for a depression support group -- Sorry for my ignorance! But appreciate your reply,
> > -cindy
>
> cindy: DMDA stands for Depression and Manic Depression support group. There is a whole thread on this over at psychobabble social. I did a lot of research on all the different groups available so you might want to check it out. Me and Phil each are checking out a group this week and reporting back on our findings.
> >
Posted by Elizabeth on July 27, 2001, at 16:53:19
In reply to Re: Nardil vs. Parnate, posted by Lorraine on July 27, 2001, at 10:02:38
> > Parnate potentiates vasoconstricting biogenic amines more than Nardil does at equivalent doses.
>
> elizabeth--what does that mean "vasoconsticting"--constriction of the veins--but what is the importance of this or the importance of reacting to "amines".When blood vessels are made narrower, the pressure on them increases. Biogenic amines (things with an amino group -- a nitrogen with hydrogens hanging off of it) often have vasoconstricting effects: they are "sympathomimetic" meaning that they imitate the action of the sympathetic nervous system.
-elizabeth
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