![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 106 to 130 of 434. Go back in thread:
Posted by Elizabeth on July 27, 2001, at 17:30:25
In reply to Re: hand holding » Elizabeth, posted by Lorraine on July 27, 2001, at 10:36:23
> Hooray! You're back. Welcome.
Thanks :)
> I'm wondering if ketamine also makes you vaguely paranoid?
Dunno, I never tried it and don't know much about it. It's considered a "dissociative" anaesthetic. It acts as an antagonist at NMDA (N-methyl-D-aspartate -- not to be confused with the support group NDMDA < g >) receptors (one type of glutamate receptor). I think that some people have "out of body experiences" (depersonalisation) on it. Anybody know anything about that?
> > > > 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.When you have a childhood history of having your feelings invalidated, I'd expect that you would be more sensitive to invalidation as an adult. And if other people view you as "mentally ill" (and therefore, it's often assumed, unable to have any rational perceptions or beliefs!), I can easily see how that would make you feel invalidated. A lot of people who spend time in psych hospitals come out feeling less sure of themselves, IMO because of the way they were treated in the hospital (as being unequal to the staff and not having what they say believed).
> Now you've motivated me to buy the PDR.
Uh-oh! Don't take the long lists of side effects too seriously! (IMO, the PDR is too expensive -- ask your doctor if s/he has any copies left over from recent years that s/he hasn't thrown out; it's updated annually.) The PDR is a good resource, but I'd try rxlist.com before you go out and spend a load of money on the PDR. A lot of monographs, especially for relatively new drugs, can be found on the pharmaceutical companies' web sites, too.
> I do find myself educating him from time to time.
Continuing education, even when it comes from seemingly unlikely sources, is an important part of practising medicine!
> It bothers me greatly though when I see someone who just blindly accepts their doctors word as gospel.
Me too. Doctors tend to know stuff we don't know, but that doesn't mean they're always right. A lot of people appeal to their authority in arguments when they don't understand what's going on (and may have misunderstood the doctor, anyway). This isn't a very good substitute for making a real argument, of course.
> 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.
Exactly: that's one of the ways that doctors, nurses, psychologists, social workers, et al. can make psych patients feel invalidated.
> 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.
Huh. Interesting way of looking at it.
> > > > 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.Xanax might be preferable, although taking that long-term is a PITA. Other high potency benzos (Ativan, Klonopin) might be better too. But see if the Neurontin helps.
> > > >I mentioned that I experienced something similar upon discontinuing Parnate; the Klonopin came in very handy.
>
> Yeah, sounds like "rebound" anxiety?One morning I didn't take my AM dose of Parnate -- I think I had put my medication organiser somewhere other than where it usually goes. I had terrible rebound symptoms: anxiety, agitated depression, extreme mood swings. (A lot like what happened when Nardil pooped out.) After a couple hours of this, it finally occurred to me that I hadn't taken my morning dose; when I did, I rapidly began to feel better. MAOI withdrawal symptoms are *bad*.
> I did decide that I need a benzo in my emergency kit generally.
< g > Yeah, me too. Just having a benzo handy can alleviate a lot of worry.
> Your Parnate withdrawal makes me a bit hopeful.
?
> Sounds like you need to be very careful. Your theraputic dose range is quite narrow?
I don't know. I've been taking it on the assumption that I metabolise it normally. The serum level check is to make sure that that's really true.
> Welcome home. Hope the desipramine holds.
Me too. Thanks.
-e
Posted by Elizabeth on July 27, 2001, at 19:51:20
In reply to Re: Handholding » Elizabeth, posted by Lorraine on July 27, 2001, at 11:19:35
> > I think that, relatively speaking, that's a good sign. To me it indicates a reactive mood, and the possibility that you have the potential to be cheered up temporarily.
>
> And so I was last night by my wonderful husband.Good for him. :-)
> Stahl talks about the "end-stage" of depressive illness as one where the lows are so low but the ability to "feel" generally has been severely blunted.
That's what I experience. I don't think of it as an "end stage," but perhaps it does have something to do with the fact that my depression first manifested when I was quite young. I would like to see more research on childhood-onset depression. I think my depression is probably not similar to most early-onset mood disorders, though.
> > > > Interesting about panic and hypothyroidism. All my TSH tests have been pretty normal, and T3/4 augmentation is something I've never tried.
>
> It might be worth a try.What do you think it might help with besides panic? Have you ever tried it?
> Also, the notion of "estrogen dominance" causing panic symptoms is interesting. Apparently, estrogen dominance is not just a problem associated with menopause, but can be a woman's normal state throughout her lifetime. Another avenue to explore.
That is interesting. Tell me, can you make anything out of my experience with the pill? (fairly sudden relapse of depression while taking Parnate)
> > > > Buprenorphine seems to make my periods irregular. I've been wondering about the mechanism there.
>
> Isn't that odd?Yes. I've heard of female opioid addicts (who, interestingly, are outnumbered 4:1 by male addicts) having irregular periods, but I assumed that was just due to the junkie lifestyle (where self-care tends to take a second chair to obtaining drugs).
> When I had endometriosis and would have great pain on starting my period, I was given a drug that is now sold over the counter (maybe it's advil?).
Ibuprofen and other nonsteroidal anti-inflammatory drugs are definitely effective for menstrual cramps. (I use Relafen -- easier on the stomach.)
> If I was successful, then my period would start and I would not be in pain. But if I missed the very very beginning, what happened was my period would be delayed. I explained this to my doctor, who dismissed it out of hand. Point is there was something operating there that might be similar to your situation.
How do you mean? I'm a little confused.
> > > > You know, any effective antidepressant has the potential to trigger mania. When I started taking buprenorphine, it seemed to cause activation, psychomotor agitation, etc., rather than the calming effect that opioids seem to have on a lot of people.
>
> Really? I have adverse reactions to drugs at times, like getting wired from decongestants.That's not too unusual. Decongestants are basically bad speed. (Ephedrine or "ma huang" is a step down from bad speed: it's bad Sudafed.)
> But is agitation and activation considered mania?
Not necessarily. They're symptoms of mania, though.
> I once (for a couple of days in the weeks just before the last stock market crash), had incredibly racing thoughts, could hardly contain my excitement and so forth, but was still able to sleep. From my reading of the DSM categories, that would not qualify as mania--although I was euphoric and felt a bit invincible.
Hypomania, perhaps?
> > > > We work with the information we have, and count on the research folks to accumulate more information. I don't think that we should feel we have to wait for more research to be done before we can be comfortable treating mood & anxiety disorders.
>
> Absolutely. We just need to recognize the limitations.Yes! I don't think it's a good idea to pretend that we have a decent understanding of the causes of depression, mania, psychosis, anxiety, etc. -- attributing them to a vague "chemical imbalance" (I wince whenever I hear that expression). For now, I think (as I mentioned before) the most reasonable approach to clinical practise is the empirical-descriptive approach (identifying symptom clusters that respond to particular treatments, and using this information to try to predict which treatments will be most likely to work for any particular patient). Our knowledge about the biology is still in its infancy and should be reserved mainly for research at this time.
> The problem is that we have an entire conceptual framework that is premised on presentation rather than on physiology.
That's not what I'm talking about: I just don't think we have enough information about the physiology of these disorders.
> I think the old system just has to be gutted. I think it gets in the way of determining what works and doesn't work because we test drugs on "depressed" people. Well, if the category "depressed" is not meaningful--that is if in fact very different physiological processes are occurring in different people with depression--then we are barking up the wrong tree.
We have to identify symptoms and symptom clusters in order to say which treatments are most effective for what. This is because known physiological markers are not reliable predictors of response, for the most part.
> It may be that the med that is tested as effective in reducing symptoms by 50% in 51% of the subjects is actually 85% effective in 90% of the subjects with a specified physiology and that is the direction we need to be heading in in terms of research.
Yes: in research. At this time, we have no way of
I think more research is needed in regards to the descriptive approach, too. As you say, the categories are very fuzzy, and it would be nice to make them more specific (which is something that we *can* do with current knowledge).
> So to the extent that the old paradigm henders rather than helps progress, it should be rethought and possibly abandoned.
That's where we disagree. I think that we can simultaneously examine psychiatric illness on both levels (behavioural signs and symptoms, and physiologic ones). Both types of information are useful.
I do like the way that your doctor does it, basing treatment decisions on statistics and not simply on his impressions of what works for whom. The guy in my town who's known for using EEGs and functional imaging doesn't seem to be doing it that way; he also makes some assumptions that are based on flawed logic.
The statistical approach can also be applied to descriptive psychiatry, although it hasn't been used nearly enough IMO.
> His believes that my QEEG indicates that a combination of stimulants (he includes MAOs here) and anticonvulsants should work.
I agree with him that MAOIs are a lot like psychostimulants in their effects on people.
> Complicated stuff. But if it is "insulin sensitivity" or "insensitivity?", then low carb should help.
I dunno, thinking about insulin always gets me confused for some reason.
> > > > Ask the pharmacist if it's okay to cut Parnate pills in half.
>
> Very good question. I will do that.They seem to have some coating on them (not a crunchy shell like Nardil -- the M&M of antidepressants), and it might be there for a reason (other than cosmetic reasons, that is).
> Actually, I think it was your suggestion that I look into DMDA.
Yes, it was. I'm glad to hear that your experience was a good one.
-elizabeth
Posted by shelliR on July 27, 2001, at 22:00:10
In reply to Re: I'll hold your hand if you'll hold mine » shelliR, posted by Elizabeth on July 26, 2001, at 22:05:44
Hi Elizabeth
I meant last time that I thought you had missed a msg from me on this board:
www.dr-bob.org/babble/20010720/msgs/71371.html
> > > > > > > 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. > > > > > > > > > > > > > > > > > > > > > >
That's incredibly excellent. Does it have the same feeling as the parnate, or different? What were your side effects on parnate? Also, how does the despamine compare to your experience on buprenorphine?About withdrawal after missing a dose of parnate:
Did you ever experience that with nardil? My experience with nardil is that it made no difference if I split my dose, or took it all at the same time. Also whether I took in all in the morning, afternoon or before I went to bed. No difference, still the same sleeping problems. How is your sleeping with desparmine?
I'm up with the air about my next step. Yesterday and today I was in a pretty crummy mood, but then I had to remind myself that most people feel down sometimes, not just very depressed people. Like I wasn't as into my work as I am usually, felt it was getting too repetitious. On the other hand, I did not spend the day in bed like I do when I am terribly depressed. Maybe this is what anhedonia feels like; it's something I don't feel too often, sort of a bored, stale feeling inside.
Maybe it's a signal for me to get out and start doing more besides working. I am going to put the decision about parnate on hold to try to see if the estrogen is having any effect. I like to keep my trials relatively clean! The reason I don't think I can do nardil and oxycontin and concerta is that I took a huge fall into darkness the third day I took prozac, oxy and concerta together. It may have been the crash of the speedball you referred to. I could try nardil and concerta together and drop the oxy. The good thing about stimulents and opiates, they work fast and no waiting period, so it's not like making a huge decision to try one over the other.
I'll let Lorraine try parnate first, although if our reactions to opiates are any indication, we don't react similarly to chemicals.
later, Shelli
Posted by shelliR on July 27, 2001, at 23:39:14
In reply to Re: Handholding Shelli » shelliR, posted by Lorraine on July 26, 2001, at 18:45:59
> 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.I think for lots of people giving is definitely a part of getting.
>
> 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.I know exactly what you mean. When I first started participating there were only a couple of names that I could pick out. It took me forever to develop an impression of someone as a person. I once talked about it on the board--how it was particularly difficult for me to identify posters who used initials, or symbols (icemaker, etc.).
Taken out of context "I want to thank you for all the support you have given me in the past when I didn't know who you were" sounds very funny. Like I had been sending my posts as a stranger and then we finally met! And in a cyberspace world, we really have. And I'm glad it helped.
>
> (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".)Gratitude is a really good thing in general. I think it is a very spiritual thing, to be grateful. I see it as a humble experience because the things that I feel graditude about are gifts; I have not directly caused them, nor can I take credit for them. Like I think if you are very good at something, it is okay to acknowlege it, because a talent is a gift, not a product of the ego, although using the gift may be. (sorry, didn't mean to get philosophical on you :-) )
>
>> > > > 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.I sort of knew what I was getting into. My pdoc said I will adjust to it, and I guess I have adjusted, but I suspected it would not go away because it never went away when I was self-medicating with vicidin. But it's only a little high, and sometimes hard to distinguish from being my normal dissociative self.
>> You know they say to do the progesterone on a constant basis as opposed to following the menstrual cycle when you have depression?
No, I didn't know that. I haven't thought too much about the progesterone. I have an appointment with my gyn the second week in August and I'll see if she agrees. She's excellent--really my best doctor. She's just so busy that I have to wait a long time to get an appointment with her.
>>
>
>
> > > > 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. What is a QEEG?
>
> 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.A lot of people who were abused in early childhood have temporal lobe epilepsy. I don't really understand about it, but I suppose I will look in up on the internet, since I've been hearing about it for so long without knowing much about it and how exactly it is diagnosed. I know someone who had one doctor give her the diagnosis and the second take it away, so I imagine there is some interpretation involved.
>
> 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.Was it strange to meet another babbler in the real world? I don't know what that would feel like. Dr. Bob was in my area for a conference and meeting with people from the board (I think two people came). I was ambivelent and it turned out I was in the hospital anyway.
>
> All my best to you Shelli. You are a jewel, truly.
blush, blush, and same to you!
Shellip.s., congradulations on picking parnate--I hope it goes well.
Posted by Elizabeth on July 29, 2001, at 14:01:07
In reply to Re: Handholding Shelli » Lorraine, posted by shelliR on July 27, 2001, at 23:39:14
> > 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.
>
> I think for lots of people giving is definitely a part of getting.That's precisely right, Shelli.
And to Lorraine: I don't know when you first became depressed or seriously anxious, but I've had problems since childhood (first dx of major depression when I was 14, but my doctor and I felt that I'd probably suffered at least one previous episode, when I was 10-11 and possibly dysthymia long before). I think that early-onset depression has much more profound effects on a person than adult-onset depression has. In a sense, I had an incomplete childhood. Although the effect is qualitatively different from the effects of serious abuse in childhood, the degree of impairment that results is comparable, I think.
> I sort of knew what I was getting into. My pdoc said I will adjust to it, and I guess I have adjusted, but I suspected it would not go away because it never went away when I was self-medicating with vicidin. But it's only a little high, and sometimes hard to distinguish from being my normal dissociative self.
(I hate to correct you again, but it's "Vicodin," as in hydrocOdone. :-) )
I'm not so sure that opioids are a good idea for someone who's had problems with dissociation, although the oxycodone seems to be doing you some good. Believe it or not, I've heard that naltrexone can be very beneficial to people who suffer from dissociation.
> A lot of people who were abused in early childhood have temporal lobe epilepsy. I don't really understand about it, but I suppose I will look in up on the internet, since I've been hearing about it for so long without knowing much about it and how exactly it is diagnosed.
It's a lot fuzzier than I think most people realise. You're right that EEGs are subject to interpretation. It does sort of make sense that people who'd suffered abuse would have hyperactive limbic systems (perhaps including the potential for limbic seizures), though.
-elizabeth
Posted by Elizabeth on July 29, 2001, at 14:04:32
In reply to Re: Give me back my hand- (just kidding) » Elizabeth, posted by shelliR on July 27, 2001, at 22:00:10
> Hi Elizabeth
Hi Shelli.
> I meant last time that I thought you had missed a msg from me on this board:
> www.dr-bob.org/babble/20010720/msgs/71371.htmlYou're right, I did miss it.
You said you have DD-NOS. "NOS" covers a lot of territory -- what does it mean in your case? (if you're comfortable talking about that here)
Most of the doctors I've spoken to in Boston, at least, seem to feel that patients are often convinced (by suggestion) that they have DID by overzealous therapists. A lot of doctors in the Boston area don't consider DID even to be a legitimate dx!
> That's incredibly excellent. Does it have the same feeling as the parnate, or different? What were your side effects on parnate? Also, how does the despamine compare to your experience on buprenorphine?I'm still taking buprenorphine, but at a lower dose than before. I only got up to 100 mg of DMI (which is the very low end of the therapeutic range) about two weeks ago, so there's still a good chance that things will continue improving. At present, it seems to be working about as well as Parnate did, but without the immediate stimulant-like effect (which was sort of a mixed blessing, anyway).
> About withdrawal after missing a dose of parnate:
> Did you ever experience that with nardil?Not that I can recall. The last time I took Nardil was in late 1997, though. I tried taking it in all sorts of dosing schedules (in an attempt to decrease the insomnia) without seeing any difference, like you described. I finally gave up and just started taking the whole dose (75 mg, I think) in the late morning or early afternoon.
> How is your sleeping with desparmine?
Desipramine, you mean? :-) It's weird. Initially my sleep seemed to be improved quite a bit. Now it's less fragmented, but I've started waking up early again, as when I was depressed (although I am feeling significantly better. (The MAOIs did the same thing, only more so -- they decreased my *need* for sleep, as far as I could tell. MAOIs have wild effects on sleep architecture.)
> I'm up with the air about my next step. Yesterday and today I was in a pretty crummy mood, but then I had to remind myself that most people feel down sometimes, not just very depressed people. Like I wasn't as into my work as I am usually, felt it was getting too repetitious. On the other hand, I did not spend the day in bed like I do when I am terribly depressed. Maybe this is what anhedonia feels like; it's something I don't feel too often, sort of a bored, stale feeling inside.
That's one major (and difficult to treat) aspect of my depression: flattened affect. Desipramine has helped -- I have a fuller range of emotions. I'm hoping I may be able to stop taking the buprenorphine altogether (it helps a *lot* with anhedonia and anergia, but desipramine might work there too).
> Maybe it's a signal for me to get out and start doing more besides working. I am going to put the decision about parnate on hold to try to see if the estrogen is having any effect. I like to keep my trials relatively clean!
I think that's a good plan in general, if you can afford to take the extra time.
> The reason I don't think I can do nardil and oxycontin and concerta is that I took a huge fall into darkness the third day I took prozac, oxy and concerta together. It may have been the crash of the speedball you referred to.
I'd attribute that more to the stimulant and perhaps the opioid than to Prozac.
> I could try nardil and concerta together and drop the oxy. The good thing about stimulents and opiates, they work fast and no waiting period, so it's not like making a huge decision to try one over the other.
That's very true. But there is the potential for bad interactions between Nardil and Concerta, whereas oxycodone is probably fine to use with Nardil. (Some of the synthetic opioids, such as Demerol and Ultram, shouldn't be used with MAOIs. Morphine, codeine, hydrocodone, etc. -- the natural and semisynthetic ones -- are fine.)
> I'll let Lorraine try parnate first, although if our reactions to opiates are any indication, we don't react similarly to chemicals.
So, Lorraine is your guinea pig? :-)
-elizabeth
Posted by may_b on July 29, 2001, at 15:20:28
In reply to Re: Give me back my hand- (just kidding) » shelliR, posted by Elizabeth on July 29, 2001, at 14:04:32
Hi Elizabeth
Ever heard of a paradoxical slowing down on Parnate? I am in my first week at 10 mg and feeling unbelievably tired, a bit weak and anhedonic. Getting feedback that I am "subdued" and "slowed down".
Would love to hear any thoughts/observations you might have re this reaction.
Thanks, May_b
Posted by shelliR on July 29, 2001, at 23:51:29
In reply to Re: Give me back my hand- (just kidding) » shelliR, posted by Elizabeth on July 29, 2001, at 14:04:32
Hi Elizabeth
>>
> You said you have DD-NOS. "NOS" covers a lot of territory -- what does it mean in your case? (if you're comfortable talking about that here)It's complicated and it's sounds much more bizarre than it feels, I am so used to it by now. I have different personalities inside; girls clustered around three and eight, related to sexual abuse at those ages. If you heard them you would not think they are me--the three year old especially, not only has the voice of a three year old, but has the verbal patterns of a three year old: repetition, disinterest in answering questions, etc. and chatters on and on. I worked a lot with them in therapy with EMDR and in body therapy, and at this point while still present, they do not dominate my life. I know there is more work to do with one of the 8 year olds., but I don’t think I am quite ready yet. I am co-conscious with them, so I don't have a DID diagnosis.; although really it depends on who does the diagnosing. I do not consider myself to have DID because I do not lose time. Only when I am sound asleep, the kids do have conversations with others that I have no knowledge of until I'm told. But to me that doesn't really count as not co-conscious. A child was the first to wake up after my knee surgery, but I had already given notice to the anesthesiologist that this might happen, and explained how alters come to be. So everyone was sort of pleased when they got to meet one of the kids.
But, also, generally when I say I dissociate, I mean I feel unrelated to my body and spacey, rather than these children are "out".
>
> Most of the doctors I've spoken to in Boston, at least, seem to feel that patients are often convinced (by suggestion) that they have DID by overzealous therapists. A lot of doctors in the Boston area don't consider DID even to be a legitimate dx!
>
That is really sad, because there is absolutely no doubt in my mind that it is real. I have met many multiples in my hospitalizations and I think that it is a rare thing that a therapist convinces a patient that she has DID unless it is a true diagnosis. There are some cases that are called multiple that I would call ddnos. The sad part is that although the prognosis is good for DID, it is a hellish journey. Personalities that one doesn't even know exist, ruin jobs and relationships and definitely put lives at risk. Can you imagine what it feels like to find yourself in LA from Washington with no clue of why you are there? Or to lose a job because a personality inside of you said extremely inappropriate things that you have no idea about. Anyway, I feel a lot of passion about it because people who are multiple have generally experienced a horrific childhood, and then as adults they have still have the coping mechanism that saved them as a child, but now it just screws them up more. So when doctors deny the validity of the diagnosis at all, I see it as another form of abuse for these patients.It is true, however, that at times I can’t deal with the histrionics of some people who are DID and have no friends now with that diagnosis. I had a friend with DID who let her eight year old personality talk at restaurants, and other public places and even had a birthday party for her. I was not at all comfortable with that and walked away from that friendship.
BTW, Dr. James Chu who used to run the dissociative disorders unit at McLean Hospital was promoted to chief of hospital clinical services. He has an excellent reputation in the field of dissociative disorders. I don’t know who the doctors you are talking to in Boston are—because his work is pretty well known and respected, and not just locally. I think that
the doctors you are speaking to, I can only consider to be at best, ignorant in this area, although as I said, I might agree that *some* people are diagnosed with DID, who really have a lesser dissociative disorder .re nardil:
The reason I don't think I can do nardil and oxycontin and concerta is that I took a huge fall into darkness the third day I took prozac, oxy and concerta together. It may have been the crash of the speedball you referred to.
> I'd attribute that more to the stimulant and perhaps the opioid than to Prozac.right, probably the combination of the stimulent with the opiate. It may be revisited. Prozac won't be.
>
> > I could try nardil and concerta together and drop the oxy. The good thing about stimulents and opiates, they work fast and no waiting period, so it's not like making a huge decision to try one over the other.
>
> That's very true. But there is the potential for bad interactions between Nardil and Concerta, whereas oxycodone is probably fine to use with Nardil. (Some of the synthetic opioids, such as Demerol and Ultram, shouldn't be used with MAOIs. Morphine, codeine, hydrocodone, etc. -- the natural and semisynthetic ones -- are fine.)I've never had an interaction with stimulants and nardil before and I've tried most of them.(adderal, ritalin, dexadrine) . So I wouldn't anticipate a reaction. Concerta is the only stimulant which didn't make me feel absolutely awful and I didn’t try it until I had stopped nardil.
> > I'll let Lorraine try parnate first, although if our reactions to opiates are any indication, we don't react similarly to chemicals.
>
> So, Lorraine is your guinea pig? :-)for sure.
>
Shellip.s., do you have a compulsive disorder re spelling :-) If so, I'll drive you nuts. I was most upset to stop taking seglegiline because I had finally learned how to spell it.
Posted by shelliR on July 30, 2001, at 10:51:18
In reply to Re: Handholding (Shelli, Lorraine), posted by Elizabeth on July 29, 2001, at 14:01:07
Hi Elizabeth,
> I'm not so sure that opioids are a good idea for someone who's had problems with dissociation, although the oxycodone seems to be doing you some good. Believe it or not, I've heard that naltrexone can be very beneficial to people who suffer from dissociation.
I actually tried naltrexone for one day. It made me feel awful, like I had taken way too much vicodin, without any of the benefits. The oxycontin is definitely not perfect, but I was fighting for my survival when I was put on it. I mind the bit of "highness" much more in the morning than in the evening, when I don't mind a little buzz, sort of like one glass of wine with dinner. I don't know whether to leave well enough alone, or to broach the subject of buprenorphine with my pdoc. Oxycontin is certainly a lot easier to take and I take it just twice a day. And I do like the high during the overlap of the two doses in the afternoon because it is for only a short time; in fact its a good time for me to do the treadmill--lots of energy. I have tons of work in the next month, and then I go on vacation the first week of september. So I can't afford to feel really bad side effects. I am also thinking about parnate; my "waiting period" after prozac is over next week.
>
Shelli
Posted by may_b on July 30, 2001, at 11:43:53
In reply to re parnate, posted by may_b on July 29, 2001, at 15:20:28
> Hi Elizabeth
>
> Ever heard of a paradoxical slowing down on Parnate? I am in my first week at 10 mg and feeling unbelievably tired, a bit weak and anhedonic. Getting feedback that I am "subdued" and "slowed down".
>
> Would love to hear any thoughts/observations you might have re this reaction.
>
> Thanks, May_b
Posted by Elizabeth on July 30, 2001, at 12:20:17
In reply to re parnate, posted by may_b on July 29, 2001, at 15:20:28
> Hi Elizabeth
Hiya.
> Ever heard of a paradoxical slowing down on Parnate? I am in my first week at 10 mg and feeling unbelievably tired, a bit weak and anhedonic. Getting feedback that I am "subdued" and "slowed down".
Sure. Some people do get groggy on Parnate. It might be due to central activation of NE autoreceptors and/or the orthostatic hypotension that is common with MAOIs. I'm not sure what to suggest. Some people can use stimulants with MAOIs. Provigil is probably safer than amphetamines or Ritalin. If the problem turns out to be related to (low) blood pressure, eating salt tablets and making sure you stay hydrated can help. There's also a steroid (fludrocortisone, brand name Florinef) that can be used for orthostatic hypotension if necessary.
I hope this is at least somewhat helpful. Try to get in touch with the doctor who prescribed the Parnate so you can figure out what to do.
-elizabeth
Posted by Elizabeth on July 30, 2001, at 13:48:54
In reply to Re: Give me back my hand- (just kidding) » Elizabeth, posted by shelliR on July 29, 2001, at 23:51:29
> Hi Elizabeth
Hi Shelli.
> It's complicated and it's sounds much more bizarre than it feels, I am so used to it by now. I have different personalities inside; girls clustered around three and eight, related to sexual abuse at those ages.
Okay; so it's basically a variant on DID. My understanding is that the experience of "multiple personalities" is usually related to childhood abuse. Is that right? Are there other correlates as well?
> If you heard them you would not think they are me--the three year old especially, not only has the voice of a three year old, but has the verbal patterns of a three year old: repetition, disinterest in answering questions, etc. and chatters on and on.
I'm very curious about this sort of thing. I wonder what sort of mechanism could lead to the experience of switching personalities (so to speak).
> I worked a lot with them in therapy with EMDR and in body therapy, and at this point while still present, they do not dominate my life.
Did you find the therapies helpful, and if so, in what ways?
EMDR sounds pretty flakey to me, and the evidence supporting it is very sketchy, but I've encountered a number of people who felt it was helpful for them, enough to make me wonder whether there might be something to it after all.
What is body therapy? That's one I'm not familiar with.
> I am co-conscious with them, so I don't have a DID diagnosis.; although really it depends on who does the diagnosing.
Psych diagnoses frequently do. Can you explain what you mean by "co-conscious?" Does it mean that you actually feel like there are several different personalities in you simultaneously? That's so hard to imagine.
> I do not consider myself to have DID because I do not lose time. Only when I am sound asleep, the kids do have conversations with others that I have no knowledge of until I'm told.
Ever had a sleep or ambulatory EEG?
> But, also, generally when I say I dissociate, I mean I feel unrelated to my body and spacey, rather than these children are "out".
Have you noticed any effect of the medications you're taking on this phenomenon?
I've had several bizarre experiences over the years that I think are related to my sleep disorder, and which are considered "dissociation" in a different (but similar) sense (intrusion of sleep states upon waking states, or vice versa). My sleep has always been odd; I can remember physically acting out dreams as early as age 4, and my parents say that I walked in my sleep intermittently throughout my childhood (for all I know, I still do it).
> That is really sad, because there is absolutely no doubt in my mind that it is real.
I can understand that. I've encountered my share of people who think that depression is just a more extreme version of grief or a bad hair day or who don't understand that ADD is more than just normal childhood behaviour. These things aren't easy to explain to a person who's never experienced them.
> The sad part is that although the prognosis is good for DID, it is a hellish journey. Personalities that one doesn't even know exist, ruin jobs and relationships and definitely put lives at risk. Can you imagine what it feels like to find yourself in LA from Washington with no clue of why you are there?
Yes, actually. As I said, I seem to have had more than my fair share of peculiar experiences, some of which involved memory lapses/lost time.
> Anyway, I feel a lot of passion about it because people who are multiple have generally experienced a horrific childhood, and then as adults they have still have the coping mechanism that saved them as a child, but now it just screws them up more. So when doctors deny the validity of the diagnosis at all, I see it as another form of abuse for these patients.
I can understand that. I've certainly known doctors, psychologists, etc. who seemed to have prejudices that made it difficult for them to listen properly.
> BTW, Dr. James Chu who used to run the dissociative disorders unit at McLean Hospital was promoted to chief of hospital clinical services.I've heard of him, and yes, he does have a good reputation. The dissociative disorders and trauma program at McLean (Proctor House 2; I've known 3 or 4 people who were hospitalised on that unit) is supposed to be good in general. I have only discussed the DID issue with a few professionals, and I'm sure my sample is biased (the psych professionals I know are mostly of the cognitive-behavioural and/or biopsychiatric schools, although the one psychoanalyst I spoke to was fairly skeptical about DID, feeling that the term "multiple personalities" is misleading -- more about that below). The general feeling I've gotten has been that DID is often overdiagnosed at treatment centres where the diagnosis is a fad of sorts, and there are those who don't think that DID exists as a distinct entity at all. Others think that "multiple personalities" are "real" in a sense but shy away from that terminology because, in their opinions, the alters tend to be stereotyped and one-dimensional as distinguished from the "core" personality; they see it as a maladaptive coping mechanism. (I think this is mostly semantic, personally.) I haven't met anyone who denies the existence of dissociative symptoms and their relationship to childhood trauma, but the prevailing view on DID in particular seems to be a skeptical one. Personally, I've never spent time with someone who had experienced alternate personalities, so I reserve judgment on the matter.
> I've never had an interaction with stimulants and nardil before and I've tried most of them.(adderal, ritalin, dexadrine).
Okay, then it's probably a safe bet that Concerta wouldn't be a problem for you.
> p.s., do you have a compulsive disorder re spelling :-)
No, I just like giving people a hard time about it. < g >
> If so, I'll drive you nuts. I was most upset to stop taking seglegiline because I had finally learned how to spell it.
Are you *sure* you learned how to spell it? :-)
-elizabeth
Posted by shelliR on July 30, 2001, at 22:23:16
In reply to Re: Give me back my hand- (just kidding) » shelliR, posted by Elizabeth on July 30, 2001, at 13:48:54
Hi Elizabeth.
>
> Okay; so it's basically a variant on DID. My understanding is that the experience of "multiple personalities" is usually related to childhood abuse. Is that right? Are there other correlates as well?It’s a variant, but a significant variant, much less of a disruption of my life as a adult. And yes, abuse has to occur and the child must have a tendency to dissociate. Obviously all children who are abused do not become multiple, some children become suicidal, others become aggressive, etc. I don't know if this is a fact or not, but it seems from my observations that the abuse had to have been kept a secret; even in the case of siblings both being sexually abused by the same adult, it has generally never been discussed until they were adults with the people that I have come to know.
>
>
> I'm very curious about this sort of thing. I wonder what sort of mechanism could lead to the experience of switching personalities (so to speak).I’m not sure what you mean by "mechanism" but the issue of personalities and switching is
so complicated that I will refer you to Frank W. Putnam's Book " Diagnosis and treatment of multiple personality disorder." Putnam (NIMH) had the strictest definition of MPD before its name change. He was also on the committee for the guide lines for DID for the DSM-IV, although the diagnosis got pretty muddled there because of compromise, I’ve heard. His book is sort of the MPD bible for purists. You might also want to read the book I mentioned before "the Magic Daughter: A Memoir of Living with
Multiple Personality Disorder " by Jane Phillips. She is a university professor, writes anonymously, and I think gives a good idea of how it feels to try to work and be multiple.
> > I worked a lot with them in therapy with EMDR and in body therapy, and at this point while still present, they do not dominate my life.
>
> Did you find the therapies helpful, and if so, in what ways?
>
>EMDR sounds pretty flakey to me, and the evidence supporting it is very sketchy, but I've encountered a number of people who felt it was helpful for them, enough to make me wonder whether there might be something to it after all.I sort of have the same feelings about its scientific reality, but it does seem to help people process through memories much quicker and less painfully than without EMDR. My therapist swears by it and one of my closest friends is a psychologist who also swears by it. I don’t have a definite opinion for me about it; in the work I did early it was useful, but I’m not sure any more useful than other things, like hypnotherapy which I also used during the same time. In some early experiences with EMDR my kids (alters) came out and in coming out and verbalizing helped "them" to share with me what had happened to them (me) at a very early age, and gave me clues how to keep us all feeling safe.
> What is body therapy? That's one I'm not familiar with.Body therapy is the combination of therapy with on-hands massage type work. That I found extremely helpful, both for my depression and for letting my kids act out their experiences in a safe place. It was a place where my "kids" got to feel safe touch. One session after light touch one child just shook and cried on the floor for the entire session and it seemed to work things out for her (us) after that and she started to feel safer. I think a lot of trauma remains locked up in the body and body work can be very useful. The woman I worked with was wonderful and I totally trusted her, so that’s why it worked so well. Body therapy can greatly vary depending on the personality and the training of the therapist. Unfortunately it was not covered under my insurance, so I only went for short periods of time. I am thinking of starting again, to work on the depression in my chest.
> > I am co-conscious with them, so I don't have a DID diagnosis.; although really it depends on who does the diagnosing.
>
> Psych diagnoses frequently do. Can you explain what you mean by "co-conscious?" Does it mean that you actually feel like there are several different personalities in you simultaneously? That's so hard to imagine.Co-conscious means that I always know when my personalities are talking -I can hear them when they are talking and I don’t let them take over my body. If I was not co-conscious I might recede all the way in, and they would take over my personality and I might find things around my house that I had no idea how they got there (like toys or candy). If you’re multiple the first task is to gain co-consciousness, to get control of your life. I never had to do that step, I always had it. And I can talk to all the personalities inside, ask them things, calm them down if they are scared, etc. It’s like talking to kids, only they’re inside. They have names, they have their own preferences about things that may or may not agree with mine and they sometimes disagree with each other. I suppose it’s odd, but it doesn’t seem odd to me. Actually my youngest one, who has recently turned three and a half (a momentous event for a child who had declared she did not want to get any older) has the name Elizabeth. BTW, they get older on their own, they tell me when they have gained a half year or a year and they sound older.
> > I do not consider myself to have DID because I do not lose time. Only when I am sound asleep, the kids do have conversations with others that I have no knowledge of until I'm told.
>
ÿ Ever had a sleep or ambulatory EEG?No, because sleep hasn’t been a problem (except on nardil) and I have no indication that I sleep-walk.
>
> > But, also, generally when I say I dissociate, I mean I feel unrelated to my body and spacey, rather than these children are "out".
>
ÿ Have you noticed any effect of the medications you're taking on this phenomenon?No, I never even deal with it with medications—just the depression and the anxiety. Valium will sometimes ground me when I am very floaty. BTW, I think one of the reasons psychiatrists dismiss DID as a diagnosis is because there is no way to treat the disorder medically. Only the affects of the disorder like anxiety and depression can be helped by meds. At this time in my life, depression is so much more of an issue for me than ddnos. And at this point I'm not sure what the relationship is, although my therapist said she has never treated anyone with alters who did not have severe depression.
>>
> >Others think that "multiple personalities" are "real" in a sense but shy away from that terminology because, in their opinions, the alters tend to be stereotyped and one-dimensional as distinguished from the "core" personality; they see it as a maladaptive coping mechanism. (I think this is mostly semantic, personally.) I haven't met anyone who denies the existence of dissociative symptoms and their relationship to childhood trauma, but the prevailing view on DID in particular seems to be a skeptical one. Personally, I've never spent time with someone who had experienced alternate personalities, so I reserve judgment on the matter.< < <
When alters are one-dimensional they are called ego states, not alters. Like if a part inside is always sad and has no other aspects to it, it is an ego state. And DID *is* a maladaptive coping mechanism for an adult. It was a very useful coping mechanism for a child; it allowed him/her to survive an abusive situation, but a partitioning is not at all helpful to an adult. That’s what the treatment is all about. I don’t believe that the prevailing view is generally skeptical. My therapist (a psychologist) lectures on dissociative disorders , including DID, to medical students at Georgetown and I wouldn’t call Georgetown med school a radical institution. And many psychiatric hospitals are now transferring their dissociative patients to hospitals like Sheppard Pratt, McLean, the PIW dissociative center, and other hospitals with trauma units, because they are recognizing the disorder and know that it requires special skills for treatment.Psychiatrists are not dumb, but many are ignorant and choose to remain so.
>
> > If so, I'll drive you nuts. I was most upset to stop taking seglegiline because I had finally learned how to spell it.
> Are you *sure* you learned how to spell it? :-)
> Well, I don’t take it anymore! When I used to take it then I spelled it selegiline! < g >.More on the topic of medication, the last three days have been pretty awful for me and I am wondering if the estrogen I’m taking is making my depression worse. I wish I had access to the whole study re menopausal depression and estrogen. Actually, my pdoc has a copy of it I think. I’m going to ask him to leave it for me with his receptionist when I see him (maybe Thursday) so I can see if anyone’s depression increased. It’s either that, or the oxycontin is starting to be less effective. Bummer.
Hope you are continuing to do well.
Shelli
Posted by shelliR on July 31, 2001, at 9:23:57
In reply to Re: DID, MDs, DSM, EMDR, etc. » Elizabeth, posted by shelliR on July 30, 2001, at 22:23:16
>
>p.s., I forgot to ask. Do you see your onset of depression at a very early age totally unrelated to emotional experiences. I think that is the impression I get when you post. That the onset was purely physiological and remains so, and it was the depression that had the impact on you emotionally, rather than the reverse.Also , when you went to college at 16, were you placed in any special program, e.g., for gifted highschool children, or were you just in the pack at 16? Because I guess that is a two year earlier start than most--I was 18 when I started college. Were you totally bored in high school or had you been pushed up grades previous to high school, so that you graduated at 16?
Shelli
Posted by Lorraine on July 31, 2001, at 11:03:39
In reply to Re: hand holding » Lorraine, posted by Elizabeth on July 27, 2001, at 17:30:25
elizabeth:
Just got back in town. Today is going to be my first dose of Parnate. The pharmacist said it was ok to split, so here we go.
> > >A lot of people who spend time in psych hospitals come out feeling less sure of themselves, IMO because of the way they were treated in the hospital (as being unequal to the staff and not having what they say believed).
I'm sure that is true. I have found that it is very difficult to hold onto your own sense of reality when you are living in a community that invalidates it--that community would be all-encompassing in a hospital. I have found though that even different jobs can have this "feel", because everyone buys into the "culture" of the job. For instance, in law school a lot of people walk around feeling stupid because the culture is a "let me prove how smart I am by showing how stupid you are" boot camp mentality. That same culture then gets transplanted in the major firms, there is no place for "learning" and you are never forgiven for lacking "experience" or self-confidence--and it is a "confidence game". If you stick with it long enough, as I did, you become the expert and then have to decide whether you will perpetuate that culture with those coming up behind you. I imagine that one way that people who work in mental hospitals make them less threatening is by distancing themselves from the patients so that the patient is "less than"--less than me, less than human in extreme cases, and this is done by discounting what they say and, ultimately who they are. The price of compassion is huge on those who give it. They must remain vulnerable to the pain of others and the possibility that a piece of this pain resides in themselves. So much easier and more efficient to just dismiss what patients have to say. I have never spent time in the hospital for my depression and, from what you are saying, it's clear that for me, it could be a very painful experience given my prior wounds from discounting.
> > >I'd try rxlist.comYes, I use this and drkoop.com drug checker for drug interactions.
> > > 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.
>
> Huh. Interesting way of looking at it.I think that people get stuck in their mind set frequently and do not allow new contradictory information in.
> > >Other high potency benzos (Ativan, Klonopin) might be better too. But see if the Neurontin helps.
I've been on the Neurontin long enough (6 mos) to know that it is not the answer to this problem, although it does help smooth things out generally. My pdoc prescribed Ativan for me to try out.
> > > > One morning I didn't take my AM dose of Parnate -- I think I had put my medication organiser somewhere other than where it usually goes. I had terrible rebound symptoms: anxiety, agitated depression, extreme mood swings. (A lot like what happened when Nardil pooped out.) After a couple hours of this, it finally occurred to me that I hadn't taken my morning dose; when I did, I rapidly began to feel better. MAOI withdrawal symptoms are *bad*.I had the same sort of reaction to a missed dose on Effexor and coming off of it was really, really difficult. That was before I was on psychobabble though. Now what they say about Effexor withdrawal is to augment it with a long half-life med like Prozac to ease the transition. I wonder if a similar argument would work with MAOs? Are there some that have a longer half-life? But then there is a wash-out switching from one MAO to another, right?
> > > Your Parnate withdrawal makes me a bit hopeful.
>
> ?I'm assuming that if you felt anxious on withdrawal, that Parnate was medicating the anxiety when you were on it. I'm not sure that this logic holds though.
>
> > Sounds like you need to be very careful. Your theraputic dose range is quite narrow?
>
> I don't know. I've been taking it on the assumption that I metabolise it normally. The serum level check is to make sure that that's really true.Let us know what the serum level check reveals. It could be an important piece of information about your metabolism.
Lorraine
Posted by Lorraine on July 31, 2001, at 12:02:17
In reply to Re: Handholding » Lorraine, posted by Elizabeth on July 27, 2001, at 19:51:20
> > > Stahl talks about the "end-stage" of depressive illness as one where the lows are so low but the ability to "feel" generally has been severely blunted.
>
> That's what I experience. I don't think of it as an "end stage," but perhaps it does have something to do with the fact that my depression first manifested when I was quite young. I would like to see more research on childhood-onset depression. I think my depression is probably not similar to most early-onset mood disorders, though.Maybe it's not the time of onset, but the duration of the disease or the length of time unmedicated. You have to wonder how it affects the development of personality and coping skills generally. My son has some anger management issues (has a learning disability also) so he was in therapy from the age of 8 until he was 11. He is so in touch with himself and very perceptive of moods. He also has the "language" of how to communicate about emotional issues generally. He's now 13, and I think whoever marries him ultimately is going to be real lucky. Course this is the effect of early intervention or therapy, not the effect of early mental illness.
> > > > > Interesting about panic and hypothyroidism. All my TSH tests have been pretty normal, and T3/4 augmentation is something I've never tried.
> >
> > It might be worth a try.
>
> What do you think it might help with besides panic? Have you ever tried it?Yes, I have tried T3 augmentation, twice. It is activating. For me, it was like taking an amphetamine. If I took too much, then I became edgy and started skin picking. I got off it the last time because I switched to Moclobemide which is also activating and needed to reduce the amount of activation in my system generally. But my panic attack stuff started somewhere around that time. I wish that I had been keep a mood chart then, like I do now.
> > > Also, the notion of "estrogen dominance" causing panic symptoms is interesting. Apparently, estrogen dominance is not just a problem associated with menopause, but can be a woman's normal state throughout her lifetime. Another avenue to explore.
>
> That is interesting. Tell me, can you make anything out of my experience with the pill? (fairly sudden relapse of depression while taking Parnate)Do you know what your pill had in it? Was it estrogen, progesterone or both and, if both, were they cycled so that the beginning of the month was estrogen with a switch to progesterone at the end? At what point in your cycle did you start the pill? If you started at the beginning of the cycle and your pill was predominantly estrogen at that point, then it might have been estrogen dominance. Progesterone can increase depression (which is why I was initially put on unopposed estrogen). So you might have had an extra dose of progesterone at the time. How are you right before your period? You know doctors who specialize in menopause and pms could figure this out for you. They would first determine your hormone levels and, I think with premenopausal women, they do this over the course of a cycle using saliva testing. I'm sure a mood chart could also help you figure this out--the NIMH has a good chart that tracks monthly cycle along with mood. I'm now sold on mood charting to help me determine what meds, supplements, therapies, hormones, life events, foods are effecting my moods. I'm going to have my hormones tested at the end of this month to determine if I have estrogen dominance.
>
> > > > > Buprenorphine seems to make my periods irregular. I've been wondering about the mechanism there.
> > > If I was successful, then my period would start and I would not be in pain. But if I missed the very very beginning, what happened was my period would be delayed. I explained this to my doctor, who dismissed it out of hand. Point is there was something operating there that might be similar to your situation.
>
> How do you mean? I'm a little confused.My point was just that when I took a pain reliever before I started my period (depending on the timing of when I took the pain reliever), it could delay my period--or make it irregular. It never made sense to me. You are saying that Buprenorphine can make your period irregular. I know Ibuprofen is a different drug, but why should pain relievers affect the timing of periods? And, yet in my case Ibuprofen did and in your case Buprenorphine does.
> > > Decongestants are basically bad speed.So why do some pdocs recommend Benedryl as a sleeping aid?
(Ephedrine or "ma huang" is a step down from bad speed: it's bad Sudafed.)
I took Ephdrine for a while when I was on Effexor. It really is bad Sudafed. < g >
>
> > > But is agitation and activation considered mania?
>
> Not necessarily. They're symptoms of mania, though.
>
> > I once (for a couple of days in the weeks just before the last stock market crash), had incredibly racing thoughts, could hardly contain my excitement and so forth, but was still able to sleep. From my reading of the DSM categories, that would not qualify as mania--although I was euphoric and felt a bit invincible.
>
> Hypomania, perhaps?Well, I looked it up and it might fit (thanx). More reading to do.
> > >I don't think it's a good idea to pretend that we have a decent understanding of the causes of depression, mania, psychosis, anxiety, etc. -- attributing them to a vague "chemical imbalance" ...I think (as I mentioned before) the most reasonable approach to clinical practise is the empirical-descriptive approach (identifying symptom clusters that respond to particular treatments, and using this information to try to predict which treatments will be most likely to work for any particular patient). ....I think that we can simultaneously examine psychiatric illness on both levels (behavioural signs and symptoms, and physiologic ones). Both types of information are useful.
I guess right now the problem is that we don't know enough about the physiology and we don't have meaningfully defined presentation categories. And, we shouldn't pretend that we do on either front. We need research in both areas. The drug company studies of the effect of a drug on "depression" or even treatment resistant depression just lack enough specificity to be helpful in determining whether the drug will work in a particular case.
> > > I do like the way that your doctor does it, basing treatment decisions on statisticsthat's what appealed to me about him
> > >The statistical approach can also be applied to descriptive psychiatry, although it hasn't been used nearly enough IMO.Yes, some correlational analysis studies using say depression presentation criteria and effectiveness of meds would be really useful.
>> > > Complicated stuff. But if it is "insulin sensitivity" or "insensitivity?", then low carb should help.
>
> I dunno, thinking about insulin always gets me confused for some reason.If you ever find yourself in a Nardil weight gain situation again, it might be worth trying to see if low carb helps. Zo over on the thread about Zyprexa said that low carb did not help with it. So it may be that these different drugs cause weight gain for different reasons.
Lorraine
Posted by Lorraine on July 31, 2001, at 12:36:12
In reply to Re: Give me back my hand- (just kidding) » Elizabeth, posted by shelliR on July 27, 2001, at 22:00:10
Shelli:
> > > I'm up with the air about my next step. Yesterday and today I was in a pretty crummy mood, but then I had to remind myself that most people feel down sometimes, not just very depressed people. Like I wasn't as into my work as I am usually, felt it was getting too repetitious. On the other hand, I did not spend the day in bed like I do when I am terribly depressed. Maybe this is what anhedonia feels like; it's something I don't feel too often, sort of a bored, stale feeling inside.
I'm sorry that your meds may be letting you down. I also have a hard time telling on a day to day basis whether it's the med or a normal mood fluctuation that is affecting me. I have found mood charting to be invaluable because I track day to day and can see if a string of days develop or even if there are more down days than there were before. NIMH has a good mood chart if you think it might be useful. I'm sure you are watching it closely. You wouldn't want to wait too long to take action if it is a down swing.
> > > Maybe it's a signal for me to get out and start doing more besides working. I am going to put the decision about parnate on hold to try to see if the estrogen is having any effect. I like to keep my trials relatively clean!
I felt the estrogen immediately in terms of cognitive effects. Some sources say that it can take up to two months to see estrogen's effects. Have you thought about how long a trial you want to give estrogen? I usually find that my mood stability directs whether I add another med or not and muddies the clean trial concept.
> > >I'll let Lorraine try parnate first, although if our reactions to opiates are any indication, we don't react similarly to chemicals.Today is the first day on Parnate. I'll keep you posted.
Lorraine
Posted by Lorraine on July 31, 2001, at 12:59:58
In reply to Re: Handholding Shelli » Lorraine, posted by shelliR on July 27, 2001, at 23:39:14
> > > I think for lots of people giving is definitely a part of getting.
This is definately true for me. Although I also have to watch myself and make sure that I am not over-giving where the gift is not appreciated or to the point where I become resentful.
> > > Gratitude is a really good thing in general. I think it is a very spiritual thing, to be grateful. I see it as a humble experience because the things that I feel graditude about are gifts; I have not directly caused them, nor can I take credit for them.I like this sentiment. It is true that as I have lived with this disease I have become more grateful so the unexpected gifts and I suppose that my level of expectation has generally decreased so that more things appear to be gifts.
> > >Like I think if you are very good at something, it is okay to acknowlege it, because a talent is a gift, not a product of the ego, although using the gift may be.
I do this too. Drives my kids nuts. They think I should respond to compliments by saying "it's kind of you to say so".
> > >sorry, didn't mean to get philosophical on you :-) )
It's your best feature.
> > >What is a QEEG?Quantitative Electro-encephalogram. They hook you up to a bunch of electrodes on your scalp and measure your brain waves, then they convert this data into numbers (quantitative).
> > > A lot of people who were abused in early childhood have temporal lobe epilepsy.I wasn't physically abused, if that's what you mean. I was emotionally abused--neglected more actually. I was severely traumatized as a child. But if it's physical injury, my hunch would be I sustained it in one of my car accidents--although those were fairly minor. The people at EEG Spectrum (the brainwave feedback place) asked me a lot of question about brain injury and thought perhaps the car accidents were the culprit.
> > >I know someone who had one doctor give her the diagnosis and the second take it away, so I imagine there is some interpretation involved.
I'm sure there is--as my pdoc says it's a matter of where you fall on the continuum. I'm not taking the diagnosis very seriously because of this.
> > > Was it strange to meet another babbler in the real world? I don't know what that would feel like. Dr. Bob was in my area for a conference and meeting with people from the board (I think two people came). I was ambivelent and it turned out I was in the hospital anyway.I felt ambivalent as well. I thought it would be like the scene in Wizard of Oz where the curtain flies up and you see that the wizard is really just an old man. But I was pleasantly surprised. He seemed to be a bright, caring and connected person. As I have said to him, psychobabble is a self selected group that has a number of great characteristics: generally bright people who believe in taking charge of their treatment options and doing research on their situation. Those characteristics alone are not that common in the general population.
> > > p.s., congradulations on picking parnate--I hope it goes well.
me too :-)
Posted by Elizabeth on July 31, 2001, at 17:34:53
In reply to Re: hand holding, posted by Lorraine on July 31, 2001, at 11:03:39
Hi Lorraine.
> > > >I'd try rxlist.com
>
> Yes, I use this and drkoop.com drug checker for drug interactions.I'm not sure about drkoop.com. I think that both sites would probably tend to come up with nonexistent drug interactions.
> I've been on the Neurontin long enough (6 mos) to know that it is not the answer to this problem, although it does help smooth things out generally. My pdoc prescribed Ativan for me to try out.
Good luck with that. How much Neurontin were you taking, incidentally? I've heard wildly variable claims about what the effective dose range is.
> Now what they say about Effexor withdrawal is to augment it with a long half-life med like Prozac to ease the transition. I wonder if a similar argument would work with MAOs?
Umm. I'd avoid Prozac if you've taken a MAOI recently! (Benzos do help with MAOI withdrawal, though.)
> Are there some that have a longer half-life?
Nardil and Parnate are both very short-lived. I don't know about others.
> But then there is a wash-out switching from one MAO to another, right?
Yes, although some people feel that this is only a problem when switching between hydrazine and non-hydrazine MAOIs.
> I'm assuming that if you felt anxious on withdrawal, that Parnate was medicating the anxiety when you were on it. I'm not sure that this logic holds though.
Rebound anxiety does suggest that the drug is an anxiolytic, yes. (Parnate controlled my panic symptoms well, BTW.)
> Let us know what the serum level check reveals. It could be an important piece of information about your metabolism.
Funny you should mention that. The serum DMI level was 456 ng/mL (therapeutic dose range is supposed to be 150-250). So my pdoc (well, the guy who's covering for him) wanted to repeat the test, so I went in today and got more blood drawn. AFAIK I did it right (blood draw 10-12 hours after last dose).
-elizabeth
Posted by Elizabeth on July 31, 2001, at 17:59:13
In reply to Re: Handholding » Elizabeth, posted by Lorraine on July 31, 2001, at 12:02:17
> Yes, I have tried T3 augmentation, twice. It is activating.
That's what I've heard, so it surprises me that it would be useful for panic.
> I got off it the last time because I switched to Moclobemide which is also activating and needed to reduce the amount of activation in my system generally.
A lot of people seem to get overstimulated when they first start taking moclobemide.
> > That is interesting. Tell me, can you make anything out of my experience with the pill? (fairly sudden relapse of depression while taking Parnate)
>
> Do you know what your pill had in it?It was a combination pill (Ortho Tri-cyclen) -- estradiol and norgestimate. The ratios changed every seven days (the amount of norgestimate increased while the amount of estradiol remained fixed), and of course there were the inactive pills for the last week of each month.
I don't recall when I first started taking it or when the depression emerged.
> Progesterone can increase depression (which is why I was initially put on unopposed estrogen).
I took Depo-Provera for a little under a year. I would say I got depressed, but I did get irritable and moody.
> How are you right before your period?
No premenstrual mood changes. (I just get bad cramps on day 1, which the pill was supposed to alleviate.)
> I'm sure a mood chart could also help you figure this out--the NIMH has a good chart that tracks monthly cycle along with mood.
I did that (mood charting) for a while. I couldn't find any patterns.
> My point was just that when I took a pain reliever before I started my period (depending on the timing of when I took the pain reliever), it could delay my period--or make it irregular.
I gather that opioids can do that in general (although I'd previously thought that irregular periods were just due to the junkie lifestyle). NSAIDs are better for cramps, anyway. It's odd that ibuprofen caused the same thing for you, though -- I'd never heard of or experienced that (I always take NSAIDs -- usually Relafen -- at the start of my period).
> > > > Decongestants are basically bad speed.
>
> So why do some pdocs recommend Benedryl as a sleeping aid?Benadryl is an antihistamine, not a decongestant. As a rule, antihistamines are sedating (if they cross the blood-brain barrier easily, that is).
> I guess right now the problem is that we don't know enough about the physiology and we don't have meaningfully defined presentation categories. And, we shouldn't pretend that we do on either front.
Exactly.
> The drug company studies of the effect of a drug on "depression" or even treatment resistant depression just lack enough specificity to be helpful in determining whether the drug will work in a particular case.
That's right. "Depression" (or even "major depressive disorder") is a pretty big umbrella.
> Yes, some correlational analysis studies using say depression presentation criteria and effectiveness of meds would be really useful.
They used to do this; it's how atypical depression and panic disorder were identified. For some reason, interest in this type of research has plummeted.
> If you ever find yourself in a Nardil weight gain situation again, it might be worth trying to see if low carb helps.
I'm never taking Nardil again -- in the long run, it did more harm than good. And anyway, a carbohydrate-restricted diet would be very difficult for me to maintain (the four food groups, for me, are: starch, starch, carbohydrates, and starch).
> Zo over on the thread about Zyprexa said that low carb did not help with it. So it may be that these different drugs cause weight gain for different reasons.
Zyprexa is a strong antihistamine. Nardil isn't; I've never been clear on the mechanism of Nardil-associated weight gain.
-elizabeth
Posted by Elizabeth on July 31, 2001, at 18:22:34
In reply to Re: DID, MDs, DSM, EMDR, etc. » Elizabeth, posted by shelliR on July 30, 2001, at 22:23:16
> It’s a variant, but a significant variant, much less of a disruption of my life as a adult. And yes, abuse has to occur and the child must have a tendency to dissociate.
My understanding is that people have different defensive styles, and dissociation is one of many possible defense mechanisms.
> I don't know if this is a fact or not, but it seems from my observations that the abuse had to have been kept a secret; even in the case of siblings both being sexually abused by the same adult, it has generally never been discussed until they were adults with the people that I have come to know.
Well, do you know anyone who was abused but did speak to someone about it?
> Body therapy is the combination of therapy with on-hands massage type work.
That sounds really cool! And I can see how it would be helpful to someone in your situation.
> Co-conscious means that I always know when my personalities are talking -I can hear them when they are talking and I don’t let them take over my body.
Talking...so they talk to each other, or is it just several different internal monologues?
> I suppose it’s odd, but it doesn’t seem odd to me.
It's odd, trust me. :-)
> Actually my youngest one, who has recently turned three and a half (a momentous event for a child who had declared she did not want to get any older) has the name Elizabeth.
Say hi to her for me, then.
> BTW, they get older on their own, they tell me when they have gained a half year or a year and they sound older.
Does the aging occur at the same rate as real aging? Or do they age in a discontinuous fashion?
> Ever had a sleep or ambulatory EEG?
>
> No, because sleep hasn’t been a problem (except on nardil) and I have no indication that I sleep-walk.Sleep studies can illuminate more than just sleepwalking. Anyway, I'd be curious if there were predictable changes in your brain wave patterns when you switch identities.
> Have you noticed any effect of the medications you're taking on this phenomenon?
>
> No, I never even deal with it with medications—just the depression and the anxiety.So I gather. (I was wondering whether any of the antidepressant and anxiolytic medications you've tried had an incidental effect on the dissociation.)
> Well, I don’t take it anymore! When I used to take it then I spelled it selegiline! < g >.
So, it improved your spelling? Or your typing?
> More on the topic of medication, the last three days have been pretty awful for me and I am wondering if the estrogen I’m taking is making my depression worse.
Could be. I had major problems with the hormonal contraceptives that I tried (see one of the posts directed to Lorraine).
> It’s either that, or the oxycontin is starting to be less effective. Bummer.
FWIW, I've heard of a number of cases in which people took full opioid agonists (morphine, oxycodone, and -- get this -- oxymorphone) as antidepressants for periods of months or years and never became tolerant.
> Hope you are continuing to do well.
Yes, very. Thank you.
-elizabeth
Posted by Elizabeth on July 31, 2001, at 18:23:18
In reply to Re: DID, MDs, DSM, EMDR, etc., PS » shelliR, posted by shelliR on July 31, 2001, at 9:23:57
> Also, when you went to college at 16, were you placed in any special program, e.g., for gifted highschool children, or were you just in the pack at 16?
In high school, you mean? I was taking a lot of advanced-placement classes and a math class at the university where my parents teach. I had skipped two grades (3rd and 8th).
In regard to your question about my depression: in the past, I've tried to rationalise it as being the natural consequence of this, that, or the other, but the truth is that there was no known cause: there wasn't anything that happened that could have explained why I became depressed.
-elizabeth
Posted by Lorraine on July 31, 2001, at 22:31:59
In reply to Re: Handholding (Shelli, Lorraine), posted by Elizabeth on July 29, 2001, at 14:01:07
> > > And to Lorraine: I don't know when you first became depressed or seriously anxious, but I've had problems since childhood (first dx of major depression when I was 14, but my doctor and I felt that I'd probably suffered at least one previous episode, when I was 10-11 and possibly dysthymia long before).
Elizabeth: I was severly traumatized when I was 8, and it is clear that I had a break-down at the age of 11 or 12, although nothing was diagnosed then and I tried to hide everything. I started seeing a therapist when I was 15. No diagnosis until I was 43.
> > >I think that early-onset depression has much more profound effects on a person than adult-onset depression has. In a sense, I had an incomplete childhood. Although the effect is qualitatively different from the effects of serious abuse in childhood, the degree of impairment that results is comparable, I think.
I honestly wouldn't know which of these categories I would fall into because if someone had intervened at 11 or 12, I'm sure I would have been diagnosed with childhood depression and certainly I spent a lot of my childhood crying. But we didn't know about depression then.
> > > It's a lot fuzzier than I think most people realise. You're right that EEGs are subject to interpretation. It does sort of make sense that people who'd suffered abuse would have hyperactive limbic systems (perhaps including the potential for limbic seizures), though.I don't think I had physical abuse (with few exceptions). The question is whether emotional abuse or depression can cause lesions. Anyway, I guess the suspicion would be car accident side effects.
Lorraine
Posted by Lorraine on July 31, 2001, at 22:35:04
In reply to Re: Give me back my hand- (just kidding) » shelliR, posted by Elizabeth on July 29, 2001, at 14:04:32
> > I'll let Lorraine try parnate first, although if our reactions to opiates are any indication, we don't react similarly to chemicals.
>
> So, Lorraine is your guinea pig? :-)
>
Hey, wait a second guys, I thought I was riding on your experiential coat tails!
Posted by Lorraine on July 31, 2001, at 22:43:38
In reply to Re: Give me back my hand- (just kidding) » Elizabeth, posted by shelliR on July 29, 2001, at 23:51:29
> > > It's complicated and it's sounds much more bizarre than it feels, I am so used to it by now. I have different personalities inside; girls clustered around three and eight, related to sexual abuse at those ages. If you heard them you would not think they are me--the three year old especially, not only has the voice of a three year old, but has the verbal patterns of a three year old: repetition, disinterest in answering questions, etc. and chatters on and on. I worked a lot with them in therapy with EMDR and in body therapy, and at this point while still present, they do not dominate my life
Shelli: I just want to say that navigating your path through this life with alters sounds like a real challenge. In therapy, I had to embrace the 8 year old child in myself that I had discarded as quickly as I could, but that is a far cry from dealing with and negotiating with alters. I have been on a couple of support groups with people who had alters and I found that these people were remarkably careful and considerate in how and whom they let communicate with the group. Then to have people discredit the notion of alters as well--that just makes things more difficult.
Lorraine
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