![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 149 to 173 of 434. Go back in thread:
Posted by shelliR on August 2, 2001, at 21:15:43
In reply to Re: mostly to one of the three of you :-), posted by terra miller on August 2, 2001, at 18:27:26
Hi Terra.
> hi, i've been trying to understand this thread and i think i give up *grin* mostly because i can't tell who is saying what and when.... and that's probably because i'm reading posts backwards or at random *S*
>
It's actually hard for me to get clear who is writing and who is being quoted, as well.> anyway, to whichever of you this applies i just wanted to say that i have laughed and laughed because of the stories that are too similar for words to what my life is like currently trying to live day to day as one person with many opinions (the comment about not eating was particularly humorous because i can miss many meals and not know it so i have "little" reminders who wake me up poking me in the middle of the night to tell me how starving they are and then i have to try to remember when i ate last, which i can rarely recall, while arguing over whether to eat the healthy l/o chicken or the chocolate donut.) anyway, just wanted to say thanks or something like that.
Ah, I think that would be me you are addressing! I have weird children. They woke up at night in the hospital and asked my roommate to get them soy milk because they were thirsty :-) Yours sound more normal--chocolate donuts--definitely.
> since elizabeth said to "jump in" i wanted to ask a question: is it difficult to get your meds to work the right way? do you have to "talk yourself" through how and when you take a certain med?
I don't know what you mean by "get your meds to work the right way?" Do you mean kids inside don't want to swallow pills? Or different pills are for different parts? I don't think it's something that comes up for me, but I'm not sure if I know what you mean.
Could you explain?shelli
Posted by Lorraine on August 2, 2001, at 21:57:12
In reply to mostly to Lorraine but others feel free to jump in, posted by Elizabeth on August 2, 2001, at 14:21:05
[re: anti-convulsants
> > > Do you feel like they've helped you? A doctor's preference isn't sufficient reason to stay on a drug that isn't doing much good.I think it's more than preference--my QEEG showed some seizure like activity in my temporal lobes. As to my response, I do feel the Neurontin has helped me. But it's odd--with the selegiline it actually provided some mood support, which I wasn't expect but my pdoc was. Now the Neurontin helps with my physical anxiety. Interesting issue that you raised was the hypomania and I suspect that I have had that pretty regularly throughout my life. Jumping into projects with a flurry of energy, zeal and racing thoughts only to leave them half completed. After I was on Neurontin for a while, I told my pdoc that I thought that I was thinking less circularly (as in running around in circles) and that I was doing more "productive" work. So I have to give the Neurontin thumbs up, although I hated depakote and lomictol. I have cognitive impairment (working memory and so forth) from my depression and am leary about anti-convulsants that add to this problem.
> > > I had an opportunity which I missed a while back. I kind of regret that I wasn't able to meet with the group.
It may come again, or you can do what Neal did and post a message here asking psychobabblers in your neck of the woods to email you.
> > > I think if I'd had my act more together in college, I might have started a support group (for people with psych disorders -- there were a lot of us at my school).
Aren't you still in school? Graduate or finishing school < g >? I always wonder how you manage to be so future oriented (or is it just my perception?) with this disease. I find myself so uncertain day to day about how my mood will be that I've lost the future so to speak.
> > > I know what you mean. At present, none of the people I interact with day-to-day "gets it." I think that one of my friends who I see fairly often probably has depression and/or panic attacks, but she doesn't want to get treatment (she's seeing a therapist, but only very irregularly).
do you ever want to shake her and say "this disease is progressive. stop fooling around?" I have a friend like that who actually has been on ADs on and off. I'm afraid she'll end up like me and have a tough time finding something that works if she keeps this up. Plus I do believe that untreated depression leads to brain damage.
> > > The split dose of Parnate is a good idea for minimising the initial side effects. (I would even consider going down to 5 mg once a day.) How do you get those tablets to break evenly, incidentally?Well, of course, I do have the expert KMART pill splitter, and, who said I break them "evenly". I can't even break scored tablets evenly. I just save the small halves and use them as I titrate up. The 5 mg 2x a day seems ok. I think I'll continue with this for the rest of the week. I've only felt the shortness of breath slightly.
>
> > >I can't remember: did you ever try a cardioselective beta blocker (e.g., atenolol)?
I tried propanolol. But it was too wierd for me and didn't really help. Me and my pdoc debated trying atenolol and decided it was time to move on generally. Thanks for the warning on sleep. I had that on moclobemide too and it was unsettling to me. I never felt rested.
>
> > > It sure is. I'll make note of that. Do you think there were withdrawal symptoms precipitated by discontinuing the selegiline, or just a relapse?I increased my adderal from 7 mg 2x day to 10 mg 2x a day and really didn't feel any withdrawal symptoms--although I was hidiously distracted at the time, painting some rooms in my house. Still, I felt sublime sometimes and, of course, was very productive.
> > > For instance, I used to have shame spirals (fortunately therapy irradicated this one).
>
> Okay, I have to ask: what do you mean by shame spirals?A shame spiral for me was a hole that I would fall in precipitously whenever my old shame injury got bumped up against in the normal day to day living. For instance, my boss would publicly shame me and I would not just feel ashamed, I would feel the amount of shame that I felt as a child when I was publicly humiliated (the other kids made fun of my scars) which was a very deep pit that would take me a couple days to climb out of. It really was awful and I didn't understand what was going on--why I was over-reacting and riding this merry-go-round. I sure am glad to have it out of my life.
> > > I think that a lot of people with DID (or subclinical DID, like Shelli has) feel an attachment to their alters, and as a result they don't necessarily *want* to integrate. I think that if somebody is co-conscious and is otherwise functioning well and feeling okay, it's probably fine to choose not to integrate (if you have the choice).
Yeah, I just think how hard it was for me to embrace the 8 year old that had been injured in me and have to feel envious that she feels this close to her alters. I think it's great.
> > >a book my dad wrote back in the '70s from Amazon. (I'm really hoping he will be able to finish the book he's writing now -- it's going to be quite a piece of work.)Really? what's it about?
> > >You might be able to find stuff like that (outdated PDRs) on eBay, too. I got my copies of Schatzberg & Nemeroff (both editions) from Amazon at about 2/3 the cover price (when they were new).
I think I tried ebay, no luck. Hmmm Nemeroff, maybe I should get that too. Say, do you own stock in a publishing company? < g >
> > > I suppose you are right. The thing about when I worked out my traumas before was that I didn't "remember" certain things and so had to "try on" various scenarios and walk around with them for a week or so to see if they "fit".
>
> Wow. How did you construct the scenarios in the first place?Well, I did remember that I set my pajamas on fire. I did remember how I did that and how I felt (dissociated?). I just didn't know the context. I knew my mom was having suicidal thoughts at the time. I knew my mom and dad were fighting. I was just missing that glue--was it childish exploration gone awry or some type of acting out? those are the two scenarios I tried on.
> > > You and Shelli were quite the little pyromaniacs, weren't you? :-)That, we are. Of course, my kids barely know how to light a candle. You can imagine how I "controlled" this possibility. It's funny, but when my kids reached about the age I was when the accident happened, I had some major anniversary type issues come up about them and fears for their safety and fear that I was emotionally abandoning them.
> > > There also was some sexual abuse by my father when I was older.
>
> God, that's awful. How old were you?I was 15 or 16. It is awful because it is a breach of trust between a parent and child, but the abuse was pretty mild.
> > > I feel a lot of heaviness in my chest.
>
(hence the idiom "getting something off your chest").You're right. Good connection.
> > > That's really interesting to me. I went to a massage therapist a few times when my back pain started (my GP recommended her).
The times I reacted were when I was with a therapist who happened to be a healing type of therapist. I don't have this reaction with normal massage therapists.
> > > Here's one data point for you: I found that the sympathomimetic stimulation from Parnate became much less with time.I'm very pleased to hear this!
>
> > > I very frequently get the back ache thing from meds.
>
> This is the kind of thing that gets me thinking, "I wonder what causes that?"Well, it's like dystonia (mild). I had it first with Zoloft. I had terrible back aches and would find myself in an ordinary phone conversation gripping the phone very tightly. I don't think it is that uncommon a side effect of a lot of these meds. I used to think my back aches were physical problems until I started tracking how meds affected them. What about your back ache--were you on meds at the time?
> > > The Parnate mood support is going to be more robust than stimulants or selegiline. We'll see.
>
> That was my experience with Parnate vs. selegiline.I'm glad to hear that.
> > >There are a lot of stimulants, and they vary in their central and peripheral effects. (Methamphetamine has the most favourable ratio of central to peripheral effects, which is also why people abuse it so much.)
My pdoc was willing to prescribe this for me, but I didn't want it. It seems like a possibility to try much later if the MAOs and TCAs fail me. By the way, Adderal kept me "awake" but otherwise didn't affect me too badly--didn't cause hyperventilation for instance. Shelli's cylert is supposed to be mild as well and might be worth a try if I need a stimulant in the future.
[re: son's attack]
> > > I can imagine! Does he have any psychological problems that you know of?He has a learning disability (dyslexia) and possibly undiagnosed ADD sort of stuff. He has anger management issues--has had them since he was quite young. He has mild generalized anxiety and is a bit compulsive. We are teaching him coping skills. He actually has made remarkable progress--it's been a year or so since he lost his temper like that. Apparently, a girl had broken up with him which added fuel to the fire when I was grounding him for misbehavior (lying). I'm thinking about cognitive therapy. He will go back to therapy as a consequence of this. I've thought of having him formally evaluated, but my therapist feels it's not necessary. (and, in truth, i would be soooo reluctant to medicate a teen in part because they don't have a sexual identity or knowledge so if a med affects their sexuality they will just assume that that is "who they are" -- i also have the same issue with identity development generally in teens and feel that unless it is really necessary to medicate them, we should let them get a sense of who they are in the raw state.) I know you were diagnosed young. Were you medicated? If you were, do you feel it impacted your developing sense of identity (other than the fact that being medicated for a mental illness is a head trip anyway) or affected your developing sense of sexuality? My niece is 15 and was diagnosed OCD and put on Luvox. I think it was necessary for her to be medicated, but I do worry--especially about her sexuality given the side effects of SSRIs generally.
> > >it means that the whole incident wasn't completely negative -- you did get something of value out of it.
we always do :-)
Say, how is desipramine treating you?
Posted by Lorraine on August 2, 2001, at 22:09:50
In reply to Re: Hope you're okay on your 3nd day of parnate » Lorraine, posted by shelliR on August 2, 2001, at 18:25:21
Hi Shelli,
>
> Hope you are having a third good day on parnate.
>I am having a good third day--more mood support, still a bit draggy and very mild hyperventilating. I am optimistic.
> > > BTW, what is the most accurate test for estrogen levels?I believe that it is a saliva test, in your case (pre-menopausal) over a period of time (one cycle). Great Smokies Diagnostic Laboratories offers one. I don't know if their's is the best, although I do know that this laboratory is generally highly regarded among functional med doctors.
> > > I'm glad to know that both that you rarely have suicidal thoughts AND that you have a plan if you do.
What about you? Do you have a plan as well? And do you get suicidal thoughts? I know that you seem quite responsible about checking yourself into the hospital when you feel you need to.
> > > I'm pretty sure I'll start parnate next week.I wish you luck on it. Didn't you want to wait to see how the guinea pig did for the whole trial period < g >.
> > >Yesterday oxycontin with concera was fine until the early evening, when I felt a little sick in my stomach and totally exhausted When I tried to take a nap, I couldn't fall asleep. So last night I was a complete zombie, didn't do the treadmill or work. And then I had trouble falling asleep at 1am. So I'm still not real positive about stimulents for me.
Sounds wretched to me. Out of curiousity, which stimulants have you tried? Adderal? Provigal? Just wondering. By the way, the Neurontin (my 3 dose at night before bed) helps with getting to sleep.
Lorraine
Posted by Lorraine on August 2, 2001, at 22:25:46
In reply to Re: mostly to Lorraine but others feel free to jump in » Elizabeth, posted by shelliR on August 2, 2001, at 21:04:23
> > > subclinical DID"! Did you create a new diagnosis for me :-)
Isn't that cool? Your very own personalized diagnosis. How considerate of you, elizabeth.< g >
> > > Me too! I was just working up to reentering the world of intimacy when I got rezapped with this depression. To be in a relationship with the depression is one thing; to start one is another.
I honestly can't imagine where I'd find the resources to do this.
>
> > > There also was some sexual abuse by my father when I was older.
> >
>
> Wow, I'm sorry Lorraine. I'm amazed with your past how well you have been able to handle a long-term intimate relationship with your husband. I give you lots of credit. (and your husband too, if he deserves it and it sounds like he does also).It's funny. My mom was sexually abused from the age of 7 to 12 (as was her sister, neither was aware of the abuse to the other until they were in their 60s and finally talked about it). My mom has a robust sexual appetite--always did and was frustrated by my father's lack of interest. My abuse was not until I was 15 or 16 and it was mild. So I don't think it affected my sexuality much. My husband has not had to be understanding about my past because for the most part it hasn't affected him. I did find him to be very unsympathetic about my sexual dysfunction caused by SSRIs, especially after he started taking Viagra < vbg >. In the end, you know, asking someone who is not impaired to give up their sex life is actually a pretty big deal.
> > > Well, if the depression feels in your body, then body therapy might be really helpful. Especially now that you've (L.) talked about abuse, I said before that I believe that horrible experiences in childhood, get sort of calcified in the body. For instance if someone is hurting you, you often hold your breath. If getting hurt (or abused) is a pattern, your body starts anticipating and after a while, your body has changed. I think body therapy can help reprogram your body to be the way it's supposed to be-more fluid, etc.This makes sense. I'll look into it. And, I'm sure being burned and being in the hospital in isolation (under one of those tents) also got etched in my body.
> > > I love the word robust. Especially when describing medications :-)Me too. Let's hope it lasts.
Lorraine
Posted by Elizabeth on August 2, 2001, at 22:43:15
In reply to Re: mostly to Lorraine but others feel free to jump in » Elizabeth, posted by shelliR on August 2, 2001, at 21:04:23
> subclinical DID"! Did you create a new diagnosis for me :-)
No, it's just a more specific way to describe your DD-NOS. (Sorry to disappoint. < g >)
> I starting to lose the effect of the oxycontin.
That's really too bad. I'd heard of several cases where people took opioids, including oxycodone (also morphine, methadone, buprenorphine, and oxymorphone), for depression without becoming tolerant, and I'd hoped that you would have the same good luck. Maybe you could continue it on an intermittent, as-needed basis (as you had been doing with the hydro)?
> Actually what I have now is the generic of lortab 7.5/500 and it doesn't feel nearly as strong to me.
Huh. What was the dose in the Vicodin you were taking before? (The most favourable ratio is in Norco 10/325.)
> Maybe that's because I've been taking oxycontin 10mg, bid, so 1/2 of 7.5 doesn't feel the same.
That seems likely. Oxycodone is definitely stronger than hydrocodone.
> It's definitely time for me to get on an AD. I think I will start parnate next week.
Best of luck to you. I found it quite tolerable once I figured out how to get around the spontaneous paroxysmal hypertension I was getting about 30 minutes after taking it. It turned out that I needed to take it in divided doses of no more than 10 mg each -- for quite a while I was taking it six times a day. Desipramine seems to be working as well as Parnate did for me, without the hypertension and insomnia and the limitations on what other medications I can use to augment it. I was pretty stunned to learn how high my serum level was (could have been a lab error but I doubt it), because I'm not really noticing many side effects.
-elizabeth
Posted by terra miller on August 2, 2001, at 23:21:16
In reply to Re: mostly to one of the three of you :-) » terra miller, posted by shelliR on August 2, 2001, at 21:15:43
> Ah, I think that would be me you are addressing!hello. :-)
>I have weird children. They woke up at night in the hospital and asked my roommate to get them soy milk because they were thirsty :-) Yours sound more normal--chocolate donuts--definitely.
:-) funny you should mention soymilk. :-)
> I don't know what you mean by "get your meds to work the right way?" Do you mean kids inside don't want to swallow pills? Or different pills are for different parts? I don't think it's something that comes up for me, but I'm not sure if I know what you mean.
yeah. here's the deal. we take wellbutrin. we've went through a whole line of AD's. for a while i forgot why i started even looking for meds. then i remembered that we have suicide issues from time to time that put us in danger and need to be dealt with, like it or not. so it's kind of a "you will take this whether you want to or not" kind of thing. and the wellbutrin has been very helpful to calm whoever it is that needs it... which is hard to describe except that i know that i know that i know that somebody in here is being helped and that i no longer can "get suicidal" even if i wanted to. it's hard to explain it.
but when it comes to sleeping meds. that's another story. i can drug myself up only to find myself wandering around the house looking for food. or i can not drug myself up and find myself wandering around the house. at least i "come to." before, i wouldn't "come to" but somebody was smart enough to leave a trail (that is, empty cans of dt.pepsi on the counter) so that i would know the next morning that i had been up in the middle of the night. i'd do things and accomplish things and, well, sigh. anyway, so i have to do all this communicating to "bargain" for a complete night's sleep. same with anxiety meds. can't get them to work either. just sometimes. and i can't drink anymore... two sips and i feel it... except parts of me can drink a truckdriver under the table, so it depends. i've just read other people saying that it's just too difficult to prescribe meds to people with DID (example: an alter with diabetes vs. other part which does not) and have been told by some that they just gave up on meds altogether because it had become such a battle and was unhelpful. so that's why i was wondering if anybody had an answer to this dilemma.
it's so confusing. you've got one body and one brain. and you've just got this brain that made all these compartments so you could handle everything. but you've still just got one brain and one body. i don't get how one brain could function as many brains and respond chemically different in those different "parts." it's still just one brain and one body. i can't understand it.
thanks for writing -terra
Posted by Elizabeth on August 2, 2001, at 23:47:39
In reply to Re: mostly response to Lorraine but do jump in, posted by Lorraine on August 2, 2001, at 21:57:12
> I think it's more than preference--my QEEG showed some seizure like activity in my temporal lobes. As to my response, I do feel the Neurontin has helped me.
Well, then by all means continue taking it.
> Interesting issue that you raised was the hypomania and I suspect that I have had that pretty regularly throughout my life. Jumping into projects with a flurry of energy, zeal and racing thoughts only to leave them half completed.
That sounds to me more like ADD behaviour, actually.
> After I was on Neurontin for a while, I told my pdoc that I thought that I was thinking less circularly (as in running around in circles) and that I was doing more "productive" work.
That's very cool. Perhaps your problems focussing are related to anxiety or seizurelike activity. TLE often does weird things to people -- globally, not just when they have a seizure.
> So I have to give the Neurontin thumbs up, although I hated depakote and lomictol.
I think Neurontin would have to be my favourite of those three, too. Depakote and Lamictal just didn't do *anything* for me (no significant side effects and no good effects either). That was when I'd been taking Nardil on and off and was having really bad mood swings which led my pdoc to believe I might be bipolar (the moods resembled dysphoric or mixed mania -- MAOI withdrawal is *really* hellish).
> I have cognitive impairment (working memory and so forth) from my depression and am leary about anti-convulsants that add to this problem.
I think I might have an acquired attention disorder secondary to depression (I did have some ADD-like traits as a child but I probably wouldn't have met the diagnostic criteria). This is really hard because being able to think clearly and focus has always been very important to me. I sure hope that it can be corrected or at least treated.
> > > > I think if I'd had my act more together in college, I might have started a support group (for people with psych disorders -- there were a lot of us at my school).
>
> Aren't you still in school? Graduate or finishing school < g >?I got my degree (bachelor of science in math) in '97. I've been taking undergraduate classes with the goal of applying to medical school. (I didn't take organic chemistry, biology, etc. in college. Biology became a required course for the class that started after me, and I had placed out of the chemistry requirement by taking AP chemistry, but that wasn't enough to satisfy medical schools so I had to retake it.)
> I always wonder how you manage to be so future oriented (or is it just my perception?) with this disease. I find myself so uncertain day to day about how my mood will be that I've lost the future so to speak.
I brood about the future a lot. Anyway, I'm not really depressed right now (there's no question in my mind that the desipramine is working), just feeling anergic and having some trouble concentrating. My general mood is very much improved.
> > I think that one of my friends who I see fairly often probably has depression and/or panic attacks, but she doesn't want to get treatment (she's seeing a therapist, but only very irregularly).
>
> do you ever want to shake her and say "this disease is progressive. stop fooling around?"She doesn't accept the idea that it's a disease, and she loathes the thought of taking medications (for some reason that I'm not quite clear on -- she knows I take them, and she has a brother who takes them too).
> I have a friend like that who actually has been on ADs on and off. I'm afraid she'll end up like me and have a tough time finding something that works if she keeps this up. Plus I do believe that untreated depression leads to brain damage.
Me too. And the on-and-off thing is very destabilising.
> Well, of course, I do have the expert KMART pill splitter, and, who said I break them "evenly". I can't even break scored tablets evenly.
Ahh yes, the famous pill guillotine. I need to swing by K-Mart and get myself one of those. :-)
Most scores suck. Xanax and Desyrel Dividose both break pretty well, though. Adderall is lame -- you really need a splitter to get those to break even close to evenly.
> I just save the small halves and use them as I titrate up. The 5 mg 2x a day seems ok. I think I'll continue with this for the rest of the week. I've only felt the shortness of breath slightly.
Well, that's good to hear. I think that many side effects don't cause much discomfort, especially the ones that go away with time.
> I tried propanolol. But it was too wierd for me and didn't really help. Me and my pdoc debated trying atenolol and decided it was time to move on generally.
Hmm. Well, it might be worth it if the autonomic activation causes you too much discomfort.
> Thanks for the warning on sleep. I had that on moclobemide too and it was unsettling to me. I never felt rested.
My experience with MAOIs has been that I do feel rested, that they decrease my sleep requirements.
> I increased my adderal from 7 mg 2x day to 10 mg 2x a day and really didn't feel any withdrawal symptoms--although I was hidiously distracted at the time, painting some rooms in my house. Still, I felt sublime sometimes and, of course, was very productive.
That's good. Sometimes stressful situations can make withdrawal symptoms harder to bear, but on the other hand, keeping yourself distracted can help.
> A shame spiral for me was a hole that I would fall in precipitously whenever my old shame injury got bumped up against in the normal day to day living. For instance, my boss would publicly shame me and I would not just feel ashamed, I would feel the amount of shame that I felt as a child when I was publicly humiliated (the other kids made fun of my scars) which was a very deep pit that would take me a couple days to climb out of. It really was awful and I didn't understand what was going on--why I was over-reacting and riding this merry-go-round. I sure am glad to have it out of my life.
Ahh, I can understand that. (Can I ask whence the scars? I don't think I've seen you mention that before.)
> Yeah, I just think how hard it was for me to embrace the 8 year old that had been injured in me and have to feel envious that she feels this close to her alters. I think it's great.
I think it sounds pretty cool, too.
> > a book my dad wrote back in the '70s from Amazon. (I'm really hoping he will be able to finish the book he's writing now -- it's going to be quite a piece of work.)
>
> Really? what's it about?My dad's a professor (both my parents are) -- his field is philosophy and history of science. It's not light reading. < g >
> I think I tried ebay, no luck. Hmmm Nemeroff, maybe I should get that too. Say, do you own stock in a publishing company? < g >
Schatzberg & Nemeroff are the editors -- it's a psychopharmacology textbook. I did get a copy of DSM-III on eBay.
I don't have any investments, no. (What do you expect? I'm a starving grad student type. < g >)
> I was 15 or 16. It is awful because it is a breach of trust between a parent and child, but the abuse was pretty mild.
Small comfort. Still, it's probably less damaging if it happened when you were older.
> > > > I very frequently get the back ache thing from meds.
> >
> > This is the kind of thing that gets me thinking, "I wonder what causes that?"
>
> Well, it's like dystonia (mild).You think so? Hmm. I don't know too much about dystonias, but that doesn't sound like any one that I've heard about.
FWIW, the time that I was first diagnosed with depression (when I was 14), I was having very bad headaches. Prozac did away with them, so I have to credit it for that, at least.
> I don't think it is that uncommon a side effect of a lot of these meds.
Maybe not, but that still doesn't answer the question: *why* do meds cause it?
> I used to think my back aches were physical problems until I started tracking how meds affected them. What about your back ache--were you on meds at the time?
It isn't medication induced -- it's been a chronic thing (started in fall '95), and there is a mechanical problem that probably contributes to it (local steroid injection made it go away for about a week). Nardil did make it go away (so does buprenorphine, of course). Soma works sometimes, but it's not as reliable. It also waxes and wanes in intensity. There are probably multiple factors contributing. But anyway, the fact that centrally acting drugs sometimes alleviate pain doesn't necessarily mean that the pain is "psychogenic." I did track my back pain for a while but couldn't find any correlations other than that it went away completely when I was taking Nardil.
> My pdoc was willing to prescribe this for me, but I didn't want it. It seems like a possibility to try much later if the MAOs and TCAs fail me.
Desoxyn, you mean? That's cool that your pdoc was willing to consider it. I think most of them shy away because of its reputation.
> Shelli's cylert is supposed to be mild as well and might be worth a try if I need a stimulant in the future.
I took Cylert for a while in college. It was pretty helpful. Unfortunately it's been "black-boxed" -- the labelling contains a big, conspicuous warning at the top about potential hepatotoxicity -- so doctors have been less willing to prescribe it.
[re your son]
> He has a learning disability (dyslexia) and possibly undiagnosed ADD sort of stuff.I think that a lot of different childhood disorders all get lumped together as "ADD."
> He has anger management issues--has had them since he was quite young. He has mild generalized anxiety and is a bit compulsive. We are teaching him coping skills. He actually has made remarkable progress--it's been a year or so since he lost his temper like that.
That's good. It's not easy to help children or adolescents with psychological difficulties, but it's definitely worthwhile to try.
> I've thought of having him formally evaluated, but my therapist feels it's not necessary. (and, in truth, i would be soooo reluctant to medicate a teen in part because they don't have a sexual identity or knowledge so if a med affects their sexuality they will just assume that that is "who they are"
May I offer a counterexample? I was 14 when I started taking Prozac, and while Prozac didn't cause me much difficulty, I most definitely did have a sexual identity by that age.
> I know you were diagnosed young. Were you medicated?
(see above)
> If you were, do you feel it impacted your developing sense of identity (other than the fact that being medicated for a mental illness is a head trip anyway) or affected your developing sense of sexuality?
No. But remaining depressed would almost certainly have stunted my emotional growth.
> My niece is 15 and was diagnosed OCD and put on Luvox. I think it was necessary for her to be medicated, but I do worry--especially about her sexuality given the side effects of SSRIs generally.
Is she doing CBT too? That's supposedly very effective for OCD.
> Say, how is desipramine treating you?
Well, I went in to repeat the serum level test (the first test gave a rather high number), but I haven't gotten the results. It's definitely working somewhat (a pleasant surprise), and things may still get better since I haven't been on it all that long. I'm not sure what my pdoc will want to do if this test comes back high too. An ECG would seem to me to be the logical course of action.
-elizabeth
Posted by shelliR on August 2, 2001, at 23:49:33
In reply to stuff » shelliR, posted by Elizabeth on August 2, 2001, at 22:43:15
> > subclinical DID"! Did you create a new diagnosis for me :-)
>
> No, it's just a more specific way to describe your DD-NOS. (Sorry to disappoint. < g >)I think it was Colin Ross who wrote an article about the DD-NOS diagnosis, saying that there were some very distinct diagnosis in that general diagnosis that should be identified on their own. He divided NOS into different categories: one subset: all but MPD, including "co-conscious MPD". I definitely agree with him because I think less people in the institutions known for diagnosing almost everyone with a DD as DID, might be less inclined to do so, if the distinctions were written out clearly.
> > I starting to lose the effect of the oxycontin.
> That's really too bad. I'd heard of several cases where people took opioids, including oxycodone (also morphine, methadone, buprenorphine, and oxymorphone), for depression without becoming tolerant, and I'd hoped that you would have the same good luck. Maybe you could continue it on an intermittent, as-needed basis (as you had been doing with the hydro)?I have been so depressed during the last few weeks that an as-needed basis would be all the time.
That's why I'm going to start parnate next week; at least that's my plan for today.
>
> > Actually what I have now is the generic of lortab 7.5/500 and it doesn't feel nearly as strong to me.
> Huh. What was the dose in the Vicodin you were taking before? (The most favourable ratio is in Norco 10/325.)
I was taking 7.5/750 of vicodin and 10/500 lortab. Does the APAP affect the condone part? When you say most favorable ratio, do you mean because you are getting less APAP in your body or because the ratio would affect its effects on your depression?
>
> > Maybe that's because I've been taking oxycontin 10mg, bid, so 1/2 of 7.5 doesn't feel the same.
> That seems likely. Oxycodone is definitely stronger than hydrocodone.Okay, what I still don't understand is this: Isn't 10mg of oxycontin the same as 10mg of vicodin -like 10/500 of vicodin is the same only the vicodin has APAP with the codone?
And same with 10mg vicodin vs 10mg lortab-same amount of synethic codeine, right?
>Desipramine seems to be working as well as Parnate did for me, without the hypertension and insomnia and the limitations on what other medications I can use to augment it. I was pretty stunned to learn how high my serum level was (could have been a lab error but I doubt it), because I'm not really noticing many side effects.
>Elizabeth, the desipramine sounds pretty incredible for you. Around what year did desipramine come on the market?
Shelli
Posted by shelliR on August 3, 2001, at 0:15:37
In reply to drugs stuff » shelliR, posted by terra miller on August 2, 2001, at 23:21:16
>
> it's so confusing. you've got one body and one brain. and you've just got this brain that made all these compartments so you could handle everything. but you've still just got one brain and one body. i don't get how one brain could function as many brains and respond chemically different in those different "parts." it's still just one brain and one body. i can't understand it.
>
> thanks for writing -terraTerra, I don't really know what to say. I've been in the hospital with a lot of DID people and everybody's been on medication. I don't think it's really looked at as taking klonopin for "Amy" or effexor for "Diana". At least that's never been my impression. I think that by taking ADs benzos, whatever, you are basically treating the whole body for PTSD symptoms. I also look at it as the calmer I am and the less depressed I am, the easier it is for everyone else since I am definitely in charge. In cases where there are several adults, the central person may be less clear, but still I think the adults are being medicated, because our bodies are adult bodies. Anyway, that's how I see it, perhaps because the med thing hasn't felt complicated for me in that sense. More complicated in the sense of trying to control my depression when so many ADs have not worked for me.
I know that there are several DID boards on the internet; I don't know if they would be helpful because my issues right now are much more around depression. You might consider checking them out, if you haven't already.Shelli
Posted by Lorraine on August 3, 2001, at 12:28:54
In reply to Re: jumping in » Lorraine, posted by Elizabeth on August 2, 2001, at 23:47:39
> > > Interesting issue that you raised was the hypomania and I suspect that I have had that pretty regularly throughout my life. Jumping into projects with a flurry of energy, zeal and racing thoughts only to leave them half completed.
>
> That sounds to me more like ADD behaviour, actually.Well, I do have ADD like cognitive issues now clearly. But what I'm talking about above just involves a level of energy, exhilerating, and exhaltation of self that seems odd. I mean I have come to "distrust" myself when I have a sudden interest in something. My husband distrusts it also and it has become somewhat of a joke among my friends "oh, that's just Lorraine, first she reads the 30 books on the subject, then...."
>
> > After I was on Neurontin for a while, I told my pdoc that I thought that I was thinking less circularly (as in running around in circles) and that I was doing more "productive" work.
>
> That's very cool. Perhaps your problems focussing are related to anxiety or seizurelike activity. TLE often does weird things to people -- globally, not just when they have a seizure.Yeah, who knows "why" it's working--it's not clear that it matters really.
> > >That was when I'd been taking Nardil on and off and was having really bad mood swings which led my pdoc to believe I might be bipolar (the moods resembled dysphoric or mixed mania -- MAOI withdrawal is *really* hellish).
A skipped dose of Effexor did this to me and withdrawal from it was really, really awful. Is there anything to alleviate MAOI withdrawal if it comes down to that? I had no withdrawal from Moclobemide by the way or selegiline. But then the stimulants and anti-convulsants during the wash out may have just been the ticket. I'm off the Adderal now too, no withdrawal.
> > > I think I might have an acquired attention disorder secondary to depression (I did have some ADD-like traits as a child but I probably wouldn't have met the diagnostic criteria). This is really hard because being able to think clearly and focus has always been very important to me. I sure hope that it can be corrected or at least treated.
There is also something called depression induced dementia, which has a lot of cognitive impairment features as you would expect. One cool thing about my pdoc is that he really cares about cognitive impairment. So if I say that a drug is dummying me down, he'll switch it out immediately. Cognitive impairment is really awful I think especially if your life has revolved much around your intellectual activities. It must be distressing to you. My SIL--who believes that depression is all in your mind--tells me to just sit with the depression and let it take it's course and quit fighting it. I tell her it is like asking someone to just sit with Alzheimers.
> > > I got my degree (bachelor of science in math) in '97. I've been taking undergraduate classes with the goal of applying to medical school. (I didn't take organic chemistry, biology, etc. in college. Biology became a required course for the class that started after me, and I had placed out of the chemistry requirement by taking AP chemistry, but that wasn't enough to satisfy medical schools so I had to retake it.)Very cool. I'm impressed. When my daughter was entering kindergarten she said "my god, I have 13 years before I am out of school". At the time, I was getting my second graduate degree and told her that I had 23 years of education. Although, I think I'm finally burned out. I realized, for one thing, that I learn better by reading rather than listening to lectures--so I was always the student buying supplemental text books if I didn't understand a professor. And, I think the concept of memorizing is really abhorent to me right now. Perhaps it will pass. I may need a new career and education might be required.
> > > I brood about the future a lot. Anyway, I'm not really depressed right now (there's no question in my mind that the desipramine is working), just feeling anergic and having some trouble concentrating. My general mood is very much improved.
I'm very happy for you. The Desipramine seems to be a lucky ticket for you. (although i know you research it before taking it). I hope the blood levels prove ok. The ECT next step sounds right to me--plus they have that monitor that you strap on that monitors your heart for 24 hours for irregularities.
> > > She doesn't accept the idea that it's a disease, and she loathes the thought of taking medications (for some reason that I'm not quite clear on -- she knows I take them, and she has a brother who takes them too).
There is a degree of acknowledgment about mental illness and our lack of control over the disease that comes from taking a drug--plus all the stigma associated with it. My SIL believes that people who are mentally ill are self indulgent and that they take drugs as "cosmetic mood brighteners". Acknowledging mental illness comes with a lot of baggage in this society.
>
> Hmm. Well, [trying atenolol] might be worth it if the autonomic activation causes you too much discomfort.I'll keep it in mind
> > > A shame spiral for me was a hole that I would fall in precipitously whenever my old shame injury got bumped up against in the normal day to day living. >
> Ahh, I can understand that. (Can I ask whence the scars? I don't think I've seen you mention that before.)3d degree burns over 1/3 of my body (thighs and upper abdomine) when I was 8.
> > > My dad's a professor (both my parents are) -- his field is philosophy and history of science. It's not light reading. < g >
Doesn't sound like it, but it does sound like it is right up my husband's alley. He loves this stuff.
> > > I was 15 or 16. It is awful because it is a breach of trust between a parent and child, but the abuse was pretty mild.
>
> Small comfort. Still, it's probably less damaging if it happened when you were older.Yes, and it was mild, I don't believe he ever touched me. It was all about his self-pleasuring really.
> You think so? Hmm. I don't know too much about dystonias, but that doesn't sound like any one that I've heard about.certainly not the familial dystonia, which is incapacitating. I don't know--I've just read a lot about "muscle" tension and cramps being associated with meds. I get muscle cramps depending on my meds also. My muscle strength (during workouts) varies remarkably depending on my meds.
>
> > > FWIW, the time that I was first diagnosed with depression (when I was 14), I was having very bad headaches. Prozac did away with them, so I have to credit it for that, at least.Some vascular relaxation thing or muscle relaxant type of action maybe.
> > > It isn't medication induced -- it's been a chronic thing (started in fall '95), and there is a mechanical problem that probably contributes to it (local steroid injection made it go away for about a week). Nardil did make it go away (so does buprenorphine, of course). Soma works sometimes, but it's not as reliable. It also waxes and wanes in intensity. There are probably multiple factors contributing. But anyway, the fact that centrally acting drugs sometimes alleviate pain doesn't necessarily mean that the pain is "psychogenic." I did track my back pain for a while but couldn't find any correlations other than that it went away completely when I was taking Nardil.
Interesting take on the issue. That the meds medicate a physiological problem. My chiropractor always said my back aches were mechanical in nature. But my experience seems to prove otherwise. I guess the chicken and the egg question (do the med alleviate the symptoms or cause them) becomes apparent when you are off meds entirely. I haven't really tried this (for obvious reasons)< g >
> > > Desoxyn, you mean? That's cool that your pdoc was willing to consider it. I think most of them shy away because of its reputation.
Yeah, I'm pretty high on him right now because of his ability to think outside the box--the fact that he let me do the 3 day wash out between MAOIs, that he was willing to try Moclobemide by writing rxs for a Canadian Pharmacy and the fact that he is willing to try meds fairly aggressively has me feeling pretty good about him right now.
> > > I took Cylert for a while in college. It was pretty helpful. Unfortunately it's been "black-boxed" -- the labelling contains a big, conspicuous warning at the top about potential hepatotoxicity -- so doctors have been less willing to prescribe it.
Yeah, I know. By the way, do you have Jensen's book--I find it really useful.
>
> [re your son]
> > He has a learning disability (dyslexia) and possibly undiagnosed ADD sort of stuff.
>
> I think that a lot of different childhood disorders all get lumped together as "ADD."True. Amen identifies 6 types of ADD, but I think some of these are not ADD truly.
> > I've thought of having him formally evaluated, but my therapist feels it's not necessary. (and, in truth, i would be soooo reluctant to medicate a teen in part because they don't have a sexual identity or knowledge so if a med affects their sexuality they will just assume that that is "who they are"
>
> May I offer a counterexample? I was 14 when I started taking Prozac, and while Prozac didn't cause me much difficulty, I most definitely did have a sexual identity by that age.
>
elizabeth, this is really very helpful to me to hear. also, i suppose there's the point of developing an identity and coping skills of someone who is depressed as opposed to healthy?
> > > My niece is 15 and was diagnosed OCD and put on Luvox. I think it was necessary for her to be medicated, but I do worry--especially about her sexuality given the side effects of SSRIs generally.
>
> Is she doing CBT too? That's supposedly very effective for OCD.No, she's not doing CBT. I've suggested it, but the logistics have been unmanagable because her mother (who had lost control over her completely) sent her to live with her father (who is more structured in his discipline approach) and to a smaller school (10 kids per class). She completely flunked out of 8th grade, 3 F's and 2 D's (in drill team and PE). So the problem had become an emergency.
Good luck on the Desipramine retest.Lorraine
Posted by terra miller on August 3, 2001, at 13:22:11
In reply to Re: drugs stuff » terra miller, posted by shelliR on August 3, 2001, at 0:15:37
>I don't think it's really looked at as taking klonopin for "Amy" or effexor for "Diana".
actually, that's really what it is like believe it or not. theoretically, it could be that if you hit upon the right med it "works for everybody." i think plenty of people with DID are on meds (for anxiety issues or depression issues) as an attempt to cope. but i suppose if you sat down with one person/body with DID, if that were possible in a perfect scenerio, you would get different opinions of how meds effect different parts. it's truly frustrating. but that's just the way it is.
>I think that by taking ADs benzos, whatever, you are basically treating the whole body for PTSD symptoms.
i agree. it becomes complicated when not "all of you" has PTSD symptoms; then those "parts" tend to just be 'brought along for the ride' or at worst can get very drugged up (because they don't have any of those symptoms). personally, i am struggling to find a way to use a benzo for anxiety because i can't seem to get it to work at the right time for the right part who needs it. long story. but true.
>I also look at it as the calmer I am and the less depressed I am, the easier it is for everyone else since I am definitely in charge.
that is a perfect way to look at it. *S* and you are fortunate in that you know that you are definitely in charge.
>In cases where there are several adults, the central person may be less clearuh huh
>but still I think the adults are being medicated, because our bodies are adult bodies.
that is a very good point. i forget sometimes what size this body is. (sometimes making those kinds of comments to me is just plain hilarious. it's better to laugh than to despair. *g*)
> I know that there are several DID boards on the internet
yeah. i've done some good reading and interacting over the years. i always like to ask questions because you never know when you will hit on a piece of information that will take you further along in understanding. the uniqueness of this board is its origination from the medication perspective. that's what makes my questions about medication more specific. however, the fact that understanding DID is still not very mainstream yet or at best still theoretical-textbook driven as opposed to actual practical clinical experience, i've found there still seem to be few answers to my questions. perhaps over time this will change. i hope that it does. guess that's also why i still choose to communicate my questions, because my words might educate or help others in my similar situation to not feel so alone- this is a very lonely dx because it is not very understood still.
thanks for listening. i went on a rambling-spree just now. *g*
-terra
Posted by Elizabeth on August 3, 2001, at 15:12:14
In reply to Re: stuff » Elizabeth, posted by shelliR on August 2, 2001, at 23:49:33
> I think it was Colin Ross who wrote an article about the DD-NOS diagnosis, saying that there were some very distinct diagnosis in that general diagnosis that should be identified on their own. He divided NOS into different categories: one subset: all but MPD, including "co-conscious MPD".
I can see the utility of that. I think I've encountered other people who are co-conscious, like you are. Was there ever a time when you weren't co-conscious? Because I think that the only cases of this version of DDNOS that I've heard of have been the result of people achieving co-consciousness through therapy, so it could be considered "DID in partial remission."
> I definitely agree with him because I think less people in the institutions known for diagnosing almost everyone with a DD as DID, might be less inclined to do so, if the distinctions were written out clearly.
Yes, that's a good point.
> I have been so depressed during the last few weeks that an as-needed basis would be all the time.
> That's why I'm going to start parnate next week; at least that's my plan for today.Good luck to you. I think that brief-acting drugs (opioids, stimulants) probably are best used with an antidepressant in the background, so to speak. I'm definitely doing much better on buprenorphine and desipramine than I was on buprenorphine alone or desipramine alone (I stopped the buprenorphine for a short time when I first started taking the DMI).
> I was taking 7.5/750 of vicodin and 10/500 lortab. Does the APAP affect the condone part?
No, there are all sorts of combinations. 7.5/750 is Vicodin ES (extra strength), I believe, and plain old Vicodin is 5/500.
> When you say most favorable ratio, do you mean because you are getting less APAP in your body or because the ratio would affect its effects on your depression?
Less APAP, that's all. The APAP is not helpful for depression; it only serves to tax your liver.
> Okay, what I still don't understand is this: Isn't 10mg of oxycontin the same as 10mg of vicodin -like 10/500 of vicodin is the same only the vicodin has APAP with the codone?
That's debatable. Some people think oxycodone and hydrocodone are equianalgesic, some think oxycodone is superior.
> And same with 10mg vicodin vs 10mg lortab-same amount of synethic codeine, right?
Hydrocodone isn't codeine, it's a semisynthetic opiate derived from codeine. But yes, the 10 mg is the amount of hydrocodone in the pill.
> Elizabeth, the desipramine sounds pretty incredible for you. Around what year did desipramine come on the market?
Early 1960's, I would think. It's just the primary active metabolite of imipramine, the first TCA. I appear to be a "slow hydroxylator" (meaning, in particular, that I don't metabolise TCAs properly), which might explain why I never was able to tolerate other TCAs (amoxapine, nortriptyline) past 75 mg.
Desipramine isn't a perfect success, but it does seem to be a suitable substitute for Parnate (with less hassle involved).
-elizabeth
Posted by Elizabeth on August 3, 2001, at 17:10:52
In reply to Re: jumping in » Elizabeth, posted by Lorraine on August 3, 2001, at 12:28:54
Hi Lorraine.
> Well, I do have ADD like cognitive issues now clearly.
I think I mentioned that I believe it's possible for ADD (or something similar) to manifest in adulthood, perhaps secondary to depression. I know that I've become more mentally disorganised.
> But what I'm talking about above just involves a level of energy, exhilerating, and exhaltation of self that seems odd. I mean I have come to "distrust" myself when I have a sudden interest in something. My husband distrusts it also and it has become somewhat of a joke among my friends "oh, that's just Lorraine, first she reads the 30 books on the subject, then...."
My suggestion: cherish your zeal and nurture it. It's precious.
> Yeah, who knows "why" it's working--it's not clear that it matters really.
I think it's important to research the reasons why drugs work as they do, but it's not necessary to know that for purposes of treating your difficulties. FWIW, when I tried Neurontin, the feeling reminded me of Xanax.
> A skipped dose of Effexor did this to me and withdrawal from it was really, really awful. Is there anything to alleviate MAOI withdrawal if it comes down to that?
I've found that benzos work well; not sure about non-benzodiazepine anticonvulsants. Psychostimulants might help also.
> There is also something called depression induced dementia, which has a lot of cognitive impairment features as you would expect.
Yes, I've heard of it. It's believed to be reversible, unlike degenerative dementias (e.g., Alzheimer's). Sometimes it's called "pseudodementia." It is sort of controversial whether it's completely a product of depression, although cognitive impairment is recognised as a sequela of depression; some believe that "depressive dementia" is the result of comorbid depression and dementia, not dementia as a result of depression.
> One cool thing about my pdoc is that he really cares about cognitive impairment.
My experience has been that they usually understand how important cognitive functioning is for me when I tell them I want to go to medical school. < g >
> Cognitive impairment is really awful I think especially if your life has revolved much around your intellectual activities. It must be distressing to you.
Very much so, yes.
> My SIL--who believes that depression is all in your mind--tells me to just sit with the depression and let it take it's course and quit fighting it. I tell her it is like asking someone to just sit with Alzheimers.
*groan* Yeah, a lot of people who've never been depressed [clinically, that is] seem to think they understand what we go through, even though it's obvious to us that they don't have a clue.
> I realized, for one thing, that I learn better by reading rather than listening to lectures--so I was always the student buying supplemental text books if I didn't understand a professor.
That's interesting. I learn better from lectures than from reading, I think. I wonder whether this difference has any broader significance.
> I'm very happy for you. The Desipramine seems to be a lucky ticket for you. (although i know you research it before taking it). I hope the blood levels prove ok.
The serum level was over 600 this time, so I'm cutting the dose in half. The doctor who's covering for my pdoc is supposedly going to call me on Monday to discuss what to do next.
> The ECT next step sounds right to me--plus they have that monitor that you strap on that monitors your heart for 24 hours for irregularities.
Okay, I'm confused now. What are you talking about here? (Sorry, I'm probably just being scatterbrained, as usual.)
> There is a degree of acknowledgment about mental illness and our lack of control over the disease that comes from taking a drug--plus all the stigma associated with it. My SIL believes that people who are mentally ill are self indulgent and that they take drugs as "cosmetic mood brighteners".
Oh jeez. That's just awful. I suppose she's never had a conversation with a homeless person before. Who's she to make that kind of judgement?
I've met a lot of people who have a hard time understanding or believing that I could ever have been very depressed, because when I'm not depressed I'm outgoing, inquisitive, etc.
About atenolol: my dad takes it (for cardiovascular disease), and he seems to be fine with it. I could ask him if he's noticed any side effects. (He takes a bunch of other things too -- hypertension is very complicated to treat -- so it might be hard to sort out what's doing what.)
> > Ahh, I can understand that. (Can I ask whence the scars? I don't think I've seen you mention that before.)
>
> 3d degree burns over 1/3 of my body (thighs and upper abdomine) when I was 8.My god. At least it's on parts that are usually covered by clothes. Still, I can see how that would cause you problems, especially with intimate relationships.
> > > > My dad's a professor (both my parents are) -- his field is philosophy and history of science. It's not light reading. < g >
>
> Doesn't sound like it, but it does sound like it is right up my husband's alley. He loves this stuff.Really? What particular interests does he have?
> > Small comfort. Still, it's probably less damaging if it happened when you were older.
>
> Yes, and it was mild, I don't believe he ever touched me. It was all about his self-pleasuring really.I'm a little confused by this remark, but if you don't feel comfortable I won't demand elaboration.
> certainly not the familial dystonia, which is incapacitating. I don't know--I've just read a lot about "muscle" tension and cramps being associated with meds. I get muscle cramps depending on my meds also. My muscle strength (during workouts) varies remarkably depending on my meds.Huh. Which meds have had which effects in that regard?
> > FWIW, the time that I was first diagnosed with depression (when I was 14), I was having very bad headaches. Prozac did away with them, so I have to credit it for that, at least.
>
> Some vascular relaxation thing or muscle relaxant type of action maybe.No idea what the cause was. Depression and pain syndromes often co-occur, though. It was very obvious to me that the Prozac was responsible for the headaches going away -- although I'm less certain that it actually caused my depression to remit!
> Interesting take on the issue. That the meds medicate a physiological problem.
Well, they have peripheral effects as well as central ones. And chronic pain is probably centrally mediated, I think.
> My chiropractor always said my back aches were mechanical in nature.
I'm dubious (of vague "diagnoses" made by chiropractors, that is). Did you ever get a more precise explanation?
> But my experience seems to prove otherwise. I guess the chicken and the egg question (do the med alleviate the symptoms or cause them) becomes apparent when you are off meds entirely. I haven't really tried this (for obvious reasons) < g >
I had the misfortune to be off antidepressants completely for several months after Nardil pooped out the second time. It was rough. I tried Paxil, selegiline, and Neurontin during that time, but they didn't really help.
> Yeah, I'm pretty high on him right now because of his ability to think outside the box--the fact that he let me do the 3 day wash out between MAOIs, that he was willing to try Moclobemide by writing rxs for a Canadian Pharmacy and the fact that he is willing to try meds fairly aggressively has me feeling pretty good about him right now.
Those are good traits for a pdoc, IMO.
> Yeah, I know. By the way, do you have Jensen's book--I find it really useful.
Jensen...which one is he? (No, I don't have his book.)
> > I think that a lot of different childhood disorders all get lumped together as "ADD."
>
> True. Amen identifies 6 types of ADD, but I think some of these are not ADD truly.Probably not. I perused his web site; neat stuff. I've been thinking about calling him up and asking if he can refer me to somebody closer to home who could interpret my SPECT scan.
> > May I offer a counterexample? I was 14 when I started taking Prozac, and while Prozac didn't cause me much difficulty, I most definitely did have a sexual identity by that age.
>
> elizabeth, this is really very helpful to me to hear.Good, I'm always gratified if I feel I've been able to help someone.
> also, i suppose there's the point of developing an identity and coping skills of someone who is depressed as opposed to healthy?
I think this really sums it up nicely, yes.
> No, she's not doing CBT. I've suggested it, but the logistics have been unmanagable because her mother (who had lost control over her completely) sent her to live with her father (who is more structured in his discipline approach) and to a smaller school (10 kids per class). She completely flunked out of 8th grade, 3 F's and 2 D's (in drill team and PE). So the problem had become an emergency.
Sure, she needs medication. But that doesn't preclude the possibility of CBT.
> Good luck on the Desipramine retest.
Sorry to disappointn, but as I mentioned earlier, I'm afraid I wasn't lucky. I guess one could say I failed the test. :)
-elizabeth
Posted by shelliR on August 3, 2001, at 18:28:03
In reply to Re: jumping in » Lorraine, posted by Elizabeth on August 3, 2001, at 17:10:52
Hi Lorraine, Elizabeth, et. al.
>
> > My SIL--who believes that depression is all in your mind--tells me to just sit with the depression and let it take it's course and quit fighting it. I tell her it is like asking someone to just sit with Alzheimers.
>
> *groan* Yeah, a lot of people who've never been depressed [clinically, that is] seem to think they understand what we go through, even though it's obvious to us that they don't have a clue.It's interesting, my sister just told me recently that my SIL thinks that I don't try hard enough to overcome my depression. This is actually fascinating to me. I dislike my brother and sil enough to never get together with them unless it is an occasion surrounding my parents, e.g. special birthday, anniversary. I don't live near my family, so this is not a major problem, although it does upset my parents. Anyway, I've never discussed my depression with her and I run a business full time, so I feel almost a sense of disbelief that she would have any opinions about me that have nothing to do with our relationship, let alone my depression. Actually she was at a wedding in her city seated with some people from my city, and they had heard of me, and my work and one of their friends was a client of mine here. So she knows I am well known in my profession. Try harder? I don't even know what she could mean. It is amazing how ignorant people can be, although I find my SIL pretty ignorant and unkind anyway, so I chalk it off to that. If someone I cared about ever thought that about me, it would hurt me really badly.
>
> > I'm very happy for you. The Desipramine seems to be a lucky ticket for you. (although i know you research it before taking it). I hope the blood levels prove ok.
> The serum level was over 600 this time, so I'm cutting the dose in half. The doctor who's covering for my pdoc is supposedly going to call me on Monday to discuss what to do next.Elizabeth, what is would be affected by having too high a blood level. Could it affect your organs? Like liver damage, etc.?
>
> > The ECT next step sounds right to me--plus they have that monitor that you strap on that monitors your heart for 24 hours for irregularities.
>
> Okay, I'm confused now. What are you talking about here? (Sorry, I'm probably just being scatterbrained, as usual.)
Lorraine, I'm confused also because I've never known you were considering ECT. You would try ETC before nardil or buph?
Wow, I really hope parnate is it for you.> > 3d degree burns over 1/3 of my body (thighs and upper abdomine) when I was 8.
> My god. At least it's on parts that are usually covered by clothes. Still, I can see how that would cause you problems, especially with intimate relationships.
Did you go through lots of skin grafts or was there really not enough skin to take from anywhere? How long til your life got back to some type of stability after the fire?
>
>BTW, in regard to back pain and meds, selegiline gave me back pain, really shoulder pain almost from the start, although I didn't think to associate it with it until I started to get bad pains in my legs. When I went off of it, both the shoulder pain and leg pain went away.
Shelli
Posted by shelliR on August 3, 2001, at 22:41:01
In reply to Re: stuff » shelliR, posted by Elizabeth on August 3, 2001, at 15:12:14
>
> I can see the utility of that. I think I've encountered other people who are co-conscious, like you are. Was there ever a time when you weren't co-conscious? Because I think that the only cases of this version of DDNOS that I've heard of have been the result of people achieving co-consciousness through therapy, so it could be considered "DID in partial remission."Once I knew I had kids inside, as each one let her presence be known, I was always co-conscious. This is also true for several other people I have met in the hospital or at a support group that I was part of for several years. So no, "DID in partial remisison" would not work for us. One of the hardest things for me was the awareness of a second child. I was so confused that I didn't even realize that it was a different child; I thought that the other one was just acting really different. So then when I realized, I was scared that I wouldn't know which child was talking to me. And that does happen, and sometimes I have to ask. Now it doesn't seem like a big deal, but then I was in a total panic about it. Also child one was not happy to share me, actually pretty scared that I might forget about her.
And I have a child who looked like the elephant man when I looked at her in my mind for the first time (I never really thought much about how they look--just normal) So when my therapist asked me and that's what I saw I totally flipped, I felt so awful and I dissociated this personality into two distinct personalities--it was very strange and I've been working with this child for a long time to get her to feel okay, since I totally screwed up.
Lorraine, perhaps you can identify in terms of embracing your eight year old.
> Good luck to you. I think that brief-acting drugs (opioids, stimulants) probably are best used with an antidepressant in the background, so to speak. I'm definitely doing much better on buprenorphine and desipramine than I was on buprenorphine alone or desipramine alone (I stopped the buprenorphine for a short time when I first started taking the DMI).
>Thanks. Today was a pretty good day and I didn't supplement the oxy. And the plan was always to have an AD in there also, because the AD I was stopping was prozac, I had a long waiting period. Monday is five weeks.
>
> Early 1960's, I would think. It's just the primary active metabolite of imipramine, the first TCA. I appear to be a "slow hydroxylator" (meaning, in particular, that I don't metabolise TCAs properly), which might explain why I never was able to tolerate other TCAs (amoxapine, nortriptyline) past 75 mg.
>
> Desipramine isn't a perfect success, but it does seem to be a suitable substitute for Parnate (with less hassle involved).
>
and it gives you more options for adjuncts. Have you ever tried buprenorphine in pill form , sub-what-ever?Later, Shelli
Posted by Lorraine on August 4, 2001, at 13:46:56
In reply to Re: jumping in » Lorraine, posted by Elizabeth on August 3, 2001, at 17:10:52
Hi elizabeth:
> > > I think I mentioned that I believe it's possible for ADD (or something similar) to manifest in adulthood, perhaps secondary to depression.I don't think it is important that it be an official diagnosis, only that the symptoms be treated.
> > > My suggestion: cherish your zeal and nurture it. It's precious.You're right.
> > >FWIW, when I tried Neurontin, the feeling reminded me of Xanax.
Well, it is anti-anxiety in its effect, although more gentle and less sudden in its effects. I hated Xanax--it made me feel very druggy, but then I was probably on the wrong dose and didn't know enough at the time to experiment with it.
[re MAOI withdrawal] > > > I've found that benzos work well; not sure about non-benzodiazepine anticonvulsants. Psychostimulants might help also.So that's the parachute then; Adderal, Neurontin and Ativan as needed. Good--it's nice to know the escape route.
> > > I realized, for one thing, that I learn better by reading rather than listening to lectures--so I was always the student buying supplemental text books if I didn't understand a professor.
>
> That's interesting. I learn better from lectures than from reading, I think. I wonder whether this difference has any broader significance.I think this ends up being an important piece of information. You might find yourself, then, taping lectures in difficult classes to relisten to whereas I'd buy another text book that approached the subject from a different angle.
> > > The serum level was over 600 this time, so I'm cutting the dose in half. The doctor who's covering for my pdoc is supposedly going to call me on Monday to discuss what to do next.What is the serum level supposed to be? Cutting it in half--isn't that drastic?
> > > The ECT next step sounds right to me--plus they have that monitor that you strap on that monitors your heart for 24 hours for irregularities.
>
> Okay, I'm confused now. What are you talking about here? (Sorry, I'm probably just being scatterbrained, as usual.)You had said that if your blood levels were high an ECT was the next logical step--I presume this is because TCAs have the heart related side effects. My husband had an abnormal heart beat (skipped a beat occassionally) and they strapped a device to him for 24 hours to see how the heart rate fluctuated over that period. It is a more complete test than an ECT because it spans more time. That was my thought.
> > >My SIL believes that people who are mentally ill are self indulgent and that they take drugs as "cosmetic mood brighteners".
>
> Oh jeez. That's just awful. I suppose she's never had a conversation with a homeless person before.
Who's she to make that kind of judgement?Yeah, but my task is to not allow her opinion on these things to get to me. It's a tough job.
>
> > > I've met a lot of people who have a hard time understanding or believing that I could ever have been very depressed, because when I'm not depressed I'm outgoing, inquisitive, etc.This is the problem with invisible chronic diseases. My SIL sees me and I'm fine. See doesn't see, nor would I allow her to see the down times. It's like energy management in a way. I can store it up for special occassions, like family visits, then I collapse afterward--as though my energy supply was depleted.
>
> About atenolol: my dad takes it (for cardiovascular disease), and he seems to be fine with it. I could ask him if he's noticed any side effects.Don't bother (although it is a nice suggestion). If it becomes necessary, I'll simply try it.
> > > 3d degree burns over 1/3 of my body (thighs and upper abdomine) when I was 8.
>
> My god. At least it's on parts that are usually covered by clothes. Still, I can see how that would cause you problems, especially with intimate relationships.When I was young, I thought I would never marry and so forth. I felt compelled to disclose my scars before I was intimate. Then I came into my own sexually and the boys didn't notice or make a big deal about it. The harder part was when I was a kid, changing for PE and so forth. We moved a lot (7 times in 5 years) so the anticipatory pain of making this "disclosure" was always with me.
>
> > >
> > > Really? What particular interests does [your husband] have?He majored in linguistics and went on to become an attorney. But his private time reading is always math and science. In high school, he thought he was headed for a career in math and science. Then he went to Harvard and found his "excellence" was mediocre in the new pool of peers. It's still part of his passion though. That and history.
>
> [re: mild sexual abuse elaboration}My father used to masturbate in front of me and take pictures of me in sexy nightgowns. Pretty strange--I was paralyzed, unable to move to leave the room (although I'm sure I could)--it was one of those "elephants" in the room that we ignored politely and then, of course, there was the issue of my complicity--but then I think there frequently is in these situations. That's why I refer to it as "mild" and it's also why it probably didn't have much impact on my own sexuality. Years later when my father was dying of lung cancer when I would visit him alone, he would tell me sexually lurid stories. It got to the point where I couldn't visit him alone and it was hard to visit him otherwise. My husband visited him nearly every day for me.
>
> > > My muscle strength (during workouts) varies remarkably depending on my meds.
>
> Huh. Which meds have had which effects in that regard?Well, for instance, the Propanolol made me weak, the Moclobemide gave me muscle cramps in my feet and legs, and the Parnate and Selegiline make me strong.
[re your headaches and Prozac]
Your headaches were not migraines (which are related to seizure activity)?> > > I had the misfortune to be off antidepressants completely for several months after Nardil pooped out the second time.
I had the stupidity to be off ADs for about a year trying SamE and so forth.
> > > Yeah, I know. By the way, do you have Jensen's book--I find it really useful.
>
> Jensen...which one is he? (No, I don't have his book.)Martin Jensen. His book is an informal self-published deal. He gets a lot of criticism for his approach which is basically to "trial" you through many meds very quickly and some people feel his treatment of the science behind mental illness is sloppy. But the book is great for a quick concise run down of the meds, there side effects, the probability of success with certain meds and so forth. You will be happy to note that he does include opiates. I refer to his book a lot as sort of a handbook for where I am because he lists the stimulants and so forth with worksheets as to what has been tried and the effects. His phone number (to order the book) is 949-363-2600.
> > > True. Amen identifies 6 types of ADD, but I think some of these are not ADD truly.
>
> Probably not. I perused his web site; neat stuff. I've been thinking about calling him up and asking if he can refer me to somebody closer to home who could interpret my SPECT scan.Yeah, I have read both of his books and looked at his website. What about his "ring of fire" ADD, don't you think that is something else?
> > >I guess one could say I failed the test. :)
I'm so sorry to hear this. So you are past the therapuetic dose range and still not in remission? If you have to back off, you could try adding an MAO, correct? Tough timing too with your pdoc being out of town. Did you guys formulate a game plan for this contingency before he left for vacation?
Lorraine
Posted by Lorraine on August 4, 2001, at 14:12:50
In reply to Re: jumping in Elizabeth, Lorriane, et.al., posted by shelliR on August 3, 2001, at 18:28:03
Hi Shelli, elizabeth et al:
> > > It's interesting, my sister just told me recently that my SIL thinks that I don't try hard enough to overcome my depression. ....Try harder? I don't even know what she could mean. It is amazing how ignorant people can be, although I find my SIL pretty ignorant and unkind anyway, so I chalk it off to that.
I think that some people know that they are better than you because you are "less than" them and they find things to support this view. Your achilles heel is ripe pickings. I do think the trick is to not internalize and obsess over this stuff. You sound fairly balanced about it. I have really tried to change her opinion by educating her--but nothing changes and there I am with a cup in my hand asking for her approval. Not a good dynamic and one I have to back off from. It's hard though because we used to be close. I used to refer to her as the sister I never had.
> > > [re: we are all so confused]
OK. I thought ECT was ECG that should help clear things up a bit. I knew that the risk side effect profile of TCAs was heart related and so I just misread ECT for ECG. elizabeth is the one considering ECT, not me, I have many roads to walk before I am there. Although, now that I get it, elizabeth don't you have augmentation strategies to consider with a reduced dose of Desipramine?>
> > > Did you go through lots of skin grafts or was there really not enough skin to take from anywhere? How long til your life got back to some type of stability after the fire?
My mom told me I could have skin grafts, I refused. I was 8 and in a lot of pain, I just wanted the pain to end. The alternative to skin grafts, by the way, is not pleasant--it involves wet soaking bandages and stripping them off along with dead (and, the painful part, not so dead) skin until the wound heals. I was back in school probably 8-10 weeks after the fire, but with bandages on. I was placed in a class for people who were handicapped, which didn't help me self-esteem. Then my family for unrelated reasons (and, no we were not in the military) started moving a lot (7 times in 5 years) so no stability, no community, no or few friends. It was a pretty rough 5 years and I did suffer a break down during that period.
> > > > BTW, in regard to back pain and meds, selegiline gave me back pain, really shoulder pain almost from the start, although I didn't think to associate it with it until I started to get bad pains in my legs. When I went off of it, both the shoulder pain and leg pain went away.
I think it's common. Day 5 Parnate. Still ok, not full mood support yet. Mild hyperventilation.
Lorraine
Posted by Lorraine on August 4, 2001, at 14:47:25
In reply to Re: stuff, posted by shelliR on August 3, 2001, at 22:41:01
> >
> > >One of the hardest things for me was the awareness of a second child. ...And I have a child who looked like the elephant man when I looked at her in my mind for the first time (I never really thought much about how they look--just normal) So when my therapist asked me and that's what I saw I totally flipped, I felt so awful and I dissociated this personality into two distinct personalities--it was very strange and I've been working with this child for a long time to get her to feel okay, since I totally screwed up.
>
> Lorraine, perhaps you can identify in terms of embracing your eight year old.Oh, yes, (Lorraine, here) this inner child of mine was so needy and clingy and weepy and weak and sad, I just couldn't stand it. It took me a long time before I realized that my job as the adult was to protect her and that I could do that and then just to open the pipeline and acknowledge that part of myself.
> > >the ADI was stopping was prozac, I had a long waiting period. Monday is five weeks.(L, here) Don't you just hate that? I could have killed my pdoc when I realized the wash out period for Prozac. They ought to tell you up front.
Posted by Elizabeth on August 4, 2001, at 15:33:57
In reply to Re: jumping in Elizabeth, Lorriane, et.al., posted by shelliR on August 3, 2001, at 18:28:03
> It's interesting, my sister just told me recently that my SIL thinks that I don't try hard enough to overcome my depression. This is actually fascinating to me.
"Fascinating" is not the word I'd use to describe it!
It sounds like your sister-in-law is a judgmental person in general. A lot of people are like that: they have strong opinions on subjects that they know nothing about.
> Elizabeth, what is would be affected by having too high a blood level. Could it affect your organs? Like liver damage, etc.?
The main risk is cardiotoxicity, actually. The heart has to be working like clockwork, and if it gets out of sync even a little bit, you can get major problems. An ECG would find any such problems, though.
I sort of feel sorry for the poor guy who's covering for my pdoc, having to deal with all this stuff!
I agree with you about ECT: I think that any medication is preferable to it. Even if you developed tolerance and had to keep increasing the dose, I would say that opioids are safer than ECT, except perhaps for people who have addictive tendencies. And even then, with proper monitoring I believe it can be done safely. (The first thing you become tolerant to is the respiratory depression, so increasing the dose to compensate for tolerance is safe -- you can't do this safely with some other types of drugs, such as barbiturates.)
> BTW, in regard to back pain and meds, selegiline gave me back pain, really shoulder pain almost from the start, although I didn't think to associate it with it until I started to get bad pains in my legs. When I went off of it, both the shoulder pain and leg pain went away.
I wonder about this sort of thing; do you think it might be related to the amphetamine metabolites of selegiline? (They're the l- enantiomers, and they have more peripheral and less central effect compared with d-amphetamine and d-methamphetamine (Dexedrine and Desoxyn).)
Buprenorphine does away with my back pain completely, and unlike other things I've tried (Valium, Soma, Ultram), it works reliably. It's also much less expensive than having a facet block every week would be. :-)
> Once I knew I had kids inside, as each one let her presence be known, I was always co-conscious.
Did you have periods of lost time before that?
> So no, "DID in partial remisison" would not work for us.
Damn. :-)
> Today was a pretty good day and I didn't supplement the oxy. And the plan was always to have an AD in there also, because the AD I was stopping was prozac, I had a long waiting period. Monday is five weeks.
Ahh. That's the main down side of Prozac, IMO: the long washout period. I definitely think that opioids are usually best used in combination with antidepressants rather than by themselves; short-acting drugs (such as opioids and stimulants) can be destabilising, and an AD can smooth things out.
> > Desipramine isn't a perfect success, but it does seem to be a suitable substitute for Parnate (with less hassle involved).
>
> and it gives you more options for adjuncts.Yes. I'm particularly interested in seeing whether psychostimulants would help me, since Cylert worked in the past and since I have ongoing attention problems.
> Have you ever tried buprenorphine in pill form , sub-what-ever?
Subutex and Temgesic are the brand names that I'm aware of. No, I've never tried getting medication from outside the U.S.
-elizabeth
Posted by Elizabeth on August 4, 2001, at 23:06:40
In reply to Re: jumping in » Elizabeth, posted by Lorraine on August 4, 2001, at 13:46:56
[re ADHD]
> I don't think it is important that it be an official diagnosis, only that the symptoms be treated.Yes; but in order for them to get treated, they generally must first be recognised! I don't think most pdocs would be willing to diagnose "adult-onset ADD," but they should be willing to consider the possibility that ADD-like symptoms associated with depression and/or anxiety might be treatable with the same medications that work for ADD (i.e., stimulants).
> > > >FWIW, when I tried Neurontin, the feeling reminded me of Xanax.
>
> Well, it is anti-anxiety in its effect, although more gentle and less sudden in its effects. I hated Xanax--it made me feel very druggy, but then I was probably on the wrong dose and didn't know enough at the time to experiment with it.That's too bad. I've found Xanax to be one of the more convenient benzos for my purposes: it works fast enough that I can use it to fend off a panic attack, and it's not too sedating or impairing for me, so I can take the high-end dose that I usually need (2 mg) without getting totally zonked.
> [re MAOI withdrawal]
> So that's the parachute then; Adderal, Neurontin and Ativan as needed. Good--it's nice to know the escape route.Heh. Yeah, I can see why stimulants would be effective, although I've never tried using them for that purpose myself.
> I think this ends up being an important piece of information. You might find yourself, then, taping lectures in difficult classes to relisten to whereas I'd buy another text book that approached the subject from a different angle.
I've tried taping lectures. It doesn't work for me. I just take copious notes and use the text as a reference rather than as my primary source of information.
> What is the serum level supposed to be? Cutting it in half--isn't that drastic?
Generally accepted therapeutic serum leves for desipramine range from about 125-300 ng/mL. Yes, cutting the dose in half is drastic, but the doctor covering for my pdoc wanted me to stop taking it altogether (to which I said "no way!").
> You had said that if your blood levels were high an ECT was the next logical step
No, I said *ECG*, not ECT! An electrocardiogram, to determine if the high desipramine levels are causing cardiotoxicity.
> This is the problem with invisible chronic diseases. My SIL sees me and I'm fine. See doesn't see, nor would I allow her to see the down times.
Heh. I'm like that: if I'm depressed, I just disappear. I don't find attention or "support" to be useful when I'm depressed (unless it's something concrete like making sure that I don't get dehydrated), so what's the point of seeking people out?
> It's like energy management in a way. I can store it up for special occassions, like family visits, then I collapse afterward--as though my energy supply was depleted.
I do a very poor job of faking it when I try to.
> When I was young, I thought I would never marry and so forth.
I had similarly fatalistic ideas when I was a child; like, I was convinced I wouldn't live past 30.
> He majored in linguistics and went on to become an attorney. But his private time reading is always math and science. In high school, he thought he was headed for a career in math and science. Then he went to Harvard and found his "excellence" was mediocre in the new pool of peers. It's still part of his passion though. That and history.
Harvard, huh? That's kind of funny to me because I've found most Harvard undergrads to be of pretty mediocre intelligence. (Although my dad and my brother went there, so I guess they aren't all bad. :-) ) I took a few science courses there when I decided to go pre-med after I'd already graduated (in case it's not obvious by now, I went to MIT < g >), and I found them really trivial compared to the science and engineering classes I'd taken as an undergrad (even the introductory-level ones).
So, what kind of law does your husband practise? I think it's always useful to have a lawyer as a relative or friend. Plus, I've always found the lawyers I've met to be interesting people to talk to.
> My father used to masturbate in front of me and take pictures of me in sexy nightgowns. Pretty strange--I was paralyzed, unable to move to leave the room (although I'm sure I could)--it was one of those "elephants" in the room that we ignored politely and then, of course, there was the issue of my complicity--but then I think there frequently is in these situations. That's why I refer to it as "mild" and it's also why it probably didn't have much impact on my own sexuality. Years later when my father was dying of lung cancer when I would visit him alone, he would tell me sexually lurid stories. It got to the point where I couldn't visit him alone and it was hard to visit him otherwise. My husband visited him nearly every day for me.
That sounds pretty bad to me; I mean, it could have been worse, but being exposed to that kind of stuff as a child -- it can't be good for you. Did you experience any sort of closure when he died? That must have been hard; I would think that you'd have really mixed emotions about it.
> Well, for instance, the Propanolol made me weak, the Moclobemide gave me muscle cramps in my feet and legs, and the Parnate and Selegiline make me strong.
Propranolol doesn't exert its effects directly on the skeletal muscles: it decreases cardiac output, so your tissues don't get as much oxygen. It's understandable why you'd feel "stronger" on stimulant-like drugs (Parnate and selegiline). The muscle cramps from moclobemide puzzle me, though.
> [re your headaches and Prozac]
> Your headaches were not migraines (which are related to seizure activity)?No, they weren't migraines. That was the only time in my life that I've ever had headaches frequently.
> I had the stupidity to be off ADs for about a year trying SamE and so forth.
Some of that stuff is actually worth trying. Don't kick yourself for doing it. What else did you try besides SamE?
> Martin Jensen. His book is an informal self-published deal. He gets a lot of criticism for his approach which is basically to "trial" you through many meds very quickly and some people feel his treatment of the science behind mental illness is sloppy. But the book is great for a quick concise run down of the meds, there side effects, the probability of success with certain meds and so forth. You will be happy to note that he does include opiates. I refer to his book a lot as sort of a handbook for where I am because he lists the stimulants and so forth with worksheets as to what has been tried and the effects. His phone number (to order the book) is 949-363-2600.
You're right, it does sound pretty unscientific: some meds work quickly (like within 3 hours after taking them), some take a few days to work, and some can take weeks. You can't generalise about how
On the other hand, with all the antidepressants that have worked for me, I've at least noticed something within two weeks, although it may have taken longer to realise the full therapeutic effect. So I think there is something to the idea of brief trials.
> I'm so sorry to hear this. So you are past the therapuetic dose range and still not in remission?
Oh no, it's definitely working -- didn't I mention that? I just hope that it will still work at the lower dose that I'm taking now!
> Tough timing too with your pdoc being out of town. Did you guys formulate a game plan for this contingency before he left for vacation?
Nope. Neither of us really thought it was likely that there'd be a problem like this; we just thought that it would be a good idea to check the serum level because of some past experiences I've had with medications that suggested I might be deficient in the relevant enzyme.
-elizabeth
Posted by Lorraine on August 5, 2001, at 10:51:57
In reply to Re: jumping in - Shelli, Lorriane, et.al., posted by Elizabeth on August 4, 2001, at 15:33:57
> > > The main risk is cardiotoxicity, actually. The heart has to be working like clockwork, and if it gets out of sync even a little bit, you can get major problems. An ECG would find any such problems, though.
L: I would think this would be the next step--an ECG:-). Is it deja vu or temporal lobe epilepsy< g >?
> > > I agree with you about ECT: I think that any medication is preferable to it.L: ECT is on my list--it's just down quite a ways. I have a hard time separating truth from fluff with it. You know, the posters who go on and on about the evils of Effexor, for instance. Well, I was on Effexor and I know about its "evils" (and it's therapeutic benefits) and so I can put what they are saying into perspective and know what's true and not true about what they are saying. With ECT you have the medical profession saying one thing and some patients saying another. I suspect this is a group of "outliers" (not people who lie, but people who fall outside the normal statistical range of response), but I don't know. One person wrote about how her memory loss resulted in her forgetting the years following her children's birth until the procedure. That scared me senseless.
> > BTW, in regard to back pain and meds, selegiline gave me back pain, really shoulder pain almost from the start, although I didn't think to associate it with it until I started to get bad pains in my legs. When I went off of it, both the shoulder pain and leg pain went away.
L: That's my experience with it--especially as I tried to increase my dose of selegiline above 2.5 mg 2x day.
> > >I wonder about this sort of thing; do you think it might be related to the amphetamine metabolites of selegiline?
L: Perhaps but Adderal doesn't do this to me.
>
> Buprenorphine does away with my back pain completely, and unlike other things I've tried (Valium, Soma, Ultram), it works reliably. It's also much less expensive than having a facet block every week would be. :-)L: elizabeth, what is your "mechanical" situation with your back. My chiro did an Xray and all of that and said T5? (lower lumber) was injured.
things out.
> > > Desipramine isn't a perfect success, but it does seem to be a suitable substitute for Parnate (with less hassle involved).L: elizabeth, what do you mean "less hassle"--the dietary restrictions? I ate cheese last night and the night before (feta and mozallera) and was fine. I also drank an import beer (Heineken) throwing caution to the wind. I was fine, although I realize that I am not up to a therapeutic dose and this "fine" may change as I up my dose. I also slept well yesterday--although I am really being particular about sleep hygiene. (Same time to bed each night, when I wake up in the middle of the night not brushing my teeth (as i like to do), practicing techniques to throw my brain waves out of "beta", lying there).
> > > Yes. I'm particularly interested in seeing whether psychostimulants would help me, since Cylert worked in the past and since I have ongoing attention problems.L: elizabeth, have you tried Provigal? Just curious.
> > > No, I've never tried getting medication from outside the U.S.
L: I don't know about your "class" of drugs and customs, but importing Moclobemide with an RX was really not a hassel and the way that you are having to take your opiates sounds like a big deal to me.
Lorraine
Posted by Lorraine on August 5, 2001, at 11:57:54
In reply to Re: jumping in » Lorraine, posted by Elizabeth on August 4, 2001, at 23:06:40
> > >[re treatment of ADD like symptoms in depression]
L: language can actually get in the way here. The concept of cognitive impairment is pretty widely recognized in depression, whereas ADD becomes like a hurdle you have to jump over to get the meds.
> > > [re MAOI withdrawal]
> > So that's the parachute then; Adderal, Neurontin and Ativan as needed.
> I can see why stimulants would be effective, although I've never tried using them for that purpose myself.L: I guess it's why my pdoc considers MAOs to be stimulants when he says my QEEG profile calls for stimulants and anti-convulsants.
> I've tried taping lectures. It doesn't work for me. I just take copious notes and use the text as a reference rather than as my primary source of information.L: See, now, you are tapping into a third method of learning which is by writing. That always worked for me--consolidating my notes into an outline and then consolidating that outline down further. By the way, have you heard of the Cornell system of taking notes? (When your child has a learning disability you end up teaching these skills explicitely).
> > >Yes, cutting the dose in half is drastic, but the doctor covering for my pdoc wanted me to stop taking it altogether (to which I said "no way!").L: elizabeth, you might want to read Preskorn's columns on therapeutic dose monitoring, toxicity and individual patient variation. I thought they were great. Perhaps you can glean something about your particular response history that is useful.
http://www.preskorn.com/columns/9605.html
http://www.preskorn.com/columns/9603.html
http://www.preskorn.com/columns/9611.html> > >You had said that if your blood levels were high an ECT was the next logical step
>
> No, I said *ECG*, not ECT!
L: I had a real laugh when I recognized what was behind this misunderstanding.
> > >if I'm depressed, I just disappear.L: I just disappear from others and from myself--I feel myself slip away. When a new drug works for a day or so I say to my husband, "I'm back!"
> > > Harvard, huh?L: He hated his experience at Harvard, yet wants my daughter to go there. At the 25 union, (which is a lot of fun there) he made it a pilgrimage of healing--so everyone that he talked with for any length of time, he would say how awful his experience at Harvard was, how alone he felt, how outclassed he felt. (Don't get me wrong, my husband is not a whiner or a guy with low self-esteem.) Anyway, it was wonderful because people started opening up on a different level. Most people said "that's exactly how I felt!" All in all a very healing experience for him.
>
> So, what kind of law does your husband practise?L: Same law I used to practice--corporate law for entertainment clients. The problem is that everyone finds it "useful" to have a friend that knows law. I find myself spending a fair amount of time "fending" people off because the balance in the relationship becomes lopsided--unless the other person is a doctor or accountant, they usually cannot give back on a comparable basis. And then people start asking you not just about their legal problems, but their friends legal problems. So (since I'm a bit co-dependent and an "over-giver generally) what I do is "help" people but not do the work for them. Like I will sit side-by-side with my friend and help her write the letter to her landlord or employer.
> > > Did you experience any sort of closure when he died? That must have been hard; I would think that you'd have really mixed emotions about it.L: Mixed emotions is right and no real closure. I did grieve his death though. Maybe you grieve for the lost opportunity or for the father you never had. I came to view him as a "sick pup". I did have closure though with my mom, which was great. This happened when I told her about the abuse and she started to explore her own abuse in childhood for the first time. She also came to recognize the emotional abuse that my father had given her. She had this dream that my father was perfect (this was our family fallacy really) and that her love for him was perfect and that if he didn't love her back as much as she wanted, then there was something lacking in her. So her own growth has been astounding to watch. It has brought us very close together.
> > > Well, for instance, the Propanolol made me weak, the Moclobemide gave me muscle cramps in my feet and legs, and the Parnate and Selegiline make me strong.
>
> Propranolol doesn't exert its effects directly on the skeletal muscles: it decreases cardiac output, so your tissues don't get as much oxygen. It's understandable why you'd feel "stronger" on stimulant-like drugs (Parnate and selegiline). The muscle cramps from moclobemide puzzle me, though.L: elizabeth, noone talks about all of the effects of these drugs, but I've found that if I suspend my disbelief and simply chart how the drugs effect me, there are real differences in these areas that aren't "supposed" to be there. My trainer notes these as well. Muscle cramps with Moclobemide are similar to back aches with selegiline. It's just an increase in muscle tone.
> > > I had the stupidity to be off ADs for about a year trying SamE and so forth.
>
> Some of that stuff is actually worth trying. Don't kick yourself for doing it. What else did you try besides SamE?L: All of the neurotransmitter precursors. And although brain blood barrier is supposed to preclude many of these from having an effect--well again I found that if I was willing to suspend my disbelief, there were real effects caused by these neurotransmitters. For instance, tyrosine was a real activating drug for me--and I couldn't take it because it increased my hyperventilation and my edginess. HTP 5 was sedating to me. Phenylalamine created a sense of pressure or urgency that was intolerable to me. GABA is in fact sedating--I use it with my son when he cannot sleep and in a pinch I use it myself.
>
> > > Martin Jensen. >
> You're right, it does sound pretty unscientific: some meds work quickly (like within 3 hours after taking them), some take a few days to work, and some can take weeks.L: I don't use Jensen for his theories. His book has great checklists and has a lot of useful charts and so forth that don't reflect his theories. I will say though that testing stimulants, benzos and anti-convulsants in rapid succession to determine which one is right for you makes sense.
> > >we just thought that it would be a good idea to check the serum level because of some past experiences I've had with medications that suggested I might be deficient in the relevant enzyme.L: You might read the articles noted above on this issue.
Lorraine
Posted by Lorraine on August 6, 2001, at 10:02:37
In reply to Re: jumping in, posted by Lorraine on August 5, 2001, at 11:57:54
Shelli: I'm concerned about you. How are you doing? Where are you with your meds?
Posted by shelliR on August 6, 2001, at 10:58:35
In reply to Re: jumping in Shelli, posted by Lorraine on August 6, 2001, at 10:02:37
> Shelli: I'm concerned about you. How are you doing? Where are you with your meds?
Hi Lorraine.
The last few days have been really hard. I have an appointment to see my pdoc today and unless he has a better idea, I'll start parnate. I increased the oxycontin to get through the last few days. My therapist, who is totally against opiate use (and valium for that matter), has told me that she would only work with me if I did not self-medicate and I had agreed to that. Of course my pdoc did not return my call to see if it was okay to increase it until the parnate set in, so I was left with a choice of signing myself into the hospital (again) or taking more oxy. I choose to increase the dose, so I could continue to work. I have vacation plans for the first week in September and have much to do before I leave. Also, I've had my fill of hospitals; they used to feel helpful for me to go in for 5 days to stablilize, but the last two times have been overstimulating for me *and* I felt trapped.
The last time, the only positive was that I was hooked up to this doctor who prescribed the oxy for me instead of me taking vicodin on my own. I remain convinced that a possible *addiction* (habituation) to codone/contin is better than the other options.
Anyway, after talking to my therapist re phone over the weekend, I told her I cannot maintain my commitment until parnate or whatever kicks in. And so,unless my pdoc says today that I can increase-- prn, my therapist will terminate with me. She wants me to come in, but she is so clear about this that I don't see the point of getting myself all crazy so she can feel that we've terminated properly.
Anyway, I see my pdoc at 2 est, then therapy is scheduled at 3, and I will go or not depending on what he says.
I feel this morning that I have gotten a lot out of our work together, and that I don't lose what I've gotten if we terminate. I have been feeling this year anyway, that we are not getting much therapy work done, because it is hard to work on issues when I am this depressed. But I wouldn't choose to terminate at this time, so I am feeling very anxious. Also, I'm sure I can go back to her if I decide at some point that I can keep the agreement, it's just that she will have given away my times ( 2x), and one of the times is a double session.So that's been what's going on; thanks for asking, but really, try not to be concerned. I am feeling fairly optimistic about parnate. I am also trying to get my next option in line; I will also be asking my pdoc if there is anything else I could try for sleep with the nardil. I think if I could raise my dose of nardil and continue the oxycontin, that might possibly work well enough for me, or dropping the oxycontin and adding concerta. (concerta and oxy were too much for me; both act as stimulents for me).
Meanwhile I am filling my work commitments which is extremely important to me. The summer is pretty loose on deadlines, but vacations will be ending at the end of August, so I need to get ready my deliverables.
I am nervous how I will get everything in with my pdoc in his allowable eight minutes. :-)
I have written everything down that we need to discuss.I'll let you know what happens either tonight or tomorrow.
Are you feelings any anti-depressants effects from the parnate, or *just* no side effects?
Shelli
Posted by Elizabeth on August 6, 2001, at 11:49:02
In reply to Re: jumping in - Shelli, Lorriane, et.al., posted by Lorraine on August 5, 2001, at 10:51:57
> You know, the posters who go on and on about the evils of Effexor, for instance. Well, I was on Effexor and I know about its "evils" (and it's therapeutic benefits) and so I can put what they are saying into perspective and know what's true and not true about what they are saying.
Heh. I had a very extreme reaction to Effexor, but I don't go around preaching about what an evil drug it is because I know that my reaction was unusual and that Effexor helps a lot of people (and besides, I don't generally apply moral judgments to inanimate objects anyway :-) ).
> With ECT you have the medical profession saying one thing and some patients saying another.
Yes. Of course, the people who feel that it caused problems for them are going to be the most vocal ones -- not the people who were helped. I've seen people respond to ECT, and it can be miraculous; also, I've never met anyone other than on the internet who claimed to have had any serious memory loss, personality change, etc. due to ECT. I don't place too much stock in internet rumors. There are a lot of people out there (not just on the net, of course, but they tend to be especially vocal on the net) who are hypochondriacal about side effects and who tend to attribute symptoms to ECT or medication regardless of the likelihood of a cause-effect relationship.
At the same time, it would take some real convincing (not just appeals to authority) to make me feel comfortable with the idea of having ECT. Anyway, there doesn't seem to be much reason why I should be considering it: it's not like I don't respond to medications or something.
> > > >I wonder about this sort of thing; do you think it might be related to the amphetamine metabolites of selegiline?
>
> L: Perhaps but Adderal doesn't do this to me.Adderall isn't just d,l-amphetamine; it's a mixture of various amphetamine salt isomers. The logic behind this mix is a mystery to me, but Adderall does seem to have some significant advantages over other stimulants.
The amphetamine metabolites of selegiline are levo- isomers, which tend to have more pronounced peripheral effects than d-amphetamine and d-methamphetamine relative to central effects (that is, they have more side effects relative to desired effects).
> elizabeth, what is your "mechanical" situation with your back. My chiro did an Xray and all of that and said T5? (lower lumber) was injured.
"Thoracic facet syndrome." (I don't fully understand the anatomy behind it.) I don't think it's an injury, but a congenital anomaly. The facet joints are located in between the vertabrae; in my case, the inflamed joints are the ones in between the vertabrae designated T8-T9 and T9-T10 (i.e., the lower thoracic vertabrae). A facet block is used as a diagnostic tool; they inject a local anaesthetic, followed by a corticosteroid, into the suspected problem joint(s). When I had one, the back pain disappeared for a full week (this was when it had been at its worst, which was what prompted me to go see a doctor about it).
A lot of my back pain is referred; it affects large areas of my back. Of interest, it is almost always limited to only one side ef my back (left or right). This reminds me of migraine headaches, and I wonder if there is a relationship (several blood relatives of mine have migraines).
> elizabeth, what do you mean "less hassle"--the dietary restrictions?
That's not as much of a problem for me as the limitations on medications that can be added to the MAOI. In particular, I'd like to give psychostimulants another try.
> I ate cheese last night and the night before (feta and mozallera) and was fine.
Mozzarella isn't a problem usually; feta is something you should probably avoid.
> I also drank an import beer (Heineken) throwing caution to the wind.
The imported beers that have been associated with problems are much more obscure ones. I think Heineken is probably fine; what you really want to be careful about is tap beer (of any kind).
> elizabeth, have you tried Provigal? Just curious.
I tried Provigil while I was on Parnate. 150 mg/day didn't seem to do a thing, but 200 made me jittery (shaking, exaggerated startle response, racing thoughts, etc.). Like I said: I want to give stimulants another try.
> LI don't know about your "class" of drugs and customs, but importing Moclobemide with an RX was really not a hassel and the way that you are having to take your opiates sounds like a big deal to me.
It's not that big a deal. If I really wanted to, my pdoc would probably be willing to try switching to something that comes in a pill (MS Contin, OxyContin) or patch (Duragesic). Buprenorphine is kind of expensive, and my insurance wouldn't cover drugs ordered from outside the U.S.
On to your other post....
> I guess it's why my pdoc considers MAOs to be stimulants when he says my QEEG profile calls for stimulants and anti-convulsants.
MAOIs behave a lot like stimulants, yes.
> See, now, you are tapping into a third method of learning which is by writing.
I know; taking notes reinforces the learning from looking and listening.
> elizabeth, you might want to read Preskorn's columns on therapeutic dose monitoring, toxicity and individual patient variation.
I'm familiar with this stuff, but it doesn't provide the information I'm really interested in (specifically, what the relationship between dose and serum level is in normal vs. slow metabolisers).
> He hated his experience at Harvard, yet wants my daughter to go there.
Uhh...that's a little weird.
> Same law I used to practice--corporate law for entertainment clients. The problem is that everyone finds it "useful" to have a friend that knows law.
Sure. But people shouldn't expect their lawyer friends to provide free services (well, except maybe if they're a really close relative -- parent, child, spouse). It's just helpful to be able to talk to someone and get an idea of what you need to do in a situation where the law is involved. Similarly, if you have a friend who's a doctor, that can be helpful in terms of getting referrals or advice as to what you should be doing.
> I did have closure though with my mom, which was great. This happened when I told her about the abuse and she started to explore her own abuse in childhood for the first time.
This seems to be common -- women who were abused as children marrying abusive men. Somewhere, the cycle has to stop. You seem to be be the one who's stopped it.
> elizabeth, no one talks about all of the effects of these drugs, but I've found that if I suspend my disbelief and simply chart how the drugs effect me, there are real differences in these areas that aren't "supposed" to be there.
It's not a question of what they're "supposed" to do and what they aren't; rather, we don't really know about all the actions of these drugs, and a lot of them probably have actions that we don't know about at all.
> All of the neurotransmitter precursors. And although brain blood barrier is supposed to preclude many of these from having an effect--well again I found that if I was willing to suspend my disbelief, there were real effects caused by these neurotransmitters.
It's not just the blood-brain barrier (which can be subject to individual variation); there are also things like first-pass metabolism.
> HTP 5 was sedating to me.
Err...you mean 5-HTP, right? < g >
-elizabeth
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