![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 220 to 244 of 434. Go back in thread:
Posted by shelliR on August 13, 2001, at 11:07:35
In reply to Re: Shelli and Elizabeth, posted by Cam W. on August 13, 2001, at 2:27:00
> Also Shelli, I did not reply to your post, as I thought that you were not asking for one. I was not ignoring you, honestly.
>
> Take Care; both you and Elizabeth. You're information is given in the context of your learning; and I appreciate that and, to no lesser extent, I appreciate the answers that you two give, especially when I end up learning something that I don't know. We may end up at loggerheads at times, but hey, that's science.
>
> Sincerely - CamThanks for replying Cam. I don't quite see things your way with Sal, although I do agree that I don't feel secure with Sal's taking a potential suicide off the board and have written a post to that effect on the other thread, in response to Zo's post.
I think we see different motives in Sal, big heart vs pretending to be doctor. In any case, I think we can just disagree, especially because one's motivation is impossible to objectively measure on the board.I'm glad you were not ignoring me on the parnate thread. Sometimes (Often) I can be oversensitive, something I am personallly working on. Next time I think you're ignoring me, I'll be more direct, CAL, HEY CAL.
Thanks again, and my thoughts are with you during this difficult time.
Shelli
Posted by Cam W. on August 13, 2001, at 11:17:42
In reply to Re: Cam, posted by shelliR on August 13, 2001, at 11:07:35
>I'll be more direct, CAL, HEY CAL.
Posted by shelliR on August 13, 2001, at 11:24:22
In reply to Re: LOL Shelli [np], posted by Cam W. on August 13, 2001, at 11:17:42
> >I'll be more direct, CAL, HEY CAL.
Hey, no wonder you don't answer me!
Someone implanted that in my head from another thread.
Chelli
Posted by susan C on August 13, 2001, at 11:44:22
In reply to Re: Shelli and Elizabeth, posted by Cam W. on August 13, 2001, at 2:27:00
Cam,
I am relatively new to all of the cyberspace and am working, I would like to think diligently, on what, how and why my brain does what it does. I am trying to understand what my pdoc prescribes and why and have been overwhelmed by his knowledge the complexity of everything, and the information on the net.
I think I am intelligent enough that I am skeptical of things and statements that are too good to be true, yet at the same time know I can not learn everything myself.
Having said all that I want to thank you and many others like you for the time you spend on this board answering my and our sometimes vague, confused questions with careful, considerate, intelligent and balanced statements, recommendations and suggestions.
As my new pdoc said, get lots of opinions, lets try to triangulate this problem.
-s> Shelli and Elizabeth - Shelli, you were correct about others things bothing me when I wrote the following post to Sal, but he is pretending to be an expert. He never refutes that claim, except to say that he has taken all of these drugs (hardly an objective opinion), usually in megadoses, and has access to all of the world's medical journals.
>
> http://www.dr-bob.org/babble/20010725/msgs/72674.html.
>
> I feel that his statements are tantamount to the Beatles taking LSD to attain nirvana. Sorry, knowledge comes from studying the facts, and knowing how to properly read these facts. That takes training (not necessarily formal training); Sal has never shown anywhere that he has done the work to be able to substantiate his claims. He picks and chooses abstracts that might happen to be on topic. I don't think that he pays attention to the vested interests involved in the writing of the article; nor does he take into account articles with theories contrary to the abstracts he posts; and several other factors that must be kept in mind when making a choice.
>
> Another thing that bothers me, is that Sal expounds the benefits of every drug, as he has taken all of them. If these drugs were so beneficial, why isn't he still taking them? How does he know that a person should take a specific sort of drug? He does this "prescribing", without taking into account the person's medical history (which, I know that I sometimes do and am occasionally left with egg on my face). I try to stick to answering questions which I am comfortable answering and if I make a suggestion of a drug, it is the same suggestion I would give to a doc; and I also say to ask the doc if this would the correct treatment for that person (the doc's patient; our poster).
>
> Many of Sal's pharmaceutical suggestions are based on his limited knowledge of reductionistic neuropharmacology. When I read an article propounding certain neurotransmitters for certain conditions, I must sit back and try to see system, then the whole picture. (ie. seeing side effects as only drug effects, and how these drug effect add to or take away from treatment).
>
> For example, if a person is not sleeping after an adequate trial of olanzapine, and still has residual effects of his/her disorder, you shouldn't say to try risperidone, instead. You look to other modalities that can be used to augment the partial efficacy of the drug that person is already on. Switching meds is by far not the first step in modifying most medication regimens.
>
> I am not saying that subjective experience is not important; it is extremely important, but this type of information should not be given the same level of import, as longterm, naturalistic studies, until they have been shown that subjective experience can be incorporated into the theory. This is done through more scientific research, where the "subjective opinion" can be integrated into what we know on whatever disorder we are taking about, or not; thus changing (improving?) our knowledge of the disorder.
>
> I do believe that Sal has found a place to vicariously act out his dream of being his father (a physician). He goes too far sometimes (ie the "suicide"-IM me" post. Those who have the knowledge, must read Sal's posts, to make sure that "no harm is being done." You cannot ignore Sal's posts, as you ignore a troll. This does lead to the question of what type of answers is Sal capable of giving, that will, or may not, lead to harm. The incident which scared me most was when Sal told a person with schizophrenia to stop his risperidone cold turkey, and that there would be no problems (James called him on that on).
>
> I don't mind Sal sharing his experiences, but prescribing is beyond his and my training, especially in this environment. Shelli, I was taking it as a personal affront to the 22 years I have been learning this stuff. If he thinks that posting abstracts and links gives him knowledge into psychopharmacology, he is just taking LSD.
>
> Also Shelli, I did not reply to your post, as I thought that you were not asking for one. I was not ignoring you, honestly.
>
> Take Care; both you and Elizabeth. You're information is given in the context of your learning; and I appreciate that and, to no lesser extent, I appreciate the answers that you two give, especially when I end up learning something that I don't know. We may end up at loggerheads at times, but hey, that's science.
>
> Sincerely - Cam
Posted by Cam W. on August 14, 2001, at 3:10:57
In reply to Cam, posted by susan C on August 13, 2001, at 11:44:22
:-)
Posted by shelliR on August 14, 2001, at 17:03:57
In reply to Shelli et al, Cam too if you're reading this » shelliR, posted by Elizabeth on August 12, 2001, at 6:02:13
I'm having such a hard time on parnate; don't know if I should just give up or stay the course. I think I'll present this question to the general board population, e.g. has anyone felt awful on parnate and then went on to have a successful run on it. I am tired and sick in my stomach at 15 mg. Can't seem to get past 10mg. I figuring this is not a good thing. Pdoc is out of town, but pdocs anyway generally want you to to hang in there and keep trying on a med until you're just about dead. (I mean they're not the one's feeling crummy). I really was optimistic about parnate, after Lorraine's success. Lorraine, I would guess, is away doing life right now, maybe a long weekend. I hope so.
Hope you are doing okay also, Elizabeth, with your half dose. Talk to you later, I hope I hope I hope. < g >
Shelli
Posted by Seamus2 on August 14, 2001, at 21:36:18
In reply to Yea, where are you guys, did you run off together? » Elizabeth, posted by shelliR on August 14, 2001, at 17:03:57
> ...I am tired and sick in my stomach at 15 mg. Can't seem to get past 10mg. ...< <
Couple Parnate tips:
Easy on the coffee if you take it first thing in the morning! It potentiates caffeine like crazy. I think that's where the queasy stomach is coming from. Try eating something too.
The fatigue goes away after a few weeks in my experience.
Try 10 mgs TID at 4 hour intervals.
Posted by shelliR on August 15, 2001, at 9:57:48
In reply to Re: Yea, where are you guys, did you run off together?, posted by Seamus2 on August 14, 2001, at 21:36:18
> > ...I am tired and sick in my stomach at 15 mg. Can't seem to get past 10mg. ...< <
>
> Couple Parnate tips:
>
> Easy on the coffee if you take it first thing in the morning! It potentiates caffeine like crazy. I think that's where the queasy stomach is coming from. Try eating something too.
>
> The fatigue goes away after a few weeks in my experience.
>
> Try 10 mgs TID at 4 hour intervals.
Seamus,Thanks for the feedback, but I'm not even able to take 10mg then 5mg at a 4 hour interval. without feeling sick and sleeping all day. And I only drink decaf coffee -strong, so it does have a little caffeine in it but, not much. I think I'm going to throw in the towel, considering I've never adapted to any other AD before after a bad start. And with all the side effects, I feel nothing that is indicating that my depression is being touched. This drug trial thing is near impossible when you're working.
Shelli
Posted by Elizabeth on August 15, 2001, at 17:38:51
In reply to Re: Stuff » Elizabeth, posted by shelliR on August 12, 2001, at 11:38:39
> > Maybe. How much hydrocodone do you take for a migraine?
>
> generally about 11.25mg in addition to the 20 oyx a day.1 1/2 Vicodin ES?
> ... I don't think that the parnate is touching me yet; it's only been five days and today I'll go up to 20mg.
That sounds like a plan. I wouldn't expect only 10 mg to have a noticeable effect.
> When I have two periods in a month, then I have more PMS and more depression.
I take it they're irregular? (Oxycodone may make them less frequent, BTW.)
> So your SO was was studying to be a neuropharmacologist: sounds like a match made in heaven. < g > So you said "originally"; what did he end up getting into? Is he an MD?
Nope, a software engineer. < g >
> who funds philosophy writings; the university itself? (Can't see that coming from Congress)
He's a professor. He gets paid a certain amount annually by the U., teaches one or two courses, and writes a lot.
> So you have an artistic sister.
I wouldn't say she's artistic, really. She's very goal-oriented; she knows what she wants to do and she does it.
> I don't even always buy the books sometimes; I'll just go to Borders with a tablet and "research"!
I've used the Longwood Coop (HMS bookstore) this way. < g > The Coops (Harvard, MIT, HMS, HLS, HBS, ...?) are run by Barnes & Noble now, so the layout is similar. I think those bookstore-cum-cafe places let people use them as libraries because they figure it will keep them there longer and they'll be more likely to buy something.
> Did you start grad school in math at UCSB? What made you choose that school?
Various things. I knew a couple people there already, and at the time I *really* wanted to go to CA.
> I think so also. And all three of us participate in other threads, so I don't feel guilty.
Hmm, we do seem to have some lurkers.
> Actually Dr. Bob quoted something I said to Lorraine on this thread; he started his question does anyone want to meet him in London when he was going there, with my comment to Lorraine about what it was actually like when she met someone off the board.
That's on way in which working in academia is so fun: going to conferences in exotic places (okay, London isn't *that* exotic, but it's not Chicago!). And yes, Dr. Bob does read all the threads; how would he moderate, otherwise?
> How are you doing on your half dose? Isn't it about time for your pdoc to come back?
I'm doing okay (back up to 225 mg now). My pdoc is back, I have an appt for next Tuesday.
> Is your plan eventually to add parnate, or do the TCA and buprenorphine? Or at your most optimistic, the TCA by itself?
In order of preference:
1. desipramine + buprenorphine
2. desipramine + Parnate
3. desipramine + Parnate + buprenorphine-elizabeth
Posted by Elizabeth on August 15, 2001, at 17:46:47
In reply to Re: Stuff -- Elizabeth et al, posted by may_b on August 12, 2001, at 13:10:53
Welcome, may_b. Flattered to see that someone else is interested in our chit-chat. < g > (I don't get all the references either, BTW.)
> Other features have not responded to talking therapies, such as: forgetfulness, confusion, hideous dreams, anxiety, ruminating, attention problems and for me, taste distortions or the loss of taste. These features survive all non-drug interventions.
You have weird dreams too? (MAOIs will most likely get rid of that symptom.)
> Re your exchanges on Parnate dose increases and slow metabolizers.
It's important to note that people who metabolise drugs abnormally (too slow or too fast) don't necessarily have the problem with all or even most drugs (unless they have liver disease or something).
> How does one know if they are a slow metabolizer?
Serum level monitoring, or a specific test for deficiency of a particular enzyme.
> Maybe I should have crept up by 5 mg increments once a day - what do you think, Elizabeth?
I don't think that an extreme reaction necessarily means you're not metabolising the drug adequately. But start low & go slow is always a good rule.
-elizabeth
Posted by Elizabeth on August 15, 2001, at 18:02:02
In reply to Re: Shelli and Elizabeth, posted by Cam W. on August 13, 2001, at 2:27:00
> He never refutes that claim, except to say that he has taken all of these drugs (hardly an objective opinion), usually in megadoses, and has access to all of the world's medical journals.
As I'm sure we all realise, "access" doesn't imply reading and understanding.
> I feel that his statements are tantamount to the Beatles taking LSD to attain nirvana.
Umm...this was before my time. ?
> For example, if a person is not sleeping after an adequate trial of olanzapine, ...
I think you're stretching it here. :-)
> Switching meds is by far not the first step in modifying most medication regimens.
I think it depends on the situation.
> I am not saying that subjective experience is not important; it is extremely important, but this type of information should not be given the same level of import, as longterm, naturalistic studies, until they have been shown that subjective experience can be incorporated into the theory.
On the other hand, theories that ignore subjective experience (of the patient, that is) aren't necessarily so meaningful either. I think that objective studies aren't always sufficient (even when subjective evaluations contribute to the results -- e.g., by the use of pseudo-objective rating scales).
> You cannot ignore Sal's posts, as you ignore a troll.
That's a good point.
> The incident which scared me most was when Sal told a person with schizophrenia to stop his risperidone cold turkey, and that there would be no problems (James called him on that on).
I missed that one, I guess. I agree, though: prescribing (or de-prescribing < g >) is not something that should be going on here.
> Shelli, I was taking it as a personal affront to the 22 years I have been learning this stuff.
I understand. Your knowledge includes knowledge of your limitations; a person without such knowledge might be unaware of his limitations.
> If he thinks that posting abstracts and links gives him knowledge into psychopharmacology, he is just taking LSD.
This is where you lose me. < g >
> We may end up at loggerheads at times, but hey, that's science.
It sure is.
-elizabeth
Posted by Elizabeth on August 15, 2001, at 18:07:14
In reply to Yea, where are you guys, did you run off together? » Elizabeth, posted by shelliR on August 14, 2001, at 17:03:57
Hi Shelli. I didn't run off with anyone, although I might have run off by myself.
> I'm having such a hard time on parnate; don't know if I should just give up or stay the course. I think I'll present this question to the general board population, e.g. has anyone felt awful on parnate and then went on to have a successful run on it.
Sure, I had spontaneous hypertension when I first started taking it. Eventually I figured out that I needed to take it in divided doses, and then things began to look up. I'm really sorry to hear you're having such a hard time. Maybe you could stay on 10 mg a while longer? I'm not sure what else to suggest (other than adding stuff to combat the side effects, which can be a steep slippery slope).
> Pdoc is out of town, but pdocs anyway generally want you to to hang in there and keep trying on a med until you're just about dead.
And what is it with that August vacation thing? < g >
> Lorraine, I would guess, is away doing life right now, maybe a long weekend. I hope so.
Me too.
-elizabeth
Posted by Elizabeth on August 15, 2001, at 18:10:27
In reply to Re: Yea, where are you guys, did you run off together? » Seamus2, posted by shelliR on August 15, 2001, at 9:57:48
Shelli,
Seamus gives good advise. I think you should listen (just MHO).
> And I only drink decaf coffee -strong, so it does have a little caffeine in it but, not much.
I thought I heard somewhere that all decaf has a little caffeine in it.
> I think I'm going to throw in the towel, considering I've never adapted to any other AD before after a bad start.
For everything there is a first time. The pessimism might be the depression talking, at least in part: don't listen.
-elizabeth
Posted by Cam W. on August 15, 2001, at 19:24:14
In reply to that other thread » Cam W., posted by Elizabeth on August 15, 2001, at 18:02:02
Elizabeth - • I believe that a lot of my tirade against Sal is just me refocusing the anger (fear?) that I have been experiencing, lately. I have said my piece (peace?) and will leave Sal alone, from now on (except to correct obvious mistakes, or to add more information). I'm sure he is a nice, compassionate guy, who just wants to help people. Hey, you can't knock a guy for that!
•I hope that you don't mind, but I will answer or explain under your comments.
> > He never refutes that claim, except to say that he has taken all of these drugs (hardly an objective opinion), usually in megadoses, and has access to all of the world's medical journals.
>
> As I'm sure we all realise, "access" doesn't imply reading and understanding.
>
•I am not sure that all of the posters and lurkers would understand the implications.
>
> > I feel that his statements are tantamount to the Beatles taking LSD to attain nirvana.
>
> Umm...this was before my time. ?
>
• The Beatles went to India(?) to learn from a yogi about life and beyond when they were heavy into LSD. They thought that taking LSD would be a shortcut to nirvana. They found out it wasn't, especially when the yogi tried to sleep with one of the girls that were brought along. In the same light,just having access to all the medical journals in the world does not make one an expert in the field. I was trying to use an analogy, but I still suck when it comes to writing clearly.
>
> > For example, if a person is not sleeping after an adequate trial of olanzapine, ...
>
> I think you're stretching it here. :-)
>
• Yeah, I'll give you that one; it was off the top of my head. ;^/
>
> > Switching meds is by far not the first step in modifying most medication regimens.
>
> I think it depends on the situation.
>
• I guess that I should have added, "when a psychotropic medication has shown some efficacy", but as a rule, their are no rules, as you state.
>
> > I am not saying that subjective experience is not important; it is extremely important, but this type of information should not be given the same level of import, as longterm, naturalistic studies, until they have been shown that subjective experience can be incorporated into the theory.
>
> On the other hand, theories that ignore subjective experience (of the patient, that is) aren't necessarily so meaningful either. I think that objective studies aren't always sufficient (even when subjective evaluations contribute to the results -- e.g., by the use of pseudo-objective rating scales).
>
• Subjective experience leads to the objective theory which can be studied using scientific method. I think that you need, as a good base, the objective theory (with it's corresponding studies showing proof), but that base needs to be malleable, so that subjective experience from post-marketing surveillance can be integrated into the theory, when the subjective experience is proven to exist. The delayed weight gain with Paxil or the increase in non-insulin-dependent diabetes with Clozaril or Zyprexa users are examples of subjective experiences that were pooh-poohed because there was no objective information in the literature. In other words, you are right, objective theory is only as good as the studies that confirm it; subjectiveness will always be needed. The posts we answer here are of the subjective nature, where we have to be careful not to read into the case, something that isn't there (hard to do sometimes).
>
> > You cannot ignore Sal's posts, as you ignore a troll.
>
> That's a good point.
>
> > The incident which scared me most was when Sal told a person with schizophrenia to stop his risperidone cold turkey, and that there would be no problems (James called him on that on).
>
> I missed that one, I guess. I agree, though: prescribing (or de-prescribing < g >) is not something that should be going on here.
>
> > Shelli, I was taking it as a personal affront to the 22 years I have been learning this stuff.
>
> I understand. Your knowledge includes knowledge of your limitations; a person without such knowledge might be unaware of his limitations.
>
• I shouldn't take his advice as a personal affront, though. He is not crowding my space or anything. I don't feel that I need to mentor him, either. I guess the best bet is to monitor his posts. He will learn what to say, and not to say, as time goes by.
>
> > If he thinks that posting abstracts and links gives him knowledge into psychopharmacology, he is just taking LSD.
>
> This is where you lose me. < g >
>
• I was alluding to the analogy of the Beatles, where knowledge and insight come only from hard work, and a lot of reading for understanding.
>
> > We may end up at loggerheads at times, but hey, that's science.
>
> It sure is.
>
• Thanks for your comments, Elizabeth.• Sincerely, Cam
Posted by Lorraine on August 16, 2001, at 23:25:22
In reply to Re: Update » Lorraine, posted by Elizabeth on August 11, 2001, at 13:06:14
elizabeth, shelli:
I was in North Carolina for a couple of days with my daughter. I just returned this afternoon and will try to catch up on the posting. I can't really say how I'm doing exactly. It's not completely clear to me. For one thing, I am pretty much done with hyperventilating. It seems to have gone away and I don't know if this is b/c I quit the estrogen cold turkey (on the theory that estrogen dominance may have been causing the problem) or if this is Parnate. I was taking 5mg Parnate 2x day and 300 Neurontin 3x day. Then I found that the sleep wasn't so great and my pdoc suggested increasing the Neurontin at bedtime. So I increased my nightly dose to 500 then 600 mg, but found myself groggy in the morning--which led me to drop my am dose of Neurontin. Then I found I was getting groggy in the afternoon as well so I dropped the Neurontin in the afternoon also. It's only been 2 days of this adjustment and I'm jet lagged major today. Time will tell. Seems odd to me though that the stimulant effect of the Parnate seems to be diminishing.
Shelli: I can see you've been through the wringer on this. I think it's terribly difficult to work and do drug trials. I also sympathize with you about lousey drug starts and how the pdocs would like for you to stay on the trial way beyond the normal limits of endurance. Too bad your pdoc is out of town and can't help you think it through.
responding to Elizabeth 8/11 post:
> (re Recovery Inc.)
> But it's a self-help group, there isn't a psychologist or anyone like that involved?Correct and the last one I attended impressed upon me the importance of the participants in the group on its value (little value in that last one).
> > > Yes; I was very into CBT for a while. I was convinced by the research that it was superior to other types of psychotherapy and that I needed to try it. And maybe it was a good idea to try, but in the end it didn't do much good for my depression.
Sounds like a lot of drugs I've tried:-). Seriously, I suspect it's like a lot of the non-med models, it works for some of the people some of the time. You know, like meditation works for some people and breathing exercises work for some people. I have no idea about the strength of the claim that thoughts are responsible for emotions or emotions are responsible for thoughts. How can we possibly know any of this? We are only an N of 1, but it's the 1 that matters most to us:-) I think the "experiments" using control groups with this or other talk therapy are just not useful. It either works for the individual or not.
> > >I did learn some tricks that have helped a lot with the panic attacks.
Do those techniques still work for you? Just curious. I've done the breathing stuff and it works for about 15 minutes.
> > > I do think that there are the physical and the mental aspects. Now, when physical is the only issue, I wouldn't expect it to be of too much help. But lots of times, both mental and physical is involved.
>
> What do you mean by all this? It's a little confusing to me.What i mean is that I believe that there is sometimes just a mental component, sometimes just a physical component and sometimes both. Take Shelli and me, for instance, we both have had substantial child hood issue to sort through. In my case, once I had "finished" my therapy and felt these childhood issues were ironed out, I was left with a depression that was not responsive to further talk. I needed the talk therapy, but I also needed meds. The need for meds, therapy or both varies by the individual I think.
> > Turns out there are people who are insensitive to side effects also--that might be you?
>
> Not especially. I notice them, but I tolerate them. It's just stoicism, nothing more.I find I can be stoic about certain side effects, like dry mouth, constipation, mild naseau and so forth, but am intolerant of others--like dramatic weight gain or sexual dysfunction.
[re effexor] > 150 is a reasonable dose, not unusually low. Why did you stop taking it?40 lbs and sexual dysfunction--and marital difficulties associated therewith :-)
[re retrospective mood chart]
> Except for the Word part, I'd like to see that, although charting retrospectively isn't ideal.I agree. But it's actually not so bad. I have the file from my previous pdoc who notes my moods and life events during our visits and then I also was on Effexor for a long time (more than a year)--so we'll see. I have a fairly good memory of how bad things were or weren't and the tracking is just by month so it can be quit useful without requiring the amount of detail that a daily chart does. I'll let you know the results.
>
> > It's one thing to not be interested in hanging out with the other kids; it's another to not fit in and hunger for it. I was the latter. It sounds like you were the former.
>
> Not generally, but when I was depressed I was. I usually (when not depressed) come out right in the middle when I take those tests that are supposed to rate how extroverted or introverted you are. I have friends, I like to party and so forth, but I also need quite a lot of time to myself, and a lot of my interests and hobbies are pretty solitary.Me too actually.
>
> > That is a stroke of luck--genetic luck--to have found been inner directed rather than outer directed. That's great.
>
> How so?I meant that some people are more internally driven while others are more dependent on others for their sense of self. You seemed to fall in the former camp--which is lucky if you were an odd duck of sorts.
> > >I take Klonopin for RBD, and it works great.What's RBD?
> [re rapid onset of effects]
> Parnate has a stimulant-like action that you may notice very shortly after starting it. I think that this should be looked into further; it might be the reason why some people have spontaneous episodes of hypertension on Parnate.Ok--more unusual stuff my pdoc said: He says that hypertensive epiosodes (not hypertension) is not common among people who are down-regulated, but are instead more common among people who are up-regulated (over-stimulated). He also says to try small amounts of the forbidden food at home with the antidote handy to see how I'll do with them. I'm fine with cheddar and jack cheeses so far.
How's your desipramine going, elizabeth? Are you augmenting with anything new?Lorraine
Posted by Lorraine on August 16, 2001, at 23:54:46
In reply to Re: Update Lorainne, Elizabeth, et. al., posted by shelliR on August 11, 2001, at 19:42:11
Shelli:
I finished the Magic Daughter while I was away this weekend. I thought it was a great book. It did not overly dramatize the condition and I felt as though I understood how having alters or personalities operates. Mainly it seemed like such a job for her to just get her history down right in chronological order given all the memory gaps that she had. Her explanation of the effect the multiple personality disorder had on her--in terms of friends, relatives and so forth was distressing. Not an easy row to hoe.
I would love to see your website with your work sometime. I am curious about it and I know how important it is to you. My email address is lbj90068@yahoo.com
[re therapist attachment]but that thing that kids do "look at me"; Mommy listen to me.
After reading the book, it seemed that she was just desperate to have someone she could trust listen to her story--the need to tell the story and have it validated was I'm sure an over-powering compulsion. Is this closer to the mark?
> > >I am one of about three or four people who are well known and highly respected for this type of work in the fairly large area that is my client base. In an area of mostly attorneys, government, journalists, research (NIH), consulting, I get to be the one of the best of a few people who are well known with my style. So I guess that is the way that I kind of get to be in the center; although I had no idea that it was going to happen that way. It was a gift that came out of much turmoil in my life.It's great when these things just happen of their own accord. In your case as the fall-out of a natural creative urge for expression.
> > >I was unable to work. I had planned to become a clinical psychologist, but wasn't together enough (I knew that, but even so got a masters), so this came out of going back to take a couple of art classes at my therapist's insistance at the time that I create some structure in my life. I now have absolutely no desire to be a therapist.
The same therapist you are seeing now? Mine is pushing me to write. I do have one published poem and it is about her:-)
> > > Well maybe I'd feel less shame if I had *chosen* not to have children. Anyway, my therapist and I do work on that shame part, under the category of "shame of my earlier adulthood" ,different from "childhood shame" :-)"shame of my earlier adulthood", that's unfortunate. Sometimes it seems that there's enough shame in childhood to last a lifetime, don't you think?
> > >Today I got my period for the second time in three weeks, so that's why this has been such a hard time. This is the third day I've felt really sick, although for most of today I was okay, fell asleep and then woke up very sick in my stomach again, but at least without the migraine.It is so hard to tell what is causing what during these drug trials, isn't it? Are these confounding, compounding or primary variables?
>
> > > You sound like you have a really good doctor; I can't remember why you were thinking of changing.B/c I was feeling hopeless and painting with a broad black brush.
Just back today from North Carolina. Tomorrow I'll catch the other posts. Look forward to seeing your site.Lorraine
Posted by Lorraine on August 16, 2001, at 23:58:55
In reply to Re: Update » Lorraine, posted by shelliR on August 11, 2001, at 19:57:12
>
> What did my comment [re Cam} make you rethink?
>
> ShelliHow broad the board is in terms of posters and how we have to just trust that people can sort things out for themselves rather than trying to curtail the posting of messages that may be harmful for the good of the community.
Posted by Lorraine on August 17, 2001, at 0:17:03
In reply to Re: Stuff -- Elizabeth et al, posted by may_b on August 12, 2001, at 13:10:53
may_b
> > > Well, sorry to intrude
Welcome--come on in, grab a cup of coffee....
> > > For example, I refer to the exchanges on CBT and other therapies, and their limited impact on depression. I have found the talking interventions useful in dealing with behavioural side effects (so to speak) of long term depression, such as self-criticism, self-isolating behaviours, catastrophizing, etc.This is what I believe as well. I'm thinking that I need to find a way to get on with my life in spite of all the uncertainty day-to-day of my moods--I'm thinking CBT might be helpful here.
Lorraine
Posted by Elizabeth on August 17, 2001, at 2:54:10
In reply to Re: that other thread » Elizabeth, posted by Cam W. on August 15, 2001, at 19:24:14
> Elizabeth - • I believe that a lot of my tirade against Sal is just me refocusing the anger (fear?) that I have been experiencing, lately. I have said my piece (peace?) and will leave Sal alone, from now on (except to correct obvious mistakes, or to add more information). I'm sure he is a nice, compassionate guy, who just wants to help people. Hey, you can't knock a guy for that!
I think he is just trying to help, and his heart is in the right place. But I also think that many of the points you made were legitimate ones and should not be simply written off as misdirected anger (although the manner in which they were *expressed* could be :) ).
> > As I'm sure we all realise, "access" doesn't imply reading and understanding.
> >
> •I am not sure that all of the posters and lurkers would understand the implications.How so? (I'm afraid your explanation here has only served to make me more confused! :) )
> • The Beatles went to India(?) to learn from a yogi about life and beyond when they were heavy into LSD. They thought that taking LSD would be a shortcut to nirvana. They found out it wasn't, especially when the yogi tried to sleep with one of the girls that were brought along. In the same light, just having access to all the medical journals in the world does not make one an expert in the field. I was trying to use an analogy, but I still suck when it comes to writing clearly.
Ahh. I think that analogies often suck anyway. < g > Too often I see poor analogies used in attempts to argue a point that degenerate into irrelevant discussion of the analogy rather than the (only tangentially related) point that was being made. But yours wasn't so bad (I do think analogies certainly have their place in discourse; people just misuse them a lot).
> > I think you're stretching it here. :-)
> >
> • Yeah, I'll give you that one; it was off the top of my head. ;^/< g >
> > > Switching meds is by far not the first step in modifying most medication regimens.
> >
> > I think it depends on the situation.
> >
> • I guess that I should have added, "when a psychotropic medication has shown some efficacy", but as a rule, their are no rules, as you state.But you state it more clearly. :) I tend to agree that if there is a partial response and the side effects are tolerated, augmentation is often preferable to substitution.
> • Subjective experience leads to the objective theory which can be studied using scientific method. I think that you need, as a good base, the objective theory (with it's corresponding studies showing proof), but that base needs to be malleable, so that subjective experience from post-marketing surveillance can be integrated into the theory, when the subjective experience is proven to exist.
Goodness. This is getting intense. My main point was that the RCTs required to get a drug approved and used in the writing of the prescribing information are impoverished when it comes to actual patient experience, which I do think should count for something. People here have often spoken of doctors insisting that their subjective experience on a medication (often, an experience confirmed by other posters!) can't possibly be an effect of the medication, or even that the experience isn't "real!" Your comments and offering of specific examples are helpful.
> The delayed weight gain with Paxil or the increase in non-insulin-dependent diabetes with Clozaril or Zyprexa users are examples of subjective experiences that were pooh-poohed because there was no objective information in the literature.
I think that phenelzine can also contribute to type 2 diabetes, no?
> The posts we answer here are of the subjective nature, where we have to be careful not to read into the case, something that isn't there (hard to do sometimes).
Exactly. And that's one reason why I think that it's important not to generalise personal experience to other people. At the same time, we may discover by reading this board that other people have had similar experiences to our own, which suggests that the experience may be caused by the medication (or whatever) in question.
> > I understand. Your knowledge includes knowledge of your limitations; a person without such knowledge might be unaware of his limitations.
> >
> • I shouldn't take his advice as a personal affront, though.That's reasonable too, but I don't recall your reply to him containing any content that I would expect to be offensive to him or others. So I don't think that the taking-it-personally thing really caused any harm: you made your point, which was a legitimate one, and you've also posted that you realise you were taking Sal's postings as a personal affront.
> I guess the best bet is to monitor his posts.
I guess so, although that's quite a task, as he's a frequent poster.
> He will learn what to say, and not to say, as time goes by.
I hope so.
> • I was alluding to the analogy of the Beatles, where knowledge and insight come only from hard work, and a lot of reading for understanding.
Yeah, I think I get it now.
> • Thanks for your comments, Elizabeth.
And you for yours. (What's with the dots, BTW?)
-elizabeth
Posted by Elizabeth on August 17, 2001, at 3:24:22
In reply to Re: I was gone but now I'm back, posted by Lorraine on August 16, 2001, at 23:25:22
> I was in North Carolina for a couple of days with my daughter.
Hey, I lived in NC (Winston-Salem) for 8 years. Where were you (what part of NC, that is)?
> I can't really say how I'm doing exactly. It's not completely clear to me.
That's understandable. Sometimes it can take time for moods and such to cement.
> For one thing, I am pretty much done with hyperventilating.
The Parnate might be responsible; it sounds like you're growing tolerant to the initial stimulant-like effects, which is probably a good thing.
I don't know anything about estrogen dominance so I can hardly form an opinion there. < g >
> Correct and the last one I attended impressed upon me the importance of the participants in the group on its value (little value in that last one).
That's often said of 12-step groups, certainly: "find a meeting you like."
> ... I suspect it's like a lot of the non-med models, it works for some of the people some of the time.
I think it just isn't that effective in severe depression, personally. When I've been off meds, I haven't been able to get a thing out of CBT; and when I've been on medication that was working, CBT was irrelevant. Anxiety disorders (except possibly generalised social phobia) are another story.
> I have no idea about the strength of the claim that thoughts are responsible for emotions or emotions are responsible for thoughts.
I think the distinction between the two is more blurred than a lot of simplistic theories make it appear.
> How can we possibly know any of this? We are only an N of 1, but it's the 1 that matters most to us:-) I think the "experiments" using control groups with this or other talk therapy are just not useful. It either works for the individual or not.
Yes, exactly! Psychologists want to be "scientific" (a phenomenon that's been known as "physics envy"), but their "experiments" are usually pretty bogus.
> >I did learn some tricks that have helped a lot with the panic attacks.
>
> Do those techniques still work for you? Just curious. I've done the breathing stuff and it works for about 15 minutes.I seldom have panic attacks anymore (although desipramine by itself doesn't seem to work as well as Parnate did). But yes, those techniques still help.
> What i mean is that I believe that there is sometimes just a mental component, sometimes just a physical component and sometimes both.
Ahh. I think I've said before that I don't find the mental-physical distinction to be meaningful. Also, I don't think it's necessarily true that endogenous depression will only respond to somatic treatments or that reactive depression will only respond to talk therapy.
> I find I can be stoic about certain side effects, like dry mouth, constipation, mild naseau and so forth, but am intolerant of others--like dramatic weight gain or sexual dysfunction.
That's true, different people have different priorities. Personally, if I find something that works, I make a serious effort to deal with the side effects.
> 40 lbs and sexual dysfunction--and marital difficulties associated therewith :-)
An effect of the tricyclic and also buprenorphine that I've been noticing is, err, dryness. I've been thinking of asking my pdoc for a cholinergic drug such as Aricept to combat this side effect.
> I agree. But it's actually not so bad. I have the file from my previous pdoc who notes my moods and life events during our visits and then I also was on Effexor for a long time (more than a year)--so we'll see.
Ahh so it's really not 100% retrospective; it's based on chart review. That's good.
> I have a fairly good memory of how bad things were or weren't
Me too, but remembering *when* sometimes eludes me! (Even on a monthly basis, as you're doing.) The only times I can reliably remember when I was feeling a certain month are when some significant, memorable event happened in that month.
> I'll let you know the results.
Cool! It will be interesting, I'm sure.
> I meant that some people are more internally driven while others are more dependent on others for their sense of self. You seemed to fall in the former camp--which is lucky if you were an odd duck of sorts.
Heh. Yes, I'm a bit of a loner, but I do have the usual basic human need for companionship.
> > > >I take Klonopin for RBD, and it works great.
>
> What's RBD?REM sleep behaviour disorder. (Physically acting out dreams while asleep. Can cause injury to self or partner.)
> Ok--more unusual stuff my pdoc said: He says that hypertensive epiosodes (not hypertension)
Umm. You mean, not the chronic hypertension that folks with cardiovascular disease often seem to have?
> is not common among people who are down-regulated, but are instead more common among people who are up-regulated (over-stimulated).
(Interesting use of the expressions "down-" and "up-regulated.") That's a possibility. I don't feel that I was especially stimulated or sedated by Parnate, except at first when it was rather activating. But it makes sense that if a stimulant mechanism were involved (presumably catecholaminergic, based on Parnate's chemical similarity to amphetamine), people who were more sensitive to that effect (i.e., who feel more stimulated on Parnate) would be more likely to have some other stimulant-like side effects. Basically, my take on the Parnate spontaneous hypertensive episodes is that Parnate probably has stimulant-like actions in addition to MAO inhibition (e.g., promoting catecholamine release), and that the stimulant actions (notably, pressor effects of dopamine) are potentiated by the MAO inhibition.
> He also says to try small amounts of the forbidden food at home with the antidote handy to see how I'll do with them.
That's a good plan.
> I'm fine with cheddar and jack cheeses so far.
Jack is probably okay; I'd avoid cheddar.
> How's your desipramine going, elizabeth? Are you augmenting with anything new?
My pdoc just got back from his vacation, and I'll be seeing him on Tuesday. So I'm still on the same stuff. The desipramine isn't working as well as it was at the high dose (300 mg/day), but I'm still noticing some benefit. My hope is that it will just take longer to work at the lower dose. Otherwise I'm just taking buprenorphine and occasionally Klonopin.
-elizabeth
Posted by Cam W. on August 17, 2001, at 5:12:44
In reply to Re: that other thread » Cam W., posted by Elizabeth on August 17, 2001, at 2:54:10
Elizabeth - I am hoping that the bullets I am putting up make it easier to see my answers.
>
> > > As I'm sure we all realise, "access" doesn't imply reading and understanding.
> > >
> > •I am not sure that all of the posters and lurkers would understand the implications.
>
> How so? (I'm afraid your explanation here has only served to make me more confused! :) )
>
•• I'm not sure that I will still make sense on this, but here goes. A person says he/she has access to journals, and then posts the abstracts. Wouldn't some of the lay public assume that this person at least understands what he is posting. For example, the layperson may believe that the person understands what the article is really saying, thus the layperson may assume the artical has been verified and is the truth, rather than a theory (or whatever). A more specific example; and doctors fall into this trap, too; a drug company puts out a study by a leading expert saying that their drug is significantly better than a competitor's drug, for a certain indication. But when you look at the data, the sample size this is derived from is very small, and the result is only significant using fancy statistics. The layperson may not understand that, from a clinical point of view, that the study is really worthless, unless it is confirmed by subsequent randomized-placebo-control trials in naturalistic settings using a much, much larger, and diverse, population. Therefore, the person using his access, can fool the layperson into thinking that the study was critiqued properly, and can take the information as gospel. Did I read too much into this?
>
> > The delayed weight gain with Paxil or the increase in non-insulin-dependent diabetes with Clozaril or Zyprexa users are examples of subjective experiences that were pooh-poohed because there was no objective information in the literature.
>
> I think that phenelzine can also contribute to type 2 diabetes, no?
>
•• Yeah, I think so, but not to the degree we are seeing it with Clozaril and Zyprexa. Even people who do not have risk factors (eg. not overweight or have not gained a lot of weight) are still becoming diabetic. I'll let minds greater than mine figure this one out. Also, the extent we are seeing it with atypicals over MAOIs is possibly due to the difference in sheer numbers of patients using these two classes of drugs.
>
> > The posts we answer here are of the subjective nature, where we have to be careful not to read into the case, something that isn't there (hard to do sometimes).
>
> Exactly. And that's one reason why I think that it's important not to generalise personal experience to other people. At the same time, we may discover by reading this board that other people have had similar experiences to our own, which suggests that the experience may be caused by the medication (or whatever) in question.
>
•• Good point.And a good exchange; it was fun. Thanks. - Cam
Posted by Lorraine on August 17, 2001, at 11:45:53
In reply to Re: I was gone but now I'm back » Lorraine, posted by Elizabeth on August 17, 2001, at 3:24:22
elizabeth:
> Hey, I lived in NC (Winston-Salem) for 8 years. Where were you (what part of NC, that is)?Ocean Isle to visit my cousins who were vacationing at the beach
>
> > I can't really say how I'm doing exactly. It's not completely clear to me.
>
> That's understandable. Sometimes it can take time for moods and such to cement.Plus, this sedating component to Parnate might be serotonin related? Now I think my reaction is my bodies response to Parnate--ie growing or shrinking neurotransmittors--I'll have to wait it out and see where I land. I may need to add a stimulant to it.
>
> > > > I think it just isn't that effective in severe depression, personally. When I've been off meds, I haven't been able to get a thing out of CBT; and when I've been on medication that was working, CBT was irrelevant. Anxiety disorders (except possibly generalised social phobia) are another story.My take is that that severe depression is so physical that monkeying with mind sets and mental gymnastics won't put a dent in it without some med support. If you have developed coping patterns for dealing with childhood abuse that are maladaptive and trigger shame spirals, you pretty much have to get in there and clean that stuff out because they cause deep mood dips (that's a technical term< g >) that are barely tolerable when you are normal and completely intolerable when you are depressed.
> > > I have no idea about the strength of the claim that thoughts are responsible for emotions or emotions are responsible for thoughts.
>
> I think the distinction between the two is more blurred than a lot of simplistic theories make it appear.It's blurred, but, for me at least, still useful in terms of determining how to tackle difficulties. Maybe it's backed into--is this something that changing my thinking or approach could help? Sometimes yes, sometimes no. When you have severe depression, swatting at it with meditation or exercise just seems pointless to me. But these things can make a difference when the depression is marginal (maybe the meds achieve response but not remission and this stuff makes the difference).
> > > Yes, exactly! Psychologists want to be "scientific" (a phenomenon that's been known as "physics envy"), but their "experiments" are usually pretty bogus.I don't know how much psychologists want to be scientific as opposed to how much they want to achieve respectability in a scientific community that doesn't value things that can't be measured or that don't fit the experimental design model in vogue today. My undergrad major was experimental psychology and I took a boat load of statistics classes and experimental design classes. It is very helpful for picking apart studies, but I find that I am still skeptical even of studies that fit the parameters of "good" scientific design. Maybe this is because so many of them show things that are false. For instance, the weight gain and sexual dysfunction side effects of the SSRIs are much higher than the studies would lead you to suspect. Now maybe this is the length of time of the study or the methodology of determining side effects (self report as opposed to asking), but it is easy to get misled by a study that is flawed in certain respects but presented in a nicely tied experimental design package. In a way, it goes back to the N of 1 and doctors saying "no, that side effect is not attributable to this med". The fact is they don't know and rather than coming clean with just how limited our knowledge is and deal with the amount of ambiguity out there, many doctors pretend (this isn't a conspiracy, the pretense gives the doctors comfort) a higher level of confidence than is warranted. In short, I think that the god of scientific methodology is a false god.
> > > I seldom have panic attacks anymore (although desipramine by itself doesn't seem to work as well as Parnate did). But yes, those techniques still help.Were the techniques to control self talk, like "this is just a panic attack. I'm not going to die" and breathing or something more?
> > >Also, I don't think it's necessarily true that endogenous depression will only respond to somatic treatments or that reactive depression will only respond to talk therapy.
Well, yeah. This is what makes it all so difficult because of the interactive nature of mind/brain stuff. But if you recognize this inherent limitation, I think the dichotomy can be useful (ie it's not wholly true, but then neither is it wholly false--it's just a useful "way of looking" at some of the issues).
> > > That's true, different people have different priorities. Personally, if I find something that works, I make a serious effort to deal with the side effects.I can see that you do. If my previous pdoc had been more open minded, I might have added a stimulant to the Effexor and stayed on it.
> > > An effect of the tricyclic and also buprenorphine that I've been noticing is, err, dryness. I've been thinking of asking my pdoc for a cholinergic drug such as Aricept to combat this side effect.Dryness is a constant companion of those who lack estrogen, like me. I use some of the better lubricants, although right now I'm using something called "wicked" (this may be an off lable use :-) I'm also doing that thing for arousal that someone posted here (a certain thigh creme with argenon mixed in)--it works, but is a bit messy.
> > > Ahh so it's really not 100% retrospective; it's based on chart review. That's good.
Yeah, Much better than relying on my memory alone.
> > > Me too, but remembering *when* sometimes eludes me! (Even on a monthly basis, as you're doing.) The only times I can reliably remember when I was feeling a certain month are when some significant, memorable event happened in that month.I have just found that it is so difficult to tell what is impacting what without a mood journal (daily--prospective). For instance, that supplement that I told you stopped my nail biting may not be what was affecting me because I'm still taking that supplement but I'm back to biting my cuticles. My pdoc thinks it was the Adderal that was affecting that activity. He said that he has had tricc??? (hair pullers) stop pulling hair on Adderal, surprised the putty out of him. So see a daily mood chart will have this info on it so that even if my "mind set" tells me it's the supplement that is supposed to calm nerves, the record is there for me to review later.
> > Ok--more unusual stuff my pdoc said: He says that hypertensive epiosodes (not hypertension)
>
> Umm. You mean, not the chronic hypertension that folks with cardiovascular disease often seem to have?no, I'm talking about the "cheese" reaction to MAOs.
>
> > is not common among people who are down-regulated, but are instead more common among people who are up-regulated (over-stimulated).
>
> (Interesting use of the expressions "down-" and "up-regulated.")Yeah, I know. It's a pretty simplistic way of looking at things (although simple does not mean wrong). The brain wave people (EEG Spectrum) looked at it this way also and used the same language.
> > >That's a possibility. I don't feel that I was especially stimulated or sedated by Parnate, except at first when it was rather activating. But it makes sense that if a stimulant mechanism were involved (presumably catecholaminergic, based on Parnate's chemical similarity to amphetamine), people who were more sensitive to that effect (i.e., who feel more stimulated on Parnate) would be more likely to have some other stimulant-like side effects. Basically, my take on the Parnate spontaneous hypertensive episodes is that Parnate probably has stimulant-like actions in addition to MAO inhibition (e.g., promoting catecholamine release), and that the stimulant actions (notably, pressor effects of dopamine) are potentiated by the MAO inhibition.
You point (re stimulant actions of Parnate being associated with hypertensive episode) is a good one. My pdoc wasn't talking about Parnate though--he meant all MAOs and would expect the same reactions on Nardil for someone who was down regulated. Maybe this is related to being a slow or fast metabolizer as well. He means that your system may be over or under stimulated to begin with and that this is associated with how you react to the dietary restrictions of MAOs.
> > > I'm fine with cheddar and jack cheeses so far.
>
> Jack is probably okay; I'd avoid cheddar.The cheddar was mild--not significantly aged.
> > > My pdoc just got back from his vacation, and I'll be seeing him on Tuesday. So I'm still on the same stuff. The desipramine isn't working as well as it was at the high dose (300 mg/day), but I'm still noticing some benefit. My hope is that it will just take longer to work at the lower dose. Otherwise I'm just taking buprenorphine and occasionally Klonopin.How many weeks are you on the desipramine now? Your patience is great and may well pay off. Let's hope.
Lorraine
Posted by Elizabeth on August 17, 2001, at 13:52:47
In reply to Re: that other thread » Elizabeth, posted by Cam W. on August 17, 2001, at 5:12:44
> Elizabeth - I am hoping that the bullets I am putting up make it easier to see my answers.
Ahh. They are -- nice.
> •• I'm not sure that I will still make sense on this, but here goes. A person says he/she has access to journals, and then posts the abstracts. Wouldn't some of the lay public assume that this person at least understands what he is posting.
Okay, I understand now. Yes, that is a good point. Understanding the nuances of what information can be gleaned from a study or an article is not a simple matter. (Good example about pharm companies!)
I'm not sure that I agree with the idea that studies should necessarily be carried out in more diverse populations. (Maybe I'm just misunderstanding what you were getting at.) I'm all for specificity, since drugs have different effects on people depending on the nature of the condition being treated as well as patient characteristics such as age, sex, etc.
> > I think that phenelzine can also contribute to type 2 diabetes, no?
> >
> •• Yeah, I think so, but not to the degree we are seeing it with Clozaril and Zyprexa.Really. That's surprising. I'm pretty sure I became insulin-resistant on Nardil; Zyprexa caused some cravings but it wasn't nearly as bad. Then again I was taking low-dose Zyprexa, and that might factor in.
> Even people who do not have risk factors (eg. not overweight or have not gained a lot of weight) are still becoming diabetic.
That's interesting that people develop type 2 diabetes without having gained weight on the drug. Do these individuals experience appetite stimulation (if you know)?
> Also, the extent we are seeing it with atypicals over MAOIs is possibly due to the difference in sheer numbers of patients using these two classes of drugs.
True. (I think it's the hydrazine MAOIs that cause it, not nonhydrazines like Parnate and selegiline.)
> And a good exchange; it was fun. Thanks. - Cam
Same to you. :)
-elizabeth
Posted by Elizabeth on August 17, 2001, at 14:29:54
In reply to Re: I was gone but now I'm back » Elizabeth, posted by Lorraine on August 17, 2001, at 11:45:53
> Ocean Isle to visit my cousins who were vacationing at the beach
I'm not sure exactly where that is, but W-S is nowhere near any beach.
> Plus, this sedating component to Parnate might be serotonin related?
It's hard to say. Messing with serotonin does throw your sleep biorhythms all out of whack. There are other (non-serotonergically mediated) effects that can contribute to drowsiness too (such as orthostatic hypotension).
> I may need to add a stimulant to it.
Careful with that, ok?
> My take is that that severe depression is so physical that monkeying with mind sets and mental gymnastics won't put a dent in it without some med support.
That sounds about right, yup. I really wanted to believe that CBT would be "the answer," too, so it wasn't like I didn't give it my best shot.
> If you have developed coping patterns for dealing with childhood abuse that are maladaptive and trigger shame spirals, you pretty much have to get in there and clean that stuff out because they cause deep mood dips (that's a technical term< g >) that are barely tolerable when you are normal and completely intolerable when you are depressed.
I understand, and this makes sense to me. I think that depression (without any deep childhood issues) can cause secondary problems such as demoralisation (just as panic disorder can lead to agoraphobia). Those secondary problems may resolve once the depression is treated, but if they don't, I think that talk therapy may be in order.
> I don't know how much psychologists want to be scientific as opposed to how much they want to achieve respectability in a scientific community that doesn't value things that can't be measured or that don't fit the experimental design model in vogue today.
That's pretty much what I meant. And I think that eliminating subjective experience from consideration in psychology is a mistake. (Reminds me of extremist behaviourism, a la B.F. Skinner.)
> My undergrad major was experimental psychology and I took a boat load of statistics classes and experimental design classes. It is very helpful for picking apart studies, but I find that I am still skeptical even of studies that fit the parameters of "good" scientific design. Maybe this is because so many of them show things that are false. For instance, the weight gain and sexual dysfunction side effects of the SSRIs are much higher than the studies would lead you to suspect.
I think this is an example of the effects that corporate pressure can have on research: if the funding's coming from the drug company, you want to get results that the drug company will like so they'll keep giving you money. So in situations where you have discretion, you [the researcher, that is] throw away data points that don't fit the curve, nudge the stats in the direction you want them to go, etc.
> Were the techniques to control self talk, like "this is just a panic attack. I'm not going to die" and breathing or something more?
That wasn't really a technique so much as a simple result of having someone point out to me that I was having panic attacks. I did some research on panic disorder, and it made me feel much more at ease, so that the panics were easier to cope with. The "techniques" I was referring to were things like diaphragmatic breathing and meditation.
> Well, yeah. This is what makes it all so difficult because of the interactive nature of mind/brain stuff. But if you recognize this inherent limitation, I think the dichotomy can be useful (ie it's not wholly true, but then neither is it wholly false--it's just a useful "way of looking" at some of the issues).
A model, you mean. Yes, that might be more accurate than to consider it the literal truth.
> > That's true, different people have different priorities. Personally, if I find something that works, I make a serious effort to deal with the side effects.
>
> I can see that you do.Well, there are a limited number of things that work, so... Buprenorphine has been a big challenge; it's much more intense (in terms of its effects, both desired and unwanted) than classic ADs were.
> If my previous pdoc had been more open minded, I might have added a stimulant to the Effexor and stayed on it.
So many people on this board could tell stories that begin, "If my previous pdoc had been more open minded..."
> Dryness is a constant companion of those who lack estrogen, like me.
Good point; I don't think estrogen supplementation is a good idea for me, though.
> I use some of the better lubricants, although right now I'm using something called "wicked" (this may be an off lable use :-)
Off label? Uh. What's it labelled for?
> I'm also doing that thing for arousal that someone posted here (a certain thigh creme with argenon mixed in)--it works, but is a bit messy.
Interesting!
> I have just found that it is so difficult to tell what is impacting what without a mood journal (daily--prospective).
I think that's true; they are useful. Unfortunately, when I first start taking something, I tend to be too depressed to be in any shape to keep a mood journal!
> For instance, that supplement that I told you stopped my nail biting may not be what was affecting me because I'm still taking that supplement but I'm back to biting my cuticles.
Same thing happened to me with lithium: I started taking it and a week later I was feeling much more alive and interested in things, so I assumed it was the lithium. In retrospect I think it was just a random fluctuation.
> My pdoc thinks it was the Adderal that was affecting that activity. He said that he has had tricc??? (hair pullers) stop pulling hair on Adderal, surprised the putty out of him.
That does seem like a symptom that could be exacerbated by stimulants, yes. (It's trichotillomania, BTW.)
> So see a daily mood chart will have this info on it so that even if my "mind set" tells me it's the supplement that is supposed to calm nerves, the record is there for me to review later.
I think that putting it in writing also has the potential to be an outlet for your thoughts about the treatment, so that you don't get preoccupied with it outside the journal.
> > Umm. You mean, not the chronic hypertension that folks with cardiovascular disease often seem to have?
>
> no, I'm talking about the "cheese" reaction to MAOs.The phrase I was confused about was "hypertensive episodes (not hypertension)." When you said "hypertension," did you mean sustained hypertension (as in CV disease)? If not, what did you mean?
> You point (re stimulant actions of Parnate being associated with hypertensive episode) is a good one.
I think of it as the Parnate interacting with itself: it has two different effects that interact. (The stimulant effect has never been confirmed, but there's a lot of suggestive evidence.)
> My pdoc wasn't talking about Parnate though--he meant all MAOs and would expect the same reactions on Nardil for someone who was down regulated.
I think Parnate and Nardil are not at all interchangeable. A person can be very tired on one and activated on the other.
> He means that your system may be over or under stimulated to begin with and that this is associated with how you react to the dietary restrictions of MAOs.
I could see that. What does it mean for people like me who tend to be slowed-down and tired but also have a hyperactive startle response?
> > Jack is probably okay; I'd avoid cheddar.
>
> The cheddar was mild--not significantly aged.OK, if you have that level of information about it, that's probably fine to use your judgment.
> How many weeks are you on the desipramine now? Your patience is great and may well pay off. Let's hope.
I sure am (hoping).
I started taking DMI on 2 July at 25 mg/day. I got to 100 mg/day (low-end effective dose) on 12 July. So it's been a good while.
-elizabeth
Posted by Cam W. on August 17, 2001, at 16:59:05
In reply to Re: that other thread » Cam W., posted by Elizabeth on August 17, 2001, at 13:52:47
Elizabeth -
>
> I'm not sure that I agree with the idea that studies should necessarily be carried out in more diverse populations. (Maybe I'm just misunderstanding what you were getting at.) I'm all for specificity, since drugs have different effects on people depending on the nature of the condition being treated as well as patient characteristics such as age, sex, etc.
>
• I believe that large scale naturalistic studies, using clinical situations, in the post-marketing surveillance stage of drug development is essential. If it were done more, we would have caught the delayed weight gain with Paxil, or the withdrawl syndrome of short-acting SRI-like drugs. The other, proper randomized, placebo-controlled clinical trials are necessary to produce a short-term therapy baseline, but these need to be extended to real world situations.
>
> > > I think that phenelzine can also contribute to type 2 diabetes, no?
> > >
> > •• Yeah, I think so, but not to the degree we are seeing it with Clozaril and Zyprexa.
>
> Really. That's surprising. I'm pretty sure I became insulin-resistant on Nardil; Zyprexa caused some cravings but it wasn't nearly as bad. Then again I was taking low-dose Zyprexa, and that might factor in.
>
• Dose does not seem to be strongly related to the incidence of the diabetes, either. It is probably a numbers game we are looking at. When you see 5 people taking Nardil and 100 people taking Zyprexa, it is going to look like the Zyprexa is a worse offender, because you see more of them.
>
> > Even people who do not have risk factors (eg. not overweight or have not gained a lot of weight) are still becoming diabetic.
>
> That's interesting that people develop type 2 diabetes without having gained weight on the drug. Do these individuals experience appetite stimulation (if you know)?• On the whole, we usually see both weight gain and diabetes, but I have read articles where no weight gain and diabetes occurred. I do not know much more than that, and it would have been interesting to see his baseline triglyceride levels prior to the initiation of therapy, as well as his family Hx for diabetes (ie. the people could have been borderline diabetics, to start with. These were not mentioned in the two different articles (can't find them quickly, of course), but the articles did not go into much detail on them. I do not know about appetite stimulation in the non-weight gainers.
Back at ya ;^)
- Cam
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