![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 313 to 337 of 434. Go back in thread:
Posted by Elizabeth on September 8, 2001, at 21:05:09
In reply to Re: Hypertensive crises, update, posted by Lorraine on September 4, 2001, at 21:25:50
> Doing my washout from Parnate to Nardil with adderal and neurontin. Took 10 mg adderal this morning, fine. Took second 10 mg adderal this afternoon, started feeling funny. Tingling moving up my neck to my head and headache coming on, waited a little (not long) felt worse. Took blood pressure 165/97, i think.
That's about the point where I was instructed by my pdoc to take nifedipine. (BTW, "bite and swallow" seems to work better than SL.)
> Took antidote crushed it under tongue, blood pressure came down, right away and within an hour or so was clearly normal, although high for me on MAO. I feel very hungover. Not an experience I want to repeat necessarily.
Nifedipine made me feel hungover too.
-e
Posted by shelliR on September 9, 2001, at 0:11:21
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 8, 2001, at 12:53:48
Hi Lorraine,
> People without atypical depression may develop insomnia instead of over sleeping. Atypical includes symptoms of rejection sensitivity, over-eating, and a generally heavy feeling or "leaden paralysis".Well, let's see. oversleeping-yes; overeating-no;
leaden paralysis-um, does horrible pain in the chest fit under leaden paralysis?
> > > >I can't imagine going on a vacation with a friend--too intense, although it would make me feel less vulnerable.
>
> This is generally? You don't like vacationing with friends? And you feel uneasy vacationing alone--at least at times? (I'm not going to suggest tour groups.)well, I used to go to the beach with friends, and that was totally relaxing. I would never consider going to the beach by myself, and my body is definitely not bathing suit ready, anyway. I think it probably will never be again, anyway I much prefer the southwest mountains. Hint. I fell in love with it here when I came out for a few years to take photo workshops. And I keep coming back.
Except for a few *really* bad hate myself/want to die moments, it's been a very nice week for me. I don't feel lonely. And I don't think many friends would come here with and let me spend about a third of my time watching the US Open. The funny thing is I always come here during the US open; I would feel guilty watching so much and not working if I was at home, plus as I said it sort of connects me while I'm here.
> > > >Not out of fear, more out of laziness.
> Not avoidance? My avoidance feels like laziness (leaden paralysis), but I suspect it's actually avoidance which is social anxiety based.Almost any social anxiety I have is related to being around single men. (Do I like them; do they like me, stuff.) Pretty much in other situations, I'm pretty comfortable. I hate doing things just to meet people, and most things I enjoy can be quite solitary. When you went to the depression groups, did the people seem interesting and depressed, or just depressed? (excluding the other babbler)
>
>> I do this with a friend. I've gone to Argentina and Santa Fe with her.
hum, southwest mountains, art, not argentina.
as the game goes, getting pretty hot < g >.
>
>
> [re your hypertensive crises} Shelli I still have a headache (not severe) in the back of my skull and my neck is really stiff. This is Friday and the crises was Tuesday. Did this stuff linger for you also? I'm trying to figure out if this means that the hypertensive crises has not resolved or if these are residual effects of a hypertensive crises. Now, I can hear you say, what does it matter--why split that hair?I don't even *get* the difference between residual effects and an unresolved hypertensive crisis. Really.
>Well, I want the hypertensive crises to be resolved before I start the Nardil.
Well, that makes sense, but you could also say you want to wait to start nardil until all the residual effects are gone. That's why I'm confused.
BTW, I had no residual effects after the episode. But my BP didn't go that high. For me I had a strong tightening of my shoulder muscles (well right on either side of my neck) and my pulse went way down. Looking back, I don't know how I even knew it was a hypertensive reaction. I had always heard a horrible headache in the back of the head. And I guess I was hypervigilent because my pdoc said she would not support my decision to try adrafinil, and I knew something felt different. It was the only stimulent I have tolerated, aside from concerta, which I have tried only recently. Concerta remains on my possible go back to list, along with nardil.
>
>
> > > > I'll be anxious to see what he says and what his plan is :-)
> > As long as the oxy is working , I am really not feeling depressed. I would like to increase the wellbutrin again....
>
> It's interesting how much you are willing to stick with it on this one. Is it because it at least has no side effects?I guess so. That and the fact that I am not feeling desperate as soon as the oxy kicks in. Also, because this is how nardil felt. No side effects; long time to kick in. So it seems worth hanging in there; like not much to lose aside from getting myself up higher on oxy.
Another important factor is that I don't even have a clue what to try next, except to go back to nardil with oxy. Suggestions would be *greatly* appreciated. No antipsychcotics or tricyclics. I think I've tried every mood stabilizer.
>
>
>
> > Good luck tomorrow with nardil.
> I've decided to play it safe and wait at least one more day.I probably would wait until the stiffness and headache go away if you can wait it out. Have you tried a muscle relaxer for the stiffness? (not a benzo, a real one :-)
Welcome back Elizabeth, if you read this. (and I hope and expect that you will). Any suggestions from you would also be appreciated. I see my pdoc monday, and I'm interested in what he has to say. My guess is that he'll have me continue the wellbutrin and up the dosage.
Shelli
Posted by Lorraine on September 9, 2001, at 12:46:15
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 9, 2001, at 0:11:21
Hi Shelli:
> > [re atypical depression] People without atypical depression may develop insomnia instead of over sleeping. Atypical includes symptoms of rejection sensitivity, over-eating, and a generally heavy feeling or "leaden paralysis".
>
> Well, let's see. oversleeping-yes; overeating-no;
> leaden paralysis-um, does horrible pain in the chest fit under leaden paralysis?I think by leaden paralysis they mean heaviness in the limbs. Elizabeth is the one who turned me on to the concept of atypical depression. It is useful to know because atypical depression apparently responds to MAOs well.
> > >[re vacationing alone] And I don't think many friends would come here with and let me spend about a third of my time watching the US Open. The funny thing is I always come here during the US open; I would feel guilty watching so much and not working if I was at home, plus as I said it sort of connects me while I'm here.Only a very good friend would allow you to do this--but those are the only friends worth having anyway. With my husband, it took a while for us to learn that we don't have to do everything in tandem. It's harder to work out with friends b/c you are not around them so much I think, but it is the evolved way to relate. While you watch the US open, I'll be at the art galleries....
>
> > > When you went to the depression groups, did the people seem interesting and depressed, or just depressed? (excluding the other babbler)Great question. I would say--it is a group of 25+ people--that of that group there are maybe 3 or 4 people that I might want to know. I've only gone 3 times so those 3 people may shift. If it turns out that there is only 1 person worth knowing, then I am a very lucky person anyway. What I need is to be in the "advanced" group, but there isn't one. My husband thinks I join these groups so that I can be a care-giver for those more needy, but what I would love is a group where people have already done a lot of intensive work and are stuggling with the day to day issues. Even the people that I don't want to befriend have some interesting points. Like a woman brought up the need for structure in our lives and talked about that. That is an important issue for me.
> > > Well, that makes sense, but you could also say you want to wait to start nardil until all the residual effects are gone. That's why I'm confused.Yeah, ok, but a crick in the neck can take weeks to go away.
> > > Another important factor is that I don't even have a clue what to try next, except to go back to nardil with oxy. Suggestions would be *greatly* appreciated. No antipsychcotics or tricyclics. I think I've tried every mood stabilizer.I'd be curious what elizabeth thinks of a Nardil and Desipramine combo.
> > >Have you tried a muscle relaxer for the stiffness? (not a benzo, a real one :-)
Aspirin work for the pain and Valium is a muscle relaxant.
In closing, Shelli, a little tennis gift for you, --a poem about Venus Williams by Al Letson Jr., who read it aloud at a Slam Poetry contest in Los Angeles and was kind enough to send me a copy of it.
The Second Planet From a Star
by Al Letson
I am waiting
for Venus Williams
to save me.Like some
great Masi-Amazon warrior
stepping out the foliage
of the jungle,
to open green fields
outlined in white,
with sword in hand.
Prepared to do battle
using breath of flame.
spiting words like...."I didn't come to play
good tennis,
I came to win!"Beads,
singing like Medusa's hair
flailing against gravity
as tennis racket
hits the full moon
across the net,
and I'm stretch back
20 years
to an uncoordinated
painfully skinny kid
holding a tennis racket in hand
sweat saturating the grip
as the coach on the other side
of the court hollers"YOU'RE PLAYING LIKE A GIRL, ALFIE!"
That's when I feel her slender fingers,
wrap around my shoulder,
and gently push me aside.Eyes of marble and onyx
stare down the little man
across the net
and…… SERVE!"Hummin' cummin' atcha'"
A little green globe
zooming through the atmosphere
narrowing in on it's target,
and at 100 miles per hour,
man, you better hit or get hit!And he decides to get hit
BAM!!!And I'm standing on the sideline
Screaming "15 LOVE!"
and don't know what the hell
I'm talking about.
as the goddess of love
stretches her statuesque arms in the airand SERVE, and SERVE, and SERVE!!!
Calling forth hail stones
shaped like tennis balls,
to rain from the sky
pounding into his premature balding head
while he's screaming at the top of his lungsSTOP (BAM!)
STOP (BAM!)
STOP (BAM!)and when she does,
she rocks back and forth
left to right,
waiting for the volley
that will never come.Standing over the bully-coach.
I'm sayin'
"Who's playin' like a girl now?
Who's playin' like a girl now!?!?!"
What!!!"and when I turn around,
she is gone.
The second planet from the star
we know so well.
flung back into the cosmos, where she belongs
leaving me to fast forward
twenty years,
back to the Future
to a man
slightly uncomfortable
with his height, weight,
and lack of athleticism
watching her on the TV screen,
as my daughter crawls on the floor
before me,
making me think of her.Every time Venus whacks
another ball into the Stratosphere,
I'm caught up in the fact
that my daughter will face
obstacles I will never have to see
just because of her sex.At that moment,
At that instant,
overcome by memories of an event
that never even happened,
I wanna grab my daughter up in my arms
and tell her,
tell her,"Baby, these flawed genes
I pass down to you,
May not have the stuff of
Venus Williams, or Mia Hamm.
You may not write novels
like Edwidge Danticot,
Or Joyce Carol Oats.
You may never see the moon so close
you can almost smell it,
that you could taste it,
like May Jamison.
But wherever your talents lie
It will be beautiful,
and you will be beautiful
for who you are
weakness,
strengths
and all.And if they ever tell you,
"your playing like a girl"
Be proud.
And know that you will win
like
a
woman. "Lorraine
Posted by Lorraine on September 10, 2001, at 20:24:39
In reply to Re: Hypertensive crises, update » Lorraine, posted by Elizabeth on September 8, 2001, at 21:05:09
> > Doing my washout from Parnate to Nardil with adderal and neurontin. Took 10 mg adderal this > > >[re hypertensive crises]Took blood pressure 165/97, i think.
>
> That's about the point where I was instructed by my pdoc to take nifedipine. (BTW, "bite and swallow" seems to work better than SL.)I think if I had to do it over again, I would start the nifedipine right when the headache starts rather than based on the blood pressure. I still have a bit of a throbbing headache in the base of the back of my head. I don't know if this is hypertensive hangover; parnate withdrawal or a side effect of the nifedipine.
I did actually bite, put under the tongue for about 2 second and then swallowed.
>
> Nifedipine made me feel hungover too.
>elizabeth: are you still on buprenorphine? Just wondering. Is the Desipramine still doing you good? Did you see the comment I made (earlier post--no need to go back to it tho) about augment Nardil with Desipramine or vica versa. Someone on the board reported good success with this.
I'm on to Nardil, started yesterday. No hypertensive episode so I'll call that success.
Lorraine
Posted by shelliR on September 10, 2001, at 23:11:56
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 9, 2001, at 12:46:15
Hi Lorraine,
Back from my vacation, and *not* relieved. All in all it was really nice. I was able to fight my insecurity enough to really enjoy the peace, beauty and art. It definitely is insecurity, not lonliness. I absolutely love dry heat and feel so much healthier in the SW, always. Of course, it was also wonderful to take a complete break from work. I saw such awesome photographs; it greatly greatly humbled me.
I think I might check out places in Arizona as a second base. (Still spending the majority of my time on the east coast.) If I can get some work there, and computer generate all my work, (the direction I am headed anyway), I might be able to break even on renting a little house/studio. (first rent; maybe later buy). I love the Santa Fe area, but it just gets too darn cold. Plus not the right population for my work, I don't think, although one of my clients moved out there and he manages Winton Marcelis. So I might have a in with the rich and famous. :-) You know, Ophrah, Jane Fonda, Julia Roberts, etc. HA. Near scottsdale is what I am thinking about in AZ.
> > > > When you went to the depression groups, did the people seem interesting and depressed, or just depressed? (excluding the other babbler)
> Great question. I would say--it is a group of 25+ people--that of that group there are maybe 3 or 4 people that I might want to know. I've only gone 3 times so those 3 people may shift. If it turns out that there is only 1 person worth knowing, then I am a very lucky person anyway. What I need is to be in the "advanced" group, but there isn't one. My husband thinks I join these groups so that I can be a care-giver for those more needy, but what I would love is a group where people have already done a lot of intensive work and are stuggling with the day to day issues. Even the people that I don't want to befriend have some interesting points. Like a woman brought up the need for structure in our lives and talked about that. That is an important issue for me.Lucky, if you are getting something out of the group, and it sounds like you are-- minimally, at least.
> I'd be curious what elizabeth thinks of a Nardil and Desipramine combo.
Is that what you're looking toward with the nardil, if it's only partially effective?
> > > >Have you tried a muscle relaxer for the stiffness? (not a benzo, a real one :-)
> Aspirin work for the pain and Valium is a muscle relaxant.
Valium doesn't work for me (or most people) as a muscle relaxer. Or if it did, you have to take enough to pretty much knock you out. I've never heard of a doc giving valium anymore for muscle pulls, etc.; it's generally only used as a sedative now.
>
>
> In closing, Shelli, a little tennis gift for you, --a poem about Venus Williams by Al Letson Jr., who read it aloud at a Slam Poetry contest in Los Angeles and was kind enough to send me a copy of it.Thanks. I liked reading it, though I imagine that hearing it and seeing who's reading it, has a fuller impact. I think the Williams sisters are pretty cool, especially considering their father. Mom must have had some influence re sensitivity.
>So you have started nardil. So far, okay?
I will start nardil tomorrow with wellbutrin. Saw my pdoc today. He wanted to go to remeron next (with wellbutrin), and I burst out crying and said I want to go on nardil, again. He was a bit nervous about the combo. I have read on this site about two people who have done that combination. Someone said in a post last year that it is mentioned on Dr. Bob's psychobabble tips, but I couldn't find it. I'm going to look again, if I can't find it, I may e-mail Dr, Bob. Anyway, I realized after my appointment that I never asked him about taking an antidote. . He did check that I had a BP cuff, but that's about all. There is a more than minute chance for me to have a hypertensive reaction
So I went back in again, caught him in the hall, and he told me that I should watch for my diabolic BP going above 110. I have never even paid attention to that number, and I didn't get the opportunity to ask him why. Also, he said he didn't want me to take a nifedipine-type antidote and I should call him and go to the hospital.
I'm going fax him tomorrow and ask him what the deal is; why can't I have one--isn't that what they would give me at the hospital, anyway? He told me he responds to faxes because he checks them every fifteen minutes. I guess he doesn't check his messages. (?) Anyway, at least someone on this staff can tell me what he says. I really want to do this combo and am going to be totally bummed if I have a reaction. He said to start with 15mg tomorrow; I think I'll start with 7.5 or less.
When he left he said, "don't worry, I will make sure you get better." And I replied that he will blame me for not trying remeron. And then he said, "Please don't feel guilty, you are feeling bad enough. It's okay that you don't want to try remeron now." That was about the nicest thing he's ever said to me.
So now we are doing nardil together. BTW, I read your post to Elizabeth about taking the antidote earlier, but I think I might actually wait a bit longer. I think it may well be the nifedipine that made you sick and maybe you could have waited a little longer to see if it was still going up. I don't know, but that's a possiblity. I did some research before on nifedipine with MAOIs and there are really contrary views about giving it to patients. If I remember correctly (and I may not, really), I think some pdocs think their MAOI patients might take it too early and then the nifedipine might make them very sick.
I don't remember how bad your headache was, though. My reaction was shoulder tightness, so there was no real pain involved. But you might ask your pdoc about exactly when he thinks you should take it. I don't know how fast it works ; I guess that would determine how high to go up before taking the antidote.
What dose did you start with nardil?
later, keep me posted,
Shelli
Posted by Lorraine on September 11, 2001, at 13:10:13
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 10, 2001, at 23:11:56
Hi Shelli,
Back from my vacation, and *not* relieved.
That's a good sign:-0
It definitely is insecurity, not lonliness.
Yeah, I rarely, rarely get lonely. Insecurity about being alone?
I love the Santa Fe area
Me too. I wasn't wild about Sedona though.
but it just gets too darn cold. Plus not the right population for my work, I don't think, although one of my clients moved out there and he manages Winton Marcelis. So I might have a in with the rich and famous. :-) You know, Ophrah, Jane Fonda, Julia Roberts, etc. HA.
I don't know--the tourists might be interested, but it might entail a different work schedule or mailing prints when done. There is a ton of foot traffic.
> > I'd be curious what elizabeth thinks of a Nardil and Desipramine combo.
>
> Is that what you're looking toward with the nardil, if it's only partially effective?It's what I think is the next obvious step. I started Nardil at 15 mg and, of course, like it very much. (I know I'm not supposed to be able to tell, but I do feel a slight boost and I do feel more hunger than usual.) So as usual I'm optimistic. I guess that's fine--this random walk through pharmacology. May as well be optimistic.
> > > > >Have you tried a muscle relaxer for the stiffness? (not a benzo, a real one :-)
> > Aspirin work for the pain and Valium is a muscle relaxant.
> Valium doesn't work for me (or most people) as a muscle relaxerI've only needed the valium at night--it knocks me out anyway even splitting the smallest tablet. But the stiffness and headache seem better whether this is because I have another MAO in my system or because time heals, I don't know.
> > >I imagine that hearing it and seeing who's reading it, has a fuller impact. I'm sure you are right. The guy who wrote it was a slight black man who had two daughters.> > > I will start nardil tomorrow with wellbutrin. Saw my pdoc today. He wanted to go to remeron next (with wellbutrin), and I burst out crying and said I want to go on nardil, again. He was a bit nervous about the combo. I have read on this site about two people who have done that combination.
I don't know of anyone on that combo though I am sure someone here has tried itAnyway, I realized after my appointment that I never asked him about taking an antidote. . He did check that I had a BP cuff, but that's about all. There is a more than minute chance for me to have a hypertensive reaction So I went back in again, caught him in the hall, and he told me that I should watch for my diabolic BP going above 110. I have never even paid attention to that number, and I didn't get the opportunity to ask him why. Also, he said he didn't want me to take a nifedipine-type antidote and I should call him and go to the hospital.
Shelli-- I was in genuine pain, excruciating headache, intense throbbing at the base of my skull--I still have slight remnants of it. I would be very uncomfortable without the antidote. So you call him and he acalls you back in fifteen minutes or worse it's half an hour and you are in the emergency room and they are making you wait. It just seems to happen very quickly and I know elizabeth had a bad experience in the emergency room. I'm aware of the controvery re the antidote. There is actually a good discussion of it in the tips section--a rebutttal to the concerns that I thought was pretty convincing. I think that doctors follow standard medical procedures until it's their head and then they take the antidote. (Isn't that a vicious thought?)
>
> > >I'm going fax him tomorrow and ask him what the deal is; why can't I have one--isn't that what they would give me at the hospital, anyway?Good.
> > >He said to start with 15mg tomorrow; I think I'll start with 7.5 or less.
I thought the lowest dose was 7.5 mg and my pharmicist told me that I could not split the tablets--he could be wrong, but you might want to check.
> > > So now we are doing nardil together. BTW, I read your post to Elizabeth about taking the antidote earlier, but I think I might actually wait a bit longer. I think it may well be the nifedipine that made you sick and maybe you could have waited a little longer to see if it was still going up. I don't know, but that's a possiblity.
You know what I ought to do a search for it here and if that comes up dry post it as a general question. It is a very good point--whether the antidote itself makes you ill.
> > >But you might ask your pdoc about exactly when he thinks you should take it.He said at the first sign of an intensive headache that didn't feel like any headache I had ever had. But then I read an old post of elizabeth's saying something like bp of 165/95 and I followed that instead.
> > >I don't know how fast it works ; I guess that would determine how high to go up before taking the antidote.
It's pretty quick. I don't know how long unmedicated hypertensive crises last ordinarily.
Good luck to you shelli on the Nardil combo. I'm glad your pdoc was able to sympathize with you--it was a big step for him and made you feel better to boot. :-)Lorraine
Posted by Elizabeth on September 12, 2001, at 3:43:08
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 9, 2001, at 0:11:21
> Well, let's see. oversleeping-yes; overeating-no;
> leaden paralysis-um, does horrible pain in the chest fit under leaden paralysis?Probably not. Leaden paralysis means your body, especially arms and legs, feels really heavy.
> I don't even *get* the difference between residual effects and an unresolved hypertensive crisis. Really.
The difference would be whether your blood pressure is still high! (People whose BP runs low seem to have worse symptoms than those with higher baseline BPs.)
> BTW, I had no residual effects after the episode. But my BP didn't go that high. For me I had a strong tightening of my shoulder muscles (well right on either side of my neck) and my pulse went way down.
That's a compensatory measure: your heart is attempting to compensate for the vasoconstriction by decreasing its output.
> Looking back, I don't know how I even knew it was a hypertensive reaction.
It probably was, though it may not have been a true "crisis." Since you've been having possible reactions, I really suggest that you try to find a BP monitor so that you can check these things. The digital self-inflating ones are expensive but a manual one should only run about $15-25.
> I had always heard a horrible headache in the back of the head.
That's the main one, yeah.
> No antipsychcotics or tricyclics.
What did these do when you tried them (if you did)?
> I think I've tried every mood stabilizer.
Tegretol? Trileptal? Keppra?
> I probably would wait until the stiffness and headache go away if you can wait it out. Have you tried a muscle relaxer for the stiffness? (not a benzo, a real one :-)
Soma, perhaps.
> Welcome back Elizabeth, if you read this.
Thanks. :-) I'm slowly catching up.
-elizabeth
Posted by Elizabeth on September 12, 2001, at 3:47:17
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 9, 2001, at 12:46:15
> Yeah, ok, but a crick in the neck can take weeks to go away.
I don't think it's a crick -- that is, it's not musculoskeletal, but vascular.
> I'd be curious what elizabeth thinks of a Nardil and Desipramine combo.
It could be worth a try, and I think it would be safe (although I'd suggest monitoring your BP closely). I haven't had any appetite loss on desipramine, so I'm not sure it would counteract the weight gain from Nardil very effectively.
-elizabeth
Posted by Elizabeth on September 12, 2001, at 3:51:20
In reply to Re: Hypertensive crises, update » Elizabeth, posted by Lorraine on September 10, 2001, at 20:24:39
> > > Doing my washout from Parnate to Nardil with adderal and neurontin. Took 10 mg adderal this > > >[re hypertensive crises]Took blood pressure 165/97, i think.
> >
> > That's about the point where I was instructed by my pdoc to take nifedipine. (BTW, "bite and swallow" seems to work better than SL.)
>
> I think if I had to do it over again, I would start the nifedipine right when the headache starts rather than based on the blood pressure.I wouldn't. People have differing levels of reactivity depending on various factors (e.g., baseline BP). You want to have a number, you know? It's a bad idea to take nifedipine if you aren't sure that your BP has reached a certain level. Also, although it's high, 160-170/90-100 isn't terribly dangerous -- it's just a good safe point to take nifedipine if the BP is still rising.
> I did actually bite, put under the tongue for about 2 second and then swallowed.
That sounds like a great compromise. :-)
> elizabeth: are you still on buprenorphine?
Yup.
> Is the Desipramine still doing you good?
Yes, it is.
-elizabeth
Posted by Elizabeth on September 12, 2001, at 4:06:26
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 10, 2001, at 23:11:56
> Valium doesn't work for me (or most people) as a muscle relaxer. Or if it did, you have to take enough to pretty much knock you out. I've never heard of a doc giving valium anymore for muscle pulls, etc.; it's generally only used as a sedative now.
Some doctors try to pass it off as a muscle relaxer.
> I will start nardil tomorrow with wellbutrin. Saw my pdoc today. He wanted to go to remeron next (with wellbutrin), and I burst out crying and said I want to go on nardil, again. He was a bit nervous about the combo.
Honestly, I think it's safe. I've heard of a number of people who tried it with no ill effects, and I've *NEVER* heard of any noticeable interaction.
> So I went back in again, caught him in the hall, and he told me that I should watch for my diabolic BP going above 110.
"Diabolic?" You mean diastolic, right? < g >
> I have never even paid attention to that number, and I didn't get the opportunity to ask him why.
It means that your heart's "at rest" state is resulting in a high pressure.
> Also, he said he didn't want me to take a nifedipine-type antidote and I should call him and go to the hospital.
I don't agree, but I understand his reasoning.
> I'm going fax him tomorrow and ask him what the deal is; why can't I have one--isn't that what they would give me at the hospital, anyway?
No, they'd give you phentolamine or nitroprusside. They'd also monitor you to make sure you were okay (no BP crash, etc.).
> When he left he said, "don't worry, I will make sure you get better." And I replied that he will blame me for not trying remeron. And then he said, "Please don't feel guilty, you are feeling bad enough. It's okay that you don't want to try remeron now." That was about the nicest thing he's ever said to me.
I think that's really sweet of him.
> I did some research before on nifedipine with MAOIs and there are really contrary views about giving it to patients.
I think that many doctors really need to have confidence that you know what you're doing before they'll give you nifedipine. It does have its dangers.
> If I remember correctly (and I may not, really), I think some pdocs think their MAOI patients might take it too early and then the nifedipine might make them very sick.
Yes. It can make your blood pressure "crash," which can progress to shock (worst-case scenario).
> I don't know how fast it works ; I guess that would determine how high to go up before taking the antidote.
IME, about 10-15 minutes when taken by "bite & swallow."
-e
Posted by shelliR on September 12, 2001, at 22:21:30
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 11, 2001, at 13:10:13
Hi Lorraine,
>
> Back from my vacation, and *not* relieved.
> That's a good sign:-0
> It definitely is insecurity, not lonliness.
> Yeah, I rarely, rarely get lonely. Insecurity about being alone?
Thinking something is wrong with me because none of my relationships worked out and not even certain that I want to try again. The old shame thing again.
> I love the Santa Fe area
> Me too. I wasn't wild about Sedona though.Did you go to Arizona on the same trip? Interesting. I've never been to Sedona, but many people have told me it's very magical. What was it that you didn't like about it?
I don't love Santa Fe or even Taos per say; I love the weather, I love the tremendous range of visual art, and I love driving out there: total overwhelming beauty in every direction.. And I do like the friendliness, especially the curtesy in driving. I mean, you signal, and people actually let you change lanes. And it completely awesome to realize that one woman (Mable Dodge) encouraged artists to come out there--really at that time in the middle of nowhere. Of course O’Keefe, but also Willa Cather and D.H. Lawrence among others, even from Europe.
On the topic of art, I would miss the general lack of culture there, not much music, independent film, concerts besides the opera. It is increasing, but it feels pretty much a void after all the access in D.C. and the closeness to NYC. I actually don’t go to NY very often, last went for the Edward Hopper exhibit; he’s probably my favorite painters of all time. At last, we have one or two direct flights a day which makes it now much much easier to get there and back without wasting two days. Maybe next year my sister and niece will come with me, if I go back. My sister and I can't spend too much time together without getting on each others' nerves. (hey, you want to meet me in santa fe next summer? :-) )> but it just gets too darn cold. Plus not the right population for my work, I don't think, although one of my clients moved out there and he manages Winton Marcelis. So I might have a in with the rich and famous. :-) You know, Ophrah, Jane Fonda, Julia Roberts, etc. HA.
> I don't know--the tourists might be interested, but it might entail a different work schedule or mailing prints when done. There is a ton of foot traffic.I don't see it as a good place for my type of work. They would have to be quick, tacky pictures, because I don't think people on vacation would find it important to spend several hours with a photographer while on vacation. I know , I wouldn't. I can't particularly envision mountain pictures in the same way I have seen beautiful beach pictures. I love simplicity. My niece once had a school picture done in what looked to me like the alps behind her. Very bizarre background for a school photo. I always wonder: "what are these photographers thinking?" Are California school pictures as strange?
> It's what I think is the next obvious step. I started Nardil at 15 mg and, of course, like it very much. (I know I'm not supposed to be able to tell, but I do feel a slight boost and I do feel more hunger than usual.) So as usual I'm optimistic. I guess that's fine--this random walk through pharmacology. May as well be optimistic.
I think nardil is a great antidepressant, and since you obviously respond to MAOIs (based on your parnate experience), I think you *should * be very optimistic. And since your body is so sensitive, you probably are perceiving some AD effect.
>
>
> Anyway, I realized after my appointment that I never asked him about taking an antidote. . He did check that I had a BP cuff, but that's about all. There is a more than minute chance for me to have a hypertensive reaction So I went back in again, caught him in the hall, and he told me that I should watch for my diabolic BP going above 110. I have never even paid attention to that number, and I didn't get the opportunity to ask him why. Also, he said he didn't want me to take a nifedipine-type antidote and I should call him and go to the hospital.
Shelli-- I was in genuine pain, excruciating headache, intense throbbing at the base of my skull--I still have slight remnants of it. I would be very uncomfortable without the antidote. So you call him and he acalls you back in fifteen minutes or worse it's half an hour and you are in the emergency room and they are making you wait. It just seems to happen very quickly and I know elizabeth had a bad experience in the emergency room. I'm aware of the controvery re the antidote. There is actually a good discussion of it in the tips section--a rebutttal to the concerns that I thought was pretty convincing. I think that doctors follow standard medical procedures until it's their head and then they take the antidote. (Isn't that a vicious thought?)Well I saw my pdoc again today, because I have plummeted down in the last two days and we were talking hospitalization. Again. I am now pretty sure it has to do with the horror of yesterday piled up on top of my depression. I couldn’t trace it though, until I read a post from Anna (sweetmarie) saying how she had definitely experienced a downward plunge, after the news. And she’s in the UK! Monday I was fine; Tuesday afternoon I was seriously contemplating suicide and today woke up severely hopeless. I have to start working again Friday—it was supposed to be today, but there was luckily a cancellation due to the airports closing and the client being out of town. I am very shaky and not sure that I can handle work.
Anyway, I did get to talk to my pdoc about the antidote. His feeling is that I will not have an immediate reaction. Sort of like last time, if I do have a reaction—where it went up to 168 and then back down within minutes. That it takes a buildup of a drug combination to get you into the stoke range, and if you pay attention to the signals, you will not get there. I am trusting him on this because he has no reason not to be completely frank with me. My friend had several hypertensive reactions with bad headaches and it was pretty scary how long they took to get to her at the hospital. I took her there once after she had a reaction to ale and was appalled. But her BP also never went over 170. I do have a blood cuff with me now at all times, until I am passed any danger point, and it if comes down to it I would not feel self-conscious bypassing triage and walking right into the ER and demanding attention.
> > > >He said to start with 15mg tomorrow; I think I'll start with 7.5 or less.I >thought the lowest dose was 7.5 mg and my pharmacist told me that I could not split the tablets--he could be wrong, but you might want to check.Too late, I already took a split pill. It’s not time release so I can’t imagine why there would be a problem. The lowest dose is 15mg. Today a whole pill, no problem, but I will continue to keep watch, especially because I will raise it on Friday to 22.5mg then Sunday to 30mg. And I have very much in mind that a buildup over several days might cause a problem. That was the case with adrafinil. It took several days until I felt a reaction, but didn’t have any physical signs and didn’t have a BP cuff. I am very hopeful that there will be no problems.
>
>It is a very good point--whether the antidote itself makes you ill.
That is the impression in my reading and also from my pdoc.So day three, any more news? When are you going to raise your dose and do you have any idea of how high you are intending to go? I started on 45mg (well, within one week, if I remember right), but generally through the years I have kept my dose at 30mg because of sleep disturbances which were minimal at 30mg. I also had very strange and scarey experiences not adjusting to natural light changes (especially from inside to outdoor sunlight) when I had been on 45mg for about six months.
Were the schools closed in California? They were closed, of course, in NY, but I was suprised that the D.C. and Philadelphia schools were closed. Maybe out of respect? I don't really understand why; I'll have to go back to the metro section of the Post.BTW, before the horror of yesterday, how was being alone all day, with the kids in school?
Take care, Shelli
Posted by Lorraine on September 13, 2001, at 11:06:20
In reply to Re: Hypertensive crises, update » Lorraine, posted by Elizabeth on September 12, 2001, at 3:51:20
9/12/01 elizabeth to Shelli
> > I don't even *get* the difference between residual effects and an unresolved hypertensive crisis. Really.
>
Ø The difference would be whether your blood pressure is still high! (People whose BP runs low seem to have worse symptoms than those with higher baseline BPs.)Elizabeth, help me understand this. When you have a hypertensive crises your blood pressure shoots up because of vascular contraction (veins get smaller) and your pulse rate decreases to compensate for this. When you take the antidote, it lowers the blood pressure by dilating the veins and the pulse rate returns to normal? (I’m sure my language is all wrong, but you get the gist.) So that crick in my neck was probably the result of residual the vascular contraction in that area. It would make sense, although my BP came down very significantly (well within the average range) after the antidote it did not return to pre-hypertensive readings (which were low because the Parnate had decreased my BP readings generally) until about 5 days later.
.
9/12/01 elizabeth to Lorraine> > I'd be curious what elizabeth thinks of a Nardil and Desipramine combo.
>
Ø It could be worth a try, and I think it would be safe (although I'd suggest monitoring your BP closely). I haven't had any appetite loss on desipramine, so I'm not sure it would counteract the weight gain from Nardil very effectively.Thanks for the info. Just want to have a next step in mind if the Nardil doesn’t do it. I know I am jumping the gun so to speak but it makes me feel better emotionally to do this. Then when things don’t work out, I don’t panic or go too low, but just take the next step and distract myself.
9/12/01 elizabeth to Lorraine (msg 2)
> > > > Doing my washout from Parnate to Nardil with adderal and neurontin. Took 10 mg adderal this > > >[re hypertensive crises]Took blood pressure 165/97, i think.
> > >
Ø > > That's about the point where I was instructed by my pdoc to take nifedipine. (BTW, "bite and swallow" seems to work better than SL.)I had searched Psychobabble and believe that I found a post of yours saying your pdoc had used these levels.
> >
> > I think if I had to do it over again, I would start the nifedipine right when the headache starts rather than based on the blood pressure.
>
Ø I wouldn't. People have differing levels of reactivity depending on various factors (e.g., baseline BP). You want to have a number, you know? It's a bad idea to take nifedipine if you aren't sure that your BP has reached a certain level. Also, although it's high, 160-170/90-100 isn't terribly dangerous -- it's just a good safe point to take nifedipine if the BP is still rising.I know, it’s just that it took so long for the episode to fully resolve. I was very out of sorts (although functional) for a good 5 days. I felt like I’d been in an auto accident and had whiplash. (Although I don’t suppose you’d know how that felt? How are the driving lessons going?)
> > Is the Desipramine still doing you good?
>
Ø Yes, it is.I am so pleased to hear this Elizabeth.
9/12/01 elizabeth to Shelli> > So I went back in again, caught him in the hall, and he told me that I should watch for my diabolic BP going above 110.
>
Ø "Diabolic?" You mean diastolic, right? < g >I thought she was referring to him when she said diabolic < vbg >.
> > I'm going fax him tomorrow and ask him what the deal is; why can't I have one--isn't that what they would give me at the hospital, anyway?
>
Ø No, they'd give you phentolamine or nitroprusside. They'd also monitor you to make sure you were okay (no BP crash, etc.).Yes, but aren’t you looking at a significant delay to treatment (driving to the hospital; getting admitted; having them draw blood to make sure you’re not on cocaine?; treating you like an idiot?) Bad attitude, I know.
> > If I remember correctly (and I may not, really), I think some pdocs think their MAOI patients might take it too early and then the nifedipine might make them very sick.
>
Ø Yes. It can make your blood pressure "crash," which can progress to shock (worst-case scenario).OK, I’ll be careful. Elizabeth, how long to hypertensive crises usually last? I thought about taking another BP reading 5 minutes after my high one to see if it was coming down, but got too scared to wait.
Lorraine
Posted by Lorraine on September 13, 2001, at 11:53:33
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 12, 2001, at 22:21:30
Shelli,
Insecurity about being alone?
> Thinking something is wrong with me because none of my relationships worked out and not even certain that I want to try again. The old shame thing again.I'm sorry to hear that. I know first hand how difficult shame can be to deal with.
> Did you go to Arizona on the same trip? Interesting. I've never been to Sedona, but many people have told me it's very magical. What was it that you didn't like about it?
Well, I loved the place we ended up staying at (don't remember the name--some exclusive resort type of place that my airline friend got for a song). Otherwise, I just wasn't inspired by the rest of Sedona--the landscape did not send me (it reminded me of California desert but red) and I missed the culture of Sante Fe. I am definately in the minority. I've been to Phoenix and it was OK. I've been on Lake Powell and that was beautiful.
> On the topic of art, I would miss the general lack of culture there, not much music, independent film, concerts besides the opera. It is increasing, but it feels pretty much a void after all the access in D.C. and the closeness to NYC. I actually don’t go to NY very often
I lived in DC for a summer as a law intern. Loved it. Might not want to live there because I suspect it's a bit provicial for all it's big city trappings--at least it was then (25 years ago).
(hey, you want to meet me in santa fe next summer? :-) )I thought you didn't like meeting psychobabblers;-). I don't know how our summer plans are shaping up (what with the kids and all summer gets crazy). But I might go to the east coast next summer. If I do, we might get together.
> I don't see it as a good place for my type of work. They would have to be quick, tacky pictures, because I don't think people on vacation would find it important to spend several hours with a photographer while on vacation.You're right.
My niece once had a school picture done in what looked to me like the alps behind her. Very bizarre background for a school photo. I always wonder: "what are these photographers thinking?" Are California school pictures as strange?Yes, very strange. No Alps thought, but I have not gotten a good picture of the kids from the school photographer.
> I think nardil is a great antidepressant, and since you obviously respond to MAOIs (based on your parnate experience), I think you *should * be very optimistic. And since your body is so sensitive, you probably are perceiving some AD effect.
> >One hopes.
> > > Well I saw my pdoc again today, because I have plummeted down in the last two days and we were talking hospitalization. Again.I'm so sorry to hear this. You are going through a terribly rough patch, right now. Eventually, it will get better. The hard part is that you (and I) don't even know if we are on the right meds now and the urge to find an answer is so strong; it's easy to just move on before the right med has a chance to work (Nardil took 5 weeks for you--I just finished 5 weeks on Parnate.) It's the old advice shelli, when you are depressed don't look at the big picture only focus on details or distract yourself. This is a terrible time to try to distract yourself with TV though. I know you know all this, still...
I am now pretty sure it has to do with the horror of yesterday piled up on top of my depression. I couldn’t trace it though, until I read a post from Anna (sweetmarie) saying how she had definitely experienced a downward plunge, after the news.
I've been feeling this too. I try not to listen to the news too much. My husband wants it on all the time, but I feel like climbing out of my skin when it's on so much. I reorganized the cabinets in the house to distract myself. I definately need to distract myself from this--I have no tolerance for stress and this is definately stressful. Avoidance is how I now deal with stress. I try to insulate myself from it. I have to. I've thought of looking at churches to attend actually, although I am not religious, I just think the structure, the ritual, the "words" might be soothing now.
> >I am very shaky and not sure that I can handle work.
So this is a photo shoot. Long time commitment. And you don't just get lost in the work once you start? Photo shooting sounds like the essence of detail and distraction to me if you are up to it.
That it takes a buildup of a drug combination to get you into the stoke range, and if you pay attention to the signals, you will not get there. ...if comes down to it I would not feel self-conscious bypassing triage and walking right into the ER and demanding attention.
That's great. My reaction came after 5 weeks on Parnate (which is more prone to causing hypertensive crises) and was in reaction to adding stimulants (although the day I took the Adderal I was off the Parnate, still it was in my system) and I added too much stimulant (really, I went full dose on day one) So in retrospect I was really being careless. I have a new respect for drugs, now, of course. :-)
> > > Too late, I already took a split pill. It’s not time release so I can’t imagine why there would be a problem.
Well, I was told I could split Parnate so I don't understand why not either. I think the pharmacist was just unwilling to look it up. I'm glad it worked out.
The lowest dose is 15mg. Today a whole pill, no problem, but I will continue to keep watch, especially because I will raise it on Friday to 22.5mg then Sunday to 30mg. And I have very much in mind that a buildup over several days might cause a problem.
Wow, you are moving fast. I need to increase my dose of Nardil (still 15 mg) but am a bit anxious about doing it. Do you remember if you had any anxiety when you were beginning Nardil?
> So day three, any more news? When are you going to raise your dose and do you have any idea of how high you are intending to go? I started on 45mg (well, within one week, if I remember right), but generally through the years I have kept my dose at 30mg because of sleep disturbances which were minimal at 30mg.
I'll probably go to 1 1/2 pills today this is how sure I am that my pharmacist was not right). I probably won't get to a very high dose. I'd be surprised if I go over 30 mg.
I also had very strange and scarey experiences not adjusting to natural light changes (especially from inside to outdoor sunlight) when I had been on 45mg for about six months.
Wellbutrin caused me to have visual trails and made lights dance--especially coming from a dark space (movie theatre or waking up) to a light space (movie theatre restroom).
> Were the schools closed in California?It was up to the parents and we took the kids to school to maintain a sense of normalacy. Their school were not near location that I thought would be potential targets and they are fairly close by.
> > > BTW, before the horror of yesterday, how was being alone all day, with the kids in school?
You know I like being alone. And I have been so busy--I'm painting the house and so forth. Also when I drive the kids, the other parents pull me aside and talk to me. They like me :-) So I'm actually a bit more social than usual.
Lorraine
Posted by Elizabeth on September 13, 2001, at 14:43:22
In reply to Re: Hypertensive crises, update » Elizabeth, posted by Lorraine on September 13, 2001, at 11:06:20
> > > I don't even *get* the difference between residual effects and an unresolved hypertensive crisis. Really.
> >
> Ø The difference would be whether your blood pressure is still high! (People whose BP runs low seem to have worse symptoms than those with higher baseline BPs.)So you mean by "residual effects" continued symptoms after BP has returned to normal? I wouldn't expect any such symptoms, unless the HT did damage.
Calcium channel blockers, like nifedipine, lower your BP by dilating blood vessels. Sometimes this can cause your body to try to compensate by raising your pulse. This is why treating hypertension is so complicated and often requires elaborate drug cocktails: the cardiovascular system tries to maintain its homeostasis by compensating for the effects of drugs.
> So that crick in my neck was probably the result of residual the vascular contraction in that area.
I don't know exactly what causes the particular symptoms, for the most part.
> It would make sense, although my BP came down very significantly (well within the average range) after the antidote it did not return to pre-hypertensive readings (which were low because the Parnate had decreased my BP readings generally) until about 5 days later.
How high was it for those 5 days before it went back to normal?
> Thanks for the info. Just want to have a next step in mind if the Nardil doesn’t do it. I know I am jumping the gun so to speak but it makes me feel better emotionally to do this. Then when things don’t work out, I don’t panic or go too low, but just take the next step and distract myself.One thing you might want to consider is that TCAs don't work very well for atypical depression. It might be worth a try, but there might be something else that's more likely to help.
> > ...although it's high, 160-170/90-100 isn't terribly dangerous -- it's just a good safe point to take nifedipine if the BP is still rising.
>
> I know, it’s just that it took so long for the episode to fully resolve. I was very out of sorts (although functional) for a good 5 days. I felt like I’d been in an auto accident and had whiplash. (Although I don’t suppose you’d know how that felt? How are the driving lessons going?)Dude, I don't have a license, but it's not like I've never ridden in a car! < g > I think it is weird that it took so long for it to go away completely. Some people just seem to be more sensitive to side effects than the average person is.
> > > Is the Desipramine still doing you good
> >
> Ø Yes, it is.
>
> I am so pleased to hear this Elizabeth.Thank you. I'm pleased to say it.
> Ø No, they'd give you phentolamine or nitroprusside. They'd also monitor you to make sure you were okay (no BP crash, etc.).
>
> Yes, but aren’t you looking at a significant delay to treatment (driving to the hospital; getting admitted; having them draw blood to make sure you’re not on cocaine?; treating you like an idiot?) Bad attitude, I know.When I showed up at an ER (or at the MIT Medical Center) with high blood pressure, I got seen at once. (MIT Medical didn't actually help me in any way, but they did monitor my BP -- they didn't just tell me to sit in the waiting room.) I think it's worth it to get a portable BP monitor (they'll fit in a reasonable-sized purse or handbag) so you can check it if you start getting symptoms.
> Ø Yes. It can make your blood pressure "crash," which can progress to shock (worst-case scenario).
>
> OK, I’ll be careful.Thanks. I would hate for something like that to happen to you.
> Elizabeth, how long to hypertensive crises usually last? I thought about taking another BP reading 5 minutes after my high one to see if it was coming down, but got too scared to wait.
I think they usually resolve within a few hours, but I might be misremembering.
-elizabeth
Posted by shelliR on September 14, 2001, at 11:06:10
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 13, 2001, at 11:53:33
Hi Lorraine,
>> I lived in DC for a summer as a law intern. Loved it. Might not want to live there because I suspect it's a bit provicial for all it's big city trappings--at least it was then (25 years ago).
I think it's probably still true in lawyer circles and some other work type situations, but I'm not much connected to that world. I imagine though in general, it is more formal. Like I wouldn't ever go into the city wearing shorts, even discounting my age and my enlarged body. Like in Santa Fe, all bodies wore shorts. :-) (or western hippie attire.)
>
> (hey, you want to meet me in santa fe next summer? :-) )
> I thought you didn't like meeting psychobabblers;-). I don't know how our summer plans are shaping up (what with the kids and all summer gets crazy). But I might go to the east coast next summer. If I do, we might get together.Well, I actually I don't think I was serious. And I'm still not feeling like bringing board life into real life. I am too vulnerable now, and need to stay light. Today I got an invitation to come out to Sierra Vista, AZ, which is supposed to be quite beautiful. The invite was from a client who just moved out there, but I don't know them well; just photographed them once recently. So I wouldn't feel comfortable taking her up on it, although I would call them if I get out there.
I meet a lot of interesting people doing what I do, but they are generally in a very different life situation, so although we like each other very much, the friendship doesn't extend into private social interactions, generally, although there have been exceptions. Interestingly, the exceptions are generally from the UK--I think they are more open about who they invite to their parties; they seem to enjoy diversity.
> > > > Well I saw my pdoc again today, because I have plummeted down in the last two days and we were talking hospitalization. Again.
> I'm so sorry to hear this. You are going through a terribly rough patch, right now. Eventually, it will get better. The hard part is that you (and I) don't even know if we are on the right meds now and the urge to find an answer is so strong; it's easy to just move on before the right med has a chance to work (Nardil took 5 weeks for you--I just finished 5 weeks on Parnate.) It's the old advice shelli, when you are depressed don't look at the big picture only focus on details or distract yourself. This is a terrible time to try to distract yourself with TV though. I know you know all this, still..Well, I've never used TV as a distraction. It doesn't engage enough of my mine for it to be a distraction. Although watching tennis is a large distraction for me (and it doesn't engage my mind either). If I can get into reading, that engages me more than anything, and it's good if I am already into a book so it doesn't involve transition.
I have not done any work this week so far, including printing, etc. I finally started returning phone calls today. I also had a few conversations with my sister (out of state) and can feel her concern and just talked to my therapist friend for about an hour on the phone, about therapy; sort of her view as a therapist; do any patients make her feel insecure, etc. It sounds like she feels very confident in her work and enjoys it quite a bit. She is working with more children recently and finds the pressure much greater. This is because of the part their parents play in creating (or reinforcing) their problems, and also because, sort of what you say about your kids, they are only this age once. You don't want them to have to compensate later for missing a developmental stage, so there is much a more immediate need to get them on track. It's always interesting to talk to her. She's about the only friend that I talk about medication with, more than just mentioning that it has changed again.
>> I am now pretty sure it has to do with the horror of yesterday piled up on top of my depression. I couldn’t trace it though, until I read a post from Anna (sweetmarie) saying how she had definitely experienced a downward plunge, after the news.
> I've been feeling this too. I try not to listen to the news too much. My husband wants it on all the time, but I feel like climbing out of my skin when it's on so much. I reorganized the cabinets in the house to distract myself. I definately need to distract myself from this--I have no tolerance for stress and this is definately stressful. Avoidance is how I now deal with stress. I try to insulate myself from it. I have to. I've thought of looking at churches to attend actually, although I am not religious, I just think the structure, the ritual, the "words" might be soothing now.I tried that years ago, and never found that, unfortunately. I have always had a hard time identifying with groups that I can't embrace completely. Sometimes that is not a good way to be, but I think it's just a part of my makeup.
>
> > >I am very shaky and not sure that I can handle work.
>
> So this is a photo shoot. Long time commitment. And you don't just get lost in the work once you start? Photo shooting sounds like the essence of detail and distraction to me if you are up to it.I hope it will feel like that; it always has before. I am going to *try* to limit my sittings this fall because of my depression. I would rather do that than go in the hospital. I don't see any benefit in being in the hospital now, aside from keeping me alive, which I'd rather do outside the hospital.
>
> > > > Too late, I already took a split pill. It’s not time release so I can’t imagine why there would be a problem.
>
> Wow, you are moving fast. I need to increase my dose of Nardil (still 15 mg) but am a bit anxious about doing it. Do you remember if you had any anxiety when you were beginning Nardil?I'm going fast, because I've been there before without any startup problems. I'd be going much faster if I wasn't taking wellbutrin still.
I don't recall having any side effects when I started, but it was so long ago. I was just aware of waiting for it to kick in , and waiting and waiting, feeling very depresssed and then it really did kick in. I went with some friends to the beach (just for the day) right after it kicked in and I remember that I couldn't stop talking. I talked the entire day without shutting up. That's why I am suspicious of this new trend of labeling people bipolar II based on drug induced hypermania. Because it was a temporary thing for me, but the antidepressant events went on for years.> > So day three, any more news? When are you going to raise your dose and do you have any idea of how high you are intending to go? I started on 45mg (well, within one week, if I remember right), but generally through the years I have kept my dose at 30mg because of sleep disturbances which were minimal at 30mg.
> I'll probably go to 1 1/2 pills today this is how sure I am that my pharmacist was not right). I probably won't get to a very high dose. I'd be surprised if I go over 30 mg.Well, as I said, I did consistently okay on 30mg, but I never felt totally without depression in my life. But I had a lot of stuff to work out. This feels much more biochemical, and that's how my pdoc refers to it.
> I also had very strange and scarey experiences not adjusting to natural light changes (especially from inside to outdoor sunlight) when I had been on 45mg for about six months.
> Wellbutrin caused me to have visual trails and made lights dance--especially coming from a dark space (movie theatre or waking up) to a light space (movie theatre restroom).This was very very scary because I would "white" out. I became literally blinded by light and it became dangerous because at one point I couldn't figure out where the sidewalk connected to the street, and I had to get some workmen to help me across the street into a building. I'm sure they thought I was drunk. I am sensitive to light, but not literally blinded by it. Coming off the beach, out of the bright light and reflection, same experience. When I went back to 30mg and 45mg premenstrually it never happened again.
>
> You know I like being alone. And I have been so busy--I'm painting the house and so forth. Also when I drive the kids, the other parents pull me aside and talk to me. They like me :-)
:-)
So I'm actually a bit more social than usual.Yes, being a parent does have some social advantages like that, connections. Because I work with kids all the time and find them interesting, I talk easily to parents about their kids. Some confide a lot to me. It's nice; many times I get to follow kids through different ages.
I am rethinking lamictal, since it was of such benefit to me as an adjunct. Rethinking that perhaps there is a safe way to prevent all the fluid retention it caused me. I know it’s not as simple as taking diuretics, because I already tried that, but I have copied some info off the board which may be useful.
Shelli
Posted by Elizabeth on September 14, 2001, at 23:27:26
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 14, 2001, at 11:06:10
[re DC:]
> I think it's probably still true in lawyer circles and some other work type situations, but I'm not much connected to that world.DC always seemed like a very segregated city -- there's the little part of town where all the politicians and lawyers hang out, and the rest of it is just as bad as any part of New York or L.A.
> I imagine though in general, it is more formal.
Yes, compared with other big cities, DCers seem to dress conservatively (like, everybody wears a suit -- no "business casual," no high fashion, etc.).
> Like I wouldn't ever go into the city wearing shorts, even discounting my age and my enlarged body.
I didn't know that you're having weight problems. Sorry to hear it. Was it related to meds? (trying desperately to find some way to make this post marginally topical)
> Like in Santa Fe, all bodies wore shorts. :-) (or western hippie attire.)
Santa Fe always sounded to me like an all-around cool town. I've only been to NM once, and I didn't make it to Santa Fe that time. And I don't have an excuse to go back -- at the time, my boyfriend from college was working at one of the national labs, but he's since moved to Rockville, MD (which is, coincidentally, where I lived until I was 8), and is working for a biotech company. He must be making a lot of money doing that, because I seem to recall that Sandia was paying him a lot already. (I guess a Ph.D. from MIT is really worth something. < g >)
> Well, I've never used TV as a distraction. It doesn't engage enough of my mind for it to be a distraction.
< g > I was about to suggest reading, but then I read further where you brought it up! Are you reading anything right now? I think it's been a while since I read anything other than textbooks, journals, or the occasional magazine or newspaper.
> I have not done any work this week so far, including printing, etc.
A lot of people I've talked to say they haven't been getting anything done this week (even the ones who don't work in New York). I know I haven't, but that's nothing new. :-}
> I hope it will feel like that; it always has before. I am going to *try* to limit my sittings this fall because of my depression. I would rather do that than go in the hospital. I don't see any benefit in being in the hospital now, aside from keeping me alive, which I'd rather do outside the hospital.
Yeah, I never saw the point of psych hospitals unless someone is in danger of hurting themselves (or somebody else). Have you ever gotten anything out of a hospital stay?
> I went with some friends to the beach (just for the day) right after it kicked in and I talked the entire day without shutting up. That's why I am suspicious of this new trend of labeling people bipolar II based on drug induced hypermania. Because it was a temporary thing for me, but the antidepressant events went on for years.
I agree. MAOIs have some effects similar to those of stimulants, and they can cause some initial wiredness. Parnate did that to me more than Nardil did. It was only temporary for me, too. Unipolar depressives do sometimes have AD-induced mania, but that doesn't mean they're bipolar -- any effective AD can cause mania, IMO. (It's "hypomania," BTW.)
> Well, as I said, I did consistently okay on 30mg, but I never felt totally without depression in my life.
30 mg of Nardil is not much. 45 is marginal, and most people seem to need at least 60.
-elizabeth
Posted by Lorraine on September 17, 2001, at 9:24:46
In reply to Re: Hypertensive crises, update » Lorraine, posted by Elizabeth on September 13, 2001, at 14:43:22
Elizabeth:
> > > So you mean by "residual effects" continued symptoms after BP has returned to normal? I wouldn't expect any such symptoms, unless the HT did damage.
Yes, residual effects, stiff neck lasted about 5 days. My blood pressure was around 128/87 druing those five days. Before the episode my BP was 105/67 (MAO influenced low BP) and before taking MAOs it was 124/72. Now it has returned to 106/71.
>
> Calcium channel blockers, like nifedipine, lower your BP by dilating blood vessels. Sometimes this can cause your body to try to compensate by raising your pulse.Well, I guess this happened. My pulse during the episode was 59 and it rose to 73 after I took the antidote, but 73 is not high.
[re: crick in neck] It is funny. I used to get cricks in my neck fairly frequently and I used to get migraines also. Now that we are talking about vascular things, I just wonder if they might have been related. Haven't had a crick in the neck in a long time--more than a year ago. They started being very infrequent. My migraines went away also (one of the few benefits of menopause in my case.)
> > Thanks for the info. Just want to have a next step in mind if the Nardil doesn’t do it. I know I am jumping the gun so to speak but it makes me feel better emotionally to do this. Then when things don’t work out, I don’t panic or go too low, but just take the next step and distract myself.
>
> One thing you might want to consider is that TCAs don't work very well for atypical depression. It might be worth a try, but there might be something else that's more likely to help.Well, I'd talk with the pdoc at any rate well before a change to get his thinking. I know you are right re atypical depression.
> > > Dude, I don't have a license, but it's not like I've never ridden in a car! < g >Hadn't really thought of that:-)
I think it is weird that it took so long for it to go away completely. Some people just seem to be more sensitive to side effects than the average person is.
Perhaps that would be me. Anyway, it is gone now.
> > > When I showed up at an ER (or at the MIT Medical Center) with high blood pressure, I got seen at once. (MIT Medical didn't actually help me in any way, but they did monitor my BP -- they didn't just tell me to sit in the waiting room.) I think it's worth it to get a portable BP monitor (they'll fit in a reasonable-sized purse or handbag) so you can check it if you start getting symptoms.
I'm glad they were attentive anyway.
>
> > Ø Yes. It can make your blood pressure "crash," which can progress to shock (worst-case scenario).
> >
> > OK, I’ll be careful.You know, I do remember you telling me to be careful re amphetamines and MAOs. It's awfully generous of you not to mention that.
I'm glad your meds continue to function.Lorraine
Posted by Elizabeth on September 17, 2001, at 10:04:15
In reply to Re: Hypertensive crises, update » Elizabeth, posted by Lorraine on September 17, 2001, at 9:24:46
> Yes, residual effects, stiff neck lasted about 5 days. My blood pressure was around 128/87 druing those five days. Before the episode my BP was 105/67 (MAO influenced low BP) and before taking MAOs it was 124/72. Now it has returned to 106/71.
So your BP *was* elevated above baseline for you during the five days. Okay. People with low baseline BP can experience symptoms of HT at BP levels that wouldn't be noticeable for most people.
> > Calcium channel blockers, like nifedipine, lower your BP by dilating blood vessels. Sometimes this can cause your body to try to compensate by raising your pulse.
>
> Well, I guess this happened. My pulse during the episode was 59 and it rose to 73 after I took the antidote, but 73 is not high.That's right. I'm surprised your pulse runs low along with the low BP and the MAOI, though.
> [re: crick in neck] It is funny. I used to get cricks in my neck fairly frequently and I used to get migraines also. Now that we are talking about vascular things, I just wonder if they might have been related.
What did you use for the migraines?
> > When I showed up at an ER (or at the MIT Medical Center) with high blood pressure, I got seen at once. (MIT Medical didn't actually help me in any way, but they did monitor my BP -- they didn't just tell me to sit in the waiting room.) I think it's worth it to get a portable BP monitor (they'll fit in a reasonable-sized purse or handbag) so you can check it if you start getting symptoms.
>
> I'm glad they were attentive anyway.Are you kidding? Small consolation for me. Should have sued the bastards. (I did mention the pulmonary hemorrhage that resulted, didn't I?)
> You know, I do remember you telling me to be careful re amphetamines and MAOs. It's awfully generous of you not to mention that.? I'm confused.
> I'm glad your meds continue to function.
I think I'm the one who's functioning (sort of). My meds are just *working*! :-)
-elizabeth
Posted by Lorraine on September 17, 2001, at 12:22:42
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 14, 2001, at 11:06:10
Hey, Shelli:
Day 7 of Nardil; Day 3 of 22.5 mg Nardil. Still alive and kicking; no sexual side effects so far (it's early, but, hey, hope is free). I'm doing ok, taking it day-by-day.
> > (hey, you want to meet me in santa fe next summer? :-) )
> > I thought you didn't like meeting psychobabblers;-). I don't know how our summer plans are shaping up (what with the kids and all summer gets crazy). But I might go to the east coast next summer. If I do, we might get together.
>
> Well, I actually I don't think I was serious. And I'm still not feeling like bringing board life into real life.I understand. I was skittish at the thought myself.
> > >Today I got an invitation to come out to Sierra Vista, AZ, which is supposed to be quite beautiful. The invite was from a client who just moved out there, but I don't know them well; just photographed them once recently. So I wouldn't feel comfortable taking her up on it, although I would call them if I get out there.
Maybe you could suggest they leave town for your visit < g >
>
> > This is a terrible time to try to distract yourself with TV though. I know you know all this, still..
>
> > > Well, I've never used TV as a distraction. It doesn't engage enough of my mine for it to be a distraction. ... If I can get into reading, that engages me more than anything, and it's good if I am already into a book so it doesn't involve transition.I'm actually thinking that reading a fiction book should be part of my wellness plan. You are right that it is very hard to "start" a book when you are down, but continuing it is not that hard. I'm also making a list of programs (radio) that I enjoy for my plan--I guess a list of distractors that I enjoy.
> > >She is working with more children recently and finds the pressure much greater. This is because of the part their parents play in creating (or reinforcing) their problems, and also because, sort of what you say about your kids, they are only this age once.
I can see that. Certainly, that is how I feel as a parent.
> > >I've thought of looking at churches to attend actually, although I am not religious, I just think the structure, the ritual, the "words" might be soothing now.
>
> I tried that years ago, and never found that, unfortunately. I have always had a hard time identifying with groups that I can't embrace completely.It's interesting. I was talking with my son about religion and which church he might want to go to and he said very much the same thing--that he doesn't accept all of the tenents of any of the religions, therefore he should form his own. Then I was reading a book about community and it said that you do not need to accept all of the tenets of a group, you just have to agree that this is what the group's tenets are--that the subordination of individuality or conformity to the group norm is no longer necessary for most modern groups and communities. Anyway, I suppose I hunger for community because I did not have it as a child. Anyway, maybe we will try it out--if it doesn't fit, well so what? Nothing lost.
> > > I hope it will feel like that; it always has before. I am going to *try* to limit my sittings this fall because of my depression.This is a good idea--just take it day by day and see how you do until you are stabilized. You might want to introduce some "structure" to take the place of the lost activities though.
> > >I would rather do that than go in the hospital. I don't see any benefit in being in the hospital now, aside from keeping me alive, which I'd rather do outside the hospital.
I suppose it is a matter of having sufficient coping skills to avoid hospitalization and realizing the limitation of your coping skills. I read somewhere that suicide occurs when someone's pain exceeds their ability to cope with pain. It places an interesting emphasis on coping skills.
> > > Well, as I said, I did consistently okay on 30mg, but I never felt totally without depression in my life. But I had a lot of stuff to work out. This feels much more biochemical, and that's how my pdoc refers to it.
Funny how we can tell the difference isn't it?
>
> > I also had very strange and scarey experiences not adjusting to natural light changes (especially from inside to outdoor sunlight) when I had been on 45mg for about six months.
> > Wellbutrin caused me to have visual trails and made lights dance--especially coming from a dark space (movie theatre or waking up) to a light space (movie theatre restroom).
>
> This was very very scary because I would "white" out. I became literally blinded by light and it became dangerous because at one point I couldn't figure out where the sidewalk connected to the street, and I had to get some workmen to help me across the street into a building. I'm sure they thought I was drunk. I am sensitive to light, but not literally blinded by it. Coming off the beach, out of the bright light and reflection, same experience. When I went back to 30mg and 45mg premenstrually it never happened again.Wellbutrin has a known side effect of seizure and I figured that these were like minor seizures or temporal lobe epilepsy sort of stuff. Not unpleasant, just unsettling and I worried that if I was driving in the dark and someone had their brights on, I'd become disoriented. I'll be alert to this side effect of Nardil tho, thanks for the heads up.
> So I'm actually a bit more social than usual.
>
> Yes, being a parent does have some social advantages like that, connections.It's even better. Because if your are social phobic (which I have some of), they provide natural conversation starters and help keep the focus off of yourself. Everyone talks to mothers of babies.
> > > I am rethinking lamictal, since it was of such benefit to me as an adjunct. Rethinking that perhaps there is a safe way to prevent all the fluid retention it caused me. I know it’s not as simple as taking diuretics, because I already tried that, but I have copied some info off the board which may be useful.
Lamictal drove me nuts with anxiety. Ah well--glad it worked for you and hope your attempts to moderate the side effects work.
Lorraine
Posted by Lorraine on September 18, 2001, at 10:14:30
In reply to Re: Hypertensive crises, update » Lorraine, posted by Elizabeth on September 17, 2001, at 10:04:15
> > Yes, residual effects, stiff neck lasted about 5 days. My blood pressure was around 128/87 druing those five days. Before the episode my BP was 105/67 (MAO influenced low BP) and before taking MAOs it was 124/72. Now it has returned to 106/71.
>
> So your BP *was* elevated above baseline for you during the five days. Okay. People with low baseline BP can experience symptoms of HT at BP levels that wouldn't be noticeable for most people.This sounds right, elizabeth.
>
> > > Calcium channel blockers, like nifedipine, lower your BP by dilating blood vessels. Sometimes this can cause your body to try to compensate by raising your pulse.
> >
> > Well, I guess this happened. My pulse during the episode was 59 and it rose to 73 after I took the antidote, but 73 is not high.
>
> That's right. I'm surprised your pulse runs low along with the low BP and the MAOI, though.It does run low on MAOs. Who knows what normal is? I know it ran fast on Effexor and Adderal--on Effexor it would go as high as 120 (this is during my last short trial) on Adderal I don't think it ever went over 95. It's very noticable to me though when it becomes fast. I don't like it.
>
> > [re: crick in neck] It is funny. I used to get cricks in my neck fairly frequently and I used to get migraines also. Now that we are talking about vascular things, I just wonder if they might have been related.
>
> What did you use for the migraines?Nothing. I never found anything that worked. I just stayed in bed, drew the blinds and waited it out. They lasted a couple of days.
> >I think it's worth it to get a portable BP monitor (they'll fit in a reasonable-sized purse or handbag) so you can check it if you start getting symptoms.
This is a good idea. I'll look into it. Of course, it won't fit in my purse, which is of the 5 x 7 wallet/organizer variety.
> >
> > I'm glad they were attentive anyway.
>
> Are you kidding? Small consolation for me. Should have sued the bastards. (I did mention the pulmonary hemorrhage that resulted, didn't I?)This is my point, elizabeth. Don't you think that any doctor in their right mind would carry an antidote if they were on an MAO? Don't you think this "I'm not sure if the patient can be trusted" stuff is a bit patronizing? Tell me about the pulmonary hemorrhage. What is it? Are you OK now? It won't happen to you again, right?
>
> > You know, I do remember you telling me to be careful re amphetamines and MAOs. It's awfully generous of you not to mention that.
>
> ? I'm confused.Well, at one point I told you that my pdoc said I could take some Adderal with the Parnate if I needed to and you advised me to be careful. My hypertensive crises came from taking Adderal during my washout period (too much, too soon).
>
> > I'm glad your meds continue to function.
>
> I think I'm the one who's functioning (sort of). My meds are just *working*! :-)It's grand when things fall in place though. My reading--Solomon's book "Noon Day Demon"--was great (about his experiences and more on depression) and now I'm reading the NAMI stuff at the California website. I love their stuff (www.mhsource.com/hy/j94.html).
The Nardil is making me "warmer" towards people. I hope I can take it. I have some side effects that I am wrestling with--skin picking and skin irritation. I am just going to go slow with this titration. I'm at 22.5 now; down 2 pounds and no sexual impairment so far. Well, it's early in the trial. But no sexual impairment means I could actually feel things like I used to--what a delight and it has been a long time. I had forgotten who I was, you know?
Lorraine
Posted by Lorraine on September 19, 2001, at 9:25:07
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 14, 2001, at 11:06:10
Shelli: Are you ok? Haven't heard in a while--worried.
Lorraine
Posted by shelliR on September 19, 2001, at 11:12:05
In reply to Re: Shelli are you ok? » shelliR, posted by Lorraine on September 19, 2001, at 9:25:07
> Shelli: Are you ok? Haven't heard in a while--worried.
>
> LorraineHi Lorraine.
I haven't had much good to write. I am not doing too well.
It is so horrible to say this but I feel like I'm ready to give up. But I could not do that to my parents, and my sister has been so clear in how much I mean to her. I actually used to get something from going into the hospital, sort of a place to get a way from work and get stable. But the last two times have been more negative than positive, so I am trying to stay out.Yesterday I faxed my pdoc (he's left today for five days), asking if I could increase my morning dose of oxy and even though I talked to his office staff and they promised me they would get back to me by the end of the day, they didn't. So I have upped the oxy in the morning by 10mg. If he has a problem with that, too bad. I am having no problem with the nardil and wellbutrin (no BP problems) but he wants to wait a week for the next increase. As I said in the last post I am rethinking nardil and lamictal, my best combo, if my pdoc can plan out a way to cut at least half of the water weight gain. (I cannot accept adding 15 lbs, and it was also very uncomfortable weight). Last time I weighed myself I had lost 10.5 lbs since May, so I have 20 more to go until I feel comfortable in my body. (I'm 5'6, just to give you an idea that with twenty extra pounds I am not obese or anything, just not me, or more of me than I can tolerate!)
It is so hard to work with my pdoc; he keeps ignoring me when I want to talk about buprenorphine over oxy or try to talk about lamictal. He says I'm changing enough at the moment, and as you truely understand, it works better for me to always have one eye to the future, to what's next. So eventually, I think he will let me try it, but I'm not sure how I will react to it anyway. I'm not sure what the answer is for me.
Monday, I was thinking of having businesses both here, and in Arizona. Then Tuesday, I was completely suicidal. I do believe that the happenings of Tues have affected me much more than I am consciously aware and just sort of sent me into a different zone, that I can't seem to climb out of. Lots of people in my life are telling me this about their lives. Not that they want to die, but just how things have not yet gone back to normal in their psyches. In addition, in the middle of this I have gotten my period three times in the last seven weeks. I have an appointment next week to see my gyn but I think she's pretty much thinking the depression has been there too long for me to treat exclusively through hormones, but I definitely know that is the reason, everything got thrown off in the last year and a half. It is so frustrating because before that, things in my life were finally feeling really managable and I was willing to move into "new" areas regarding relationships. Actually it will be two years ago this Christmas that nardil was no longer able bounce me back from short depressions, as it had for years and years.
So that's good that you aren't having any side effects with nardil. I truely am very optimistic for you. Nardil is my security drug and I'd rather take it and work with adjuncts again, then to try again a new base antidepressant.
Please don't worry. I have good friends, healthy parents, a sister, and a therapist to support me. And if I lose faith in mypdoc I would probably go to Boston and check myself into either McLean or Mass General.
I hate writing bad news. Again that damn shame thing comes into play. Have a lot of work to do on that even if/when this depression lifts
I hope you are continuing to do well,
Shelli
Posted by Lorraine on September 20, 2001, at 10:00:40
In reply to Re: Shelli are you ok? » Lorraine, posted by shelliR on September 19, 2001, at 11:12:05
Hello, Shelli
> > > It is so horrible to say this but I feel like I'm ready to give up. But I could not do that to my parents, and my sister has been so clear in how much I mean to her.I'm sorry you are in this place. Are you still seeing your talk therapist? Remember that feelings come and go even the really awful ones.
> > > Yesterday I faxed my pdoc (he's left today for five days), asking if I could increase my morning dose of oxy and even though I talked to his office staff and they promised me they would get back to me by the end of the day, they didn't. So I have upped the oxy in the morning by 10mg. If he has a problem with that, too bad.
You are doing what you need to do to survive. Is the Oxy working otherwise? What is your current dose? The lack of responsiveness is normally irritating but when you are feeling desparate becomes very upsetting. I have an almost panic reaction if my meds aren't working and I need an adjustment and it's Friday.
> > >As I said in the last post I am rethinking nardil and lamictal, my best combo, if my pdoc can plan out a way to cut at least half of the water weight gain. (I cannot accept adding 15 lbs, and it was also very uncomfortable weight). Last time I weighed myself I had lost 10.5 lbs since May, so I have 20 more to go until I feel comfortable in my body. (I'm 5'6, just to give you an idea that with twenty extra pounds I am not obese or anything, just not me, or more of me than I can tolerate!)
Have you tried Topamax or thought of augmenting with it? It is reputed to help with weight loss. Woman at my NDMDA meeting swore by it.
> > > It is so hard to work with my pdoc; he keeps ignoring me when I want to talk about buprenorphine over oxy or try to talk about lamictal. He says I'm changing enough at the moment, and as you truely understand, it works better for me to always have one eye to the future, to what's next. So eventually, I think he will let me try it, but I'm not sure how I will react to it anyway. I'm not sure what the answer is for me.
I guess this is why I decided to stay with my pdoc--he does let me lead the charge so to speak while he "consults" with me. It helps me feel more in control. I suppose if these guys haven't been depressed they don't know how frantic we become looking for a solution. Even if our solution is the wrong one (doesn't work), there is some piece of mind in crossing it off our list. At least that is how it is for me.
> > >In addition, in the middle of this I have gotten my period three times in the last seven weeks. I have an appointment next week to see my gyn but I think she's pretty much thinking the depression has been there too long for me to treat exclusively through hormones, but I definitely know that is the reason, everything got thrown off in the last year and a half.
I think you are right, shelli. This is why I am focusing on getting my hormone mix right--although you know it's another complication. You might look at www.mhsource.com/hy. In their journal devoted to women and mental health they note:
"As women reach their 30s to 50s, there begins an increase in sensitivity to the change in estrogen and progesterone levels that leads to a cluster of symptoms now called the premenstrual dysphoric disorder. Many women who suffer depression often have these symptoms preceding their actual onset of depression. The underlying mechanism may be the neurodynamics of the individual losing its constraints, shifting the balance towards a more chaotic mood state.
This is also a time when many women with bipolar disorders notice an increase in symptoms, including a shift to more rapid cycles of mood change and even mixed states of both mania and depression. Researchers have found that estrogen and progesterone directly influence the balance of other neurotransmitter systems whose function, in part, may be to minimize excessive swings in mood. Estrogen increases the activity of the glutamate system, which helps keep memory functioning. Increased activity in this system may also lead to hypomanic behavior. Progesterone is crucial to keeping the neuroreceptors for GABA operational. When progesterone levels drop, the ability for GABA to tone down neuronal activity decreases dramatically. This can lead to sleep disturbances, increased agitation, irritability and anxiety."
Shelli, I have no doubt that it is the changes in your hormones that destabilized you. That is what precipitated my depression. So you may need to work with both hormones and meds to find your footing again.
> > >It is so frustrating because before that, things in my life were finally feeling really managable and I was willing to move into "new" areas regarding relationships. Actually it will be two years ago this Christmas that nardil was no longer able bounce me back from short depressions, as it had for years and years.
Shelli, I have been mourning the disruption in my life lately. It's like just recently I have understood that this is a chronic illness, that it doesn't "go away" and that I will need to be able to manage it, through it's ups and downs when the meds are working and when they are not. What I mean is that I need to reclaim my life and stop waiting for a cure before I resume my old life. The truth is that my old life died and I need to move on from there. I was reading a quote about the difference between religiousness and spirituality that said essentially that religion is for those who want to avoid going to hell and spirituality is for those who have been to hell and don't want to go back. I have been feeling like no matter how hokey group meetings can be, no matter how unintellectual spirituality feels to me, I have to add things to my support system to help keep me afloat. I'm not saying you should do this because you should do what works for you--nothing more, nothing less. At one of the hospitals here they have a day program as well as an in-patient program for people with mental illness. Could this be a possibility for you? All you are trying to do is make the time pass between now and when meds start working--any tricks can help.
> > > So that's good that you aren't having any side effects with nardil.
Well, I increased my dose to 15mg 2x day. Let's see what that does. I was dipping in the afternoon. I am having some hyperventilating and back aches. I have also been having hot flashes like made (really worse than I have ever had them) so I have restarted the estrogen and added some progesterone. This on my own pretty much. I see the doctor tomorrow re hormone mix.
> > > Please don't worry. I have good friends, healthy parents, a sister, and a therapist to support me. And if I lose faith in mypdoc I would probably go to Boston and check myself into either McLean or Mass General.
Shelli, I'm concerned, not worried I guess. I hate to see you go through this. I hadn't realized it has been two years since you were stabilized. That's a long time--that's more or less my time frame too. I know how awful it can be to do the survival mode thing and wait for something to work.
> > > I hate writing bad news. Again that damn shame thing comes into play. Have a lot of work to do on that even if/when this depression lifts
I don't know--is it shame? I always want to be "competent" and this illness robs me of that. Continue to write please. What do you do to add structure to your days when you can't work?
Taking extra special care of yourself---
Lorraine
Posted by shelliR on September 20, 2001, at 11:40:34
In reply to Re: Shelli are you ok? » shelliR, posted by Lorraine on September 20, 2001, at 10:00:40
> Hello, Shelli
>
>
> > > > It is so horrible to say this but I feel like I'm ready to give up. But I could not do that to my parents, and my sister has been so clear in how much I mean to her.
> I'm sorry you are in this place. Are you still seeing your talk therapist? Remember that feelings come and go even the really awful ones.yes, I am still seeing my therapist.
> You are doing what you need to do to survive. Is the Oxy working otherwise?
I increased by 10mg and I'm feeling a lot better and am planning on going ahead with work commitments.
> > > >As I said in the last post I am rethinking nardil and lamictal, my best combo, if my pdoc can plan out a way to cut at least half of the water weight gain. (I cannot accept adding 15 lbs, and it was also very uncomfortable weight). Last time I weighed myself I had lost 10.5 lbs since May, so I have 20 more to go until I feel comfortable in my body. (I'm 5'6, just to give you an idea that with twenty extra pounds I am not obese or anything, just not me, or more of me than I can tolerate!)> Have you tried Topamax or thought of augmenting with it? It is reputed to help with weight loss. Woman at my NDMDA meeting swore by it.
Yes, did a trial for five weeks (I have some anger at my last pdoc for insisting on such long trials,) and all I did was sleep; no anti-depressant effects.
>
>
> > > >In addition, in the middle of this I have gotten my period three times in the last seven weeks. I have an appointment next week to see my gyn but I think she's pretty much thinking the depression has been there too long for me to treat exclusively through hormones, but I definitely know that is the reason, everything got thrown off in the last year and a half.
> I think you are right, shelli. This is why I am focusing on getting my hormone mix right--although you know it's another complication. You might look at www.mhsource.com/hy. In their journal devoted to women and mental health they note:
> "As women reach their 30s to 50s, there begins an increase in sensitivity to the change in estrogen and progesterone levels that leads to a cluster of symptoms now called the premenstrual dysphoric disorder. Many women who suffer depression often have these symptoms preceding their actual onset of depression. The underlying mechanism may be the neurodynamics of the individual losing its constraints, shifting the balance towards a more chaotic mood state.
> This is also a time when many women with bipolar disorders notice an increase in symptoms, including a shift to more rapid cycles of mood change and even mixed states of both mania and depression. Researchers have found that estrogen and progesterone directly influence the balance of other neurotransmitter systems whose function, in part, may be to minimize excessive swings in mood. Estrogen increases the activity of the glutamate system, which helps keep memory functioning. Increased activity in this system may also lead to hypomanic behavior. Progesterone is crucial to keeping the neuroreceptors for GABA operational. When progesterone levels drop, the ability for GABA to tone down neuronal activity decreases dramatically. This can lead to sleep disturbances, increased agitation, irritability and anxiety."yes, I'll look into that, but I have an appointment with my gyn and she is not thinking that hormones are the larger answer. My depression is the only increase, no agitation, irritability and not much anxiety, unless I am go to the hospital and I become much more agitated and my anxiety goes up.
>
>
At one of the hospitals here they have a day program as well as an in-patient program for people with mental illness. Could this be a possibility for you? All you are trying to do is make the time pass between now and when meds start working--any tricks can help.I have a hard time with the term mental illness. I feel much more comfortable with the term depressed. The term mental illness puts everyone in the same category. If you say you are mentally ill, pictures come up of schizophrenia, and other psychoses. And if you simply go into a program for all mental illnesses, that's pretty much what you get. (Sorry if I am not being politically correct.) I have been lucky to go into abuse programs which feel a bit closer to home. But I think I do not get much knowledge or therapeutic use out those groups anymore. Frankly, I find them unstimulating or insultingly childish. I am continuing to work when it is possible, and that is the best tactic for me. If I become too suicidal, I'll go inpatient, where I generally also skip most of the groups (been there, done that, wasn't learning anything new). I don't think I have the same needs for community as you do. And there is always an element of being treated like a child in a day hospital (or regular hospital) and I can't contend with the authority issue things at this point in my life. I am depressed, not a child. I like the idea of self-help groups the best, but truthfully for me now it is better to spend time with people who are not having such a *major* struggle in their lives, and use this board and my therapist to talk about depresssion. That is enough now.
> > > > So that's good that you aren't having any side effects with nardil.
> Well, I increased my dose to 15mg 2x day. Let's see what that does. I was dipping in the afternoon.do you mean depression, or tiredness, by the term dipping?
I am having some hyperventilating and back aches. I have also been having hot flashes like made (really worse than I have ever had them) so I have restarted the estrogen and added some progesterone. This on my own pretty much. I see the doctor tomorrow re hormone mix.
It sounds like things also get confusing for you between depression, anxiety, and hormones. I don't believe that nardil will increase your anxiety; you just may have to deal with anxiety separately.
>
>
> Shelli, I'm concerned, not worried I guess. I hate to see you go through this. I hadn't realized it has been two years since you were stabilized. That's a long time--that's more or less my time frame too. I know how awful it can be to do the survival mode thing and wait for something to work.As long as the oxy is working, I am able to work. I became very worried about work, it has taken many years to build my business. I did start printing again last night and have work scheduled tomorrow and Saturday, both with families that I know, then a four day break from shooting. Hopefully, the nardil will kick in; I'd like to increase, but my pdoc is being cautious and I cannot argue with that.
>
> > > > I hate writing bad news. Again that damn shame thing comes into play. Have a lot of work to do on that even if/when this depression lifts
> I don't know--is it shame? I always want to be "competent" and this illness robs me of that. Continue to write please. What do you do to add structure to your days when you can't work?I understand the importance of structure, but I don't feel a lack of structure. If I am "can't stand it depresssed", it is best for me to sleep off the worst--distraction does not work for me. But generally days go quickly. I have lots of paper work to do, take long naps in the afternoon, return messages, etc. I have not been bored.
>
> Taking extra special care of yourself---Thanks,
Shelli
Posted by Lorraine on September 22, 2001, at 13:06:10
In reply to Re: Shelli are you ok? » Lorraine, posted by shelliR on September 20, 2001, at 11:40:34
Shelli:
> > > > > It is so horrible to say this but I feel like I'm ready to give up. But I could not do that to my parents, and my sister has been so clear in how much I mean to her.
Did I tell you that I am keeping a "why I live" file for tough times? It includes wonderful notes that people have sent me over the years about how much I mean to them. I keep it in my notebook with my mood chart and so forth. It helps to know that it is there and when times are tough to read it and remember all of the people who care. The insidious thing about this illness is that it robs us of our past by shading what we remember and how we remember it and then robs us of our future when we project our present mood onto what will be. So it seems like it has always been as bad as it is and will always be as that bad. But neither is true. Our past includes bright spots--how many years on Nardil worked for you and how long for it to take effect (5 weeks)? I guess what I am trying to do with my notebook is represent a better reality in it. For you it might include some of your photography that you are proud of. I hope it has gotten better, Shelli. It sounds like the Oxy is helping.
> > I'm sorry you are in this place. Are you still seeing your talk therapist? Remember that feelings come and go even the really awful ones.
>
> yes, I am still seeing my therapist.Is she being helpful?
> > > Have you tried Topamax or thought of augmenting with it? It is reputed to help with weight loss. Woman at my NDMDA meeting swore by it.
>
> Yes, did a trial for five weeks (I have some anger at my last pdoc for insisting on such long trials,) and all I did was sleep; no anti-depressant effects.Topamax is a mood stabilizer (or anti-convulsant). I didn't think these were supposed to have anti-depressant effects, although Neurontin can for me.
> > > [re hormones] yes, I'll look into that, but I have an appointment with my gyn and she is not thinking that hormones are the larger answer.They probably are not the larger answer. But sometimes having some of these small pieces in place helps to balance the equation. It's complicated because hormones affect neurons as do anti-depressants.
> > > I have a hard time with the term mental illness. I feel much more comfortable with the term depressed. The term mental illness puts everyone in the same category. If you say you are mentally ill, pictures come up of schizophrenia, and other psychoses.
I sat in a Recovery, Inc. meeting one day with only 5 of us there (including the leader), two of the people were very heavily medicated (maybe with schizo-affective disorder). Anyway the meeting was fairly humorous because the leader was trying valiantly to keep the ball moving from one person to the other and keep participation up, although at least two people were not capable of truly contributing to the meeting. So she would say "Now Sally wouldn't you say that you spot [blah,blah, blah] with Lorraine?....Of course, you would". You are right about the mixed bag of nuts that the term mental illness represents. And among the stigmas, depression is merely viewed as self indulgent, whereas schizophrenia is actually frightening to public at large. The issue of level disability is also a big one, depending on the illness. Still, for me, I've been trying to come to grips with the fact that this is first and foremost an illness and that it is a chronic illness without a known cure. I feel like I have to accept that level of reality to move forward in my life.
> > >[re: support groups]Frankly, I find them unstimulating or insultingly childish.Did you try NDMDA? I don't find it childish. Unstimulating? Well, sometimes, but then the manics help keep the energy level up even though they take most of the focus. Shelli, you know the best way for you to get support. I'm not trying to push you one way or the other.
> > > > > So that's good that you aren't having any side effects with nardil.
> > Well, I increased my dose to 15mg 2x day. Let's see what that does. I was dipping in the afternoon.
>
> do you mean depression, or tiredness, by the term dipping?I meant depression. At 15 mg 2x day, I still feel the depression but I am not that far into the trial (2 weeks). I do feel better, although the hyperventilating is still an issue as are the backaches but these may resolve or I may find a way to deal with them. A benefit is that I am able to back down on my bedtime meds b/c falling asleep is not the struggle that it was on Parnate.
> > >[re hormones] I saw the new doctor regarding hormones and I finally feel like I have found someone who knows what they are doing. I got so tired of seeing ob/gyns that had waiting rooms full of pregnant women and knew nothing about hormones. This woman tested all of my hormone levels: DHEA, estrogen, progesterone, testosterone, thyroid and as well as my adrenal glands. Taking this info and taking into account the history of breast in my family, they sent a prescription to a compounding pharmacy for a combination hormone mix that she will adjust according to my reaction. She also will do a new test that measures hormone levels to make sure that they are in a range that minimizes breast cancer risk. Anyway, I am pleased.
> It sounds like things also get confusing for you between depression, anxiety, and hormones. I don't believe that nardil will increase your anxiety; you just may have to deal with anxiety separately.They are confused b/c each of these element impacts the others. Hormones and AD's both impact brain chemistry; plus they interact with each other so that it becomes a simultaneous equation to be solved. You are probably right about the nardil not increase, but not addressing the anxiety component.
>
> > > As long as the oxy is working, I am able to work. I became very worried about work, it has taken many years to build my business. I did start printing again last night and have work scheduled tomorrow and Saturday, both with families that I know, then a four day break from shooting. Hopefully, the nardil will kick in; I'd like to increase, but my pdoc is being cautious and I cannot argue with that.It's important to keep the work part of your life in place. I hope the Nardil kicks in for you soon, Shelli.
Lorraine
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