Psycho-Babble Medication Thread 67742

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Re: hanging in there » shelliR

Posted by Lorraine on September 26, 2001, at 10:26:56

In reply to Re: hanging in there » Lorraine, posted by shelliR on September 24, 2001, at 22:58:07

Hi Shelli:
> My therapist and I try to work on things as basic as organization, both in how I live and in how I work.

Oh, that wouldn't work for me because I have read about 30 books on organization. I know the principles well enough to teach, but not follow, them. Or I follow them half way (I do have the folders):-) I'm trying to get some structure into my life (i know that this is not your issue--so how quickly I learn?) So one of the things that I want to have is a day where I close projects b/c all i want to do is open them--it's my nature.

> > >I am totally focused on the computer so it doesn't bother me, but when I really look I am appalled.

We have dinner parties occassionally--which means that I have to clean up from time to time. Once a friend who had been here for dinner when things were "neat" came to the house and looked at my office and said "is that what the inside of your mind looks like?" It gave me pause.

> > Your pdoc might be able to make your partial response work. I read his article. It sounds so simple and full of hope. Do they really believe what they write or is it just the need to have a strong thesis without words like "I believe" thrown in to muddy it up.
>
> That's really funny. I think he probably believes what he writes and when things don't work out with someone, it probably breezes right out of his consciousness, so he can keep his theories in tact. Like I think he really didn't anticipate that I would get habituated to the oxy, and he's not sure how to play it yet. Sometimes he's reassuring; other times he sounds like he's quite annoyed that my body didn't do it's job to conform to his plan.

I find that whole thing irritating--sort of the "i live in my world with my books, don't you muck it up with your humanity". I think all doctors should be forced to go through a depression caused by depletion of that enzyme for a spell just to "taste" it.

>
> > > Also, did you notice how he dismissed MAIOs and tricyclics because of their side effects. As as there aren't a milllion side effects from the other ADs.

To me, it sounded like it wasn't convenient for him to stray from his chosen list that he knows

> > The Ambien is working well for me now.
>
> I know I've tried Ambien but I don't remember what happened--it was a long time ago.

I like Ambien a lot. I sleep soundly and refreshingly. When I take it with valium (which I don't anymore), I actually dream. Isn't that nice? But I like to wake up with the sleepy head and roll out of bed with the option of drifting off to sleep again.

I think I'm going to ask my pdoc of ten years to give me a copy of all my files. When I asked her last time, she had her nurse practioner go through all my records and write what meds I had tried, when, how much, and why I went off. I can't find those sheets (surprise, surprise), but I think she missed things anyway, (I mean it was ten years). I'd like to see the whole thing and I want a copy, even if I have to pay. I don't think she can refuse in Maryland unless seeing them would create a danger to myself.

This is a really good idea. I have some long term charts that I am creating for myself based on my review of my files. If you'd like and become serious, I'll send you a copy of the file so you can have a template for yours.

> >
> > > > >And it will be in combination with wellbutrin which will help with the tiredness, if the depression lifts. And the oxy might stay if the AD stops me from having to keep going up.
> > Your oxy seems pretty ambitious about assuming a larger part of your life.

I mean it wants to own you by making you ever more dependent. I'm having fun by assuming that the oxy has a will of it's own:-)

> > > > > Have you tried the other MAOs? You had a positive response to one. My pdoc says until you have tried all of the MAOs you haven't tried MAOs--meaning that they are all different.
> > > Well. remember I tried parnate just after you. So there's really just one non-reversible MAOI that I haven't tried.
> > Which one are you thinking of? Marplan? I hadn't compiled a serious list. Somehow I thought there was more on the list than just one or two more.
>
> I think that's all in the US.

Oh no, that is scarey b/c the Nardil is giving me no mood support, it is making my hyperventilation worse (hence the Neurontin); it is making me sedated. I drop off a cliff in terms of energy about 8 o'clock (so I'm trying to adjust my times). I'm increasing my dose to 45 mg today. I'll see my pdoc next week and we'll see what we think. I'm not real positive. My best response so far was the (don't laugh) Moclobemide, but the anxiety and loss of sleep made me hyperventilate and wake up unrefreshed. Maybe now I could temper that with what? Ambien for sleep. Anxiety, I don't know. Marplan is supposed to be hard to get (limited manufacture).

> > Are you continuing on the neurontin as you build up the nardil?

Hyperventilating has caused me to use the neurontin during the day.

> > > I don't know if that's a good idea to add the adderal yet; it's probably best if you can to see what the nardil exactly does if you can. Why do you want to add the neurontin now? I guess maybe the waiting period is feeling too hard right now?

the waiting period is very trying. i haven't felt this low in a long time. no mood support at all.

> > > > > > >
> > > > I don't understand that. Because you can experience pleasure sometimes, that is a roller coaster? I think of a roller coaster as Bipolar II, which I realize you think you may have, but I don't get the imagine of a roller coaster when you describe your days.

OK. Hard to describe but a bit like ricocheting off of events. I don't begrudge the pleasure. I just "buy into" it and start to believe that it is saying something about what is going on with me when it is not. Hence, is it working. Is it not? All becomes much more muddled. I distrust my sense of my own body and mental state. I walk in and say I feel great. The next day, I'm hitting bottom. Do I change my meds? Are they working? Is this just my pattern?

> > > I didn't really understand how bad your ratio was. But then my bads are worse than your bads, and my ratio is better, so the overall result could be close. (I just realized how competitive that sounded. :-) Really, I am just trying to understand. (I always want to understand. It can drive me and others crazy at times.)

You aren't driving me crazy, just making me think.

> >
Shelli, have you seriously tried drugs?
> No, only the vicodin and now the oxy.
>
> The life of an addict is not attractive or pleasant. Reality peeks in.
>
> Okay, the plan is : get high, go to France, have fun and spend all my money; when I become poor and an addict, *then* kill myself. But why not use money and drugs in excess first.
>
> However. It's only a plan if I decide to kill myself, and that, as we have discussed, is not an option. So it's more like a perverse fantasy.
> Or black humor.

I like black humor. When I was a very young I experimented with enough drugs to know that I do not want anything to do with that way of life.

I'm up to 45 on Nardil now. I'm not optimistic though. We will see. Side effects of hyperventilating are a trial and the lack of mood support does not make this look promising.

Lorraine

Re: more stuff » Lorraine

Posted by Elizabeth on September 26, 2001, at 15:51:13

In reply to Re: more stuff » Elizabeth, posted by Lorraine on September 25, 2001, at 17:04:23

> > I start noticing it around 100 or 110. Often drinking a glass of water will slow it down some, IME.
>
> That's good to know. Maybe hydration is important for this, increasing blood volume to slow the pulse?

Exactly.

> I hate condoms. I think it is so sad that your generation didn't have the sort of free abandon with sex that mine had.

Can I ask what you hate about them?

> > > Aren't people on MAOs supposed to avoid antihistamines?
> >
> > No, antihistamines are fine; it's decongestants (e.g., Sudafed) that are a problem (the locally-acting ones like Afrin don't seem to be a problem, though).
>
> OK. I'll have to take note of that. I may need this info later.

See, this is the kind of thing I hate: when doctors (or pharmaceutical companies) tell patients to avoid "cough or cold medicine" rather than just telling them which ingredients are dangerous. (The result is that the patient ends up thinking that s/he can't take *any* "cold medicine" -- or takes one, finds out it's okay, and doesn't take the restrictions seriously anymore.)

re Asperger's d/o:
> I read up on it. I know someone whose son was recently diagnosed--although I don't know her well.

Do you know her son?

> In my mind it goes like this. Is there a neurotransmitter in the human body that uses this chemical in the absence of addiction? If so, there may be a deficiency.

Sure; there are neuropeptides called endorphins and enkephalins. Drugs don't really do anything new; there's a reason why we have opioid receptors -- because we have an endogenous opioid system.

> I just read an article that said that the incidence of bipolar II among those with atypical depression is 64% so there clearly is a more than chance relationship going here.

Exactly.

> OK. So, what caused this coma? What was this about? (elizabeth, are you stoic? I go for the drama and you go for the understatement< g >)

They never figured out what caused it. I posted about this way back when (sometime in late March, I think) -- it's in the archives. And yes, I don't like to be dramatic or to exaggerate.

> We are having a crises with my son Austin and anger management right now. He had a real explosive and scarey episode last night. I'm meeting with his therapist in an hour.

I hope it goes well. It's bad enough that we have to deal with emotional problems ourselves; having to deal with them in a child must be very difficult (one reason I don't think I'm going to have any children).

-elizabeth

Re: more stuff » Elizabeth

Posted by Lorraine on September 27, 2001, at 10:15:59

In reply to Re: more stuff » Lorraine, posted by Elizabeth on September 26, 2001, at 15:51:13

Elizabeth:

> > I hate condoms. I think it is so sad that your generation didn't have the sort of free abandon with sex that mine had.
>
> Can I ask what you hate about them?

I don't like the way the feel. Maybe they have improved the technology (how hi tech can it be tho?) since I used them (10 years ago).

>
> re Asperger's d/o:
> > I read up on it. I know someone whose son was recently diagnosed--although I don't know her well.
>
> Do you know her son?

No.

>
> > In my mind it goes like this. Is there a neurotransmitter in the human body that uses this chemical in the absence of addiction? If so, there may be a deficiency.
>
> Sure; there are neuropeptides called endorphins and enkephalins. Drugs don't really do anything new; there's a reason why we have opioid receptors -- because we have an endogenous opioid system.

All the rest of it is just value judgement and as Shelli would say puritanical value judgement at that. Definitely not helpful.

> > We are having a crises with my son Austin and anger management right now. He had a real explosive and scarey episode last night. I'm meeting with his therapist in an hour.
>
> I hope it goes well. It's bad enough that we have to deal with emotional problems ourselves; having to deal with them in a child must be very difficult (one reason I don't think I'm going to have any children).

Even with the tough times, I'm glad I had kids and particularly glad I had my son. He has taught me a lot. His therapist said that he thinks we have a bully/victim dynamic going in our household (do you want to guess who the bully is? how about the victim?) Anyway, he said we need to break this pattern and that I need to be less of a victim--which in part means being less reactive to bullying behavior. This last thing--about me being the victim--was pretty distressing to me b/c I do unfortunately see the thread throughout some of my life anyway. So it became more than a realization about the family--it just sort of bounced around inside me like a ping-pong ball setting off lots of difficult feelings. These cognitive therapy types are pretty wierd (based on an n=1). They don't really care about your "petty" wounds. They care about thought patterns that work or don't work. I like this guy for Austin, but he seems a bit military to me--like maybe they forgot to pour the feminine side in him when they set the mold. Anyway, unique experience. The family goes in today for a 2 hour session. It's possible that I would want to see this guy individually--but I guess I would want to have a touchy-feeling therapist on the side to pick up the pieces from some of the realizations.

He believes that Austin does not have a biochemical thing going on b/c his behavior only occurs in the family and not in school or with his friends. But then I know that sometimes we can just hold things together until we are in a safe place like home when things unwind. He views Austin as an alpha male who has learned to bully--which does make sense.

I have a friend who is big and tall and wide whose son started trying to intimidate her physically at around this age. She said you have to grab him by the collar, pull him up from the chair, get right in his face and scream at him letting him know who is boss. When I mentioned this to his therapist, he said yes that would work but you have to play your hands with the cards you are dealt and I am much smaller than my son, who towers over me.

Anyway, I think that I will have Austin tested meanwhile in case there is something physical and not just biological going on.

He said another thing that was interesting to me. He said that we all have two brains--a mature brain and an immature or primitive brain. Austin's mature side is very highly developed (this is true--he is remarkably insightful and bright). His immature side though is very immature--like dealing with a two year old. When Austin is in the immature or primitive mode, reasoning with him is not effective (this is certainly true). Well, perhaps it is all a way of looking at things, but an interesting way.

My Nardil is making me anxious--hyperventilate and also lowering my energy level (or not helping it). I'm taking 22.5 in the am and 15 in the afternoon (3:oo pm). I never fully recover from the pm dose drowsiness and sludge through my evening with no energy and without much mood support. For the hyperventilation, I have been taking Neurontin and increasing it b/c the hyperventilation can be quite bad. So I'm taking 200 mg or Neurontin with my am and pm dose and 600 at night b/4 bed. Yesterday I substituted 1/2 tab of valium for the Neurontin--which knocked me out further so won't be repeated. Does this sound like a pattern that will ultimately yield success to you? It is getting hard to hang in there with this trial. Is is now day 18 on Nardil. I feel pretty good in the morning only then sort of crash around 3 for the rest of the day. My memory is really terrible right now also--like losing my way on the way to the store not once but twice. Anyway, I will see my pdoc next week, but I have always had a fairly fast response to meds. Effexor, being the exception, took 3 weeks for me to feel much better.

I'd appreciate your thoughts.

Lorraine

Re: hanging in there » Lorraine

Posted by shelliR on September 27, 2001, at 20:20:46

In reply to Re: hanging in there » shelliR, posted by Lorraine on September 26, 2001, at 10:26:56

> Hi Shelli:

> > My therapist and I try to work on things as basic as organization, both in how I live and in how I work.
> Oh, that wouldn't work for me because I have read about 30 books on organization. I know the principles well enough to teach, but not follow, them. Or I follow them half way (I do have the folders):-) I'm trying to get some structure into my life (i know that this is not your issue--so how quickly I learn?) So one of the things that I want to have is a day where I close projects b/c all i want to do is open them--it's my nature.

Well the things that we've worked on have more to do with organizing my life between work and other. I often feel like I have no other because I am always running to catch up on work. One of the interesting things I discovered is that I have more control over my focus or lack of focus than I had thought. I spent time trying to figure out how I actually spend a whole day only getting doing four simple things. I am more aware now that I let myself drift off in thought, because it is more fun to "free-think" than to stay focused. But if I focus, then I have time to do other things, *guilt-free*. I'll go upstairs to get a ruler, for example, then I'll see the computer, and decided to check messages, then maybe look at PB, etc. So I am working, I suppose, on organization in terms of self-control now, rather than an amorphous "don't know where my time went." I can, sometimes at least, catch myself go off track in thought, and make a conscious decision to come back (even when I don't want to). And I am trying much harder to stick to a work plan each day.
>
>
> We have dinner parties occassionally--which means that I have to clean up from time to time. Once a friend who had been here for dinner when things were "neat" came to the house and looked at my office and said "is that what the inside of your mind looks like?" It gave me pause.

I wouldn't know how to take that either. So I suppose I'd end up deciding it was a compliment. < g >
>
>
Re oxy:
> I mean it wants to own you by making you ever more dependent. I'm having fun by assuming that the oxy has a will of it's own:-)

Umm, dependent. Well I actually had a productive 10 minutes with my pdoc today. I found out by accident last night that I don't wake up depressed if I add a third dose of oxy. (Sort of what everyone's been telling me, and I felt--rebound depression.) I put out my morning pills and mistakingly took them with my hs meds! I told him and he said yes, he realized that even for depression (along with other types of pain), I should be taking it three times a day. I said, thanks a lot (sarcasticly), I had been telling him this for a while. He admited that he was fairly new to the use of oxy for depression and he had been working with a pain specialist. That made me feel very good. (And sort of like a guinea pig). But definitely more good than pig, because I like the combination of a psychopharmacologist and a pain specialist. And as far as habituation, "they" think that sort of like pain, when I get to the right dose of oxy, I'll settle in and not need to go up. And I'm willing to take that chance.

So back to dependent: I do think that this pdoc had always thought that oxy would be a major part of my cocktail, along with an anti-depressant and a stimulent. It was never in the game plan to use oxy temporarily. At least for him it wasn't. I was the one who was thinking that the oxy would be a smaller part, or that the oxy was just there to get me through until another combo worked. But I also knew that I didn't have a lot of choices left--I had pretty much run out of options when I tried selegiline. I guess I was thinking that selegiline would take on the bigger role, but when that and parnate fell out, I wasn't left with a lot of choices, so that's why I decided to go back on nardil. At least to have some stabilization for the oxy. And wellbutrin has turned out to be the stimulent, instead of a "real" stimulent. One other good thing is that since this other doctor is in the picture, it doesn't leave me totally and fully dependent on working with my current pdoc, if I decide at some point I don't want to.

So if my dose is stablilized, it's really not different to me than using any other drug, and probably a lot better in terms of side effects than most.
>

> > I think that's all in the US.
> Oh no, that is scarey b/c the Nardil is giving me no mood support, it is making my hyperventilation worse (hence the Neurontin); it is making me sedated. I drop off a cliff in terms of energy about 8 o'clock (so I'm trying to adjust my times). I'm increasing my dose to 45 mg today. I'll see my pdoc next week and we'll see what we think. I'm not real positive. My best response so far was the (don't laugh) Moclobemide, but the anxiety and loss of sleep made me hyperventilate and wake up unrefreshed. Maybe now I could temper that with what? Ambien for sleep. Anxiety, I don't know. Marplan is supposed to be hard to get (limited manufacture).

Are you sure it's the nardil that is making you hyperventilate. That would mean it was activating and sedating. Were you on any meds during which time hyperventilation was not an issue? I am assuming that hyperventilating is overbreathing because of anxiety? When I hyperventitate, or get very spacy, I take valium. But with valium, you also do need to take something stimulating or it will knock you out.

Lorraine, I really don't know what to say. I can only say for me that it took a full five weeks of 45mg, and it changed my life. You haven't even done one week at 45mg. I also have to say that nardil alone wasn't enough. I also used a benzo throughout my whole adult life, sometimes more, sometimes none. It allowed me more or less to lead a normal life. And if I could have tolerated a stimulent, I would have been on that also.

I wish you could be easier on yourself for the trials. Let yourself take an early afternoon (before the kids come home) nap. Sometimes just a half hour will do it. Then if the nardil works, you will find the right stimulent, and fatigue will be less of a factor. I don't think I can convince you to take a benzo for hyperventilation and anxiety, if you are really against it.

It's strange. You are coming to terms with having a disease, and I try to ignore my disease as much as possible by medicating it in any way possible, not to play with drugs, just to feel my "disease" as little as possible. When I first started dance class I couldn't do it unless I took valium. After a while, I got a dance scholarship and wasn't needing the valium. So I used it to get by until I could get by on my own. And I never felt guilty; I always felt so grateful that it was there to take.
>

But going back to the nardil, I wish I could say, if you hang in there it will work. I believe that it has an excellent chance of working, based on your diagnosis, and based on the number of people who hav ehad success with it. When I tried it, there wasn't a lot of everything else, so after determining that I could not take tricylics, it was my first AD. And the rap was that it was supposed to work in three weeks. So I literally read the page in a book that said it may take up to six weeks for it to work every single day, at least once. It was my bible. (Nathan Klein, "From Sad to Glad", little paperback, I'm sure out of print).
No one, in or out of the hospital at that time even suggested MAOIs to me, and by absolute luck, I turned on PBS at my parents house, right after getting out of the hospital at age 24 and he was being interviewed.

How long did it take for the Moclobemide to kick in? Also what was your experience with effexor? Is that an AD you would consider going back to?

> Shelli, have you seriously tried drugs?
> > No, only the vicodin and now the oxy.
> > The life of an addict is not attractive or pleasant. Reality peeks in.
> > Okay, the plan is : get high, go to France, have fun and spend all my money; when I become poor and an addict, *then* kill myself. But why not use money and drugs in excess first.
> > However. It's only a plan if I decide to kill myself, and that, as we have discussed, is not an option. So it's more like a perverse fantasy.
> > Or black humor.
> I like black humor. When I was a very young I experimented with enough drugs to know that I do not want anything to do with that way of life.
>
I also played a little with drugs in college. I tripped twice and have never been sorry, although I would never take the risk again. I was really talking about being in France, stoned with a form of codeine. Nothing heavier. Letting myself be high because I wouldn't have work to do, and not caring if I became addicted or habituated, and because the French Countryside is so beautiful.

Re your son:
> He said another thing that was interesting to me. He said that we all have two brains--a mature brain and an immature or primitive brain. Austin's mature side is very highly
developed (this is true--he is remarkably insightful and bright). His immature side though is very immature--like dealing with a two year old. When Austin is in the immature or primitive mode, reasoning with him is not effective (this is certainly true). Well, perhaps it is all a way of looking at things, but an interesting way.

That is very much how I have seen myself. I haven't divided it into two brains, but definitely two parts of myself, and that's the way my therapists have seen me also. One very very young emotionally, the unmothered part for me, extremely vulnerable and aching and not at all strong. The part that has hurt myself, and unravels almost totally. And the very adult, very perceptive even as a young child, very smart in terms of verbalization and understanding, and always with an incredible amount of integrity. I think to some extent everyone has both mature and immature parts, but for some, like your son, it is the great difference that makes it so noticable. Sort of like having a huge scatter in an IQ test. I had a great scatter in living.

I'm so sorry that you are having a hard time, and are becoming scared. I wish I could help. I have finally had two good days in a row, but as you know, I very understand very well how hard it is to go through the bad times, not knowing.

Shelli

Re: hanging in there » shelliR

Posted by Lorraine on September 28, 2001, at 17:34:23

In reply to Re: hanging in there » Lorraine, posted by shelliR on September 27, 2001, at 20:20:46

Hi Shelli:

> > > Well the things that we've worked on have more to do with organizing my life between work and other. And I am trying much harder to stick to a work plan each day.

This is so positive, Shelli. I have been working with an activity log of sorts, trying to plan the work, work the plan--it does keep me moving. And then trying to break up the days into different tasks. Returning calls, running errands, support groups, home maintenance stuff, creative stuff, cleaning desk. I'm even trying to limit the time that I spend thinking re depression to a set time.

> > > I put out my morning pills and mistakingly took them with my hs meds! I told him and he said yes, he realized that even for depression (along with other types of pain), I should be taking it three times a day.

Very cool! This will make a big difference for you.

> > >He admited that he was fairly new to the use of oxy for depression and he had been working with a pain specialist.

I like the admitted part. Big step for him. I'm hoping you gave him lots of positive reinforcement. Also great to know that he is working with a pain specialist and that they believe your dosage is a "water seeks its own level" sort of thing. What a blast of positive news, Shelli. I know you have been worried about the role oxy would assume. It is nice to know that his intention was for it to assume a fairly large role and sit there as a hinge piece. This is much better than as a crutch to help you get through and it takes a lot of pressure off your other meds in terms of how much work they have to do. Good stuff.

> > >It doesn't leave me totally and fully dependent on working with my current pdoc, if I decide at some point I don't want to.

Have you met the other doctor? Would he be comfortable working with you without your pdoc or substituting in another pdoc?

> > > Are you sure it's the nardil that is making you hyperventilate. That would mean it was activating and sedating.

Nardil is wierd. I'm not sure what it is in terms of activating/sedating. The only med that I used that I think made my hyperventilating go away was Adderal. When I was on Adderal and Neurontin alone during a washout. I also didn't hyperventilate when I was between meds (med free) this time (the 5 days between the parnate termination and the nardil beginning).

> > >When I hyperventitate, or get very spacy, I take valium. But with valium, you also do need to take something stimulating or it will knock you out.

OK, that is a really useful piece of info for me and I suspect that this is where I may end up. Given my last experience with Adderal the day after terminating Parnate (hypertensive crises), I'm leary of adding it again but may end up there.

>
> Lorraine, I really don't know what to say. I can only say for me that it took a full five weeks of 45mg, and it changed my life. You haven't even done one week at 45mg. I also have to say that nardil alone wasn't enough. I also used a benzo throughout my whole adult life, sometimes more, sometimes none. It allowed me more or less to lead a normal life. And if I could have tolerated a stimulent, I would have been on that also.

I think your attitude toward all of this is more mature than mine actually. I'm fighting myself in addition to my depression. I've also been reluctant to add things to the mix until I have a better lay of the land. What with the Nardil, the Neurontin, my new HRT and so forth, it is hard to figure out what is causing what.

> > > I wish you could be easier on yourself for the trials. Let yourself take an early afternoon (before the kids come home) nap. Sometimes just a half hour will do it. Then if the nardil works, you will find the right stimulent, and fatigue will be less of a factor. I don't think I can convince you to take a benzo for hyperventilation and anxiety, if you are really against it.

I don't know Shelli. I'm really trying to stay on the Nardil to give it time to work. You are right I may end up with a cocktail that is Nardil, neurontin, stimulant and benzo. I do appreciate your words of encouragement--it does help stop me from just jumping off a train that may be heading for the right destination.

>
> > > It's strange. You are coming to terms with having a disease, and I try to ignore my disease as much as possible by medicating it in any way possible, not to play with drugs, just to feel my "disease" as little as possible. When I first started dance class I couldn't do it unless I took valium. After a while, I got a dance scholarship and wasn't needing the valium. So I used it to get by until I could get by on my own. And I never felt guilty; I always felt so grateful that it was there to take.

You are much more evolved on this. Maybe you have been dealing with the depression longer and have already come to terms with some of the things that I am struggling with. Although I do feel like I am having some success with my struggles. It's just that I never really accepted the fact that it was a long term chronic condition and then the fact that I might not be able to predict my next day. The problem has been that for the past 18 mos or so I have been holding my breath waiting for a drug to work--putting my life on hold. I need to live a bit more than that.

>
> > > But going back to the nardil, I wish I could say, if you hang in there it will work.

I'm going to try to hang with it for a while...

>
> How long did it take for the Moclobemide to kick in?

Day 1 i felt positive effects and day 5 I was pretty much there

> > >Also what was your experience with effexor?

Three weeks.

Is that an AD you would consider going back to?

I tried. It didn't work.

> > > Re your son:
> > He said another thing that was interesting to me. He said that we all have two brains--a mature brain and an immature or primitive brain. Austin's mature side is very highly
> developed (this is true--he is remarkably insightful and bright). His immature side though is very immature--like dealing with a two year old. When Austin is in the immature or primitive mode, reasoning with him is not effective (this is certainly true). Well, perhaps it is all a way of looking at things, but an interesting way.
>
> That is very much how I have seen myself. I haven't divided it into two brains, but definitely two parts of myself, and that's the way my therapists have seen me also. One very very young emotionally, the unmothered part for me, extremely vulnerable and aching and not at all strong. The part that has hurt myself, and unravels almost totally. And the very adult, very perceptive even as a young child, very smart in terms of verbalization and understanding, and always with an incredible amount of integrity. I think to some extent everyone has both mature and immature parts, but for some, like your son, it is the great difference that makes it so noticable. Sort of like having a huge scatter in an IQ test. I had a great scatter in living.

That's a good way of putting it Shelli.

> > > I'm so sorry that you are having a hard time, and are becoming scared. I wish I could help.

You are.

I have finally had two good days in a row...

Woohoo! Let the good times roll!

Lorraine

Re: hanging in there » Lorraine

Posted by shelliR on September 29, 2001, at 20:18:11

In reply to Re: hanging in there » shelliR, posted by Lorraine on September 28, 2001, at 17:34:23

Hi Lorraine.

> > > > I put out my morning pills and mistakingly took them with my hs meds! I told him and he said yes, he realized that even for depression (along with other types of pain), I should be taking it three times a day.
> Very cool! This will make a big difference for you.

I think it will, only for the last two days I have lay down, setting my clock for a 30minute nap, and woken up three hours later. I have been very very tired. I'm not sure why, whether the oxy at night is affecting the quality of my sleep. All the sudden I went from very stimulated on the oxy and wellbutrin to very sleepy. But I'm not going to worry about it yet, although certainly I can't live this way. Sometimes I am like this premenstrually, but I can't figure out my cycle at all now, to see if it's related.

>
>
> > > >He admited that he was fairly new to the use of oxy for depression and he had been working with a pain specialist.
> I like the admitted part. Big step for him. I'm hoping you gave him lots of positive reinforcement. Also great to know that he is working with a pain specialist and that they believe your dosage is a "water seeks its own level" sort of thing. What a blast of positive news, Shelli. I know you have been worried about the role oxy would assume. It is nice to know that his intention was for it to assume a fairly large role and sit there as a hinge piece. This is much better than as a crutch to help you get through and it takes a lot of pressure off your other meds in terms of how much work they have to do. Good stuff.

I am really excited. Probably I didn't reinforce him enough :-) , but I did forgive him! I feel good having two doctors working with me (even if I only see one). The best thing is that I don't feel that I am in so much pain that I must die for an hour in the morning and think if I got habituated to the oxy, this is how my whole day would be. Because it probably would not be as bad as the rebound was making me feel in the morning. Oh, and I am up to 45 mg of nardil (well, I'm alternating every other day with 30mg, instead of splitting pills).

> >It doesn't leave me totally and fully dependent on working with my current pdoc, if I decide at some point I don't want to.
> Have you met the other doctor? Would he be comfortable working with you without your pdoc or substituting in another pdoc?

He told me the other doctor's name, but I already forget. And I'll have to wait a bit to work it into a conversation so I can get it there again (without hurting my pdoc's feelings). I have no idea if I ever could work with the other guy, he's not a psychiatrist, I gather. I think it's more this thing that stays in my head as a possibility if I ever have any questions, or concerns that my pdoc is not able to address or if my pdoc and I break up. So maybe I don't want to know anything negative, like no he wouldn't work with my next pdoc around narcotics. Sometimes it is better to live with illusions until it is necessary to figure out the reality. Now when my pdoc is good (as the saying goes), he is very very good, and when he is bad....... I also think it is in my best interest to take great care with his ego. He keeps asking me what number I am at in the depression scale. (1 being the most depression). I never answer. This time he said 5 to 6, and I said yes. I have to figure out this scale thing. What would it mean for *me* to be at 10. (I also want to write back to Zo, because she bought up happiness related to hypomanic, sort of when is it hypomania instead of a 10 or 10 plus. For example if it doesn't involve anything concrete, like spending money, but she is painting really well and really happily. Do you stop yourself to ask: , "Is this hypomania?". I have had absolutely no signs of hypomania ever, but I'm asking questions like could I be at a 10 and not need therapy? What does a ten feel like?

If my the physical elements of my depression really go away, then how much more therapy will I need? I talked some with my therapist about this on Thursday and we also used EMDR to start to process how much of my life I have missed. I am so so sad, under the depression. I am not ready to be my age. I want those years back. Things that I was working on two years ago when everything (with the exception of survival and work came to a halt.) But there were lots of years lost before that because of my self-image, because of my dissociation, etc. So, now, if I depression is sad, and I have mourned enough, what is next in my life. Am I up to the challenge of looking for an emotiona/sexual relationship, and do I really think I have the potential to love someone fully. I don't know, and I'm not even sure I want to go through all the effort.

But I must feel very encouraged by my now three good days in a row ( :-) , to even be thinking what comes next.
And there's a photo meeting that I actually want to go to next week about imaging off the computer. This is where I am headed so I think there will be lots of people there that I can learn from, specifically about paper and inks that are available. I already have my system up and running, finally. I met one guy in the photo supply store last month who has converted all his stuff from darkroom to computer and he did give me his number. I never got around to calling, but I think he will be at the meeting. Plus it's in the studio of a commercial photographer, a women who I've never met but have respected her work for years. She's highly published in Washington magazines. (When you're a photographer, you get in the habit of always looking for credits). She changed her last name to Z very early; her father is a well-known political figure and she didn't want to be identified with him in her work. So I 'm sort of excited to meet her.

>
> > > > Are you sure it's the nardil that is making you hyperventilate. That would mean it was activating and sedating.
> Nardil is wierd. I'm not sure what it is in terms of activating/sedating. The only med that I used that I think made my hyperventilating go away was Adderal. When I was on Adderal and Neurontin alone during a washout. I also didn't hyperventilate when I was between meds (med free) this time (the 5 days between the parnate termination and the nardil beginning).
>

Well if you take the neurotin and adderal, will you be able to tell when the nardil kicks in? Because that is probably an easier option for you, to take that route, rather than the purity route. Actually it is the way my doctor wanted to handle things in the hospital and I resisted, then gave in after one day. I wanted to try selegiline for a while before I added the oxy, because I really did feel that the oxy made me feel so good, that I wouldn't be able to see if the selegiline was working. But my pain was too great, and we decided that I could always take away the oxy, in other words I guess it would be called the subtraction method, rather than the addition method.

> OK, that is a really useful piece of info for me and I suspect that this is where I may end up. Given my last experience with Adderal the day after terminating Parnate (hypertensive crises), I'm leary of adding it again but may end up there.

I've heard that there are a lot less interactions with nardil and other meds vs. parnate and other meds. Is adderal time release? If so, is it a capsule that can be split? Is it a capsule and a pill? JUST KIDDING. See we already have a history :-)

> > Lorraine, I really don't know what to say. I can only say for me that it took a full five weeks of 45mg, and it changed my life. You haven't even done one week at 45mg. I also have to say that nardil alone wasn't enough. I also used a benzo throughout my whole adult life, sometimes more, sometimes none. It allowed me more or less to lead a normal life. And if I could have tolerated a stimulent, I would have been on that also.
> I think your attitude toward all of this is more mature than mine actually. I'm fighting myself in addition to my depression. I've also been reluctant to add things to the mix until I have a better lay of the land. What with the Nardil, the Neurontin, my new HRT and so forth, it is hard to figure out what is causing what.

That’s why I mentioned subtraction above. That really may be easier. easier = better.

>
You are much more evolved on this. Maybe you have been dealing with the depression longer and have already come to terms with some of the things that I am struggling with.

Well, yes, I have been depressed since my early twenties and if I had not put it in some perspective, my life would have been unbearable. I have had the image of myself as fucked up, much more than depressed until two years ago. Lots of stuff to work on outside the depression which was managed by nardil.

Although I do feel like I am having some success with my struggles. It's just that I never really accepted the fact that it was a long term chronic condition and then the fact that I might not be able to predict my next day. The problem has been that for the past 18 mos or so I have been holding my breath waiting for a drug to work--putting my life on hold. I need to live a bit more than that.

When you find the right drug, then you will naturally put it into perspective. I really never thought about my depression, only premenstrually. It’s sort of like you’re actually not depressed when meds take away the depression. Especially ADs. I took nardil once a day like a vitamin for depression and that was it.
>
>
> >
> > How long did it take for the Moclobemide to kick in?
> Day 1 i felt positive effects and day 5 I was pretty much there

What is your next plan, if nardil doesn’t kick in. I know that one plan would be to go back to moclobernide with adjuncts, but is that next? I know you always have a next plan.

> > > >Also what was your experience with effexor?
> Three weeks.
ÿ Is that an AD you would consider going back to?
ÿ I tried. It didn't work.

You mean you took effexor successfully once and when you retried it, it didn’t work?
>
> I have finally had two good days in a row...
Woohoo! Let the good times roll!
Three now. (Today though I’m very spacey, but not depressed)

Well, you have your little niche when your depression goes away. It’s not like you have to start from scratch.
I remember that you said that you had quit work to be home with your kids, because that was something you had missed. Had you thought you’d stay home until the kids were a certain age, or just left it open-ended?

Shelli

Re: more stuff » Lorraine

Posted by Elizabeth on October 1, 2001, at 13:20:33

In reply to Re: more stuff » Elizabeth, posted by Lorraine on September 27, 2001, at 10:15:59

> > > I hate condoms. I think it is so sad that your generation didn't have the sort of free abandon with sex that mine had.

Among people my age there is a saying: "I don't want cheap sex. I want *free* sex."

> > Can I ask what you hate about them?
>
> I don't like the way the feel. Maybe they have improved the technology (how hi tech can it be tho?) since I used them (10 years ago).

I don't know about that. They do have some now that are supposed to be quite thin but also strong. I think that _Consumer Reports_ even investigated different brands. < g > But in what way do they feel different to you? I'd expect a man to have an opinion, but most women I've talked to about the subject (surprisingly many) don't seem to care, so they insist on using condoms for safety reasons (mostly -- keep in mind, I'm at the tail-end of "gen-x" so these are people who don't remember much of the seventies or anything of the sixties). Some people just count on the pill and assume that their [allegedly] monogamous partners are "clean," but I wouldn't be willing to take that risk except under very unusual circumstances. (Anyway, I had a depressive relapse closely coinciding with trying the pill, which mostly subsided when I stopped taking the damned hormones, so I'm not keen on the idea of women just being expected to use it and men having to responsibility whatsoever for BC.)

> > Sure; there are neuropeptides called endorphins and enkephalins. Drugs don't really do anything new; there's a reason why we have opioid receptors -- because we have an endogenous opioid system.
>
> All the rest of it is just value judgement and as Shelli would say puritanical value judgement at that. Definitely not helpful.

Well, the "reason" I gave is only the tip of the iceberg, of course. The opioid receptor was (I think) the first one to be discovered, and a while back there was research into "enkephalinase inhibitors" (which would work like MAOIs only on endogenous opioids instead of monoamines) which my s.o. was involved with. The problem turned out to be that there was no such thing as "enkephalinase." < g > (That is, there were enzymes that catalysed the breakdown of enkephalins, but these were general neuropeptide-ases, which would be much dirtier than anything we'd want to use on ourselves.)

> These cognitive therapy types are pretty wierd (based on an n=1). They don't really care about your "petty" wounds. They care about thought patterns that work or don't work.

I have a much higher n, and I agree.

> It's possible that I would want to see this guy individually--but I guess I would want to have a touchy-feeling therapist on the side to pick up the pieces from some of the realizations.

I can't deal with the touchy-feely types, myself. They nauseate me.

> He believes that Austin does not have a biochemical thing going on b/c his behavior only occurs in the family and not in school or with his friends. But then I know that sometimes we can just hold things together until we are in a safe place like home when things unwind.

I agree. My guess is that he knows little or nothing about the endogenous side of things (or he denies it because he sees it as a threat to him professionally), and he's making assumptions based on what boil down to old wives' tales. There are some kids who have problems that are exaggerated at school, too. Either way, it doesn't mean that it's "just behavioural" (an absurdity in any case).

> He views Austin as an alpha male who has learned to bully--which does make sense.

Oh jeez, here come the gender stereotypes.

> When I mentioned this to his therapist, he said yes that would work but you have to play your hands with the cards you are dealt and I am much smaller than my son, who towers over me.

I don't think you've mentioned his age. ?

> Anyway, I think that I will have Austin tested meanwhile in case there is something physical and not just biological going on.

What kind of tests do you expect will be helpful?

(I've gotten pretty cynical about such tests, especially in the last couple of weeks, after a battery of various tests failed to identify anything that might account for what a number of different doctors, including several neurologists and psychiatrists, feel was almost certainly a complex partial seizure.)

> He said another thing that was interesting to me. He said that we all have two brains--a mature brain and an immature or primitive brain.

I wouldn't put it that way, but yes, you could say that. The "lower brain" is very old, even reptiles have it. It controls emotions and other basic functions. The neocortex, unique to humans, is thought to be involved in our apparently unique facility with language, and probably a lot of other stuff.

> Austin's mature side is very highly developed (this is true--he is remarkably insightful and bright). His immature side though is very immature--like dealing with a two year old.

"When he was good he was very, very good, but when he was bad he was horrid?"

(I should be one to talk. My boyfriend said that talking to me in my (putatively postictal) confusional state was like trying to talk to a caveman or something. I got a real kick out of that.)

> When Austin is in the immature or primitive mode, reasoning with him is not effective (this is certainly true).

In spite of everything, our emotions can still overcome our capacity for reason. One has to understand this in order to have a feel for what mental illness is (IMO).

> My Nardil is making me anxious--hyperventilate and also lowering my energy level (or not helping it). I'm taking 22.5 in the am and 15 in the afternoon (3:oo pm).

Well that's good, you're getting up into the might-possibly-be-effective range. Try to make at least 45 mg/day a target (not necessarily a final target, since I think most people need at least 60, but a target where you should expect to be getting some benefit out of it).

> I never fully recover from the pm dose drowsiness and sludge through my evening with no energy and without much mood support.

I'm not sure if that's a result of the PM dose or if it's part of the disruptive effect that phenelzine has on circadian rhythms. I had nighttime insomnia and afternoon fatigue no matter how I arranged my doses.

> For the hyperventilation, I have been taking Neurontin and increasing it b/c the hyperventilation can be quite bad. So I'm taking 200 mg or Neurontin with my am and pm dose and 600 at night b/4 bed. Yesterday I substituted 1/2 tab of valium for the Neurontin--which knocked me out further so won't be repeated.

You know, the first time I took Valium (5 mg) it knocked me on my *ss too. Everafter, it has been completely nonsedating, even when I tried as much as 40 mg in a single dose. I guess my brain is pretty adaptive (a mixed blessing).

> Does this sound like a pattern that will ultimately yield success to you?

I don't presume to know such things. But I hope it will.

> It is getting hard to hang in there with this trial. Is is now day 18 on Nardil.

How many days have you been taking >30 mg?

> I feel pretty good in the morning only then sort of crash around 3 for the rest of the day.

Yeah, that's common with Nardil, the afternoon nod. I wonder if Provigil or the like would help. (If you do try it, be cautious, but I feel confident in saying it's definitely safer than amphetamine-like stimulants.)

> My memory is really terrible right now also--like losing my way on the way to the store not once but twice.

Hmm...do you think that's a problem with memory, or attentiveness?

> Anyway, I will see my pdoc next week, but I have always had a fairly fast response to meds. Effexor, being the exception, took 3 weeks for me to feel much better.

But it worked -- why did you switch?

> I'd appreciate your thoughts.

Well, you've got 'em. Hope they're of more help to you than they have been to me.

-elizabeth

Re: hanging in there » shelliR

Posted by Lorraine on October 2, 2001, at 10:00:41

In reply to Re: hanging in there » Lorraine, posted by shelliR on September 29, 2001, at 20:18:11

Hello Shelli:

> > > I think it will, only for the last two days I have lay down, setting my clock for a 30minute nap, and woken up three hours later. I have been very very tired. I'm not sure why, whether the oxy at night is affecting the quality of my sleep. All the sudden I went from very stimulated on the oxy and wellbutrin to very sleepy. But I'm not going to worry about it yet, although certainly I can't live this way. Sometimes I am like this premenstrually, but I can't figure out my cycle at all now, to see if it's related.

Maybe with the increase in oxy you need to increase the Wellbutrin?

> > > >Oh, and I am up to 45 mg of nardil (well, I'm alternating every other day with 30mg, instead of splitting pills).

What does this mean? 60 mg one day and 30 the other? Any reason for not splitting? I'm at 45 with splitting.

> > > He told me the other doctor's name, but I already forget. And I'll have to wait a bit to work it into a conversation so I can get it there again (without hurting my pdoc's feelings).

Don't you hate that? Pay attention to these things, shelli! I have the suspicion that oxy and other opiates are being used with fms patients, who frequently (always) have depression as well as tender points and that this is how its use is spreading.

>
> If my the physical elements of my depression really go away, then how much more therapy will I need? I talked some with my therapist about this on Thursday and we also used EMDR to start to process how much of my life I have missed. I am so so sad, under the depression. I am not ready to be my age. I want those years back. Things that I was working on two years ago when everything (with the exception of survival and work came to a halt.) But there were lots of years lost before that because of my self-image, because of my dissociation, etc. So, now, if I depression is sad, and I have mourned enough, what is next in my life. Am I up to the challenge of looking for an emotiona/sexual relationship, and do I really think I have the potential to love someone fully. I don't know, and I'm not even sure I want to go through all the effort.

When we are depressed we can make up issues--really just attach the feelings to events with self talk. If this is the case then the need for talk therapy falls by the wayside. But other people have real issues to work through and those stay with us "in sickness and in health" until we work them through with talk therapy or otherwise. Your's sound like the latter. But maybe things will move more quickly. The can I love stuff though is probably going to be resolved experientially (although you may need a coach along side). When I first got involved with my husband, I went into therapy because I knew this was a good thing and I didn't want to screw it up--the urge to push him away was pretty overwhelming, but I was healthy enough to distrust the feeling.

> > >I met one guy in the photo supply store last month who has converted all his stuff from darkroom to computer and he did give me his number. I never got around to calling, but I think he will be at the meeting. Plus it's in the studio of a commercial photographer, a women who I've never met but have respected her work for years. She's highly published in Washington magazines. (When you're a photographer, you get in the habit of always looking for credits). She changed her last name to Z very early; her father is a well-known political figure and she didn't want to be identified with him in her work. So I 'm sort of excited to meet her.

Embracing the future instead of living in the wreckage of your future--sure sounds like your mood is in the right place.

> > > Well if you take the neurotin and adderal, will you be able to tell when the nardil kicks in? Because that is probably an easier option for you, to take that route, rather than the purity route. Actually it is the way my doctor wanted to handle things in the hospital and I resisted, then gave in after one day. I wanted to try selegiline for a while before I added the oxy, because I really did feel that the oxy made me feel so good, that I wouldn't be able to see if the selegiline was working. But my pain was too great, and we decided that I could always take away the oxy, in other words I guess it would be called the subtraction method, rather than the addition method.

I'm a believer in the subtraction method too. I'm so sorry I'm off the selegiline in a way. I loved what it did cognitively for me. Really felt like I was back to my old self in term of being able to think. I read some of my posts from back then, it shows.

> > > I've heard that there are a lot less interactions with nardil and other meds vs. parnate and other meds. Is adderal time release? If so, is it a capsule that can be split? Is it a capsule and a pill? JUST KIDDING. See we already have a history :-)

And, you're funny...Well I am taking my second dose of Nardil at 4 pm and if I have a dinner party at 5 pm because otherwise I crash. I don't understand you or elizabeth with this steady state stuff and "it doesn't matter when you take your dose"--it matters a great deal to me. I really feel the doses kick in and then I feel myself crash or come down off the dose--in the evening, it's like coming down off an amphetamine.

>
> > > Lorraine, I really don't know what to say. I can only say for me that it took a full five weeks of 45mg, and it changed my life. You haven't even done one week at 45mg.

I didn't know there was a "whining" license competancy requirement:-)

> > > I also have to say that nardil alone wasn't enough. I also used a benzo throughout my whole adult life, sometimes more, sometimes none. It allowed me more or less to lead a normal life. And if I could have tolerated a stimulent, I would have been on that also.

I'm being difficult with this, I know. The valium I could take at night (b/4 bed) and it actually might work throughout the day (I know it shouldn't with half lives and so on but I think it might have when I was taking it to sleep). But I also think I felt sexual impairment on it--which, by the way, I think Neurontin is also contributing to. When I was on Nardil alone, surprisingly, I had no impairment so I actually felt things normally for a week or so. I'm reluctant to try Klonopin (??) b/c I have heard it has some sexual impairment plus I have also heard that while it helps with anxiety it can actually worsen depression. I'm also very sensitive to cognitive impairment caused by these drugs.

Speaking of cognitive impairment, I have been in two accidents (very minor--backed into a parked car and solidly tapped the car ahead of me at a stop light). This plus losing some ability to concentrate. It's funny the accident where I hit the car at the stop light, it was actually as though I was "gone" for a moment. Then the other day, I had what I am convinced was a "smell" hallucination. In Beverly Hills on Rodeo, when I went to get into my parked car, I smelled marijuana very strongly. I looked around (it's not THAT uncommon in Beverly Hills after all) and saw no parked car with occupants, no car on the road that would explain the smell and no people in site. It was so odd that I actually stood there for about 3 minutes trying to figure out if there was a diner or restaurant that might be emitting exhaust that smelled like mj. Plus I am getting electric tingles on my arms or legs. Anyway, I think this may be temporal lobe seizure like stuff. I'm going to ask my pdoc. I'm wondering if Nardil might increase seizure like activity. I'm also wondering if I should add a different anticonvulsant.

> > > That’s why I mentioned subtraction above. That really may be easier. easier = better.

Yes. I just need to move on this stuff I think. I am getting some mood support now I believe.

> > >I have had the image of myself as fucked up, much more than depressed until two years ago. Lots of stuff to work on outside the depression which was managed by nardil.

I had this image of myself as super-competent b/4 my depression. It's all nonsense. It's like we collect our moods roll them into a ball and call it "self".

>
> > > When you find the right drug, then you will naturally put it into perspective.

I know this is true, but I also know that I may not find the right drug and that I still need to be able to live a life to my fullest capability.

> > > What is your next plan, if nardil doesn’t kick in. I know that one plan would be to go back to moclobernide with adjuncts, but is that next? I know you always have a next plan.

I'm going to give the Nardil some more time and work on the anxiety and anticonvulsant side of the equation for right now.

What was atarax like?

You mean you took effexor successfully once and when you retried it, it didn’t work?

Precisely. Ain't that a b****?

> > > I remember that you said that you had quit work to be home with your kids, because that was something you had missed. Had you thought you’d stay home until the kids were a certain age, or just left it open-ended?

I'm not sure what I'm doing with this. I don't think I can 9-5 anymore or assume my old 12 hour days. I don't think that I have the ability to withstand stress the way I used to. So I would need to do some sort of "home" work which I could transition into slowly.

Shelli, I'm hoping you are progressing on your meds and feeling better, less sleepy. Let me know and let me know about that trade group meeting.

Lorraine

Re: more stuff » Elizabeth

Posted by Lorraine on October 2, 2001, at 14:14:34

In reply to Re: more stuff » Lorraine, posted by Elizabeth on October 1, 2001, at 13:20:33

Elizabeth:

[re condoms] > > > > But in what way do they feel different to you? I'd expect a man to have an opinion, but most women I've talked to about the subject (surprisingly many) don't seem to care,

Take your left hand and wrap it around the index finger on your right hand. Now put on a thin latex glove and do the same thing. Do you feel the difference? That's as close as I can get to describing it.

> > >they insist on using condoms for safety reasons (mostly -- keep in mind, I'm at the tail-end of "gen-x" so these are people who don't remember much of the seventies or anything of the sixties).

These are compelling reasons. I have residual STDs from the sixies that effect my life (please don't ask for details). Also the concept of responsibility is great. But if you get into a long term committed relationship and are choosing contraception, my hunch is that the decision gets based on how much the contraception interferes with sex. I was on the pill for at least 15 years, then used an IUD, then my husband got a vasectomy. The pill didn't bother me, but my doctor wanted me off it when I reached a certain age so I used the IUD. I was very resistant to the idea of using an IUD--I had endometriosis and it isn't really recommend for people who have painful periods--but I found that the IUD was absolutely great. I had it in for 7 years, then renewed for another 5 or so.

> > > Sure; there are neuropeptides called endorphins and enkephalins. Drugs don't really do anything new; there's a reason why we have opioid receptors -- because we have an endogenous opioid system. Well, the "reason" I gave is only the tip of the iceberg, of course. The opioid receptor was (I think) the first one to be discovered, and a while back there was research into "enkephalinase inhibitors" (which would work like MAOIs only on endogenous opioids instead of monoamines) which my s.o. was involved with. The problem turned out to be that there was no such thing as "enkephalinase." < g >

This is too funny. But is further demonstrated by the fact that the active ingredient in an antidepressant my not be the obvious but rather the metabolites. Bottom line--we don't have a clue.

> > > It's possible that I would want to see this guy individually--but I guess I would want to have a touchy-feeling therapist on the side to pick up the pieces from some of the realizations.
>
> I can't deal with the touchy-feely types, myself. They nauseate me.

Man, you are really one tough nut, aren't you< vbg >?

>
> > He believes that Austin does not have a biochemical thing going on b/c his behavior only occurs in the family and not in school or with his friends. But then I know that sometimes we can just hold things together until we are in a safe place like home when things unwind.
>
> I agree. My guess is that he knows little or nothing about the endogenous side of things (or he denies it because he sees it as a threat to him professionally), and he's making assumptions based on what boil down to old wives' tales.

You may ber right, but during our initial consultation he did say that young boys (13) with aggression issues sometime have a deficiency in serotonin and too much testosterone aggravates the issue. After reading fairly extensively on the issue, it looks like they end up categorizing teenage boys with aggression issues into two camps--those that use aggression defensively (lots of these kids are abused in the family and aggressive outside the family) and kids that are use aggression offensively (bullies--or alpha males). The kids that use aggression offensively they are saying do not have a chemical imbalance. Now whether this is all poppy-cock, who knows. It's a theory.

>
> > He views Austin as an alpha male who has learned to bully--which does make sense.
>
> Oh jeez, here come the gender stereotypes.

Elizabeth, I am as feminist as they come. I have pursued careers dominated by males most of my life (law and being the Chief Operating Officer of an entertainment company). My whole career was spent with me being the only woman in a meeting of 12 males. When I was an attorney in an aerospace company I never spoke with a woman in performing my job. There were no other women in management. I have always believed that the way society views and raises children is the most important factor in determining "male" and "female" attributes. Blah, blah, blah. Then I had children and wala ala kazam I saw things differently. My son had no toy guns; my daughter no Barbie dolls. I gave my son a toy baby when he was young; I nurtured and cultivated his tender side. I encouraged my daughter to do team sports (she refused)--she is taking Kung Fu. You get the point. Anyway, my son is such an alpha male, I can't tell you. And my daughter is such sweetness and light. My conclusion is that we are not so removed from the chimps after all. I still think the thing to do is to cultivate the masculine in the daughter and cultivate the feminine in the son. It does pay off just not in the ways I expected.

> > > I don't think you've mentioned his age. ?

He's 13 and 5'9" to my 5'4".

> > > Anyway, I think that I will have Austin tested meanwhile in case there is something physical and not just biological going on.
>
> What kind of tests do you expect will be helpful?

Yes, that is the question, isn't it? I guess DSM category test. Psychological testing. I guess I could do an EEG or QEEG.

> > > (I've gotten pretty cynical about such tests, especially in the last couple of weeks, after a battery of various tests failed to identify anything that might account for what a number of different doctors, including several neurologists and psychiatrists, feel was almost certainly a complex partial seizure.)

I'm sorry. You do drop these rather low key bomb shells, don't you? What on earth happened, elizabeth? Complex means no physical convultions? What were you're symptoms and when did this happen?

My pdoc says my QEEG revealed MILD temporal lobe epilepsy type stuff--which apparently can be assoiciated with both panic/anxiety and depression. Jensen says tegretal is supposed to be the best for this type of disorder (i think you said use the kinder more gentle cousin drug--called?). My notes on what he says read "rarely depressed patients have symptoms of partial seizure of which 85% show remarkable improvement on Tegretal. Seizure can cause anxiety. Epileptic depression is greater than that of other chronic neurologic diseases. Originating particularly in the left ermporal hemisphere, it resembles major depression and responds especially well to Tegretal. (Carrieri et al 1993)." Do you think this is what is going on with you? Elizabeth, read my post to Shelli--where I talk about some possible seizure like symptoms that I have been having--2 car accidents in 3 weeks; olfactory hallucination. Curious about your thoughts and also about what is going on with you.

> > > I wouldn't put it that way, but yes, you could say that. The "lower brain" is very old, even reptiles have it. It controls emotions and other basic functions. The neocortex, unique to humans, is thought to be involved in our apparently unique facility with language, and probably a lot of other stuff.

You know we are talking concepts here--so sometimes people try to bolster a concept with physical evidence when the concept is really what is important.

> > > "When he was good he was very, very good, but when he was bad he was horrid?"

Very true:-) Mother's wisdom survives.

> > > (I should be one to talk. My boyfriend said that talking to me in my (putatively postictal) confusional state was like trying to talk to a caveman or something. I got a real kick out of that.)

e--I really appreciate your intellect but what the h*** is "putatively postictal". There is a woman in my NDMDA group that says that her boyfried calls her "psycho" and says "that's ok; everybody's a bit psycho".

> > > In spite of everything, our emotions can still overcome our capacity for reason. One has to understand this in order to have a feel for what mental illness is (IMO).

Absolutely, this guy (who you can see is my new guru) says that when you are depressed or anxious you should not trust or follow your thoughts--you should turn off the self talk and try to find a way to shift your mood (walking, music, movie, message, sitting in sun, reading, sex--what ever) and your thoughts will follow. I think he is right about this.

>
> > My Nardil is making me anxious--hyperventilate and also lowering my energy level (or not helping it). I'm taking 22.5 in the am and 15 in the afternoon (3:oo pm).
>
> Well that's good, you're getting up into the might-possibly-be-effective range. Try to make at least 45 mg/day a target (not necessarily a final target, since I think most people need at least 60, but a target where you should expect to be getting some benefit out of it).

Well, that is my plan and I am trying to stick it out and wait out the side effects.

>
> > I never fully recover from the pm dose drowsiness and sludge through my evening with no energy and without much mood support.
>
> I'm not sure if that's a result of the PM dose or if it's part of the disruptive effect that phenelzine has on circadian rhythms.

I now take my pm dose at 4 or 5 pm. I can feel myself come "off" the Nardil and crash about 10 or 11. When I took my pm dose at 1 or 2, I crashed at 6 or 7. I have found my lowest point is at 4 or 5. When I take my blood pressure then, it has clearly dipped 97/63. I am convinced that this dip is the sluggishness and that the way to combat it is either salt tablets (which I have and will try) or low blood pressure medication.

> > >I had nighttime insomnia.

I can see that happening.

> > > You know, the first time I took Valium (5 mg) it knocked me on my *ss too. Everafter, it has been completely nonsedating, even when I tried as much as 40 mg in a single dose. I guess my brain is pretty adaptive (a mixed blessing).

You are right, I'm not permitting my body to adapt.

> > Does this sound like a pattern that will ultimately yield success to you?
>
> I don't presume to know such things. But I hope it will.

I am so disappointed with you,e. You presume to know (and do know) so many things, why not predict the future?

>
> > It is getting hard to hang in there with this trial. Is is now day 18 on Nardil.
>
> How many days have you been taking >30 mg?

12 days 30 mgs or more and 7 days 45 mgs. You're not calling me impatient are you< vbg >?

> > My memory is really terrible right now also--like losing my way on the way to the store not once but twice.
>
> Hmm...do you think that's a problem with memory, or attentiveness?

Attentiveness is right. But some of it fairly extreme--2 accidents in two weeks.

Anyway, I will see my pdoc maybe today and I will try to focus on anticonvulsants and antianxiety meds. My list includes Buspar (med chart shows I had some response to this previously at least sexually); Betaxolol (you talked about this earlier as well), Clonidine and Tegretal's kinder gentler cousin. By the way, Jensen says the benzodiazepine w/drawal increases calcium flux from hippocampus and in rats produces anxiety response that was reversed by verapamil (File et al 1993) and that Clinidine also helps with benzodiazepine w/drawal (Baumgartner et al 1991).

Effexor, being the exception, took 3 weeks for me to feel much better.
>
> But it worked -- why did you switch?

45 lbs and no sexual interest whatsoever. Marriage was suffering big time. It was awful. My husband was not at his best.

Lorraine

Re: hanging in there » Lorraine

Posted by shelliR on October 3, 2001, at 20:53:28

In reply to Re: hanging in there » shelliR, posted by Lorraine on October 2, 2001, at 10:00:41

Hi Lorraine.
>
> > > > I think it will, only for the last two days I have lay down, setting my clock for a 30minute nap, and woken up three hours later. I have been very very tired. I'm not sure why, whether the oxy at night is affecting the quality of my sleep. All the sudden I went from very stimulated on the oxy and wellbutrin to very sleepy. But I'm not going to worry about it yet, although certainly I can't live this way. Sometimes I am like this premenstrually, but I can't figure out my cycle at all now, to see if it's related.
> Maybe with the increase in oxy you need to increase the Wellbutrin?

Actually, I might ask about raising the wellbutrin and keeping the nardil at 30mg. Nardil at 45mg really messes up my sleep.
He'll probably want to add more for me to sleep, but I'm curious anyway what wellbutrin at 400 or 450mg might feel like.
I do think the tiredness is premenstrual. This is my normal premenstrually, different from the last few crazy months.
>
>
> > > > >Oh, and I am up to 45 mg of nardil (well, I'm alternating every other day with 30mg, instead of splitting pills).
> What does this mean? 60 mg one day and 30 the other? Any reason for not splitting? I'm at 45 with splitting.
No, it comes back to idea that the half-life is long enough that it shouldn't matter. Except for very sensitive and/or stange people. < g >
>
> > > > He told me the other doctor's name, but I already forget. And I'll have to wait a bit to work it into a conversation so I can get it there again (without hurting my pdoc's feelings).
> Don't you hate that? Pay attention to these things, shelli!

Actually, it's getting to write down these things. Paying attention isn't even quite enough anymore. Especially with names and other things that don't hold any meaning. And this was before any senior moments. It used to cause a huge scatter on my IQ test. I have a very hard time with languages, and even with English, I don't pick up new words the way one would expect an avid reader would.

I have the suspicion that oxy and other opiates are being used with fms patients, who frequently (always) have depression as well as tender points and that this is how its use is spreading.

that may be true. Have you read about opiates used for fms patients? Last time I followed anyone with fms they were given elivil for the fms and it seemed to really work. Interesting to use tricylics in that way. Definitely not as an antidepressant (she was already on prozac), but for targeting the specific pain of FMS. I know that there there is now a field for pain specialists and pain management clinics and I don't know how long these clinics have been around, like whether these are new things being moved away from internists.

> > If my the physical elements of my depression really go away, then how much more therapy will I need? I talked some with my therapist about this on Thursday and we also used EMDR to start to process how much of my life I have missed. I am so so sad, under the depression. I am not ready to be my age. I want those years back. Things that I was working on two years ago when everything (with the exception of survival and work came to a halt.) But there were lots of years lost before that because of my self-image, because of my dissociation, etc. So, now, if I depression is sad, and I have mourned enough, what is next in my life. Am I up to the challenge of looking for an emotiona/sexual relationship, and do I really think I have the potential to love someone fully. I don't know, and I'm not even sure I want to go through all the effort.
>
The can I love stuff though is probably going to be resolved experientially (although you may need a coach along side). When I first got involved with my husband, I went into therapy because I knew this was a good thing and I didn't want to screw it up--the urge to push him away was pretty overwhelming, but I was healthy enough to distrust the feeling.

Good move. Was your inclination to push *him* away , or *anyone* away who was interested in a long-term relationship.
>

> Embracing the future instead of living in the wreckage of your future--sure sounds like your mood is in the right place.

My mood is getting better with some major setbacks. But I try to remember that the on and off again suicidal feelings that on when I am prementstual, will not last. In the past few days, I decided I wanted to terminate with my therapist, then last night I talked to my therapist friend to get her feedback. I wasn't happy with any of the options that my friend was bringing up in trying to help. (I hate that. I hate when I ask for help,then I keep saying, no, that wouldn't work, no I couldn't do that, no, etc. etc. etc., and I end up being sorry that I brought the whole thing up, and I'm sure that my friend felt so also.). And then this huge black cloud came whirling, pushing me in another state of being, entirely, and I wanted to hurt myself in lieu of dying. My therapist would call it poor affect management. Her constant need to classify everything in psychobabble (if you'll excuse that term on this board!) makes me feel that she needs to push her status up (really all therapists) and mine(patients) down. I am feeling sick of having a therapist, told her what I really wanted was a coach. I don't know if I should leave her and go to another therapist, or leave and see what happens. Or stay until I am more stable. She has always been very supportive when i feel that I am completely becoming unraveled and the thought of giving up that support is scary. But I also feel that I've worked with her for over three years and it may be that I have gotten all that I can out of this relationship and that some new ideas coming from other therapist might prove to be very useful to me now. Known vs the unknown at a time when I can descend into very black feelings very quickly. Also I remember what you said about getting more from a therapist who is not necessarily smarter than you, but my experience has been that having a very very quick and smart therapist has helped me so much. She taught me more in these three years than I have ever learned from theapist who were stronger in their feeling rather than thinking function. Have you taken the Myer Briggs? I am a INTJ. I'm guessing that my therapist is a ETNJ or a ENTJ. All my past therapists have been feeling types and I have gotten very frustrated much of the time. This therapist has taught me a lot about staying on track

> > > > Well if you take the neurotin and adderal, will you be able to tell when the nardil kicks in? Because that is probably an easier option for you, to take that route, rather than the purity route. Actually it is the way my doctor wanted to handle things in the hospital and I resisted, then gave in after one day. I wanted to try selegiline for a while before I added the oxy, because I really did feel that the oxy made me feel so good, that I wouldn't be able to see if the selegiline was working. But my pain was too great, and we decided that I could always take away the oxy, in other words I guess it would be called the subtraction method, rather than the addition method.
> I'm a believer in the subtraction method too. I'm so sorry I'm off the selegiline in a way. I loved what it did cognitively for me. Really felt like I was back to my old self in term of being able to think. I read some of my posts from back then, it shows.

It may be possible to add a very low dose of seligeline, while it's still a reversible MAOI. Have you done any research on this?

>
> > > > I've heard that there are a lot less interactions with nardil and other meds vs. parnate and other meds. Is adderal time release? If so, is it a capsule that can be split? Is it a capsule and a pill? JUST KIDDING. See we already have a history :-)
> And, you're funny...Well I am taking my second dose of Nardil at 4 pm and if I have a dinner party at 5 pm because otherwise I crash. I don't understand you or elizabeth with this steady state stuff and "it doesn't matter when you take your dose"--it matters a great deal to me. I really feel the doses kick in and then I feel myself crash or come down off the dose--in the evening, it's like coming down off an amphetamine.

That's so strange to me. I literally took 45mg for weeks and felt nothing, and than it totally kicked in. But that's true, it never made any different when I took it, still same side effects (around waking up every few hours at night, and afternoon fatigue.)
>
>
> >
> > > > Lorraine, I really don't know what to say. I can only say for me that it took a full five weeks of 45mg, and it changed my life. You haven't even done one week at 45mg.
> I didn't know there was a "whining" license competancy requirement:-)
:-). Hey, my statement was intended to give you support and encouragement. :-) To say that you've been on too low a dose to feel discouraged yet. (Oh, yes, I am also the president of the discouragement committee. I get to assess at what points you are allowed to feel discouragement < g > Very powerful roles, I have).

>
> > > > I also have to say that nardil alone wasn't enough. I also used a benzo throughout my whole adult life, sometimes more, sometimes none. It allowed me more or less to lead a normal life. And if I could have tolerated a stimulent, I would have been on that also.
>
> I'm being difficult with this, I know. The valium I could take at night (b/4 bed) and it actually might work throughout the day (I know it shouldn't with half lives and so on but I think it might have when I was taking it to sleep). But I also think I felt sexual impairment on it--which, by the way, I think Neurontin is also contributing to. When I was on Nardil alone, surprisingly, I had no impairment so I actually felt things normally for a week or so.

Well, now you are on a higher dose, so that's going to be hard to separate that out based on one week several weeks ago. It sounds like you are experiencing ony partial impairment. If that is true, then a little serzone or a bit of wellbutrin might help.

You might want to do some searches to se if klonopin or neurotin actually affects sexaul impairment. I've known a lot of people on both, and haven't heard much said about that. Nothing like the SSRIs, etc.

BTW, I think you are testing this impairment possiblity a bit more than is truely neccesary for a fair trial. < g >.
I don't think I've heard of sexual impairment on valium. Didn't affect me at all that way. Now if you want to talk about impairment, the codiene I think has quite a factor. But I have not participated in any trials lately. It could be very frustrating because it is actually very sensual, but full release is difficult.

I'm reluctant to try Klonopin (??) b/c I have heard it has some sexual impairment plus I have also heard that while it helps with anxiety it can actually worsen depression. I'm also very sensitive to cognitive impairment caused by these drugs.

Most people who have a dissociative disorder are both on an AD and klonopin. I don't think there are many complaints about it worsening the depression. I would say valium would have a greater tendency than klonopin to cause depression. I also haven't read much about it causing sexual disfunction. As for cognitive impairment, I actually think valium helps me with that, because it stablizes me and grounds me and that adds to my cognitive abilities.

Klonopin doesn't seem to worsen depression the way valium can for me. If I am really really depressed, I wouldn't take valium, but if I'm that depressed, I'm generally not that agitated or anxious so I don't need to take valium.
>
> Speaking of cognitive impairment, I have been in two accidents (very minor--backed into a parked car and solidly tapped the car ahead of me at a stop light). This plus losing some ability to concentrate. It's funny the accident where I hit the car at the stop light, it was actually as though I was "gone" for a moment. Then the other day, I had what I am convinced was a "smell" hallucination. In Beverly Hills on Rodeo, when I went to get into my parked car, I smelled marijuana very strongly. I looked around (it's not THAT uncommon in Beverly Hills after all) and saw no parked car with occupants, no car on the road that would explain the smell and no people in site. It was so odd that I actually stood there for about 3 minutes trying to figure out if there was a diner or restaurant that might be emitting exhaust that smelled like mj. Plus I am getting electric tingles on my arms or legs. Anyway, I think this may be temporal lobe seizure like stuff. I'm going to ask my pdoc. I'm wondering if Nardil might increase seizure like activity. I'm also wondering if I should add a different anticonvulsant.

Well, I got my masters on nardil, and I don't remember having any cognitive difficulties. And I supplemented with valium to keep me grounded. .
.
>
> > > > That’s why I mentioned subtraction above. That really may be easier. easier = better.
>
> Yes. I just need to move on this stuff I think. I am getting some mood support now I believe.

But then you feel that everything else is not going right. Maybe you can deal with the sideeffects after.
>
>
> > > >I have had the image of myself as fucked up, much more than depressed until two years ago. Lots of stuff to work on outside the depression which was managed by nardil.
>
> I had this image of myself as super-competent b/4 my depression. It's all nonsense. It's like we collect our moods roll them into a ball and call it "self".

Well, maybe you were super-competent before the depression? Do you look back and see great sex and clear mind, because those are the things that come up over and over for you , when wondering about what is being affected by the AD or mood stabilizer, other than the depression.
>
> >
> > > > When you find the right drug, then you will naturally put it into perspective.
> I know this is true, but I also know that I may not find the right drug and that I still need to be able to live a life to my fullest capability.

I think you will find the right drug. but you may have to prioritize what you are willing to live with, and work on the side effects after the success of the AD. I don't think I have the sublety of side effects that you do. Like I don't usually have to ask the questions, is this pill effecting something. I have such strong reactions to the drugs I can't tolerate, and there were many of them. On the other hand, it never occurred to me to go off of nardil because it was causing afternoon tiredness. Taking a 1/2 nap seemed a small price to pay, and when it didn't work anymore, in hindsight, an even smaller price to pay.
>
> > > > What is your next plan, if nardil doesn’t kick in. I know that one plan would be to go back to moclobernide with adjuncts, but is that next? I know you always have a next plan.
> I'm going to give the Nardil some more time and work on the anxiety and anticonvulsant side of the equation for right now.

> What was atarax like?
I take atarax to sleep and it also works the next day for me as an antihistamine. I sometimes adjust up and down depending on my drug trials. But I just use it for sleep, so I don't think too much about it. And I also have histimine which rises to the surface and makes me itch horribly (I think it's from grass) and now I don't have to worry about that anymore.
>
> You mean you took effexor successfully once and when you retried it, it didn’t work?
> Precisely. Ain't that a b****?

Well, you gave it up for pretty important reasons for you.
>
>
> > > > I remember that you said that you had quit work to be home with your kids, because that was something you had missed. Had you thought you’d stay home until the kids were a certain age, or just left it open-ended?
>
> I'm not sure what I'm doing with this. I don't think I can 9-5 anymore or assume my old 12 hour days. I don't think that I have the ability to withstand stress the way I used to. So I would need to do some sort of "home" work which I could transition into slowly.

If you can get away with it financially (and it appears that you can), I can't see working twelve hours a day, except for myself. And if I had kids, I probably couldn't see it at all.
>
> Shelli, I'm hoping you are progressing on your meds and feeling better, less sleepy. Let me know and let me know about that trade group meeting.

Group meeting was go crowded and it was totally open. I thought there was going to be a presentation. I learned a few specific facts about some plug-ins to photoshop, so it was worth it for me to go. I wouldn't go again, unless there was a speaker or demonstration that had to do directly with my work. I did see a young woman who did some freelance work for me, so that was fun--it's been about two years and she's been assisting and is ready to go solo if she can get some work. She'd like to do portraits and support that work by doing weddings. There were a bunch of people who have been converting to purely digital, but their commercial photographers which has very little relevance to my work. Still it was worth it for the few tibits I learned and also made me realize that I need to follow more closely what software is being put out by other companies to support photoshop. My digital pictures are coming out beautiful, although I can't find exactly the right thicknesss of paper. The big thing for me is going to be a huge change in marketing, selling myself and my decision to go digital, without seeming defensive. Once people see the work they'll know. Also my past clients have enough confidence in me to know that I woudn't change unless I thought the quality of my work would be equal. But it is harder to explain on the phone (not doing hand-prints anymore?) I think the first year will be rough, but I think it's absolutely a neccesary change for me to have a much better quality of life.

Shelli
>

Re: hanging in there » shelliR

Posted by Elizabeth on October 5, 2001, at 11:53:51

In reply to Re: hanging in there » Lorraine, posted by shelliR on October 3, 2001, at 20:53:28

> Actually, I might ask about raising the wellbutrin and keeping the nardil at 30mg. Nardil at 45mg really messes up my sleep.
> He'll probably want to add more for me to sleep,

I'm confused here: more of what?

> but I'm curious anyway what wellbutrin at 400 or 450mg might feel like.

You're getting into the danger zone there, and your pdoc might be unwilling (though he seems to be willing to do an awful lot of surprising things :-) ).

> I do think the tiredness is premenstrual. This is my normal premenstrually, different from the last few crazy months.

Are your periods regular? I'm curious because buprenorphine seems to be making mine very irregular and unpredictable.

> No, it comes back to idea that the half-life is long enough that it shouldn't matter. Except for very sensitive and/or stange people. < g >

It's not the half-life as such (Nardil is actually very short-lived); it's the time required for new MAO to be manufactured that is relevant here. Alternating days with Nardil or Parnate is a reasonable way to increase the dose more gradually than the available pills allow you to do easily. (Marplan comes in regular tablets, without the thick layer of pharmaceutical glaze that Nardil and Parnate have, so it's easier to split.) It's useful for tapering off MAOIs, as well.

> I have the suspicion that oxy and other opiates are being used with fms patients, who frequently (always) have depression as well as tender points and that this is how its use is spreading.

I think so too. Really, opioids were the first antidepressants ever used; it's just become politically incorrect to prescribe them for depression today. But it's becoming more acceptable to prescribe them for chronic pain. Pain specialists have more experience in using opioids than psychiatrists do, so they're presumably more comfortable about prescribing opioids.

> Last time I followed anyone with fms they were given elivil for the fms and it seemed to really work.

I've heard of Effexor and Meridia being used, too.

> Interesting to use tricylics in that way.

They help with neuropathic pain; I don't know much about FMS or why they might help with it. It might be of interest to you that when I was taking Nardil, my back pain went away. Both times. And the pain returned very soon after I d/c'd the Nardil.

> I know that there there is now a field for pain specialists and pain management clinics and I don't know how long these clinics have been around, like whether these are new things being moved away from internists.

"Pain management" sounds like a code phrase to mean something other than "pain *treatment*," if you know what I mean!

> In the past few days, I decided I wanted to terminate with my therapist, then last night I talked to my therapist friend to get her feedback. I wasn't happy with any of the options that my friend was bringing up in trying to help. (I hate that. I hate when I ask for help, then I keep saying, no, that wouldn't work, no I couldn't do that, no, etc. etc. etc., and I end up being sorry that I brought the whole thing up, and I'm sure that my friend felt so also.)

I know the feeling -- although it's even more annoying when the well-meaning suggestions are offered unsolicited, IMO. :-}

> My therapist would call it poor affect management. Her constant need to classify everything in psychobabble (if you'll excuse that term on this board!) makes me feel that she needs to push her status up (really all therapists) and mine(patients) down.

Oh yes, pathologizing every feeling you have, everything you do, etc., is annoying on many different levels!

> I am feeling sick of having a therapist, told her what I really wanted was a coach.

I feel the same -- I'm not in talk therapy right now, but I feel like a "coach" or somebody like that could be helpful to me. How do I go about finding such a person, though (if you know)?

From what you say, it sounds to me like you should start trying to find a new therapist -- preferably one with references -- before closing the book with your current therapist. Would that be possible?

> Also I remember what you said about getting more from a therapist who is not necessarily smarter than you, but my experience has been that having a very very quick and smart therapist has helped me so much.

I understand -- you need a therapist who can keep up with you. :-)

> I am a INTJ.

INTP here.

> It may be possible to add a very low dose of seligeline, while it's still a reversible MAOI. Have you done any research on this?

Selegiline is an irreversible MAOI, but at low doses it's a selective inhibitor of MAO-B. I've heard of some people being helped by low-dose selegiline, so it might be worth a try (depending on what you were thinking of mixing it with). I think it tends to be better tolerated than the other MAOIs.

> That's so strange to me. I literally took 45mg for weeks and felt nothing, and than it totally kicked in. But that's true, it never made any different when I took it, still same side effects (around waking up every few hours at night, and afternoon fatigue.)

I think that MAOIs interfere with circadian rhythms, rather than simply being activating.

> I don't think I've heard of sexual impairment on valium. Didn't affect me at all that way.

I think that sedatives can be impairing for men but would expect barbiturates or alcohol to be much more of a problem than benzos.

> I'm reluctant to try Klonopin (??) b/c I have heard it has some sexual impairment plus I have also heard that while it helps with anxiety it can actually worsen depression.

I think it can, although I also think that some people might be interpreting sedation as depression. I'm not sure about the sexual thing, apart from the sedative effect which seems to be common to all benzos. (FWIW, my SO takes Klonopin -- recently switched from Xanax -- and I haven't noticed a problem.)

> Most people who have a dissociative disorder are both on an AD and klonopin.

That makes sense, but why Klonopin instead of any other benzo?

> I would say valium would have a greater tendency than klonopin to cause depression.

Why would that be, I wonder?

> As for cognitive impairment, I actually think valium helps me with that, because it stablizes me and grounds me and that adds to my cognitive abilities.

That's kind of what buprenorphine does for me, among other things. (This isn't unique to buprenorphine: morphine and other mu-opioids have the same effect. Benzos, however, do not.)

> Well, I got my masters on nardil, and I don't remember having any cognitive difficulties.

I took the GRE on Nardil, to provide a counterexample. :-)

> I take atarax to sleep and it also works the next day for me as an antihistamine.

A very strong antihistamine. I've taken it a few times (to offset the pruritis caused by buprenorphine), and although it works very well, it's pretty heavy on the side effects (sedation, appetite stimulation, etc.). It's a great sleeping pill for lots of people, that's definitely true -- I think that it's often forgotten when doctors are looking for something to help their patients sleep.

I think that promethazine probably has milder side effects and is just as good an antihistamine, but if you're looking for a sleeping pill, Atarax is a good choice.

> If you can get away with it financially (and it appears that you can), I can't see working twelve hours a day, except for myself. And if I had kids, I probably couldn't see it at all.

I don't work 12 hrs/day, but my SO does (counting commute time). It sucks.

best,
-elizabeth

Re: more stuff » Lorraine

Posted by Elizabeth on October 5, 2001, at 12:15:39

In reply to Re: more stuff » Elizabeth, posted by Lorraine on October 2, 2001, at 14:14:34

Re condoms: [this is way OT, isn't it? :-) ]
> Take your left hand and wrap it around the index finger on your right hand. Now put on a thin latex glove and do the same thing. Do you feel the difference? That's as close as I can get to describing it.

Okay. I don't have any latex gloves handy, so I'll just have to take your word for it. :-)

> These are compelling reasons. I have residual STDs from the sixies that effect my life (please don't ask for details).

HPV?

> Also the concept of responsibility is great.

It's great as a concept; in actual practise.... < g >

> But if you get into a long term committed relationship and are choosing contraception, my hunch is that the decision gets based on how much the contraception interferes with sex.

Here you get into a spot where both partners have to demand monogamy of one another. I think it's important that everyone feel comfortable being honest with their partner if they hook up with someone (even if they are using condoms). So if you can pull that off, I think that's great, but I wonder how likely it is.

> I was on the pill for at least 15 years, then used an IUD, then my husband got a vasectomy.

IUD? Yikes, you're dating yourself again! :-)

> The pill didn't bother me, but my doctor wanted me off it when I reached a certain age so I used the IUD.

That's weird, that your doctor wanted you to go off the pill. When I was in college (pretty recent history) it seemed like the doctors & nurses at the med center were encouraging (perhaps even pressuring) just about all women students to take the pill. They actually suggested to me that I take the pill to prevent menstrual cramps. Kinda creepy, IMO. (It turned out that all I needed was a stronger NSAID than the OTC ones I'd tried.)

> I was very resistant to the idea of using an IUD--I had endometriosis and it isn't really recommend for people who have painful periods--but I found that the IUD was absolutely great. I had it in for 7 years, then renewed for another 5 or so.

Huh. That's good, that it wasn't a problem for you. I don't know anybody else who's used one (well, that is, I don't know anybody else who's used one well enough that she would have told me about it < g >).

> But is further demonstrated by the fact that the active ingredient in an antidepressant my not be the obvious but rather the metabolites.

Yes, that's called a prodrug -- an inactive drug whose activity is owed to its metabolites. Codeine is an example: it doesn't work for people who don't metabolise it into morphine. Other opioids have active metabolites -- for example, oxycodone is metabolised to oxymorphone (active) as well as noroxycodone (inactive). But oxycodone itself has some effect too, so it's not considered a prodrug. (I think that very little of it is transformed into oxymorphone, actually. Oxymorphone (brand name NuMorphan) is a very strong opioid, one of the ones that are pretty much only prescribed to people who have cancer and the like. Dilaudid (hydromorphone) is another (better-known) such drug.)

I've heard it suggested that Wellbutrin might be a prodrug. Bupropion itself doesn't seem to do very much in the dose range that's used clinically, but it has multiple metabolites that might be responsible for its AD effects.

> > I can't deal with the touchy-feely types, myself. They nauseate me.
>
> Man, you are really one tough nut, aren't you< vbg >?

Dunno about the "tough" part...

> You may ber right, but during our initial consultation he did say that young boys (13) with aggression issues sometime have a deficiency in serotonin and too much testosterone aggravates the issue.

That would be an oversimplification.

> The kids that use aggression offensively they are saying do not have a chemical imbalance. Now whether this is all poppy-cock, who knows. It's a theory.

I think that the term "chemical imbalance" would have to be defined in order for it to be a theory!

> > Oh jeez, here come the gender stereotypes.
>
> Elizabeth, I am as feminist as they come.

I don't doubt it. It sounds like we've had some similar experiences (being the only woman in various groups, that is). But anyway, I think that stereotyping men and boys is just as irrational as stereotyping women and girls, and causes just as much trouble. This is not to say that I don't believe there are any intrinsic differences between the sexes. But I want to see those differences delineated and studied scientifically, and not accepted prima facie. This isn't to say that your experience with your children isn't valid. I have no children myself and probably never will, but I know a lot of parents who feel the way you do. It's hard to do a controlled experiment with kids, though, because sooner or later they are going to get a taste of the popular media, and one thing that all kids do (except maybe if they're B.F. Skinner's kids < g >) is interact with other kids. It's hard to control for these effects.

I think it's important that children be taught, explicitly, about the existence of gender stereotypes (and other stereotypes, for that matter) and that parents discuss this stuff with their kids. (One simple way to bring it up is to point out stereotypes on TV.) I think that this sort of interaction with children helps teach them to think critically so that they can deal with new issues that arise in life.

> I still think the thing to do is to cultivate the masculine in the daughter and cultivate the feminine in the son. It does pay off just not in the ways I expected.

How do you think it has payed off?

> He's 13 and 5'9" to my 5'4".

That must be awkward!

> > What kind of tests do you expect will be helpful?
>
> Yes, that is the question, isn't it? I guess DSM category test. Psychological testing. I guess I could do an EEG or QEEG.

I don't think there is a particular DSM test -- the doctor (or other clinician) just tries to get a handle on the symptoms by observation. I'm interested in how some doctors have been able to make predictions about what treatment will be effective based on EEGs and brain imaging.

I haven't been very impressed by psychological tests such as the MMPI, and I hate the idea that people are pigeonholed because of their responses on such tests.

> I'm sorry. You do drop these rather low key bomb shells, don't you?

Uhh...I dunno. What would that mean?

> What on earth happened, elizabeth? Complex means no physical convultions? What were you're symptoms and when did this happen?

I posted about it, different thread (http://www.dr-bob.org/babble/20010917/msgs/79454.html).

> My pdoc says my QEEG revealed MILD temporal lobe epilepsy type stuff--which apparently can be assoiciated with both panic/anxiety and depression.

It sure can.

> Jensen says tegretal is supposed to be the best for this type of disorder (i think you said use the kinder more gentle cousin drug--called?).

That's right -- I'm taking Trileptal (oxcarbazepine). I don't think it's been tested much in psych disorders, but Tegretol has and it does work for a lot of people who don't respond to conventional ADs. (I haven't noticed anything from the Trileptal, BTW.)

> Elizabeth, read my post to Shelli--where I talk about some possible seizure like symptoms that I have been having--2 car accidents in 3 weeks; olfactory hallucination. Curious about your thoughts and also about what is going on with you.

It does sound like you could be having seizures. (the pot smoke thing made me laugh, BTW. :-) ) I'd say it's crucial that you get this under control, whatever it is, because of the car accidents. Highway hypnosis is one thing, but when you actually black out while driving, that's just dangerous.

> You know we are talking concepts here--so sometimes people try to bolster a concept with physical evidence when the concept is really what is important.

I know what you mean, but in this case the "reptilian brain" actually does correspond to something.

> e--I really appreciate your intellect but what the h*** is "putatively postictal".

"putatively" = allegedly, supposedly

"postictal" = following a seizure

> There is a woman in my NDMDA group that says that her boyfried calls her "psycho" and says "that's ok; everybody's a bit psycho".

I guess it's all a matter of context!

> Absolutely, this guy (who you can see is my new guru) says that when you are depressed or anxious you should not trust or follow your thoughts--you should turn off the self talk and try to find a way to shift your mood (walking, music, movie, message, sitting in sun, reading, sex--what ever) and your thoughts will follow.

That works for a lot of people, I think. Wish I was one of them. (I really got into CBT for a while -- I was convinced it was going to "fix" me -- and the behaviour- >mood thing, like you describe, was a big deal, but in the end I just couldn't make it work.)

> Well, that is my plan and I am trying to stick it out and wait out the side effects.

I hope they become manageable. Hang in there.

> When I take my blood pressure then, it has clearly dipped 97/63. I am convinced that this dip is the sluggishness and that the way to combat it is either salt tablets (which I have and will try) or low blood pressure medication.

I would try salt first (did I ever tell you about my magical potion of McDonald's french fries and Gatorade?). The main medication used for this is a steroid that might have nasty side effects of its own.

> > I don't presume to know such things. But I hope it will.
>
> I am so disappointed with you,e. You presume to know (and do know) so many things, why not predict the future?

You'd better be joking here. :-)

> > How many days have you been taking >30 mg?
>
> 12 days 30 mgs or more and 7 days 45 mgs. You're not calling me impatient are you< vbg >?

No, I can understand how you're feeling, with all the side effects and not getting anything positive out of it. But I encourage you to stick it out. There might be ways that you can alleviate some of the side effects.

> Anyway, I will see my pdoc maybe today and I will try to focus on anticonvulsants and antianxiety meds.

That sounds like a plan. Let me know how it went.

> By the way, Jensen says the benzodiazepine w/drawal increases calcium flux from hippocampus and in rats produces anxiety response that was reversed by verapamil (File et al 1993) and that Clinidine also helps with benzodiazepine w/drawal (Baumgartner et al 1991).

I've also heard of people using Neurontin and other anticonvulsants.

> Effexor, being the exception, took 3 weeks for me to feel much better.

Exception to...?

> > But it worked -- why did you switch?
>
> 45 lbs and no sexual interest whatsoever.

'Nuff said! :-) That sex thing seems to be really hard to treat, especially the loss-of-interest.

-elizabeth

Re: Nardil vs. Parnate

Posted by BK on October 6, 2001, at 20:41:20

In reply to Re: Nardil vs. Parnate, posted by lawrence s. on July 25, 2001, at 1:15:41

> > > > > >Nardil for me was a social lubricant/personality amplifier. A miricale drug for my S.P. I Had the best results with 90mg. a day.
> > > Parnate seemed better geared for deppresion. Also seemed to react to amines much more than Nardil. Hope this helps.
> >
> > Lawrence: Thank you for your response. What do you mean by "seemed to react to amines much more than Nardil"? There seem to be a lot of Nardil fans out there and not as many Parnate fans. The difficulty with Nardil is the weight gain and sexual dysfunction side effects that are prevalent. Were these a problem for you?
> >
> > > >When I was on Parnate I noticed my blood pressure increasing while eating certain foods that I used to eat all the time on Nardil. For instance: chocolate, caffeine, bacon to name a few. Maybe because of Parnate being more stimulating it caused the problem.
> Sex was a problem for me on Nardil, but not impossible. Just thought Iwas going to have a heart attack before ejaculation. I also gained about 30lbs while on it. It was amazing the amount of sweets I could eat!
> >LARRY
> > > >Lawrence S.

lawerence,

Why did you stop taking Nardil? I took it for four months before it finally became completely inactive. While it was working, it was amazing. Quite the social lubricant! Have you found a suitable replacement? Nothing i tried since, which covers just about every AD out there, has worked even remotely for me. I tried Nardil again years later, but to no avail. Thanks in advance.

Re: hanging in there » Elizabeth

Posted by shelliR on October 7, 2001, at 15:08:35

In reply to Re: hanging in there » shelliR, posted by Elizabeth on October 5, 2001, at 11:53:51

Elizabeth,
I have had a horrible horrible weekend. It seems that when I need to go up on the oxy, I don't get a little more depressed, I get totally horribly depressed. You have never gone up on bupe since you have started it? Did you get the idea from Alexander Bodkin that most people don't have to go up on buprenorphine? The studies are all so short-term , it's hard to say that I would not find the same need to go up on bupe also. My pdoc thinks it does not make a difference--that the same thing will happen with buprenorphine. He is consulting with a pain special and they think I reach a certain level and then stabilize on that level. I think maybe that's what happens with pain patients. I am getting panicked about how much oxy is carrying the whole load. Apparently, I am getting no effect from the wellbutrin or nardil at 30mg. My pdoc said I could go up on wellbutrin (actually up to 450 is sort of an approved dose) but I think I'm going to go up instead of nardil and go for augmentors again. Besides tricyclics do you have any ideas? I feel like I've tried every adjunct. Does Bodkin see in-patients at McLean?

My pdoc suggested either effexor or remeron (before I chose the nardil) and I was afraid of weight gain, although he said that my wellbutrin would balance that out. I haven't seen very much success with remeron on the board, and effexor seems like a complicated mess of a drug. So I am not eager to take either of them. Again I may ask my pdoc to try buprenorphine, just to see if I can tolerate it. Then I would know whether or not that was an option.

> > I do think the tiredness is premenstrual. This is my normal premenstrually, different from the last few crazy months.
> Are your periods regular? I'm curious because buprenorphine seems to be making mine very irregular and unpredictable.

That's really interesting. They became irregular about the time I started oxycontin. I got three in very quick succession.
I didn't think much about it, because I'm in my forties. So I just thought perimentopausal.

> > Most people who have a dissociative disorder are both on an AD and klonopin.
> That makes sense, but why Klonopin instead of any other benzo?
>
For some reason that I have no clue about, klonpin was touted as potentially slowing down switching of personalities.
I don't know about the structural mechanism (as you would expect by now), but I do think klonopin became PC. I think it must have a different structure (shorter half life?) because it often doesn't work as a prn like valium; rather, it seems to work better if one stays on it continuously, but again I don't know why.

> > I would say valium would have a greater tendency than klonopin to cause depression.
> Why would that be, I wonder?
I think probably the unknown mechanism that I was referring to above. :-)
>
> > As for cognitive impairment, I actually think valium helps me with that, because it stablizes me and grounds me and that adds to my cognitive abilities.
> That's kind of what buprenorphine does for me, among other things. (This isn't unique to buprenorphine: morphine and other mu-opioids have the same effect. Benzos, however, do not.)
well if I am relaxed, then I can focus better. So the valium didn't improve my cognitive abilities per say, but allowed me to relax and study, etc. I guess grad school in psych wasn't all that hard. :-) I actually had to take neuropsychology as an undergrad, but not in grad school.
>

Shelli

Re: hanging in there » shelliR

Posted by SLS on October 8, 2001, at 0:24:47

In reply to Re: hanging in there » Elizabeth, posted by shelliR on October 7, 2001, at 15:08:35

Dear Shelli,

For now, weight-gain might be the price you must pay for freedom from depression. You would think that given my experiences, I wouldn't be so picky about side effects, but I am still reluctant to start taking Remeron for fear of weight-gain and sedation. I know that an objective observer would think me irrational to place more importance on a dozen pounds than a dozen years of agony. God, I don't want to take that damned drug. After all is said and done, maybe I'll be happy that I did.

Perhaps adding thyroid hormone would both augment your drug regimen and minimize weight-gain. Also, one's metabolism is often reduced in a biogenic depressive state. I experience a noticeable increase in my metabolism while I'm responding to an antidepressant evidenced by a reduction in subcutaneous fat (as opposed to the omentum) and an increase in thermogenesis (I'm always cold while I'm depressed).

EFFEXOR IS NOT A MESS!

I know you'll hate me, but...

There are drugs that you know will help you. Stop being so picky!

(now running away)

Maybe I'll even end up practicing what I'm preaching. Damned drugs.

- Scott

Re: hanging in there » SLS

Posted by shelliR on October 8, 2001, at 5:11:02

In reply to Re: hanging in there » shelliR, posted by SLS on October 8, 2001, at 0:24:47

> Dear Shelli,
>
> For now, weight-gain might be the price you must pay for freedom from depression. You would think that given my experiences, I wouldn't be so picky about side effects, but I am still reluctant to start taking Remeron for fear of weight-gain and sedation. I know that an objective observer would think me irrational to place more importance on a dozen pounds than a dozen years of agony. God, I don't want to take that damned drug. After all is said and done, maybe I'll be happy that I did.
>
> Perhaps adding thyroid hormone would both augment your drug regimen and minimize weight-gain. Also, one's metabolism is often reduced in a biogenic depressive state. I experience a noticeable increase in my metabolism while I'm responding to an antidepressant evidenced by a reduction in subcutaneous fat (as opposed to the omentum) and an increase in thermogenesis (I'm always cold while I'm depressed).
>
> EFFEXOR IS NOT A MESS!
>
> I know you'll hate me, but...
>
> There are drugs that you know will help you. Stop being so picky!
>
> (now running away)
>
> Maybe I'll even end up practicing what I'm preaching. Damned drugs.
>
>
> - Scott

Scott,
It's hard because the odds for remeron working don't even look good. At least not a lot of people on this board have found it to be very successful with depression. And it would feel horrible to fight hunger all the time; that's how most people describe it. It's really unhealthy to be obsese and a bad self-imagine is not nothing; and I could see me going there. I think it was Dr. Stahl who was giving his patients heavy duty diet pills with remeron. The only hope I would have is that the wellbutrin would help diminish that urge to eat and eat. Effexor I tried years ago and couldn't keep it down. Even a half of pill. And when I read this board, I think it's such a horrible drug; two of my friends also have very hard times getting off. I'm so tired of this. I'm tired of trying.

If I knew my pdoc was right about reaching a steady state of oxy, I have no side effects from that. But I don't know whether to believe him (how can he really know?) and then be stuck having on a huge dose and with no effectiveness.

Yes, the choices are awful. Be depressed or be obese and non-sexual.

Life is grand.

Shelli

p.s. I've already been on thyroid for years t2 and t3.

Re: hanging in there » shelliR

Posted by Lorraine on October 8, 2001, at 10:38:32

In reply to Re: hanging in there » Lorraine, posted by shelliR on October 3, 2001, at 20:53:28

Hi Shelli:

I responded to your email as I was zipping out of town and of course my computer crashed as I hit the submit button. So sorry about the delay in responding.

How is the oxy/wellbutrin/nardil going now?

> No, it comes back to idea that the half-life is long enough that it shouldn't matter. Except for very sensitive and/or stange people. < g >

Hey! You talking to me?

> > > I have the suspicion that oxy and other opiates are being used with fms patients, who frequently (always) have depression as well as tender points and that this is how its use is spreading.
>
> that may be true. Have you read about opiates used for fms patients?

No, it's just a hunch and it may be wrong.

> > >I am so so sad, under the depression. I am not ready to be my age. I want those years back. Things that I was working on two years ago when everything (with the exception of survival and work came to a halt.) But there were lots of years lost before that because of my self-image, because of my dissociation, etc.

I mourn my lost years too.

> > > Good move. Was your inclination to push *him* away , or *anyone* away who was interested in a long-term relationship.

Probably anyone--certainly anyone that I had a real potential for relating to on an adult level. I had been in one other long term relationship with someone before this one but it was not nearly as threatening although I was committed.

> > >My therapist would call it poor affect management.

Ouch! That sounds like the ob/gyn who told me not to complain if I needed a C section because it wasn't as if I had a "virgin belly" (meaning I'd had abdominal surgery before). It so treats humans like automobiles or something.

> > >Her constant need to classify everything in psychobabble (if you'll excuse that term on this board!) makes me feel that she needs to push her status up (really all therapists) and mine(patients) down.

Sure sounds like it.

[re switching therapists] I wouldn't right now Shelli. Wait until you are feeling strong. It takes a lot of effort to find a new therapist (it's not like you look in the yellow pages) and develop a relationship that works.

> > >Have you taken the Myer Briggs? I am a INTJ.

So am I and so is my husband.

> > >I'm guessing that my therapist is a ETNJ or a ENTJ.

My abusive exboss was ESTP. If you like Myers Briggs, have you read "Please Understand Me: Character and Temperament Types" by Keirsey and Bates? It's a great book.

> > >All my past therapists have been feeling types and I have gotten very frustrated much of the time. This therapist has taught me a lot about staying on track

So her no nonsense approach is actually appreciated by you usually...?

>

> > > It may be possible to add a very low dose of seligeline, while it's still a reversible MAOI. Have you done any research on this?

Maybe. Selegeline makes me very anxious physically. Nardil does too, but if I have a feeling this side effect may work it's way out.

> > > > > Lorraine, I really don't know what to say. I can only say for me that it took a full five weeks of 45mg, and it changed my life. You haven't even done one week at 45mg.
> > I didn't know there was a "whining" license competancy requirement:-)
> :-). Hey, my statement was intended to give you support and encouragement. :-)

And, it did, Shelli.

> > > To say that you've been on too low a dose to feel discouraged yet.

I've increased my dose as of yesterday to 45mg day. 22.5 in the am and pm.

> > >(Oh, yes, I am also the president of the discouragement committee. I get to assess at what points you are allowed to feel discouragement < g > Very powerful roles, I have).

And deserve.

> > > > > I also have to say that nardil alone wasn't enough. I also used a benzo throughout my whole adult life, sometimes more, sometimes none. It allowed me more or less to lead a normal life. And if I could have tolerated a stimulent, I would have been on that also.

Well, I have a script for Klonipin, but I am reluctant to start it. I will see how this anxiety thing plays out. The more drugs I take, the more likely I am to have side effects.

> > > Well, now you are on a higher dose, so that's going to be hard to separate that out based on one week several weeks ago. It sounds like you are experiencing ony partial impairment. If that is true, then a little serzone or a bit of wellbutrin might help.

You are right. It is hard to know if it is the increased Nardil or Neurontin that is causing the side effects.

> > > You might want to do some searches to se if klonopin or neurotin actually affects sexaul impairment. I've known a lot of people on both, and haven't heard much said about that. Nothing like the SSRIs, etc.

I'll do this. I should know what people are saying about it. I don't put much stock in the drug company research--they don't ask the right questions so they never have to disclose some things like sexual impairment.

>
> BTW, I think you are testing this impairment possiblity a bit more than is truely neccesary for a fair trial. < g >.

It's the married thing--full of trials and tribulations. Some single people, by the way, are pretty self-sufficient.

> I'm reluctant to try Klonopin (??) b/c I have heard it has some sexual impairment plus I have also heard that while it helps with anxiety it can actually worsen depression. I'm also very sensitive to cognitive impairment caused by these drugs.
>
> > > Well, I got my masters on nardil, and I don't remember having any cognitive difficulties.

I suppose this could be read two ways--you got your masters while taking nardil and you got your masters "in" taking nardil. Probably both true.

> > > But then you feel that everything else is not going right. Maybe you can deal with the sideeffects after.

I'm just going to tough out the side effects for now and give Nardil a full chance.

> > > Well, maybe you were super-competent before the depression? Do you look back and see great sex and clear mind, because those are the things that come up over and over for you , when wondering about what is being affected by the AD or mood stabilizer, other than the depression.

The sex is a gift to the marriage. The truth is that when I lose interest or desire because of my meds, it doesn't bother--but it wreaks havoc on the marriage in lots of ways. Sex is more than sex. In my marriage, it is one of the ways my husband feels loved--me too actually.

> > >Taking a 1/2 nap seemed a small price to pay, and when it didn't work anymore, in hindsight, an even smaller price to pay.

A 1/2 hour nap is a small price to pay. I have been crashing for about 3 hours--I just increased my afternoon dose and I'll see if that makes a difference.

> > > > > What is your next plan, if nardil doesn’t kick in. I know that one plan would be to go back to moclobernide with adjuncts, but is that next? I know you always have a next plan.
> > I'm going to give the Nardil some more time and work on the anxiety and anticonvulsant side of the equation for right now.

Next plan is to add some Klonopin; then Adderal if that makes me too drugged out; then I think Marplan; then I think maybe an SSRI and amphetamine. My pdoc wants me to do another QEEG and he may be right.

>
> > What was atarax like?
> I take atarax to sleep and it also works the next day for me as an antihistamine.

But it works to put you to sleep. I think I speed up on antihistamines.

> > > If you can get away with it financially (and it appears that you can), I can't see working twelve hours a day, except for myself. And if I had kids, I probably couldn't see it at all.

Yeah, it's hard to separate out the mourning that I do because I can't do things I used to do whether I actually want to do those things anyway.

> > >The big thing for me is going to be a huge change in marketing, selling myself and my decision to go digital, without seeming defensive.

I think you just say that you are making the switch because of the artistic flexibility that digital affords you. You might show a side by side of hand painted vs digital to quiet their fears.

> > >But it is harder to explain on the phone (not doing hand-prints anymore?)

Put a side by side on the website? It might help although not everyone does the web.

I rejoined my writing class. I think I shocked them a bit. The theme of my first poem was suicide. The second about being seduced by depressionl. Guy who runs it makes a big point about presentation. I wanted to sort of sink into the chair, but he made me move and talk about my kids and then read--which pretty much had me reduced to tears. Reading is such a vulnerable act, you know.

Lorraine

Re: hanging in there Elizabeth » shelliR

Posted by Lorraine on October 8, 2001, at 10:48:06

In reply to Re: hanging in there » Elizabeth, posted by shelliR on October 7, 2001, at 15:08:35

Shelli and Elizabeth:

> > >I have had a horrible horrible weekend. It seems that when I need to go up on the oxy, I don't get a little more depressed, I get totally horribly depressed. You have never gone up on bupe since you have started it? Did you get the idea from Alexander Bodkin that most people don't have to go up on buprenorphine?

Did Bodkin do research on buprenorphine? My pdoc looked it up and seemed to think that it was being used in lieu of clonodine . Does that make sense?

> > >Apparently, I am getting no effect from the wellbutrin or nardil at 30mg. My pdoc said I could go up on wellbutrin (actually up to 450 is sort of an approved dose) but I think I'm going to go up instead of nardil and go for augmentors again. Besides tricyclics do you have any ideas? I feel like I've tried every adjunct. Does Bodkin see in-patients at McLean?

Did you try Desipramine specifically Shelli. I know other TCAs don't work for you--just curious.

> > > My pdoc suggested either effexor

Effexor is hard to get on and off of. The Wellbutrin augmentation or amphetamine might control the weight gain. If you elect to try it, I'd think benzos the first couple of weeks or so would help. There is an initial increase in anxiety on Effexor.

> > > Most people who have a dissociative disorder are both on an AD and klonopin.
> > That makes sense, but why Klonopin instead of any other benzo?

My pdoc favors Klonopin because it is an anticonvulsant as well.

Lorraine

Re: hanging in there » SLS

Posted by Lorraine on October 8, 2001, at 10:50:55

In reply to Re: hanging in there » shelliR, posted by SLS on October 8, 2001, at 0:24:47

Scott:

Pretty tough love, but then I suppose we (incuding I) all need a dose of reality from time-to-time.

> Dear Shelli,
>
> For now, weight-gain might be the price you must pay for freedom from depression. You would think that given my experiences, I wouldn't be so picky about side effects, but I am still reluctant to start taking Remeron for fear of weight-gain and sedation. I know that an objective observer would think me irrational to place more importance on a dozen pounds than a dozen years of agony. God, I don't want to take that damned drug. After all is said and done, maybe I'll be happy that I did.
>
> Perhaps adding thyroid hormone would both augment your drug regimen and minimize weight-gain. Also, one's metabolism is often reduced in a biogenic depressive state. I experience a noticeable increase in my metabolism while I'm responding to an antidepressant evidenced by a reduction in subcutaneous fat (as opposed to the omentum) and an increase in thermogenesis (I'm always cold while I'm depressed).
>
> EFFEXOR IS NOT A MESS!
>
> I know you'll hate me, but...
>
> There are drugs that you know will help you. Stop being so picky!
>
> (now running away)
>
> Maybe I'll even end up practicing what I'm preaching. Damned drugs.
>
>
> - Scott

Re: hanging in there » shelliR

Posted by Lorraine on October 8, 2001, at 10:59:33

In reply to Re: hanging in there » SLS, posted by shelliR on October 8, 2001, at 5:11:02

Shelli:

Effexor I tried years ago and couldn't keep it down. Even a half of pill. And when I read this board, I think it's such a horrible drug; two of my friends also have very hard times getting off.

You know there are many posting on how to get off Effexor--you take a longer dose SSRI (prozac) for a couple of days or so and it smooths out the withdrawal. Shelli, it can't be worse than coming off of benzos or oxy, which you do not bat an eye at.

>
> Yes, the choices are awful. Be depressed or be obese and non-sexual.

I agree with you here. As for the "I'm tired of trying", my son's pdoc would say "so what, keep moving." Not very sympathetic, but his point (which should appeal to you because of it's lack of touchy feeliness) is that some of the things we think when we are depressed are not useful. In fact, he believes that you should pretty much ignore any thoughts you have while you are depressed or anxious and just work on altering your mood. Once your mood is in place, the thoughts will follow. Anyway, I am playing with this concept. When I think a depressing thought, I note it and file it away. I think it helps.

Lorraine

>
> Life is grand.
>
> Shelli
>
> p.s. I've already been on thyroid for years t2 and t3.

Re: hanging in there » Lorraine

Posted by shelliR on October 8, 2001, at 11:21:41

In reply to Re: hanging in there » shelliR, posted by Lorraine on October 8, 2001, at 10:59:33

Hi Lorraine.
>
> Effexor I tried years ago and couldn't keep it down. Even a half of pill. And when I read this board, I think it's such a horrible drug; two of my friends also have very hard times getting off.
> You know there are many posting on how to get off Effexor--you take a longer dose SSRI (prozac) for a couple of days or so and it smooths out the withdrawal. Shelli, it can't be worse than coming off of benzos or oxy, which you do not bat an eye at.

Well, I've gotten off benzos before and it wasn't that hard. I had been up to 30mg for one week and went into the hospital. I got off the valium pretty fast, much faster than the staff expected. And I never got that high again on either valium or klonopin. It just seems with effexor, if my body hates it enough to throw it back up, I can't see it helping me. That's how I see both valium and nardil.

I made an emergency appt with my pdoc for today. Saturday I came as close to suicide as I have ever been. I was making a list of what money I owed to which people who didn't get their pictures to leave for whoever found me. It was so scary, but I kept thinging about my parents going through my stuff, etc. Anyway, I am still alive and things are not as black, more very dark gray.
>
> >
> > Yes, the choices are awful. Be depressed or be obese and non-sexual.
> I agree with you here. As for the "I'm tired of trying", my son's pdoc would say "so what, keep moving." Not very sympathetic, but his point (which should appeal to you because of it's lack of touchy feeliness) is that some of the things we think when we are depressed are not useful. In fact, he believes that you should pretty much ignore any thoughts you have while you are depressed or anxious and just work on altering your mood. Once your mood is in place, the thoughts will follow. Anyway, I am playing with this concept. When I think a depressing thought, I note it and file it away. I think it helps.

It's Elizabeth who doesn't hates the touchy feeling types. I loved my last therapist, and she hugged me often. But she couldn't provide enough structure for me to work the areas that needed to be worked on. But I certainly didn't leave because of the hugs.

Shelli

>

Re: hanging in there » Lorraine

Posted by shelliR on October 8, 2001, at 11:26:37

In reply to Re: hanging in there Elizabeth » shelliR, posted by Lorraine on October 8, 2001, at 10:48:06

Lorraine,

> Did Bodkin do research on buprenorphine? My pdoc looked it up and seemed to think that it was being used in lieu of clonodine . Does that make sense?

Bodkin did research on bupe for depression. Did your pdoc have an opinion on using painkillers?

Shelli
>
>
>
>

Re: hanging in there » shelliR

Posted by Elizabeth on October 8, 2001, at 11:42:13

In reply to Re: hanging in there » Elizabeth, posted by shelliR on October 7, 2001, at 15:08:35

> I have had a horrible horrible weekend.

God, I'm sorry to hear it. I hope you're doing a little better?

> It seems that when I need to go up on the oxy, I don't get a little more depressed, I get totally horribly depressed.

Rebound, you think?

> You have never gone up on bupe since you have started it?

I started at 1/2 mL to adjust to it, then went up to 1 mL, where I've stayed. Once after having stopped it for a few days I tried starting again at 1 mL. I was vomiting all day. So starting at a lower dose is a good plan.

> Did you get the idea from Alexander Bodkin that most people don't have to go up on buprenorphine?

It's been a while since I spoke to him about it. The impression I get is that there are some people who can stay on a stable dose (of buprenorphine, morphine, oxycodone, whatever they happen to be taking) for a long time, while others require dose increases. I have heard of cases where the person became tolerant so gradually that it wasn't really a problem (like, they had to increase the dose after a year or something). My general impression is that while there are people who can take opioids long-term without needing to raise the dose, they're probably a minority.

> The studies are all so short-term, it's hard to say that I would not find the same need to go up on bupe also.

Bodkin et al. tried to maintain long-term contact with the ten patients in their buprenorphine trial. (Three of these ten were unable to tolerate buprenorphine and dropped out after the first or second dose.) Five cases are discussed in detail in this paper. Of these five, one developed no tolerance over 2 years, one became tolerant very gradually over 2 years, one stayed at the same dose for six months but then began to relapse and decided to discontinue the buprenorphine rather than increasing the dose, and two improved initially but then relapsed and did not respond to dose increases. Ambiguous? You bet.

> My pdoc thinks it does not make a difference--that the same thing will happen with buprenorphine. He is consulting with a pain special and they think I reach a certain level and then stabilize on that level.

That's what happens with methadone maintenance patients. But I'm concerned that you might "plateau," reaching a dose at which dose increases no longer have any effect.

> I am getting panicked about how much oxy is carrying the whole load. Apparently, I am getting no effect from the wellbutrin or nardil at 30mg.

30 mg of Nardil really isn't enough to be able to say that it doesn't work for you. How much WB are you taking?

> My pdoc said I could go up on wellbutrin (actually up to 450 is sort of an approved dose) but I think I'm going to go up instead of nardil and go for augmentors again. Besides tricyclics do you have any ideas? I feel like I've tried every adjunct. Does Bodkin see in-patients at McLean?

I don't know. I think he's mostly concentrating on research now. He has seen inpatients in the not-too-distant past.

Things to augment Nardil...hmm, I'm drawing a blank here. You've tried stimulants, thyroid hormones, ... what else?

> My pdoc suggested either effexor or remeron (before I chose the nardil) and I was afraid of weight gain, although he said that my wellbutrin would balance that out.

FWIW, I didn't gain weight or feel hungrier on Remeron or Effexor at all. I wouldn't rule them out. Both of them are very good ADs (even for severe, SSRI-resistant depression), and the combination of the two is supposed to be especially effective, even for people who haven't responded to other things. I gather that they sort of cancel out each other's side effects for some people. My boyfriend (who has tried an awful lot of things with little success) is taking Remeron now and I'm very impressed with how much it's helping him.

> That's really interesting. They became irregular about the time I started oxycontin. I got three in very quick succession.

Weird. Buprenorphine just seems to be suppressing mine: they've become infrequent and unreliable. (No, there's no chance that I might be pregnant.)

> I didn't think much about it, because I'm in my forties. So I just thought perimenopausal.

Well, I'm in my 20s, so that's not what's going on for me, at least!

> For some reason that I have no clue about, klonpin was touted as potentially slowing down switching of personalities.

Huh. Who did the touting, and did they have any basis for it?

> I don't know about the structural mechanism (as you would expect by now), but I do think klonopin became PC. I think it must have a different structure (shorter half life?) because it often doesn't work as a prn like valium; rather, it seems to work better if one stays on it continuously, but again I don't know why.

Klonopin has a long half-life and its effect lasts quite a bit longer than Valium's. It takes a long time to start working, which is why it isn't so great as a PRN. I think it probably has little abuse potential, even less than other benzos.

> well if I am relaxed, then I can focus better. So the valium didn't improve my cognitive abilities per se, but allowed me to relax and study, etc.

I understand; like I said, I think that's one way that buprenorphine helps me, too (among other things -- it's also activating and mood-elevating).

-elizabeth

Re: hanging in there » shelliR

Posted by SLS on October 8, 2001, at 14:03:51

In reply to Re: hanging in there » SLS, posted by shelliR on October 8, 2001, at 5:11:02

Hi Shelli,

> I know you'll hate me, but...

I hope you don’t.

> There are drugs that you know will help you. Stop being so picky!

The main one I had in mind was Lamictal.

> > (now running away)

I’m still here.

> > Maybe I'll even end up practicing what I'm preaching. Damned drugs.

Damned drugs. Damn it!.

I hope you knew where I was coming from. I hope I made myself clear in conveying to you that I am as picky as you are, and that I also place great importance on my physical beauty and sexuality. But I am trying to pound the idea into my head that I don’t have the luxury of too many options at this point. I am frustrated for us both.

> EFFEXOR IS NOT A MESS!

> Scott,
It's hard because the odds for remeron working don't even look good. At least not a lot of people on this board have found it to be very successful with depression.

Yeah. I don’t see universal praise of this drug either. However, I would certainly place it above Serzone. I probably have more reason to be pessimistic about the chances of Remeron working for me than you do. In 1992, the folks at the NIMH put me on a drug called idazoxan. Like Remeron, it blocks NE alpha-2 receptors. It made my depression significantly worse. In 1996, my doctor chose to try Remeron immediately after my having had an intolerable experience with moclobemide. I was unwilling to put myself through that again. After two days of taking Remeron, I was pretty sure it was making me feel worse – pretty sure. Not only did it make me feel worse, but it made me feel worse in the same way that idazoxan had – I think.. Knowing their commonalities, I was sure that Remeron would produce the same result, so I stopped taking it. I’m hoping that I was overreacting then. I still don’t have a good feeling about it, though.

> And it would feel horrible to fight hunger all the time; that's how most people describe it. It's really unhealthy to be obsese and a bad self-imagine is not nothing; and I could see me going there.

Did the 15 pounds you gained on Lamictal push you into the category of obesity?

> I think it was Dr. Stahl who was giving his patients heavy duty diet pills with remeron.

Really? How well did it work? I’ll keep that in mind.

> The only hope I would have is that the wellbutrin would help diminish that urge to eat and eat.

I’m hoping that some of the stuff I’ve read about Remeron is true. Some doctors seem to feel that once the dosage is pushed beyond 45mg., the NE effects offset the H1 effects, and appetite is reduced.

> Effexor I tried years ago and couldn't keep it down. Even a half of pill.

For how many consecutive days did you try it?

It is my impression that the nausea is caused by the actions of the drug in the brain as opposed to it upsetting the stomach directly like Depakote can. Within the first 10 minutes of my first dose, I had explosive dry-heaves the likes of which I’d never known. They dissipated within 15 – 20 minutes, and I never had trouble again. Most people who experience nausea initially see it disappear within the first week. It sounds like yours might be different, though. What do you think?

For most people, 300mg is absolutely the minimum dosage at which one can determine efficacy of Effexor. In addition, I would say that at least 4 weeks at that dosage is required to evaluate whether there is a trend towards improvement. The greater the severity or chronicity of the depressive illness, the longer it takes to respond to antidepressants. Anyone who thinks otherwise is sabotaging his or her chances of getting well.

> And when I read this board, I think it's such a horrible drug; two of my friends also have very hard times getting off. I'm so tired of this. I'm tired of trying.

I know, babe. That’s why I’m trying to help you make sure that you are leaving no stone unturned. I do appreciate that it is a risk to your business that you try drugs that might make things worse. I’m not sure how I would approach things were I in your position. I can no longer tolerate being made to feel worse for even a fraction of a day, and I can “afford” to. It’s sort of like someone forcing you to hold your hand over a flame.

> If I knew my pdoc was right about reaching a steady state of oxy, I have no side effects from that. But I don't know whether to believe him (how can he really know?) and then be stuck having on a huge dose and with no effectiveness.

I mentioned a drug called memantine in another thread. This drug is reported to prevent the phenomenon of tolerance to opioids. I would have to research it in more depth to determine if this is limited to their analgesic effects or if it applies to their psychotropic effects as well. Memantine is in clinical phase III trials for the indication of Alzheimer’s Dementia, but it is reported to be effective for treating a variety of psychiatric and neurological conditions. Like Provigil, it will probably sell more prescriptions for off-label use than that for which it will be approved.

> Yes, the choices are awful. Be depressed or be obese and non-sexual.

Remeron can offset the sexual side effects (decreased libido and dysorgasmia) of Effexor or SSRIs. I don’t know how consistently it acts as a remedy, though.

> Life is grand.

No comment.

I’m sorry I write such long posts.

- Scott

Re: hanging in there » Elizabeth

Posted by shelliR on October 8, 2001, at 16:41:41

In reply to Re: hanging in there » shelliR, posted by Elizabeth on October 8, 2001, at 11:42:13

>
> > You have never gone up on bupe since you have started it?
>
> I started at 1/2 mL to adjust to it, then went up to 1 mL, where I've stayed. Once after having stopped it for a few days I tried starting again at 1 mL. I was vomiting all day. So starting at a lower dose is a good plan.

And it still makes you nauseous? And it's a pain to administer. Those are the two side effects for you?

> > Did you get the idea from Alexander Bodkin that most people don't have to go up on buprenorphine?
> It's been a while since I spoke to him about it. The impression I get is that there are some people who can stay on a stable dose (of buprenorphine, morphine, oxycodone, whatever they happen to be taking) for a long time, while others require dose increases. I have heard of cases where the person became tolerant so gradually that it wasn't really a problem (like, they had to increase the dose after a year or something). My general impression is that while there are people who can take opioids long-term without needing to raise the dose, they're probably a minority.

I think my pdoc has some other patients pretty well stabilized on oxy. I started to also get freaked out about the price; I am paying out of pocket. Well, my business pays all my medical expenses (C-Corporation), but I don't have an unlimited pot there. He said when everything is all stabilized, we could talk about changing, perhaps to a shorter acting generic. I like the long-acting, but it's not worth what I have to pay. If I can save a couple of hundred dollars a month, I'll very willing to take pills six times instead of three.

> > The studies are all so short-term, it's hard to say that I would not find the same need to go up on bupe also.
> Bodkin et al. tried to maintain long-term contact with the ten patients in their buprenorphine trial. (Three of these ten were unable to tolerate buprenorphine and dropped out after the first or second dose.) Five cases are discussed in detail in this paper. Of these five, one developed no tolerance over 2 years, one became tolerant very gradually over 2 years, one stayed at the same dose for six months but then began to relapse and decided to discontinue the buprenorphine rather than increasing the dose, and two improved initially but then relapsed and did not respond to dose increases. Ambiguous? You bet.

Wow, inextremely ambiguous; nothing to write home about, as the expression goes.
>
> > My pdoc thinks it does not make a difference--that the same thing will happen with buprenorphine. He is consulting with a pain special and they think I reach a certain level and then stabilize on that level.
> That's what happens with methadone maintenance patients. But I'm concerned that you might "plateau," reaching a dose at which dose increases no longer have any effect. > > I am getting panicked about how much oxy is carrying the whole load. Apparently, I am getting no effect from the wellbutrin or nardil at 30mg.

> 30 mg of Nardil really isn't enough to be able to say that it doesn't work for you. How much WB are you taking?

Well, that's todays adjustment. It's a shame you don't get paid for your onboard consults. You'd be doing okay. Nardil goes up to 60mg and wellbutrin I think stays at 300. I forgot to ask him whether to stay at 300 or continue with 400. I'll have to call him tomorrow.

>
Does Bodkin see in-patients at McLean?
> I don't know. I think he's mostly concentrating on research now. He has seen inpatients in the not-too-distant past.

I was thinking that I would go to Boston if I need to be hospitalized. But I think I should stay with my pdoc, not go jumping around now. He thinks I will find something that works. Plus I could barely get out of the house today; no way I'd make it to Boston.

> Things to augment Nardil...hmm, I'm drawing a blank here. You've tried stimulants, thyroid hormones, ... what else?

I'm on a combo T2, T3 thyroid. Stimulents tried all and they made me feel awful. Then I tried concerta and I could tolerate that, but with the wellbutrin and oxy, I was so well stimulated, didn't even ask about stimulators. Although I'm surprised he hasn't brought that up because he is big on thinking that stimulents added to any pooped out AD is generally the way to go.
I've tried most of the mood stabliizers.

> > My pdoc suggested either effexor or remeron (before I chose the nardil) and I was afraid of weight gain, although he said that my wellbutrin would balance that out.
>
> FWIW, I didn't gain weight or feel hungrier on Remeron or Effexor at all. I wouldn't rule them out. Both of them are very good ADs (even for severe, SSRI-resistant depression), and the combination of the two is supposed to be especially effective, even for people who haven't responded to other things. I gather that they sort of cancel out each other's side effects for some people. My boyfriend (who has tried an awful lot of things with little success) is taking Remeron now and I'm very impressed with how much it's helping him.

I would be willing to try effexor. I asked him about it today (because it had been his suggestion), but he doesn't like to keep changing the main stabilizer of his cocktail. It is one of the few things that he is pretty hard line about. So he would like to play nardil out.
>

> > For some reason that I have no clue about, klonpin was touted as potentially slowing down switching of personalities.
> Huh. Who did the touting, and did they have any basis for it?

Every time I've been hospitalized (except once years ago) have all been on the same dissociative disorders unit. That's where the touting was done, and I can pretty much control personalities (the co-conscious thing) so I don't know.
>
> > I don't know about the structural mechanism (as you would expect by now), but I do think klonopin became PC. I think it must have a different structure (shorter half life?) because it often doesn't work as a prn like valium; rather, it seems to work better if one stays on it continuously, but again I don't know why.
> Klonopin has a long half-life and its effect lasts quite a bit longer than Valium's. It takes a long time to start working, which is why it isn't so great as a PRN. I think it probably has little abuse potential, even less than other benzos.

Well that makes sense. I guess the long time to start working would limit it's abuse. Also some people get a bit of a high on valium and they don't on klonopin. I don't feel a buzz with either one. Valium in grounding me, has quite the opposite effect.
>

Shelli

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