![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 359 to 383 of 434. Go back in thread:
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
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
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.
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
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
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.
>
>
> - ScottScott,
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.
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
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 effexorEffexor 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
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
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.
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
>
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
>
>
>
>
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
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
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
Posted by shelliR on October 8, 2001, at 17:24:57
In reply to Re: hanging in there » shelliR, posted by SLS on October 8, 2001, at 14:03:51
Hi Scott.
> The main one I had in mind was Lamictal.
Well, it's how the weight gain works. It's all in my stomach and breasts and ankles. I'm happy with my regular breasts and I feel all the water weight just sitting on me. Plus I doubt it would even work a third time. Second time it took 400mg to work. I don't understand why the body likes something the first time and if you go back and try again, it sort of snubs its nose.
But I'm sure you have the same question about not working anymore, all the time. With me it was a hormonal change I think that caused the nardil not to work. And my pdoc never encouraged me to go higher on nardil because of the sleeping problems.
Anyway, today I went to my pdoc willing to try effexor and he said that he wants to keep me on nardil and have me go up to 60mg and I should just take more valium and more aterex to sleep at night.
Re effexor:
The thing that scares me about effexsor is those flashing things that go around your head that make me think all is not right. No one should get electric shocks from a drug. Also one of my friends had a long lasting effect on her joints, so she said. It's the possibility of joint damage that bothers me, or that it will screw up my immune system and on top of everything else I'll have FMS or CFS. That's scary stuff to me. The people who say that they never were the same again.
>
>
> 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.I just want to be normal. I am too old to get my old body back anyway, no matter how much I lose. I don't want to be fat.
Or very very thin. Just NORMAL.> > 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?Not obsese in the sense of people thinking that I am huge. But I'm truly 20lbs heavier than I should be, and I can sort of live with that. I don't want to, and I am trying really hard to lose the weight. But adding 15lbs now would really crush any self esteem I have left.
>
> > 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.I read it on PB. (In the same thread in which he had been quoted as saying things like zantac can prevent weight gain. And he vigorously denied it. Then he said that he's found it really hard with patients and weight and sometimes uses some diet pill stuff on a short term basis.) But I don't get what a short term basis would do, unless you are taking remeron for only a short time.
>
>
>
> > 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?
2; 1 whole pill; next day 1/2 pill. How many times do you have to throw up to decide you body is telling you, "I don't like that drug?"
>
> 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?Well, mine just heaved right on out. I can't imagine how your body can get used to that because if its expelling the substance then the next day you're at the same place. I guess I could have started with tiny bits, but then I went back on nardil and it worked better.
>
>
> > 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.Sounds great. But how many years is phase III to your drugstore?
>>
> I’m sorry I write such long posts.
well, they don't seem long to read, just hard to answer. So I read it all, but can't respond to it all. I think posts seems to take longer for me to write than most people.Shelli
Posted by shelliR on October 8, 2001, at 19:06:47
In reply to Re: hanging in there » shelliR, posted by SLS on October 8, 2001, at 14:03:51
> Scott, I misquoted Dr. Stahl. He did not say short term use of diet aids, or whatever.
Posted by shelliR on October 8, 2001, at 19:15:13
In reply to Re: hanging in there » shelliR, posted by Lorraine on October 8, 2001, at 10:59:33
Lorraine,
>
>
>
> >
> > 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.Just wanted to say, I think your son's pdoc is right. I think once you make the decision not to kill yourself: for whatever reasons (and there are plenty of good ones), I think it doesn't help me to think about the depression. I don't really think about altering my mood, but I am trying to do exactly what you are, letting depressing thoughts fly by without letting my brain catch them. There really doesn't seem to be any benefit in going over them. I felt the worst I ever felt in my life in my early twenties, just during one year; I don't remember exactly what year. If I had ended my life then, I would have missed so much.
Shelli
Posted by SLS on October 8, 2001, at 20:27:44
In reply to Re: hanging in there » SLS, posted by shelliR on October 8, 2001, at 17:24:57
> > The main one I had in mind was Lamictal.
>
> Well, it's how the weight gain works. It's all in my stomach and breasts and ankles. I'm happy with my regular breasts and I feel all the water weight just sitting on me.Oh, I forgot.
> Plus I doubt it would even work a third time. Second time it took 400mg to work. I don't understand why the body likes something the first time and if you go back and try again, it sort of snubs its nose.
I guess withdrawing a drug might allow an opportunity for receptors and second messenger systems to play catch-up. They regroup and are ready for the next “attack”. I think Lamictal has treated me the same way it has you. The first time, it helped me more than it is helping now – and at half the dose.
> Anyway, today I went to my pdoc willing to try effexor and he said that he wants to keep me on nardil and have me go up to 60mg and I should just take more valium and more aterex to sleep at night.
I’m glad you are willing to consider treatments for which you already have some prejudice against. You never know.
> Re effexor:
> The thing that scares me about effexsor is those flashing things that go around your head that make me think all is not right. No one should get electric shocks from a drug.I’m confused (not so difficult to do). Have you already tried Effexor? I think the electric-shock thing is associated with the discontinuation of the drug rather than its use during treatment. I experienced these electric shocks as withdrawal symptoms from Effexor, Nardil, Parnate, Ativan, and Klonopin. Effexor is not unique in this regard. The shocks from these drugs pretty much all felt the same.
> Also one of my friends had a long lasting effect on her joints, so she said.
Joint pain is a rather common side effect from drugs that inhibit the reuptake of serotonin: SSRIs and Effexor. It is often part of the “flu-like symptoms” that these drugs can produce. You’d have to ask Cam W. or Sunnely more about it.
> It's the possibility of joint damage that bothers me, or that it will screw up my immune system and on top of everything else I'll have FMS or CFS. That's scary stuff to me.
I can’t comment with surety that SRIs are incapable of producing FMS or CFS. Your thinking is very sound, though. I don’t think you would have to worry about physical damage to your joints in the absence of alterations of the immune system.
> The people who say that they never were the same again.
I am interested to know more. I was unaware of this possibility. Can you describe what symptoms appeared and for how long after discontinuing these drugs they persisted?
> I just want to be normal. I am too old to get my old body back anyway, no matter how much I lose. I don't want to be fat.
> Or very very thin. Just NORMAL.> But adding 15lbs now would really crush any self esteem I have left.
I understand how taxing on one’s self-esteem these illnesses are. For me, they produce a biological warping of thought to yield unrealistically negative perceptions of myself. They also have relegated my life, as accurately perceived by anyone, to a mere fraction of my potential for achievement and my capacity to create and enjoy the experience of living. I am nothing but failure when compared to those I grew up with.
Having said all of that, I cannot now find sufficient words to describe how much I think of your intelligence, your effective and constructive use of that intelligence, your warmth, your caring, your social adeptness and approachability, your tenacity to work and achieve, your willingness to endure pain and hardship to maintain your life and personal affairs, and your richness and complexity of personality.
Well, I guess I did find a few words after all. You have much to be proud of. I have plenty of esteem for you to throw some back in your direction. Hold on to it.
:-)
- Scott
Posted by Lorraine on October 9, 2001, at 9:30:49
In reply to Re: hanging in there » Lorraine, posted by shelliR on October 8, 2001, at 11:21:41
Hi Shelli:
> > >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.Shelli, I'm just saying effexor did take away my depression for 2 years and aside from the weight gain and sexual impairment, I really had no side effects--this from the side effect queen. I think the weight gain could be counteracted by adding Wellbutrin or a stimulant, but my pdoc at the time wasn't very adventurous. Still, we are all different and you need to choose a drug that you and your pdoc think may work. What do you mean about Valium and Nardil? Have you given up hope on the Nardil? Has it been 5 weeks?
>
> > > 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.Shelli--I'm really sorry that you ended up in this dark place. You seem to be on a bit of a roller coaster--just a few days ago you had had a string of good days and were feeling pretty optimistic it seemed. Plus, weren't you forgetting something--the tickets to France and so forth? (dark, dark humor--hope it's ok). How did you manage to make it to Monday? What were your coping strategies? Distraction?
> > >Anyway, I am still alive and things are not as black, more very dark gray.
It's great that your therapist was able to get you in so quickly and it sounds like it helped a bit anyway.
.
> >
> > >
> > > 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.I could have sworn that you said in defense of your therapist when thinking about making a shift that you couldn't tolerate or didn't have patience for those who were too touchy feely, although I don't think you used this expression. Well, perhaps I misread that or maybe it's just one more indicator that I am losing more grey matter than I want. (I did not confuse you with elizabeth though, in my mind, elizabeth can't tolerate therapists period.)
I hope things brighten for you
Posted by Lorraine on October 9, 2001, at 9:36:58
In reply to Re: hanging in there » Lorraine, posted by shelliR on October 8, 2001, at 11:26:37
Shelli:
I don't think he understood that I was talking about pain killers and it wasn't important to me, although he is adventurous.
I did run across an article yesterday on pain killers used in the management of pain and the potential for addiction as opposed to withdrawal difficulties. Here is the article: Drawing the Line Between Pain Management and Addiction:
http://www.medscape.com/Manisses/PU/2001/v12.n09/pu1209.01/pu1209.01.html
> >
> >
Posted by JahL on October 9, 2001, at 9:59:58
In reply to Re: hanging in there » shelliR, posted by SLS on October 8, 2001, at 20:27:44
> > The people who say that they never were the same again.
>
> I am interested to know more. I was unaware of this possibility. Can you describe what symptoms appeared and for how long after discontinuing these drugs they persisted?Effexor changed me for good. Before, I was dysthymic with ADD-like problems & mild s. phobia. 2 weeks into the course I began developing major, suicidal depression, which has stayed with me since (3yrs). I perservered (unwisely with hindsight), taking 425mg for 6 weeks (3 mths in all). Haven't been the same since. Not my fave drug of all time.
J.
Posted by Elizabeth on October 9, 2001, at 11:47:44
In reply to Re: hanging in there Elizabeth » shelliR, posted by Lorraine on October 8, 2001, at 10:48:06
> Did Bodkin do research on buprenorphine?
Yes, and he seemed impressed with it. I know that I and others have posted this, but here's a URL where you can find a relevant article:
http://balder.prohosting.com/~adhpage/bupe.html
> My pdoc looked it up and seemed to think that it was being used in lieu of clonodine . Does that make sense?
No. Clonidine is not an opioid, it's an adrenergic autoreceptor agonist. It is used to help people through opioid withdrawal, although people who've taken it for this purpose don't seem to think much of it. (It's also used to treat childhood ADHD, interestingly.)
> Did you try Desipramine specifically Shelli. I know other TCAs don't work for you--just curious.
I'm a bit behind on this thread, but I just wanted to second that. :-) Desipramine is the most innocuous TCA in terms of side effects and toxicity. I don't find it to have any side effects at all (even when my serum level was way outside the range that's considered "safe!").
> Effexor is hard to get on and off of.
I didn't have a problem getting off Effexor XR. I had only been taking it a little more than a month, though.
> The Wellbutrin augmentation or amphetamine might control the weight gain.
I'm not sure it's even legal to use amphetamine as an appetite suppressant (and anyway, it stops working after a couple of weeks). Phentermine (a weak amphetamine-like drug) might be easier to get (although I wouldn't expect it to work long-term, either).
> 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.
Yes, this applies to the SSRIs too, especially for people who have panic attacks.
> My pdoc favors Klonopin because it is an anticonvulsant as well.
All benzos are anticonvulsants.
-elizabeth
Posted by Elizabeth on October 9, 2001, at 12:36:51
In reply to Re: hanging in there » Elizabeth, posted by shelliR on October 8, 2001, at 16:41:41
re bupe:
> And it still makes you nauseous? And it's a pain to administer. Those are the two side effects for you?No, of course it doesn't still make me nauseous. That was the point of starting at a lower dose. The side effects I still get are itching, constipation, and dry mouth, all of which are easily controlled. (They're also side effects that you're liable to get from just about any opioid, although I gather that fentanyl -- which comes in transdermal patch (Duragesic) that most people need to change every 2-3 days -- is generally more tolerable than the others.)
> I think my pdoc has some other patients pretty well stabilized on oxy.
Yes, that's not a surprise. I know a few doctors (all in Boston, of course) besides Dr. Bodkin who've successfully used opioids to treat depression. But I don't know how many times they've tried it and failed (or the patient kept needing dose increases).
re cost of OxyContin:
> 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.It might interest you to know that generic MS Contin (slow-release morphine) is available.
> Wow, inextremely ambiguous; nothing to write home about, as the expression goes.
I think it works best as an add-on for people who've responded partially to ADs. (I think that applies to most people here -- I don't see a lot of people posting that nothing has helped at all.)
> 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.
And you're comfortable going up to 60 mg of Nardil? What dose were you on previously? (I'm thinking maybe I misunderstood you; it sounded like you were only on 30 mg/day.)
I like the idea of combining Wellbutrin and Nardil; it seems like the WB might alleviate the appetite increase from Nardil.
> 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.
I think so too. McLean is a good hospital, but it's better to stay somewhere familiar. Your pdoc sounds like he's pretty good, anyway, so I'm not convinced there would be any advantage to going to McLean.
> Plus I could barely get out of the house today; no way I'd make it to Boston.
I know the feeling. Do you find that the oxycodone helps you get started?
> > 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.T2? Do you mean T4? What are the generic names on the bottles?
> 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.
Heh. Well, there are always benzodiazepines, if you want to go the other way. As far as tricyclics go, I'd stick with the ones that are mainly NE reuptake inhibitors -- desipramine, nortriptyline, amoxapine. (Protriptyline and maprotiline fall into this category too but they have some serious toxicity issues and I think they are best avoided.) Hmm...lithium and anticonvulsants can be added to MAOIs. So can BuSpar (you have to monitor your blood pressure closely, though, and I would keep a lookout for signs of serotonin toxicity). I'll keep thinking on it and let you know if anything else comes to mind.
Something interesting to consider: I had a friend in college (I've long since lost track of her so I don't know how she's doing now) who had problems with dissociation and cutting, and she said that naltrexone (of all things!) really helped her (she was also taking, I think, Wellbutrin and lithium). Obviously this isn't feasible for you now, but it might be worth considering if you decide to go off the oxycodone. Positive response to agonists doesn't necessarily mean that an antagonist wouldn't work -- I don't get why this should be, but it's demonstrably true. (My friend had taken a number of recreational drugs, including heroin, which she liked although crystal was her drug of choice.)
> 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.
Which AD pooped out?
> 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.Well, switching from Nardil to Effexor could be very painful. I'm not sure I'd agree if you weren't taking a MAOI, though.
> 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 think they just like it because it has a rep for being less addictive than other benzos.
re Klonopin:
> I guess the long time to start working would limit it's abuse.It has limited reinforcing power because it can take as long as an hour for it to start working. (This is one reason why antidepressants aren't addictive: it takes weeks for their mood-elevating effect to manifest.)
-elizabeth
Posted by Elizabeth on October 9, 2001, at 12:50:45
In reply to Re: hanging in there » shelliR, posted by Lorraine on October 9, 2001, at 9:36:58
> http://www.medscape.com/Manisses/PU/2001/v12.n09/pu1209.01/pu1209.01.html
This article does a nice job of explaining the difference between addiction and nonpathological dependence ("Pain Management Vs. Addiction").
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.