![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 373 to 397 of 434. Go back in thread:
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").
Posted by Lorraine on October 9, 2001, at 13:17:38
In reply to Re: hanging in there » Lorraine, posted by shelliR on October 8, 2001, at 19:15:13
Shelli:
I read on Dr. Phelp"s site that although he believes that T3 or T4 thyroid augmentation on their own are fairly unimpressive, he has had good clinical experience with T3/T4 combination. Here is the site:
www.psycheducation.org/thyroid/introduction.htm
You might want to check it out.
Hope you start feeling better soon. I think my Nardil is going ok, but you know me, easy up easy down.
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 Lorraine on October 9, 2001, at 13:33:04
In reply to Re: hanging in there » Lorraine, posted by Elizabeth on October 9, 2001, at 11:47:44
Elizabeth:
Thanks for the Bodkin research. I printed it out and will give it to my pdoc. Not that I am interested now, but he should be informed. I'm also going to give a copy to Neil, who I expect to see at the NDMDA meeting tonight.
> > > 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).We could quibble about whether you are really using the drug for weight control or just to counterbalance the side effects of one drug. I don't understand the philosophy here of them working a short time. After all, I gain weight on Effexor the entire time I was on it and I lost weight when I came off it. It seems that this weight thing should work both ways. I mean if your body adjusts to weight loss agents, it should adjust to weight gain agents. My personal experience (n=1) on Adderal was that the weight loss factor did not abate at least in the two months that I was on it. I think it resets your metabolism like thyroid does and makes it less likely that you will gain weight and easier to lose weight.
>
> > My pdoc favors Klonopin because it is an anticonvulsant as well.
>
> All benzos are anticonvulsants.I thought you'd say that:-)
Elizabeth, did you see my post a while back (last post from me to you b/4 this one) that talked about temporal lobe epilepsy sort of stuff and anticonvulsants that seem to be more effective for it? I read about your episode, sounded scarey to me. I think my much milder stuff (olfactory hallucination and car accidents from discontinuities--eg not there for a moment) happen when I am increasing my meds and I just need to be careful at those times.
Hope your desipramine is still treating you well.
Lorraine
>
> -elizabeth
Posted by shelliR on October 9, 2001, at 21:15:17
In reply to Re: hanging in there » shelliR, posted by SLS on October 8, 2001, at 20:27:44
> > 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.I wonder if taking a long break from lamictal would help it to work again: like the receptors would be caught off guard again.
But I'd have to find a really strong diuretic. And my pdoc keeps saying one thing at a time, meaning the increase of nardil is enough for now.> > 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.Actually, I am curious to see if raising the nardil to 60mg might help. My last pdoc would not support any increase in sleep meds if I went up, so I have been basically tied to 30-45 mg of nardil to be able to sleep throughout the night. This doc seems willing to support my need for sleep at night. So I *am* hoping the increase will make a difference.
>
> > 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.I tried effexor for two days several years ago. I threw up 1 pill; next day threw up 1/2 pill, then gave up. I have never had any withdrawal symptoms when getting off prozac, or nardil and very few effects after withdrawing from valium. (sweaty palms for one day!) I have never had electric shocks. I actually have never heard of them associated with a benzo.
> 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?Actually I can't. I would have to look through the specific cases in the California class action suit for Zoloft (or is it Paxil, I can't recall) to see whether claims were made for permanent damage opposed to "addiction". When people say they have symptoms long after they go off of effexor and others, I really don't know how long they mean. Certainly the drug companies are not keeping stats. They are still denying habituation.
>
> 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.Well, at least a part of you recognizes that they are unrealistic. That's a start.
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.You write beautifully; you put together an wonderful website after the attack. I know it seems like a fraction of your potental. I think that in some ways you may be absolutely be reaching your potential. Just not for very long times and in not as many ways. For example, I can't imagine that the story of your father could have been written any better, even if your depression was removed. I think you would probably disagree. It is natural to think , look at good I am with so little energy and motivation. Think of what I could do with all of me. But I again am talking about quality, not quantity. I'm not trying to minimize your frustration, just to give you another possible angle, which I happen to really believe. That story was perfect and any journalist would have been proud to have been its author.
I am nothing but failure when compared to those I grew up with.
That is the kind of thinking, that it is best to let yourself get entangled in as little as possible. Success is part talent and lots of luck and timing. I look at the very talented people who are working in frame shops (for one example), because it is next to impossible to make a living off of fine art. A tiny tiny fraction of people are recognized for their talents in that field. For every painter that has a successful show, there are dozens and dozens more that weren't linked in the right way to the right people to get shown. So having mental health is no guarantee of success, in the way that the western world defines it. But I do agree that you should have gotten your shot, and I'm sure you will.
> 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.
I will try to accept those beautiful words graciously and without argument. (I cried last night when I read them.) I only wish you could turn them around and see how much of you lives in the very words you have directed toward me.
Take care,Shelli
Posted by shelliR on October 9, 2001, at 23:05:31
In reply to Re: hanging in there » shelliR, posted by Lorraine on October 9, 2001, at 9:30:49
> 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?No, I haven't given up hope on nardil. I was worried that I keep going back to nardil because it is my security drug, not because it is effective anymore. But when my doc thought it was best to go further with it and raise it to 60mg, that felt like it made sense. Play it out until I'm sure it doesn't work. But that means totally medicating myself with atarex and valium to sleep through the night. Since the one time I had gone up very high on valium (30mg), then got off it, I have been conscious to try not to get it higher than 15mg a day. And 10mg have been to assist sleep. Now I am up to 20, and I still woke up after three hours (it's such a strange thing--it's always been after three hours, no matter what time I go to bed). And it took about 1 1/2 to fall back to sleep with 5mg more of valium. I am not worried about getting off; I do think my pdoc should be helping me find something better to help me sleep. But if the nardil kicks in at 60mg, then I have think he'll work on my sleeping with me. He likes to deal with only one change at a time. At least no additions of new drugs. He's very methodical that way.
>
>
> >
How did you manage to make it to Monday? What were your coping strategies? Distraction?It was so hard on Saturday. It's hard to explain how much I hurt. It's so physical I felt like I couldn't stand it. But once I got through Saturday, Sunday was much easier. I had a sitting Saturday morn and it was okay, but knew my insides were not doing well. Then after, I caved in. I can't distract when I feel that awful. I took valium and sleep it off as much as I could. Sleep has always been the best way for me to handle it when I feel pain that intensely.
>
> It's great that your therapist was able to get you in so quickly and it sounds like it helped a bit anyway.It was my pdoc that got me in. I cancelled my therapy Monday, in case that was the only time I could get in to see my pdoc. (you know, 24 hour notice or you pay.) The bad thing about my pdoc is how short a time he sees you. The good part is that he'll fit you in everyday if you need to go. I actually ended up seeing both of them yesterday, because he had a non-conflicting time open, and my therapist hadn't given away my hour. (I could add that I don't see it as humanitarian that she would even consider giving away my hour if there was a possibly that I could be there, but that's another issue.)
> .
> 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 think you're referring to my statement that I seem to do better with quick thinking therapists, rather than feeling types. But I meant that in the Myer-Briggs way, not as a statement on physically touching.
> I hope things brighten for youToday was better. I worked all day and met all work goals. That is always gratifying. (and did the treadmill, although fairly slowly.) And the depression was under control. I also keep reminding myself that I am very premenstrual (can tell by how swollen my body is, how much I am crying, as well as time of the month). Considering that Monday I was 90% sure that I had to go into the hospital today to stay alive, I made quite a shift.
Glad you are doing well.
Shelli
Posted by shelliR on October 9, 2001, at 23:11:07
In reply to Re: hanging in there » shelliR, posted by Lorraine on October 9, 2001, at 9:36:58
> 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
> > >
> > >Thanks. I never have confused the two issues of pain control vs getting high. The big deal about oxy is the time release and the deaths were caused by crushing it and either snorting it or shooting it. Still, in retrospect, I would have chosen another, lower dose pain reliever, but too late now. If I become stabilized, I have already talked to my pdoc about switching pain meds. Elizabeth wrote in another post about it being available generically--because besides the high dose increases, it is incredibly expensive--I literally spend several hundred a month out of pocket.
Posted by shelliR on October 9, 2001, at 23:32:54
In reply to Re: hanging in there » shelliR, posted by Elizabeth on October 9, 2001, at 12:36:51
> 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 guess I keep asking because in posts you say quite often that you'd rather find a substitute with less side effects. Itching is pretty bad, nothing to control that? And constipation, I think, has to be managed with so many medications.
>> 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.I didn't know that. My pharmacy is supposed to automatically substitute generics, and it always has before. Is the generic a new thing?
> 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 was on 30mg, then I started 45mg. I am fine, except for the sleep problems which are serious and constipation (already compounded by oxycontin). Magnesium helps that; sleep is going to be a much more complicated issue if 60mg kicks in. Also I could not adjust to changes in light on 45 mgs after several months, so I'll have to see how that goes. It was pretty dangerous--I was "whiting out"--couldn't see anything until I got into a building (from a bus to outside, or from my car to outside.) If it just happened in the car I could see it related to blood pressure changes, but I used to stand on the bus when I worked downtown years ago.
>
> I like the idea of combining Wellbutrin and Nardil; it seems like the WB might alleviate the appetite increase from Nardil.So far I have no appetite. My carbo cravings on Nardil are gone, but as I've said before, I don't think it made me gain weight. But I don't remember. When I first started it, I was seriously underweight from the severe depression.
>> I know the feeling. Do you find that the oxycodone helps you get started?
I'm okay except when I reach a level when the oxy is not working. And it feels like it's not working at all until I increase it.
I hope the 60mg of nardil makes a difference. I want there to be something backing up the oxy--not relying on that for the whole job, especially in light of the fact that I keep developing tolerances.>
>
> T2? Do you mean T4? What are the generic names on the bottles?
Yes, I guess I do mean t3, t4. It's amour thyroid, a natural thyroid combination.
>
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.)Tried tricyclics years ago and couldn't tolerate several; don't remember which ones.
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).
Done both lithium and most anticonvulsives, as well as BuSpar with no success. If I can control water weight I might try lamictal again because it was the only one I was successful one. But I carried 15lbs of pure water (swollen everything), which I dropped immediately when off the drug.
>
> 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 herTried that also. My last pdoc was hopeful because of the relationship to opiates, but it felt awful. I only did a one day trial, then gave it up.
>
> > 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?Nardil. But he was talking about the success of adding stimulents to any pooped out AD in general.
>
Shelli
Posted by Elizabeth on October 10, 2001, at 13:17:48
In reply to Re: hanging in there » Elizabeth, posted by shelliR on October 9, 2001, at 23:32:54
> I guess I keep asking because in posts you say quite often that you'd rather find a substitute with less side effects. Itching is pretty bad, nothing to control that?
Like I said, they can all be controlled. I use ChlorTrimeton for itching (the non-drowsy antihistamines don't seem to work very well).
> And constipation, I think, has to be managed with so many medications.
Not really; I think fiber supplementation is the most effective way to deal with it.
> > It might interest you to know that generic MS Contin (slow-release morphine) is available.
>
> I didn't know that. My pharmacy is supposed to automatically substitute generics, and it always has before. Is the generic a new thing?It's not the same drug; it's morphine, not oxycodone. They don't substitute different drugs or different formulations -- for example, if you had a prescription for Celexa, the pharmacist wouldn't give you generic fluoxetine, but if there were generic citalopram they would give you that (unless your doctor wrote "do not substitute" or "dispense as written" on the prescription).
> I was on 30mg, then I started 45mg. I am fine, except for the sleep problems which are serious and constipation (already compounded by oxycontin).
MAOIs do cause quite a bit of sleep disruption. I thought Ambien was pretty effective.
> Also I could not adjust to changes in light on 45 mgs after several months, so I'll have to see how that goes. It was pretty dangerous--I was "whiting out"--couldn't see anything until I got into a building (from a bus to outside, or from my car to outside.)
That's odd. I wonder what could be causing that.
> So far I have no appetite. My carbo cravings on Nardil are gone, but as I've said before, I don't think it made me gain weight.
Well, you're lucky then!
> When I first started it, I was seriously underweight from the severe depression.
I was moderately underweight, but phenelzine more than compensated.
> I'm okay except when I reach a level when the oxy is not working.
I meant, does the oxycodone help you get started in the morning?
> And it feels like it's not working at all until I increase it.
Buprenorphine doesn't have much noticeable effect anymore except dry mouth (it used to make me very dizzy and wired), but it still makes me feel "normal" as it did when I first took it.
> I hope the 60mg of nardil makes a difference. I want there to be something backing up the oxy--not relying on that for the whole job, especially in light of the fact that I keep developing tolerances.
You might want to ask your doctor to justify the continued dose increases. If I were in your situation, I'd be concerned about what might happen if the doctor prescribing the oxycodone became unavailable (like if something happened to him or if he were called out of town) -- getting another doctor to prescribe it would be hard. Another issue is that if you ever get hurt and needed analgesics, you'll have a major tolerance and you'll need much more than an opioid-naive person would. Just some things to think about -- once you start taking high doses of opioids on a daily basis, stopping can be pretty hard.
> Tried tricyclics years ago and couldn't tolerate several; don't remember which ones.
Do you remember if desipramine was among them? I ask because it's been almost entirely free of side effects for me, even when my serum level was extremely high (around 500-600 ng/mL). (And I didn't tolerate other tricyclics, either.)
> Done both lithium and most anticonvulsives, as well as BuSpar with no success.
Have you tried them with Nardil?
> If I can control water weight I might try lamictal again because it was the only one I was successful one.
It has a good reputation. Did you think about trying a diuretic for the edema?
> Tried that also. My last pdoc was hopeful because of the relationship to opiates, but it felt awful. I only did a one day trial, then gave it up.
That's probably what would happen if I took naltrexone, too. Thanks for the warning. :-)
> > Which AD pooped out?
>
> Nardil. But he was talking about the success of adding stimulents to any pooped out AD in general.Hmm. Well, I don't know what to suggest for Nardil poop-out -- obviously I wasn't very successful with it.
-elizabeth
Posted by Elizabeth on October 10, 2001, at 13:28:50
In reply to Re: hanging in there » Elizabeth, posted by Lorraine on October 9, 2001, at 13:33:04
> Thanks for the Bodkin research. I printed it out and will give it to my pdoc.
Thank the guy who put it on the net! :-)
> We could quibble about whether you are really using the drug for weight control or just to counterbalance the side effects of one drug.
Heh. I'm not sure it's actually illegal to use amphetamine for that purpose, but it certainly is frowned upon (and, of course, off-label).
> I mean if your body adjusts to weight loss agents, it should adjust to weight gain agents.
It's generally easier to gain weight than it is to lose it!
> My personal experience (n=1) on Adderal was that the weight loss factor did not abate at least in the two months that I was on it.
That's cool. I know that some kids who take stimulants for ADHD have problems with weight loss, too.
> I think it resets your metabolism like thyroid does and makes it less likely that you will gain weight and easier to lose weight.
All I know is, amphetamine is definitely an appetite suppressant.
> Elizabeth, did you see my post a while back (last post from me to you b/4 this one) that talked about temporal lobe epilepsy sort of stuff and anticonvulsants that seem to be more effective for it?
Which post? (URL?) I don't think so, although I generally know which anticonvulsants are used for which types of seizures. I'm not even sure that what happened to me was a seizure, though.
> Hope your desipramine is still treating you well.
The desipramine-buprenorphine combination continues to work well, yes. (I can't credit the desipramine alone because I tried taking it by itself for a while and it only worked about as well as Parnate did.)
-elizabeth
Posted by SLS on October 10, 2001, at 15:25:52
In reply to Re: hanging in there » SLS, posted by JahL on October 9, 2001, at 9:59:58
>
> > > 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.
Dear JahL,I wish I had a magic wand to undo to you what Effexor did. That this happened to you does not surprise me. I have had similar experiences with other drugs. I don't think Effexor is any more liable to do this than other drugs, though. Someone here had the same thing happen to them with amoxapine (Asendin).
Damn.
- Scott
Posted by shelliR on October 10, 2001, at 16:21:02
In reply to Re: hanging in there » shelliR, posted by Elizabeth on October 10, 2001, at 13:17:48
> > I guess I keep asking because in posts you say quite often that you'd rather find a substitute with less side effects. Itching is pretty bad, nothing to control that?
> Like I said, they can all be controlled. I use ChlorTrimeton for itching (the non-drowsy antihistamines don't seem to work very well).
> > And constipation, I think, has to be managed with so many medications.
> Not really; I think fiber supplementation is the most effective way to deal with it.I think you misunderstood my statement. I meant that constipation is a problem with many medications ("has to be managed with so many medications.") Not that constipation itself requires many meds to deal with it.
>
> > > It might interest you to know that generic MS Contin (slow-release morphine) is available.
> > I didn't know that. My pharmacy is supposed to automatically substitute generics, and it always has before. Is the generic a new thing?
>
> It's not the same drug; it's morphine, not oxycodone. They don't substitute different drugs or different formulations -- for example, if you had a prescription for Celexa, the pharmacist wouldn't give you generic fluoxetine, but if there were generic citalopram they would give you that (unless your doctor wrote "do not substitute" or "dispense as written" on the prescription).Elizabeth you must think I have a bird brain. I misread your statement. I thought that you were saying they are the same drug; of course I know that pharmacists can't substitute difference meds. ;-). Though at some point I might bring up the issue of morphine; right now I think he wants to see what happens if the nardil is increased.
>
> > I was on 30mg, then I started 45mg. I am fine, except for the sleep problems which are serious and constipation (already compounded by oxycontin)
> MAOIs do cause quite a bit of sleep disruption. I thought Ambien was pretty effective.I'm pretty sure I tried that in the past. I need to get my old records from my pdoc of 10 years--just keep forgetting to call before 4--her office closes early. I need to go through exactly what I tried in those ten years. Her nurse practioner gave me a list of meds, doses, why I stopped, but I can't put my hands on it. And I'd like to have all the notes; I'm willing to pay for the copying.
>
> > Also I could not adjust to changes in light on 45 mgs after several months, so I'll have to see how that goes. It was pretty dangerous--I was "whiting out"--couldn't see anything until I got into a building (from a bus to outside, or from my car to outside.)
> That's odd. I wonder what could be causing that.I haven't a clue. But I do know that if it happens on 60mg, we'll have to figure out why. I had been on 45 mg for about a year when it started happening. Then I went down on nardil to 30mg with 45mg premenstrually, and it never happened again.
>> Buprenorphine doesn't have much noticeable effect anymore except dry mouth (it used to make me very dizzy and wired), but it still makes me feel "normal" as it did when I first took it.
I guess I get confused as to why you want to replace it. I thought I had read that several times in your posts that the despramine and buprehorphine was working, but that you'd rather find a replacement for the bupe?
>
> > I hope the 60mg of nardil makes a difference. I want there to be something backing up the oxy--not relying on that for the whole job, especially in light of the fact that I keep developing tolerances.
> You might want to ask your doctor to justify the continued dose increases. If I were in your situation, I'd be concerned about what might happen if the doctor prescribing the oxycodone became unavailable (like if something happened to him or if he were called out of town) -- getting another doctor to prescribe it would be hard. Another issue is that if you ever get hurt and needed analgesics, you'll have a major tolerance and you'll need much more than an opioid-naive person would. Just some things to think about -- once you start taking high doses of opioids on a daily basis, stopping can be pretty hard.
>I have been dealing with all those concerns. The increased doses are pretty much to keep me alive until something else takes some of the workload. That's why I am I am going up on the nardil, basically doubling it from a week ago. Also, he's in practise with another doctor and he's on the staff of a private psychiatric hospital, so I'm not worried about getting another pdoc to prescribe it, certainly at least until I detoxed. He has also given me on his prescription pad a list of all my meds, so if I had to be hospitalized in an emergency, I have the doses of all meds with his license number.)
> > Tried tricyclics years ago and couldn't tolerate several; don't remember which ones.
>
> Do you remember if desipramine was among them? I ask because it's been almost entirely free of side effects for me, even when my serum level was extremely high (around 500-600 ng/mL). (And I didn't tolerate other tricyclics, either.)Is desipramine the generic or brand name? I don't recall much about the tricylics. It was many years ago. Did the other tricyclics make you disoriented? That was the effect on me--total disorientaton.
>
> > Done both lithium and most anticonvulsives, as well as BuSpar with no success.
>
> Have you tried them with Nardil?
yes. All my augmentations were with nardil. It's really the only AD I've ever been on, except for other trials.> > If I can control water weight I might try lamictal again because it was the only one I was successful one.
> It has a good reputation. Did you think about trying a diuretic for the edema?I did try furosemide (80mg), but I'm not sure that I actually followed through and took it for more than several days. And in several days it had little effect. It must not be that strong because even premenstrually, it works, but minimally. I still have minor pain and swelling in my breasts.
>> > > Which AD pooped out?
> > Nardil. But he was talking about the success of adding stimulents to any pooped out AD in general.
>
> Hmm. Well, I don't know what to suggest for Nardil poop-out -- obviously I wasn't very successful with it.Well, thanks anyway, I think I've pretty much tried everything, except concerta, which is a likely possibility. Oh, and
I did have pindolol on my list, but from everything I've read, it acts more to help ADs kick in faster than it does for
poopout.
>
Shelli
Posted by shelliR on October 11, 2001, at 0:20:27
In reply to Re: hanging in there » shelliR, posted by Lorraine on October 8, 2001, at 10:38:32
Hi Lorraine,
missed this post, I think.
> > > > 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.why was the first one less threatening?
>
>> > > >Have you taken the Myer Briggs? I am a INTJ.
> So am I and so is my husband.That's interesting to me. I have always been attracted to intraverts, and never bought for me the idea that opposites attract. One exception was my best friend for many many years -from college on-was an extroverted feeling type. If I had been gay, I would have married her!, although I struggled around her feeling vs thinking, and as a friend I would pull back because she was so intense about expressing how important I was to her. But I was never bored with her. She's a therapist now and for various reasons we have not kept in close contact. But she is in group supervision for her practise and she told me the leaders are intriged with her--they have never supervised a therapist who had such hysteric tendencies.
But I have never been attracted to an extraverted man. I do think it might be easier for me to get along with a INTP because I would think that our Js might clash a lot. Have you felt the tug I am talking about at all with your husband?
>
>
> > > >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's very complicated. She has been able to teach me to get myself back on track and that is very satisfying to me; going around in circles of course is very frustrating. She has helped me make my life easier, let go off distructive feelings, let go of little hurts that I had a tendency to hold on to. There are things about her that I have a great deal of difficulty with. When they come up I identify them as peculiarities of her personality. I think she has some very very blind spots that I have to contend with as her patient. But there is no point focusing on them because she can't see them (and I have no doubt that they are there). Recently I think that perhaps because of these things it may be time to move on to work with someone else. This would not be a good time for change. And I don't have anyone in mind, because there are a limited amount of specialists in dissociative disorder that acccept my insurance. My therapist friend has a supervisor who she thinks is both brilliant and very caring but I don't know yet if he accepts my insurance.
> >
> >
> > 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.Actually, I think it is very special that you work so hard to have a good marriage, and the working seems to very much pay off.
>
> 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.I understand, and again I think that is a very wonderful thing.
>>
> 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.I forget. What will a QEEG show?
>
>
> >
> > > What was atarax like?
> > I take atarax to sleep and it also works the next day for me as an antihistamine.It knocks me out pretty well, with not much hangover. I do wake up slowly in the morning, but that seems more recent. I don't remember having an drowsiness before in the morning from it until this year. And as a bonus, I don't itch anymore from histamine problems.
>
> But it works to put you to sleep. I think I speed up on antihistamines.I have that effect on most over the counter antihistamines. Like benadril messes me up pretty badly--loud pulse, morning anxiety when I tried it for sleep. This feels totally different. No side effects.
>
>>
> > > >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.Actually my hand-colored work will still be printed by hand because I haven't found a flat photolooking paper that will let me blend the oils. It's the black & white only that will change.
> > > >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.Easy in person. But yes, difficult on the phone, although I imagine that I will get better at making it sound matter of fact after a while. People generally come from too far a distance to pop over to see my work. Especially because Washington is such a workaholic town, and kids are all on soccer teams among various other actiivities. So mostly people have either seen my work hanging (and it would be complicated to change it now, because of factors I'm too tired to get into), have friends that have come to me, or they have seen my ad, and my website. On the website at at 76 dpi resolution, there would be no difference even if the quality of my new system was really bad. (Plus I think it would be too defensive of an act). I may print up wallet size samples that I could send out, but it's been nice lately--I e-mail everything to people now (price list, directions)--no more snail mail.
>>
> 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.So before you read, you talked about your family? It seems like a really interesting and personal class.
>Shelli
Posted by judy1 on October 11, 2001, at 0:49:09
In reply to Re: hanging in there » Elizabeth, posted by shelliR on October 10, 2001, at 16:21:02
By now I'm hoping you're feeling better. I found myself on the king/queen of narcotics- fentanyl which along with klonopin keeps me pretty even execept for those damn manic episodes where depakote marches in. It was a bear to get it- I have all sorts of nasty MRI's so I went to a pain clinic even though my shrink is supportive of the narcotic/benzo combo, he can't approach my tolerance. So wishing you the best- Judy
Posted by shelliR on October 11, 2001, at 3:59:15
In reply to Hi Elizabeth, posted by judy1 on October 11, 2001, at 0:49:09
> By now I'm hoping you're feeling better. I found myself on the king/queen of narcotics- fentanyl which along with klonopin keeps me pretty even execept for those damn manic episodes where depakote marches in. It was a bear to get it- I have all sorts of nasty MRI's so I went to a pain clinic even though my shrink is supportive of the narcotic/benzo combo, he can't approach my tolerance. So wishing you the best- Judy
Hi Judy.
I'm so happy you posted. Way back in early September (I know because I was in New Mexico) you wrote me a post about dissociative disorders, and when finally got around to answering it, I couldn't find it. So I have been thinking about you often, but not knowing exactly what to write.
Are you doing okay? Did you go to the pain clinic to get detoxed (i.e., reduce your needed dose) or did you go because they would watch you on that dose?
Shelli
Posted by Lorraine on October 11, 2001, at 9:44:01
In reply to Re: hanging in there » Lorraine, posted by shelliR on October 9, 2001, at 23:05:31
Hi Shelli:
> > >[re going up on Nardil] But that means totally medicating myself with atarex and valium to sleep through the night.I take 10 mg ambien to go to sleep and 600 neurontin to keep me asleep. It works for me. Otherwise, like you, I am up after 3 hours.
> > > How did you manage to make it to Monday? What were your coping strategies? Distraction?
>
> It was so hard on Saturday. It's hard to explain how much I hurt. It's so physical I felt like I couldn't stand it. But once I got through Saturday, Sunday was much easier. I had a sitting Saturday morn and it was okay, but knew my insides were not doing well. Then after, I caved in. I can't distract when I feel that awful. I took valium and sleep it off as much as I could. Sleep has always been the best way for me to handle it when I feel pain that intensely.Sleep seems to be a good strategy for you. I hope that things are up a bit for you now.
I tried to take a nap yesterday with the Nardil slump and when I woke up was really off in a lousy place. Then I remembered that that is what happens to me when I take naps since I have been depressed. I had the same reaction on Effexor; afternoon grogginess, but if I took a nap I always woke up feeling much worse.
>
> > > Today was better. I worked all day and met all work goals. That is always gratifying. (and did the treadmill, although fairly slowly.) And the depression was under control.This is quite an accomplishment. I haven't managed the exercise thing this week:-(. Know I should but haven't had the discipline for it this week. I'm up 3 lbs also. It looks like I will need to be more careful than I have been with my eating habits.
> > >I also keep reminding myself that I am very premenstrual (can tell by how swollen my body is, how much I am crying, as well as time of the month).
I read somewhere that one of the reasons they do so little research on women is b/c they make such bad subjects. They are also premenstrual, postmenstrual, ovulating, pregnant, perimenopausal or menopausal. I suppose it's true.
> > >Considering that Monday I was 90% sure that I had to go into the hospital today to stay alive, I made quite a shift.
Yep, you're moving on up. Your ability to bounce back has always been pretty amazing. My resilence is one of the things that we learn with this condition.
Lorraine
>
> Glad you are doing well.
>
> Shelli
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