![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 389 to 413 of 434. Go back in thread:
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
Posted by Elizabeth on October 11, 2001, at 11:09:26
In reply to Re: hanging in there » Elizabeth, posted by shelliR on October 10, 2001, at 16:21:02
> 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.
You're right, I did misunderstand. Oops. :-} (It is a pretty difficult-to-manage side effect, though.)
> 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.
MS Contin would be *much* cheaper than OxyContin is. You'd have to take a much higher dose, though (I don't know the relative potencies, exactly). I know of someone who's taking morphine (MSIR) for depression (and has been for some time without needing to increase the dose); he takes 150 mg/day (as 30 mg five times a day). (MS Contin is supposed to be taken twice a day.)
> > 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.And how did it go?
> I need to get my old records from my pdoc of 10 years--just keep forgetting to call before 4--her office closes early.
Being a control freak, I keep my own records. :-)
> 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.
Hmm. I'm not sure if there's anything you can do about photosensitivity other than be careful and maybe wear sunglasses everywhere. :-) You have the weirdest drug reactions!
> 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?
Yes. The side effects are troublesome to manage, and I'd like to be able to take a pill or wear a patch instead of doing this weird ritual and fiddling with syringes and so forth.
> 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.
Okay. I hope that you're able to find that "something else," because I think it would suck to be so dependent on a particular doctor, and even though he's well respected you might meet with some resistance if you tried to get a new doctor to prescribe it. I've had some troubles lately because I've had to move several times. I did manage to convince the new doctors to prescribe buprenorphine, of course, but you can't be certain that someone will be willing to do that. You might find that even if a new doctor is willing to prescribe it, they might pressure you to "detox."
> 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.)
That's pretty cool. I wish I'd had that when I was in the hospital back in February-March.
> Is desipramine the generic or brand name?
Generic. Brand name is Norpramin.
> 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.
No, but I had problems with constipation and appetite stimulation.
> yes. All my augmentations were with nardil. It's really the only AD I've ever been on, except for other trials.
So you're sticking with Nardil as your main AD, and experimenting with augmentations. Okay. What, if anything, did thyroid hormones do to you, BTW? I've been thinking about trying that, since it's something I haven't tried before.
> 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.
I don't know how fast those things are supposed to work or whether 80 mg is a reasonable dose. I find that I need higher doses of antihistamines for opioid-induced itching than I would for allergies, and I seem to need pretty high doses of bethanechol, too (the largest tablet size is 25 mg, and often that isn't enough).
> Well, thanks anyway, I think I've pretty much tried everything, except concerta, which is a likely possibility.
I would like to try it, if I had prescription insurance. (I think I'll ask for Adderall or Cylert instead.)
> 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.
That's true; I've never heard of it being used for poop-out.
-elizabeth
Posted by Elizabeth on October 11, 2001, at 11:16:22
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've been doing well for quite a while. How are you?
> 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.
Depakote and fentanyl sounds like a fine mix for bipolar disorder. Were you using the fentanyl patch (Duragesic)? Fentanyl is good in that it has a favorable ratio of desired effects to adverse effects. You're right that it's one of the strongest legal opioids. Alpha-methylfentanyl (a longer-acting fentanyl analog) is sold on the street as "China white."
> 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.
I can imagine how hard it must have been to get it. I have a hard enough time convincing doctors to prescribe buprenorphine!
-elizabeth
Posted by Lorraine on October 11, 2001, at 11:36:11
In reply to Re: hanging in there » Lorraine, posted by shelliR on October 11, 2001, at 0:20:27
Shelli:
[re: the article: Drawing the Line Between Pain Management and Addiction:]
I thought the article was interesting b/c it did talk about how for some people the increased dosage was a "water seeks it's own level" and how the rate of actual addiction was quite low.Next post
> missed this post, I think.Glad you found it:-)
[re pushing away lovers] > why was the first one less threatening?My husband was such an "eligible bachelor"--you know, on the right track, heading for success, conventional, good provider, good gene pool for kids. All this "picture perfect" stuff scared the putty out of me b/c I was not very conventional and wasn't looking for an eligible bachelor. Plus, my husband wasn't needy. In my previous relationship (with a great guy who has remained a friend)I was a giver and everything was kind of messy--he had no "career" track (he's a janitor now) and he was kind of messed up in a fairly delightful way. When I got together with my husband, it was a big fork in the road for me--to follow my ambitions into law and be involved with someone who wasn't one of the "walking wounded" but was actually capable of giving back in a fairly powerful way. It meant giving up my image of being "f**** up" and becoming a highly functional competent human being. This notion, of sort of giving up my past and walking into the future, was very scarey to me. A life plays out and in retrospect either road may have been good. But taking the road I did required me to push all of my abilities to the limit and seize the day. So I'm not one of those people who has regrets about the things they haven't done, the opportunities that they let pass them by because they were too frightened to risk failure. I risked everything, but then again, to a certain extent I destroyed myself in the process, by pushing too hard, taking on too much stress and ultimately collapsing into a depression.
> > > > >Have you taken the Myer Briggs? I am a INTJ.
> > So am I and so is my husband.
>
> > > 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?I don't think my Js are very similar to my husband's Js. He is compulsive about time and things being in their proper place. His "schedule" of activities is a bit amazing. I'm more prone to be late and like having unscheduled time. The only time this conflicts is when he tries to fill up our "social" calendar or when we are on vacation and he want to "accomplish" the city we are visiting (hit all the museums etc). The way we have dealt with this is by recognizing that we are separate and don't have to do the same things even on vacations.
> >[re your therapist] > 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.It almost sounds a little cognitive therapy in approach, although I'm sure she delves into your past as well or maybe she's just organized in her approach.
> > > 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.It's important to me and, you know, once a gulf begins between two people, it is easy for it to widen. Especially when you have kids that demand a lot of your time.
> >My pdoc wants me to do another QEEG and he may be right.
>
> I forget. What will a QEEG show?My brain wave activity--what affect the meds are having on my brain waves--for instance the spikey beta thing I have, is the anticonvulsant affecting that
> > > 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.
Will the Atarax be enough to knock you out? Is your sleep difficulty just staying asleep? I know you are doing the valium--have you thought about Neurontin? I only need to add valium to my nighttime cocktail when I was on Parnate, which was much more activating than Nardil.
> > >[re showing side by side digital vs hand painted] (Plus I think it would be too defensive of an act).I think you're right.
> > >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.
This idea is actually a great way of doing it. "Let me send you out some samples of my recent work since I've switched to digital"
> > 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.It's a remarkably personal class and the people are very interesting. Some actors, a comedian, ---mainly though just good writers. A lot of the work brings me to tears, it is very deep. The guy who runs it is from the Second City comedy team. He really requires that you approach this stuff from a deep voice and if you are lucky enough to have written from that place, then he will require that you read it from that place. Sometimes when people read their work the start to cry and he says "it's ok to cry, just breath" and then at most maybe someone will extend a hand to touch the person's arm. I had forgotten how deep this class was. It's what I love about the NDMDA meetings I go to as well. It is life at a deeper level. Anyway, it's a big move for me to get myself back into writing. It requires the discipline of daily writing--let's see if I can do that. Plus, he has me writing from different voices--the child, the mother, the whore, the madonna, the hag, the crone. It's amazing how hard it was to write from the child.
Lorraine
Posted by judy1 on October 11, 2001, at 18:29:08
In reply to Re: Hi Judy, posted by shelliR on October 11, 2001, at 3:59:15
Hi Shelli,
Actually I'm doing a little too well according to my shrink, but I'm not complaining. Went to the pain clinic to be watched like the good girl I am and to be tapered when I have to. I did ask you about DID, didn't know if that was your diagnosis, mine is dissociative disorders NOS. I was curious if that is your diagnosis, how long did it take was it obvious, etc. If not just ignore the last couple of sentences and have a great day- Judy
Posted by judy1 on October 11, 2001, at 18:35:08
In reply to Hi Judy, posted by Elizabeth on October 11, 2001, at 11:16:22
I'm glad to see all my favorite posters. I use the patch- it feels very even to me, more so than ms contin (that I used a couple of years ago). I'm amazed at how ignorant some (most?) pdocs are when it comes to narcotics, I hope your buprenorphine is helping. Take care, Judy
Posted by Neal on October 11, 2001, at 23:52:41
In reply to Re: hanging in there » shelliR, posted by Elizabeth on October 11, 2001, at 11:09:26
> Yes. The side effects are troublesome to manage, and I'd like to be able to take a pill or wear a patch instead of doing this weird ritual and fiddling with syringes and so forth.Elizabeth
Another person on this board had her Bupe made into lozenges at a compounding pharmacy. That isn't an option for you?-Neal
Posted by Elizabeth on October 12, 2001, at 9:35:53
In reply to Re: Hi Judy » Elizabeth, posted by judy1 on October 11, 2001, at 18:35:08
> I'm glad to see all my favorite posters. I use the patch- it feels very even to me, more so than ms contin (that I used a couple of years ago).
Hi Judy. I think that Duragesic is probably one of the better formulations if you're taking opioids long-term. It's very smooth, and fentanyl is supposed to have fewer side effects than other opioids. How are you tolerating it -- any side effects? What dose are you on?
> I'm amazed at how ignorant some (most?) pdocs are when it comes to narcotics, I hope your buprenorphine is helping.
It certainly is, and I've been taking it on a regular basis for nearly a year now (I was using it intermittently before I started taking it daily).
I agree, pdocs sure aren't educated enough about opioids, which I think are a valuable tool for mood and anxiety disorders that haven't responded adequately to more conventional treatments.
What symptom(s) did you have that were only relieved by fentanyl?
> Take care, Judy
You too. :-)
-elizabeth
Posted by Elizabeth on October 12, 2001, at 9:41:04
In reply to Re: hanging in there » Elizabeth, posted by Neal on October 11, 2001, at 23:52:41
> Another person on this board had her Bupe made into lozenges at a compounding pharmacy. That isn't an option for you?
Yeah, I read those posts. I think that if you're taking it SL, the dose required is probably significantly higher -- I'd have to recalibrate, and I'm not sure that it's absorbed consistently through that route. And finally, compounded medications are *expensive*, and bupe is expensive enough in the regular formulation!
I would like to ask my pdoc if I can give myself intramuscular injections -- I think that would be less of a hassle -- but I'm kind of afraid of what his reaction would be. You know?
-elizabeth
Posted by judy1 on October 12, 2001, at 11:29:53
In reply to Judy, posted by Elizabeth on October 12, 2001, at 9:35:53
Hi Elizabeth,
I'm using a 50 ug? per hour and it works really well for depression which is my only alternative since I can't take AD's. I'll have to taper soon due to pregnancy, and because of problems in the past go right back on after delivery. I'm really really glad you're doing well- Judy
Posted by Elizabeth on October 13, 2001, at 16:45:06
In reply to Re: Judy » Elizabeth, posted by judy1 on October 12, 2001, at 11:29:53
> Hi Elizabeth,
> I'm using a 50 ug? per hour and it works really well for depression which is my only alternative since I can't take AD's.That's not an unreasonable dose (and yes, it is ug or mcg: micrograms) -- the lowest-dose patch is 25 mcg/h. How long have you been on it, and how often do you change the patches?
> I'll have to taper soon due to pregnancy, and because of problems in the past go right back on after delivery. I'm really really glad you're doing well- Judy
I'm glad you're doing well, too, and I hope your pregnancy is uneventful. :-)
-elizabeth
Posted by jojo on October 13, 2001, at 20:43:28
In reply to Re: Hypertensive crises, update » Lorraine, posted by Elizabeth on September 24, 2001, at 10:11:53
A few weeks ago, after taking 0.3 mg. of Bup and 10 mg. of Dexedrine, I foolishly decided, four hours later, and being out of town and low on Dexedrine, to substitute 2.6 mg. of Yohimbine for the Dexedrine. My bp went up to 185/107. Wishing to avoid the E.R., I smoked ½ of a joint of mj, took 10 mg of Valium, and about 30 mg. of Viagra. Within 15 minutes my bp was down to 135/87. I've got to believe that the reduction was due to the marijuana, as the pills would barely have had time to dissolve. If these results are typical, it would seem that smoked mj may be the fastest way to lower bp without an injected med.
Posted by Neal on October 13, 2001, at 23:02:45
In reply to Re: hanging in there » Neal, posted by Elizabeth on October 12, 2001, at 9:41:04
And finally, compounded medications are *expensive*, and bupe is expensive enough in the regular formulation!
How expensive is it.
Neal
Posted by Elizabeth on October 14, 2001, at 10:31:48
In reply to Re: Hypertensive crises, update » Elizabeth, posted by jojo on October 13, 2001, at 20:43:28
> A few weeks ago, after taking 0.3 mg. of Bup and 10 mg. of Dexedrine, I foolishly decided, four hours later, and being out of town and low on Dexedrine, to substitute 2.6 mg. of Yohimbine for the Dexedrine. My bp went up to 185/107.
Yohimbine is, I believe, a beta-adrenergic agonist. It can do that. I also find that my BP runs a little high on buprenorphine.
> Wishing to avoid the E.R., I smoked ½ of a joint of mj, took 10 mg of Valium, and about 30 mg. of Viagra. Within 15 minutes my bp was down to 135/87. I've got to believe that the reduction was due to the marijuana, as the pills would barely have had time to dissolve.
It might just have been due to the passage of time. Usually BP goes down pretty quickly in situations like that one. (Valium works fairly fast, and it might have played a role.)
> If these results are typical, it would seem that smoked mj may be the fastest way to lower bp without an injected med.
Maybe somebody can test this hypothesis by smoking a joint next time they find their blood pressure elevated. [in jest]
-eliz
Posted by Elizabeth on October 14, 2001, at 10:35:27
In reply to Re: how expensive » Elizabeth, posted by Neal on October 13, 2001, at 23:02:45
> How expensive is it.
Depends where you get it. I get 90 cartridges (of the Abbott generic, not Buprenex(R)) at a retail pharmacy for about $140. That's the lowest price I've gotten it for. I did get some Buprenex recently (pharmacy screwup), I'll dig up the receipt and see how much it was (same quantity, 90 ampuls).
-elizabeth
Posted by Lorraine on October 18, 2001, at 14:29:27
In reply to Re: hanging in there » Lorraine, posted by Elizabeth on October 10, 2001, at 13:28:50
Elizabeth:I thought you'd find this portion of an article of interest:
The FDA is preparing to approve a new medication for opiate addiction that won't be restricted this way. Buprenorphine is an unusual opiate - it has mixed effects on opioid receptors. At lower doses, it produces an opiate receptor-agonist effect like methadone; at high doses, it produces the opiate-blocking effects of naltrexone. Researchers say that at an agonist dose, most patients cannot distinguish it from methadone. (Interestingly, naltrexone is approved as a treatment for opiate addiction, but, because it doesn't provide the anxiety-reducing effects of opiate agonists, it is not as effective as methadone.)Congress has just passed legislation allowing any doctor with training in addictions to prescribe buprenorphine - addicts won't have to venture to ghetto areas or give up freedom to get it. And because it has antagonist effects if addicts try to take extra or use street drugs on top of it, it offers some satisfaction for those who want a drug to punish.
Here is the site:
http://news.bmn.com/hmsbeagle/91/notes/feature1
I just thought that it was interesting that at high doses bupe is an opiate blocker--I guess that is why my pdoc thought it was used with addicts.
Posted by shelliR on October 18, 2001, at 20:40:41
In reply to Re: Hi Judy » shelliR, posted by judy1 on October 11, 2001, at 18:29:08
> Hi Shelli,
> Actually I'm doing a little too well according to my shrink, but I'm not complaining. Went to the pain clinic to be watched like the good girl I am and to be tapered when I have to. I did ask you about DID, didn't know if that was your diagnosis, mine is dissociative disorders NOS. I was curious if that is your diagnosis, how long did it take was it obvious, etc. If not just ignore the last couple of sentences and have a great day- JudyHi Judy. I do have the same diagnosis as you. I have little kids inside but since I'm co-conscious with them, some therapists have put me in the DID category, others in DDNOS. I feel much more like DDNOS because there are so many ways that I don't have the same stresses as with MPD. My "kids" are always cooperative, don't come out unless they're allowed, and I don't find things that I don't know how they got in my house. In other words, the things that make DID so damn hard.
There was a long time that I knew there was one child inside, but all she would say is "I want my mommy". I don't remember exactly when that changed and she was a whole personality. I think the first time I was in the hospital. Then it was a big shock to have others inside--like how would I know who's talking to me, etc. But it all worked out, and the youngest have abreacted a lot of what happened to them. The eight year olds have not talked yet about what happened to them, except to say that it did happen. I don't focus on it a lot because I had a friend that only focused on memories and they never came to her--so I think when they're really they'll come out.
How did you come to diagnosed as DDNOS, instead of DID? Do you have different personalities inside? I guess you must have at least ego states, or you wouldn't be diagnosed.
I'm glad you are doing well. Is that why you went to the pain clinic--to be tapered down? Can they do that outpatient?
When are you due?Shelli
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