![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 31 to 55 of 101. Go back in thread:
Posted by not exactly on February 5, 2003, at 13:25:19
In reply to Re: Provigil » not exactly, posted by Stan on February 5, 2003, at 4:43:56
Stan,
Good questions. I'll try to answer them as well as I can. Sorry if this turns out to be more information than you wanted. :-)
> why were you reluctant to increase the provigil dosage in an attempt to recapture your initial good fortune with this med?
If I thought that the poop-out proved that I had not been at an effective level, and expected that a *single* dosage increment would reinstate the benefits *indefinitely*, then of course I would have done so. But I don't think that was the case. It was clearly an effective level at first, and even seemed "too much" at times. The poop-out was a tolerance effect, and my understanding of this (based on my readings and personal experience) is that chasing after the lost "high" only leads to a frustrating and dangerous spiral of repeated dose escalation. I did not want to become a Provigil "junkie". I figured I had given it a fair try, and it had failed to provide an ongoing benefit. Time to move on.
> also, you mentioned that you'd taken mirapex (with good results) during a clinical trial some years back, but you weren't specific about whether you had revisited it later on in life -- did you try it again, and if so, how did you make out the second time 'round? i'm guessing it pooped out on you since you're apparently not using it now.
Since Mirapex was not an option after the trial, I began a search for an effective substitute. Almost everything I tried was useless or worse. Eventually I settled on Wellbutrin + Ritalin, which actually worked rather well for an extended period with no sign of waning benefit. But it never lived up to my glorious memory of my pramipexole experience. So I anxiously awaited the approval and release of Mirapex. Once it became available, I immediated switched over to it, with mixed and overall disappointing results.
One of the problems was determining the right dose. The trial data had not yet been "unblinded", so I could not find out what my dose had been (trial participants were randomly assigned different dosage regimens). At first I was actually taking about 8 times (!) the optimal (for me) dose. When I finally adjusted to the appropriate level, the previous "overdose" exposure may have predisposed me for reduced benefit and premature tolerance effects. I continued on it for about a year, while its effectiveness slowly and imperceptably diminished until I finally realized that I was depressed again.
I could have gone back to the Wellbutrin/Ritalin combo, but instead I volunteered for another AD drug trial: the selegiline patch. It was "deja vu all over again" - dramatically positive results, return to depression after the trial, and a new "magic bullet" that was not available. Damn.
So now I know of 3 completely different drug treatments that have helped - all dopamine boosters, but by different mechanisms. I've been trying to use this knowledge to lead me to another "cure" that hopefully will combine effectiveness, freedom from troublesome side effects, enduring benefits, convience of administration, and low maintenance cost. A tall order, to say the least. But because I know that I have some acceptable (tho not optimal) fallback options, I'm willing to risk the quest. Kinda like rock climbing - you drive in a piton and climb a little higher, reassured by the expectation that a fall won't be fatal.
I recently started desipramine - so far so good. Augmenting with Ritalin or BuSpar (the dopamine thing again) are possible strategies if monotherapy proves disappointing. I'll report on my progress once it fully kicks in.
- Bob
Posted by LAURA777 on February 5, 2003, at 15:50:49
In reply to Re: Provigil / Mirapex » Stan, posted by not exactly on February 5, 2003, at 13:25:19
Hey bob, i have been doing alot of research , and it seems to me my most basic problem is dopamine in the mesolimbic system , i have been reading and it seems some of us have a genetic error of reduction of the d2 receptors in the nucleus accumbens .. people who have this sooner or later become incapable to obtain gratification from the common pleasure of life ..
i further looked into it and found out of tests they did with the nucleus accumbens reguarding reward / punishment , and while the nucleus accumbens lit up or showed more activity when reward was anticipated it did not light up when punishment was atticipated , the medial caudate showed activity with punishment as well as reward too ..
this all meaning that positive and negitive feelings do not emulate from the same places in the brain .. because i can feel the negitive feelings like sad , boredom , ect ect. but when it comes to feeling pleasure anticipation exuberation , fun, these things are muted blunted .. have been for quite some time .. no interest and such ... people who are deficient in this area usually take up atypical and noxious pleasure .. impulsive gambling alcohol and drugs , eating excessive sweet foods , (i used to eat a ton when i was a kid ) alcoholism runs in my family as well as drug abuse...
i have taken up reading and working out my frontal lobe quite alot ... but this dampens too just like every addiction or diversion does ..
i need the other half of life !!!! the other half of emotions .. ya know .. anticipation stimulates motivation .. the menial tasks in my life are so much harder to do at times because i have nothing to temper it with .. am i explaining this right ???
i know this is responsible because of other culminating factors (this post would be too long}i know why people drink and take drugs , it is absolutly misrable in this state ..Unfortunately the path of addiction is also extremely painful and intolerable ... so what is one left to do ..
why do they not make a good dopaminergic damn it !!!!!! you see serotonin and nuroepinephrine where is the dopamine ???????? this is a real malady !!! you can pile on tons of ssris snris and whatever the hell , i know that i need dopamine .. i don't want to go supper high and i do not want to stay in the grey .. i want to cry .. anyone out there give me a hand !!!
i know the stimulants increase dopamine right where i need it .. but how does that work for a solution ??? do you build tolerance ?? what are the worse side effects ?? also from what i am reading about stimulants is that they are like MOAI's ... let me know , thanks in abundance and with gratefulness , laura
Posted by jumpy on February 5, 2003, at 17:43:36
In reply to Re: Provigil / Mirapex » Stan, posted by not exactly on February 5, 2003, at 13:25:19
Hey Bob,
Mirapex is availible in most countries for parkinson's disease ... I am surprised you are not able to find it. Also, if the selegiline patch worked for you ... why not try the standard oral preparation? Most people who responded to the patch switch to the oral tablets after the study. And if you need dopamine, go get your self some parnate at least. Lots of luck, hope your well soon.
Jumpy
Posted by PuraVida on February 5, 2003, at 17:58:46
In reply to Re: Provigil / Mirapex The Dopamine Thing » not exactly, posted by LAURA777 on February 5, 2003, at 15:50:49
Hi Laura,
I am just revisiting the boards after a long time away looking for info/ideas on my current new state of apathy. Not that I'm depressed, at least, not according to how depression usually feels for me. It is more of a numbness, a nothingness - the negativeness of my typical depression isn't present. I too find myself just bored to death, and there is so much that I really should be doing. I know somewhere in my mind that the real me should want to be doing it! Yet, unlike typical depression, the "shoulds" don't cause a bit of concern for me at all - I just sleep, procrastinate, or enjoy my favorite hobby of late, drinking to pass the evenings away. This is fairly new for me, having had all episodes of depression so far and more recently anxiety, which has caused me to go on Topomax for mood stabilization. I actually don't mind it as much as the other states, but its not right, either, as I am normnally a very active, social, enthusiastic person. Especially that I need to self-medicate with alcohol to get myself motivated about anything at all.
Good thing is that there is a bit of motivation on both our parts to be here. Your post reminded me of a book I've enjoyed called Natural Prozac by Joel Robertson - I've posted about it before. He talks about two different types of depression - arousal and satiation, and how levels of serotonin, dopamine and norepinephrine get imbalanced. He suggests Wellbutrin, amphetamines and Ritalin as potential medications for low dopamine levels, as well as a host of natural remedies including high protien diets and strenuous exercise.
Anyhow, thanks for making me think a bit more on how to get myself unstuck...and best wishes -
Posted by PuraVida on February 5, 2003, at 18:14:20
In reply to The Dopamine Thing » LAURA777, posted by PuraVida on February 5, 2003, at 17:58:46
BTW, I just switched back to 20 mgs of Prozac from Serzone, which pooped. The Prozac took me right out of my wallowing self-pity depression, but now I've got the apathy and lack of motivation. Just read a post about a new drug called Abilify? Going to check it out...
Posted by jonh kimble on February 5, 2003, at 21:02:59
In reply to Re: The Dopamine Thing, posted by PuraVida on February 5, 2003, at 18:14:20
I didnt realize how many anhedonics there were hear. Thats great! (dont take that the wrong way) Alot of interesting stuff here. Pura vida, your description is very accurate. Ive always had a tough time explaining how I feel, but that is so close to it.
Dopamine in the mesolimbic system is certainly a primo target for this sort of thing. D2 but also D3 receptors have the biggest implication in this sort of thing. Abilify sounds great as it really has multiple DA enhancing effects but it is new so you wont here all that much and it is very expensive from what I here. But I think our lives are worth it:) Tom
Posted by not exactly on February 6, 2003, at 3:50:14
In reply to Mirapex/Selegiline/Parnate » not exactly, posted by jumpy on February 5, 2003, at 17:43:36
> Mirapex is availible in most countries for parkinson's disease ... I am surprised you are not able to find it.
I couldn't get it right after the trial (about 7 years ago) because it hadn't been approved yet. I *was* able to get it a couple of years later. I explained all this in a previous post [http://www.dr-bob.org/babble/20030204/msgs/139600.html].
> Also, if the selegiline patch worked for you ... why not try the standard oral preparation?
I did. For about a year. But it never worked as well. When selegiline is taken orally, the metabolic pathways are somewhat different, and hence the plasma levels of active metabolites end up at different ratios. So the overall effect is not exactly the same. Also, you need to take such a large dose orally that the MAOI diet is mandatory (which I found to be a big disadvantage). Cheese-safe levels of oral selegiline aren't effective as an AD.
> And if you need dopamine, go get your self some parnate at least.
Parnate is near the top of my "to be tried" list, but I'm not looking forward to the MAOI diet restrictions. How can I live without pepperoni pizza? :-(
- Bob
Posted by LAURA777 on February 6, 2003, at 7:33:39
In reply to Re: Mirapex/Selegiline/Parnate » jumpy, posted by not exactly on February 6, 2003, at 3:50:14
hi bob , can you read this post , i do not know if you saw it .. also my question to you is , did the stimulants like ritalin and dexadrine make you feel like you were coming down from cocaine , what i mean to say is was it similar to the uncomfortable feelings you get with cocaine ?? let me know , thanks laura
here is the post too
http://www.dr-bob.org/babble/20030204/msgs/139623.html
Posted by not exactly on February 6, 2003, at 16:32:20
In reply to Re: Mirapex/Selegiline/Parnate » not exactly, posted by LAURA777 on February 6, 2003, at 7:33:39
Laura,
Yes, I saw your other post about anhedonia & dopamine [http://www.dr-bob.org/babble/20030204/msgs/139623.html] and I've been thinking about what you said - more on that topic later.
> did the stimulants like ritalin and dexadrine make you feel like you were coming down from cocaine , what i mean to say is was it similar to the uncomfortable feelings you get with cocaine ??
I have generally responded quite well to Ritalin and amphetamines. But I'm very sensitive to them, and the optimal dose for me is extremely small - 1 or 2 mg (far less than the smallest pill made), once or twice a day. At this effective level, they give me mild mood-boosting effects, and help dramatically with motivation, focus, and, yes, anhedonia (which, after thinking about your previous post, I'm coming to believe may well be the root cause of the mood, motivation, and focus problems). Side effects are virtually absent. Anxiety is not worsened, and sometimes it's reduced. The let-down is gradual & gentle, with no significant rebound effect. If I take my daily dose(s) early in the day, by bedtime I feel a bit drowsy (in a normal, healthy way) and sleep well. I set the alarm 1/2 hr. early and keep the morning dose ready by the bedside. When the alarm goes off, I'm a zombie (but getting up in the morning has always been like this, with or without stimulants), so I take my stim dose and go back to sleep. 30 minutes later I awake refreshed and ready to face the day. Used in this very conservative style, I find the benefits to be sustainable for months with no significant tolerance or "poop-out" effect. By themselves, stimulants are no substitute for an antidepressant, but they are a valuable adjunct.
However, if I take the kind of dose that most folks do - 5, 10, or more mg at a time - it makes me manic, anxious, and "hyper" (almost as unpleasant as cocaine, but discernably different), and afterwards I crash like a rock. Repetions of this roller-coaster ride cause tolerance to build rapidly.
Of course, YMMV, but I wonder if the reason many folks say they can't tolerate stimulants (including anhedonic low-dopamine folks who theoretically should benefit from them) is because they are actually taking far too much.
BTW, MAOIs are very different from stimulants in terms of benefits, side effects, duration, and underlying mechanism. My exposure to MAOIs is limited to selegiline, both at low oral doses, when it inhibits only MAO-B, and as a patch, when it acts like a general MAOI AD. Selegiline helped, but my subjective experience was not at all like with the stims.
Hope this helps. I'd be happy to discuss any aspect of these topics in more depth if you (or anyone else) is interested.
- Bob
Posted by LAURA777 on February 6, 2003, at 19:21:52
In reply to Re: stimulants / anhedonia » LAURA777, posted by not exactly on February 6, 2003, at 16:32:20
Hey bob , i found out incredible things today ..first i have high norepinephrine . this is know because my metabolism is very fast . i remain skinny although i eat .. i have energy but the anhedonia makes me tired because of the boredom and the fact that there is no temperance with the pleasant emotions .. initially i was put on prozac because of my excess energy .. i am not add nor am i adhd .. it is just in my natural state i am revved up ..go go go gota go ..The ssris have done a good job with this , it has put my noreprinephrine in check .. but i am still very sensitive to stimulants , i can not take cold meds with psedoephedrine , i feel horrid both emotional like the coke thing smaller scale and physcally .. Provigil is way too much for me .. it gives me energy , but nervous useless energy.. physically i do not feel well either , and this is due to the norepinephrine i have already .. this neurotransmitter is responsible for energy , metabolisim .. people who have fast metabolisim have lots of norepinephrine .. another proof of this is at the dental office when they give you novicaine they add what is called epinephrine .. it prolongs the novicaine effect , when i get this my heart pounds in my chest i shake and i get halos in my vision similar to migraine auras ...it is a scary thing ... my mother is also reactive this way to epinephrine ... these substances are all related .. i looked it up .. ephedrine and psuedoehedrine act of norepinephrine in our brains ,, ehedrine being a natural substance in herbs can cause very bad effects in a normal person .. it speeds up heart rate because it acctivates norepinephrine as does psuedoephdrine ..epinephrine and norepi act in conjuction , that is why you hear on emergency room shows when someones heart stops they say give me a vial of epi .... i have never coralated this before in my life with such clarity as i surfed the net .. that is why when they gave me effexor i had a bad reaction same goes for the wellbutrin .... none of these meds touch the dopamine , and as far as effecting dopamine levels inadvertantly it is not enough , i do not think alot of people have a dopamine deficit , hence the 70 percent response to ssri and snris when treating depression soley .. here is an interesting read the link is below ..
http://www.acnp.org/g4/GN401000093/CH.html
this is a good read because in mania dopamine is at a high in the brain . same with schiz when they are in the wild end .. antipsychotics reverse this .. so much so with schiz that they get severe apathy and anhedonia .. what makes me laugh is that i read a study involving depressives and schiz depressives .. the depressives measured very low on the serotonin scale . they measure this by some by product produced from the sero .. any way the measured the schiz depressives and the had high levels of sero .. that thought this strange .. i had to laugh .. how could they not see !! if you take away dopamine because of adverse schiz states serotonin is going to increase .. but lack of dopamine causes this negitive state of schiz , i guess that is why afiliby is a better treatment for them ...the upshot of all this is that dopamine is essential and not to be discarded for study as was previously thought ... noro and sero are not the end all for the depressive . they have to develop a good dopaminergic that targets the area of the mesolimbic , and i also think they need to investigate the opiates and created better drugs like buprenorphine .. i mean we use snake venom for anti venom .. i know if they put some time into it they could do this , it is just that profits are important and when you are talking opiate there is a massive amount of buearocratical bullshit .. sorry about the spelling .. read alot but still can't spell ..
so what do you think bob ??? if you would like to read further on the net . put in a search with nucleus accumbens dopamine .. mesolimbic system dopamine .. give me your thoughts .. thanks much ..laura
Posted by LAURA777 on February 6, 2003, at 22:29:54
In reply to Re: stimulants / anhedonia » not exactly, posted by LAURA777 on February 6, 2003, at 19:21:52
hey bob i made an error in the above post about antipsycohtic meds , i still am learning , there is so so much to learn .. anyway anyone out there .. please educate me when i post wrong info .. i would appreciate it , thanks laura
Posted by jumpy on February 6, 2003, at 23:18:34
In reply to Re: Mirapex/Selegiline/Parnate » jumpy, posted by not exactly on February 6, 2003, at 3:50:14
> I couldn't get it right after the trial (about 7 years ago) because it hadn't been approved yet. I *was* able to get it a couple of years later. I explained all this in a previous post [http://www.dr-bob.org/babble/20030204/msgs/139600.html].
Sorry, I didn't have time to read every post
> I did. For about a year. But it never worked as well. When selegiline is taken orally, the metabolic pathways are somewhat different, and hence the plasma levels of active metabolites end up at different ratios. So the overall effect is not exactly the same. Also, you need to take such a large dose orally that the MAOI diet is mandatory (which I found to be a big disadvantage). Cheese-safe levels of oral selegiline aren't effective as an AD.
True, people end up takeing anywhere from 20 to 50 mg of selegiline in the oral preparation and one does have to adhere to the diet. I haven't heard of people having difficulties with the switch from the patch to the pill and problems with the metabolite "ratios". Sorry to hear you were one of the few with this reaction.
> Parnate is near the top of my "to be tried" list, but I'm not looking forward to the MAOI diet restrictions. How can I live without pepperoni pizza? :-(
Actually, the diet is pretty healthy and easy to follow. No sausage, cheese, certain wines and beers ... they all add to a slimmer waistline and healthier heart. I would for go 1,000,000 pepperoni pizzas *and* the pitcher of beer that follows to find some relief from my depression. But if pizza mean that much to you, I guess your stuck. :-(
Good Luck
Keep us posted
Jumpy
Posted by missinglynxx on February 6, 2003, at 23:43:15
In reply to bob not exactly made an error in above post, posted by LAURA777 on February 6, 2003, at 22:29:54
be fantastic Good Luck with it.. WHat exactly did they give you Laura?
Posted by LAURA777 on February 7, 2003, at 1:15:53
In reply to Crosses Fingers that Lauras new medication will , posted by missinglynxx on February 6, 2003, at 23:43:15
hey mike they gave me provigil and it is a no no for me .. very bad , i can not take stimulants . i explained it in this post ..
http://www.dr-bob.org/babble/20030204/msgs/139866.html
be well and you be happy too!!!
Posted by not exactly on February 7, 2003, at 16:30:40
In reply to Re: Mirapex/Selegiline/Parnate » not exactly, posted by jumpy on February 6, 2003, at 23:18:34
> I haven't heard of people having difficulties with the switch from the patch to the pill and problems with the metabolite "ratios". Sorry to hear you were one of the few with this reaction.
Orally-administered selegiline results in significant exposure to numerous active metabolites, including l-amphetamine and l-methamphetamine. At the dosages required to induce robust MAO inhibition (MAO-A as well as B), these metabolites can dramatically alter the side effects and overall experience of selegiline, especially for those individuals (such as myself) who are highly sensitive to sympathomimetics. The selegiline patch avoids most of these problems by circumventing first-pass gut metabolism.
see:
http://www.nimh.nih.gov/ncdeu/abstracts2001/ncdeu2011.cfm
http://www.parkinson.org/med25.htm> Actually, the diet is pretty healthy and easy to follow. No sausage, cheese, certain wines and beers ... they all add to a slimmer waistline and healthier heart.
The MAOI diet might be easy for some folks, but for me it would mean a radical change in lifestyle. I live on cheeseburgers, chocolate candy, and other junk food. I eat in ethnic restaurants where the menu items don't list all the ingredients and the servers don't speak much English. I go to potluck dinner parties. Cheese, soy sauce, aged meats, and other tasty tyramine tidbits could be lurking anywhere.
Before you try to tell me that I'd be much better off with a different diet, let me point out that I'm slim, fit, and quite healthy. I have low cholesterol and normal blood pressure. Even though I'm 56, most people think I'm in my 30's, especially if they've seen me dance non-stop for hours or trot up a steep mountain trail. I'm in fine physical shape despite (or perhaps because of) my "terrible" diet. My pcp is impressed - claims I have "good genes".
> if pizza mean that much to you, I guess your stuck. :-(
My comment about "How can I live without pepperoni pizza?" was mostly meant as a joke, but it is true that I really love pepperoni pizza - it's one of the few joys in my pleasure-starved anhedonic existence. Probably more than half of my favorite foods contain dangerous amounts of tyrosine. But my hesitancy to try MAOI meds is not because I'm reluctant to deprive myself, it's because I'm concerned about the irreversible side effect known as "accidental death".
I'm sure I'll try a "real" MAOI like Parnate eventually. My intellectual curiosity and my need to "leave no stone unturned" will ultimately be stronger motivating factors than my quest for better mental health (which is too often impeded by my pervasive "why bother" attitude). But it will be a daring and scary step.
- Bob
Posted by missinglynxx on February 7, 2003, at 17:36:27
In reply to Re: Mirapex/Selegiline/Parnate » jumpy, posted by not exactly on February 7, 2003, at 16:30:40
Bob.. would you be unable to Eat Szechwan FOOD on the Parnate, that would Really SUCK... ( I cant live with Szechwan)Cant you drink White wine tho
And cant you eat NON aged,,,Monterry Jack type cheese for those cravings you get. or Mozarella Cheese? Just curious.. GOOD Luck
How have you done on Nortriptyline?
Posted by LAURA777 on February 7, 2003, at 19:11:35
In reply to Re: Mirapex/Selegiline/Parnate » jumpy, posted by not exactly on February 7, 2003, at 16:30:40
Hi Bob , it sounds like you have a fast metabolism too ,, are you also sensitive to ephedrine products in cold meds ?? i do not know if you read my post but the provigil sent me flying .. yuk , the doc gave me 200 mg. i took one at 10.00 am and was up to 3.00 am , and the day before i took one at 8.00 am and stayed up till 3.00 am . i felt miserable physically and emotionally , nervous energy .. needless to say i will not take anymore .. also i could not eat at all .
i read somewhere that tyrosine converts to dopa then dopa converts to dopamine ,then dopamine to norepinephrine then to epinephrine . i have also read that if you have a fast metabolisim that you have plenty norepinephrine .. if that is the case . where is my dopamine ???
when you go to the dentist does epinephrine bother you in the novicaine , do you get a reaction ..
i do hope that i can find a solution because i am miserable .Bob what is responsible for motivation and interest , i get conflicting reports when i read , some say it is norepinephrine some say dopamine .
Also do you think the mesolimbic system is responsible for anhedonia ?? do you think a deficiency in opiods is responsible too ..??
What do people do ?? i can't bear to think i have to be like this till i die ..
bupenorphrine is something i would like to try . because of the positive feelings i had with percocet and vicodin ..
i think my energy level is fine , it is the boredom that sends me to sleep , and it is hard to wake in the mornings cause i know what is ahead of me . more boredom .. and the endless push .. and because i have to push i get tired.. this routine would sap anyones energy .
i see alot of links that link cocaine abuse to anhedonia . and i also see also of links about drug/alcohol abuse in general causing anhedonia , and they also say it is prexisting genetics .
i have also read that constant stress raises our level of norepinephrine fight or flight and if we get enough stress for too long are endorphins become no longer able to work .. hence blunted feelings like post tramatic stress disorder ..
do you think having constant high levels of norepinephrine all through the years of your life cause this also ??? please let me hear what you have to say on many of my questions , i do thank you for you time ,laura
Posted by LAURA777 on February 7, 2003, at 19:48:30
In reply to Re: Mirapex/Selegiline/Parnate » jumpy, posted by not exactly on February 7, 2003, at 16:30:40
do you think that all the sensitivity to the stimulants is because of lots of norepinephrine ? is that what highly sensitive to sympathomimetics means ?? being senstive to stimulants ,, because if that is what it means then i am this also with out a doubt .. please let me know , laura
Posted by not exactly on February 7, 2003, at 20:00:49
In reply to Re: Mirapex/Selegiline/Parnate » not exactly, posted by missinglynxx on February 7, 2003, at 17:36:27
> would you be unable to Eat Szechwan FOOD on the Parnate
Yes, I fear that Szechwan food would be risky because it often contains soy sauce. That's a common ingredient in most oriental cuisines. Worse yet, Thai food (my favorite) often contains fish sauce. I've never seen fish sauce on a list of MAOI taboos, but since it's made from fermented anchovies, I bet it's chock full of tyramine. Italian & Mexican are of course loaded with cheese. Indian food might be OK, but nobody knows what's in those curries.
> Cant you drink White wine
White wine is safer than red, but I MUCH prefer red. I'll just stick with water, which is my favorite beverage anyway.
> And cant you eat NON aged,,,Monterry Jack type cheese for those cravings you get. or Mozarella Cheese?
Non-aged cheeses are OK, but a poor substitute for the sharp-tasting (and highly fatal) varieties.
> How have you done on Nortriptyline?
Thanks for asking. I'm on desipramine, actually (I guess they're pretty similar). It's been a week, and so far the improvement has been subtle. My mood & concentration are somewhat improved, but so far it hasn't noticably helped with procrastination or anhedonia. At least the side effects haven't been a problem - very minimal and already abating. Each day it's a little better - encouraging.
- Bob
Posted by not exactly on February 7, 2003, at 21:57:48
In reply to hey bob can you give me some info !!! » not exactly, posted by LAURA777 on February 7, 2003, at 19:11:35
Laura,
> it sounds like you have a fast metabolism too
I guess I must. I can eat like a horse and still fit into size 30 jeans.
> are you also sensitive to ephedrine products in cold meds ?
Definitely. They work fine for me as long as I make sure I don't take any more than 1/4 the recommended dose.
> provigil sent me flying .. yuk , the doc gave me 200 mg
I've never dared to take 200mg at once. 50 mg b.i.d. worked well for me.
> i read somewhere that tyrosine converts to dopa then dopa converts to dopamine ,then dopamine to norepinephrine then to epinephrine
Sounds right. BTW, you left out the first step - phenylalanine (much more common in food than tyrosine) gets converted to tyrosine. Don't forget that enzymes and cofactors are needed to make each conversion happen, so if there's a deficiency anywhere, it's like closing a valve. Conversely, an overactive enzyme can deplete the precursors. This is an oversimplification, but you get the idea.
> i have also read that if you have a fast metabolisim that you have plenty norepinephrine
Perhaps. That's no doubt an oversimplification too.
> if that is the case . where is my dopamine ???
One possibility is an overzealous enzyme that's converting every bit of dopamine it can find into norepinephrine. But I'm sure there are numerous other possible explanations.
In some cases, there's enough dopamine, but a deficiency of neurons that respond to it. This happens in the later stages of Parkinson's Disease, for example.
> when you go to the dentist does epinephrine bother you in the novicaine , do you get a reaction ..
Hard to say. Epinephrine, as you may know, is just another word for adrenaline. When the dentist turns on the damn drill, I probably generate plenty of my own.
> what is responsible for motivation and interest , i get conflicting reports when i read , some say it is norepinephrine some say dopamine.
My simplistic understanding is that motivation/drive is mediated by norepinephrine, pleasure/reward is mediated by dopamine, and satisfaction/joy is mediated by serotonin. "Interest" is a more complex emotion that probably needs all 3 working together.
> Also do you think the mesolimbic system is responsible for anhedonia ?? do you think a deficiency in opiods is responsible too ..??
Can't say. Now you're moving away from my area of expertise. I understand the chemistry, but you've probably researched brain structure/function much more than I have.
> What do people do ?? i can't bear to think i have to be like this till i die ..
Unfortunately, "trial and error" seems to be the state of the art. You need to be persistent, reflective, insightful, and patient. Having a good pdoc and good health insurance helps too.
> i see alot of links that link cocaine abuse to anhedonia . and i also see also of links about drug/alcohol abuse in general causing anhedonia , and they also say it is prexisting genetics .
> i have also read that constant stress raises our level of norepinephrine fight or flight and if we get enough stress for too long are endorphins become no longer able to work .. hence blunted feelings like post tramatic stress disorder ..
> do you think having constant high levels of norepinephrine all through the years of your life cause this also ???Stress (of various types) can lead to depletion of certain neurotransmitters. This can diminish one's ability to cope with the stress, thereby amplifying the effect of the stress and causing a vicious cycle.
> do you think that all the sensitivity to the stimulants is because of lots of norepinephrine ? is that what highly sensitive to sympathomimetics means ?? being senstive to stimulants
Sympathomimetics are agents which act like the body's natural hormones (specifically epinephrine and norepinephrine) that stimulate the sympathetic nervous system. Sympathomimetics are therefore (directly or indirectly) stimulants, and most meds which are called "stimulants" are in fact sympathomimetics. But there are exceptions. Provigil and caffeine are certainly stimulants, but they are not true sympathomimetics.
However, hypersensitivity to stimulants is very different from "having too much norepinephrine". The sensitivity simply means that a small amount of a stimulant has a big effect. High norepinephrine levels wouldn't cause this sensitivity, but might possibly be a result of it.
I am extremely sensitive to stimulants, but I think my norepinephrine levels are if anything too low. I say this because meds which are known to increase norepinephrine, such as amphetamines, Wellbutrin, and desipramine, have a positive effect on me.
But I may be just as confused about what all this really means as the next guy. Like you, I read a lot, and try to put it all together in a way that makes sense. But we're all just groping around in the dark. When we find something that works (a drug, a belief, an activity), we stick with it until it fails us. Then we move on.
- Bob
PS: I really enjoy your questions and theories. It's given me a lot to think about and respond to.
Posted by fachad on February 7, 2003, at 22:22:34
In reply to Re: stimulants / anhedonia » not exactly, posted by LAURA777 on February 6, 2003, at 19:21:52
Laura777,
Have you or your pdoc ever considered that you might be bipolar, and that your primary symptoms are actually a manifestation of dysphoric hypomania?
I only ask because of your description of your state as both high energy and unpleasant. Also to me (a very lethargic low energy person) the style of your posts seem to be like descriptions I have read of bit pressured speech.
Here is the link:
http://bipolar.about.com/library/blmisc/bl-faq-presspeech.htm
I hope that my suggesting this possibility does not offend you. It's just an observation, and all I have to go on is your posts. I'm just throwing it out as a possibility to consider.
Posted by fachad on February 7, 2003, at 22:39:28
In reply to ADHEDONIA QUESTIONS ?? please read , posted by LAURA777 on February 2, 2003, at 16:53:01
I can't find the message where you said that you cannot tolerate pseudoephedrine, but I just wanted to throw in that I can't live without it. I can't breathe because of nasal congestion, and I consequently feel all around horrible.
I've been taking it regularly for as long as I can remember, long before any psych meds. I considered not trying Ritalin 10 years ago because my pdoc told me not to take Sudafed with it!
I ended up trying the Ritalin, and then cautiously adding back the Sudafed, monitoring my BP. My BP remained low, even on both.
It turns out that with Dextrostat and Sudafed combined, for the first time in my life I have enough sympathetic tone to be able to stand up quickly without passing out! woohoo!
Posted by LAURA777 on February 8, 2003, at 6:24:25
In reply to dysphoric hypomania? » LAURA777, posted by fachad on February 7, 2003, at 22:22:34
Hi fachad , no i am not at all offended , My sister has bipolor.. i have also looked up dysphoric bipolor , it is all very interesting ..
i do not think i have this for many reasons ..
i have never suffered from insomnia .. This for which i am very grateful .. i am very sensitive to stimulants , very , and the posts from feb. 5 and the 6th , i had taken provigil 200mg and i was flying .. so my writing may have been a little less ordered ..
all my life i have been discribed as hyper .. lots of energy .. prozac has changed this for me.. so the "push gota go gota go " has practically disappeared .. i used to think that i was adhd .. but i am able to sit and read for hours .. even prior to prozac ... plus i am not that irratible , no more that ordinary and i don't get pms ..
i have also been seeing a therapist for 3 years and i think he would have seen this in me if it were a diagnosis .... ( just in case i am in denial)
My theory is that my brain or body converts all my dopamine very quickly into norepinephrine .. this is very simplistic and i need to look into it .. i enjoy your posts by the way , and i see that you like philosophy , i do too .. can you tell me about the philosophy that you mentioned in previous posts ??? thanks , laura
Posted by LAURA777 on February 8, 2003, at 7:20:49
In reply to Re: hey bob can you give me some info » LAURA777, posted by not exactly on February 7, 2003, at 21:57:48
> I guess I must. I can eat like a horse and still fit into size 30 jeans.
hey Bob you have a fast metabolisim
I have a theory , First let me say that when i go to the dentist , i get a very bad reaction to the epinephrine , my heart starts to pound , i shake , tremors , and i get halos in my vision like migraine auras ...
Now to my theory , When i did cocaine , the pleasure or so called euphoria was very short acting for me .. i went straight to the crappy feeling faster than most people from what i can observe .. do you think that my brain converts dopamine right to norepinephrine .. i remeber in a previous post you had mentioned that cocaine has little to do with NE .. i disagree .. the stimulant effect is directly related to NE .. don't you think ..
Heres something else.. when most people do opiates they get sedated .. I do not . i am awake , but it is pleasant , not like on stimulants , the only reason i can account for this is the opiate (endorphin) property of this drug .. like a good balance .. to further this , when opiates are taken, they shut up the fight of flight chemicals . it lowers the Ne .. While on Heroin there is no stress .. to even go further .. When withdrawling from heroin the NE goes why up .. hence the leg twitches diarhea , cramps , elevated blood pressure , anxious , irritable, sort of like being on stimulants ..They know that the body acts as if in fight or flight ...as you may know they give people clonidine to help smooth these reactions ..As you know Ne regulates blood pressure ,metabolism , energy level ..what if someone has a dysfuction of Ne , meaning the dopamine is eaten up to NE and as a result the person may on a low level, but constant , expierience fight of flight anxiousness ....resulting in a dysfunction of the endorphins not workinng like they are supposed too . i correlate this with what they know about post tramatic stress syndrome .. please give me your thoughts on this .. it is my theory that i have a depleation in dopamine as well as endorphins .. thanks laura
Posted by JaneB on February 8, 2003, at 7:26:04
In reply to Psuedoephedrine is My Most Important Med » LAURA777, posted by fachad on February 7, 2003, at 22:39:28
> I can't find the message where you said that you cannot tolerate pseudoephedrine, but I just wanted to throw in that I can't live without it. I can't breathe because of nasal congestion, and I consequently feel all around horrible.
>
> I've been taking it regularly for as long as I can remember, long before any psych meds. I considered not trying Ritalin 10 years ago because my pdoc told me not to take Sudafed with it!Interesting! Have you tried other allergy meds? I tried 3 and they made me lethargic,etc.
>
> I ended up trying the Ritalin, and then cautiously adding back the Sudafed, monitoring my BP. My BP remained low, even on both.What brand/dosage of Sudafed do you take? Does it interfere with your sleep? I can't remember what other meds you are taking. Could you remind me. My BP remains low and without the Sudafed I get dizzy sometimes from just bending over. A little annoying when doing many work and pleasure activities!
If I don't take Sudafed I invariably wake up with a headache.
>
> It turns out that with Dextrostat and Sudafed combined, for the first time in my life I have enough sympathetic tone to be able to stand up quickly without passing out! woohoo!
>
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