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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Arias on May 15, 2000, at 15:21:08
Hello all,
Have been reading the bulletins for a couple of months now, thankful for this site.
I seek now your collective advice and experience...
Dx with anxiety/major depression. Happy on wellbutrin but had a grand mal seizure in jan/00 and since then, have tried various AD's including Celexa, Zoloft, Serzone, and now coming off of Effexor XR 75 mg once a day. Small but significant side effects of sedation, and anorgasmia, even with 37.5 mg/day. Did not recede with time. Now undergoing the seemingly prerequisite withdrawal sx of GI distress, nausea, and nightmares, including one of a paraplegic homicidal dwarf. In short, i'm miserable. Spoke with psych doc, she said that this was in my head, that the side effects were non-existent and that the anorgasmia was "not an issue because you're not married and because what you have with your boyfriend is casual." (exact words)
so my questions are these:
1. what to do about this effexor withdrawal? I read about the prozac, and the ondansetron---has anyone ever tried st john's wort?
2. a new drug? i'm a bit tired of trying these drugs, but then again, not doing well without one.
3. is there any such thing asa good psychiatrist? no offense dr. bob--i'm still reeling from my bad experience. my current psych doc was little more than a pill pusher, frankly. not to mention incompetent.
thanks all, best wishes.
Posted by Mark H. on May 15, 2000, at 18:00:42
In reply to A cliched subject, now mine, posted by Arias on May 15, 2000, at 15:21:08
Dear Arias,
Obviously, I've grown very comfortable with this group of people in Babble-land, because I'm willing to ask the seemingly stupidest of questions without embarrassment.
Truly, I hope someone can tell me why having a seizure is a "good" thing if it's induced in a hospital and produced by application of direct current under general anaesthesia (surely one of the crudest tools in our box of depression remedies), but a "very bad" thing if it's produced by an anti-depressant, EVEN WHEN THE PATIENT (you, in this case) EXPERIENCES MARKED IMPROVEMENT?
Let's assume you don't drive, for the moment, when under the influence of prescription drugs, and that you don't operate heavy equipment or fly commercial jetliners for a living.
My question is about the seizure itself, not about the impact of a seizure on others or the environment. The author of Toxic Psychiatry, whose writings I take with a HUGE grain of salt, claims that seizures physically damage the brain, and that any "anti-depressant" effect is simply the body's normal production of endorphins and euphoria in response to head injury.
How do the proponents of ECT answer this claim?
I have long longed for an easy, limited way to give myself a seizure, short of electrocuting myself. What would be wrong with developing a drug that gave a short, predictable seizure as needed, taken at bedtime? Might something less than a full-body reaction give anti-depressant results? I'm passingly familiar with the work being done with magnetic currents, but the effects so far are very short-lived and return to depression almost guaranteed in refractive cases (the only cases it is being used on last time I checked).
At the core of this is this basic question: is having a seizure a bad thing in itself or not?
Best wishes,
Mark H.
Posted by AndrewB on May 15, 2000, at 18:15:46
In reply to A cliched subject, now mine, posted by Arias on May 15, 2000, at 15:21:08
I would think that if you benefited from Wellbutrin that you would benefit from similar medicines. Wellbutrin seems to have mostly norepinephrine action, so a drug like reboxetine may benefit you. But it would be easier to tell if this might be the case if you tell us in which ways Wellbutrin made you better off.
Another strategy would be to augment Effexor to counteract the side effects. A stimulant is one example of an augmenting agent. Read Dr. Bob's tips (i.e. SSRI sexual dysfunction) for more ideas.
Also make sure you look at Dr. Bob's Tips under 'Antidepressant discontinuation reactions'. There is story after story of people having troublesome withdrawals from Effexor as well as some tips for dealing with it.
He said sex isn't important in a casual relationship? I think sex is important, whomever I am screwing to get it! Some psychiatrists think money is important, whomever they are screwing with to get it.
AndrewB
Posted by Rebecca on May 15, 2000, at 19:00:20
In reply to Re: What's Wrong with Having a Seizure???, posted by Mark H. on May 15, 2000, at 18:00:42
to add to Mark H.'s questions, are there long-term effects of having seizures?
I had a series of seizures as a newborn, and after getting shipped to another hospital, they sent me home when they couldn't find a cause and I hadn't had any for a few days. At the time, the doctors didn't know if there was any brain damage. I haven't had any seizures since then and have turned out too smart for my own good, but I wonder from time to time if something did happen that affects my mental health.
Posted by bob on May 15, 2000, at 20:38:45
In reply to A cliched subject, now mine, posted by Arias on May 15, 2000, at 15:21:08
Paraplegic homicidal dwarves, huh? Well, at least you still have your imagination. ;^)
> Spoke with psych doc, she said that this was in my head, that the side effects were non-existent and that the anorgasmia was "not an issue because you're not married and because what you have with your boyfriend is casual."
Tell her she's right, the side effects are in your head because that's exactly where your brain is located. I wonder how she knows that anorgasmia shouldn't be an issue ....
Anyway, sometimes its best to let pdocs be "pill pushers" and leave your therapy to a psychologist or social worker. Some folks here have found psychiatrists who can do both well (so yes, there must be some "good" psychiatrists out there), but I prefer to keep mine separate. If anything, my therapist is always willing to look towards non-medical solutions and answers instead of jumping right to a different drug or something like that. She recognizes their values, but understands their limitations.
Anyway, wrt a new drug -- many of us here (me, for one) who have had difficulty responding to SSRIs or any of the newer wonder drugs have had some success with TCAs. Nortriptyline and desipramine are two good choices -- they work pretty well compared to others in the class and they have the least nasty side effects of the lot. Only side effect I've ever had from either was some sedation which went away after a few weeks. (Finally got lucky with something.)
Definitely check into the other stuff on the Dr. Bob site ... print it out and bring it with you to your next pdoc appointment.
cheers,
bob
Posted by Mark H. on May 15, 2000, at 21:22:16
In reply to Re: A cliched subject, now mine, posted by bob on May 15, 2000, at 20:38:45
> Paraplegic homicidal dwarves, huh? Well, at least you still have your imagination. ;^)
Ooops, that was a quadruple amputee with a knife in his teeth -- never mind.
God, I love bob.
;-) Mark
Posted by medlib on May 16, 2000, at 0:01:35
In reply to Re: What's Wrong with Having a Seizure???, posted by Mark H. on May 15, 2000, at 18:00:42
> At the core of this is this basic question: is having a seizure a bad thing in itself or not?
----------------------------------Mark--
I had just seen the subject-line of your post when my son called, so I asked him your question--he's an epileptic who has tonic-clonic seizures with aura (prodromal syndrome). After deleting his expletives and incredulity, he said (approximately--and minus quotes):
--It's damned inconvenient. Assuming I don't injure anyone else, I could be badly injured falling or thrashing against something.
--I wake up with a headache you can't even imagine, thickheaded, confused, nauseated, and feeling like I've been tumbled in a concrete mixer for 2 days. My tongue is the worst, of course. (He bites nearly clear through it.) I can't eat or talk normally for days and have to take mega painkillers.
--It's terrifying. The aura is like staring into the jaws of hell--pure panic with all systems revving full out and knowing that only becoming and staying perfectly calm will give me the slightest chance of avoiding falling in.
--I wouldn't wish it on my worst enemy, and if drugs didn't completely control it, I'd rather be dead. (BTW, his last seizure was about 10 years ago, and he was depressed for *weeks* after it.)I'm fairly confident that the medication he has to take to prevent seizures (1200 mg/day Tegretol) has more potential for brain damage than his seizures. He didn't mention the potential for status epilepticus. Certainly memory problems on Tegretol are more serious than those from a single seizure.
So, you see, the sedation, muscle relaxants, controlled conditions, and limited voltage of ECT are all there for a reason. However enticing the fantasy of an occasional cerebral "reboot" might seem, reality is a much rougher ride. To mix a metaphor--If wishes were horses, we'd probably get kicked in the teeth!
"Well" wishes--medlib
P.S. I'd tell you about *my* favorite fantasy and Babbleland's connection, but computer's acting peculiarly, so will try to get this posted (sans editing) before it "seizes."
Posted by Chris A. on May 16, 2000, at 0:50:21
In reply to Re: What's Wrong with Having a Seizure???, posted by medlib on May 16, 2000, at 0:01:35
At least when I go for ECT they keep me well oxygenated, my muscles relaxed and keep me safe. When brain damage occurs as a result of seizures it is invariably due to the airway becoming obstructed and subsequent lack of oxygen to the brain. Another cause of damage is when a person falls and strikes their head during a siezure. I've witnessed that, and it is sad.
Chris A.
Please don't shoot me. I am feeling vulnerable and would like to find some support here for my decision to try to treat my refractory Bipolar depression/mixed states with ECT. It's not working as well as I'd like, as we're using low dose RUL, as higher dose and bilateral treatments cause more temporary confusion and temporary memory loss for me, which I don't much care for. Still, I'll go on record saying the ECT is safer than all of the medication treatment I've been through. That's a very long story. My husband says ECT and meds have probably saved my life even though neither of them are perfect. Kay Jamison has given her husband a power of attorney to authorize ECT should she become sick enough. Dr. Manning honestly recounts her experience with ECT and major depression in the book "Undercurrents".
Posted by medlib on May 16, 2000, at 3:23:51
In reply to Re: What's Wrong with Having a Seizure???, posted by Chris A. on May 16, 2000, at 0:50:21
Chris--
There is a *world* of difference between an uncontrolled seizure disorder and a carefully controlled ECT. That is one of the points I was trying to make. No one *really* wants the former; the latter has many proponents.
I fully support your right to choose whatever treatment you believe may be helpful. It is not an option I would select, but I can understand very easily the desperation that years of illness and multiple failed interventions can bring. There appears to be almost *no* predictability to treatment results; no one can claim successfully that any given treatment will or won't work. That's why I think it's so important to maintain and expand the treatment options we have. (My state is trying to ban ECT.)
I hope your treatments are successful for you--if anyone's patience deserves a break, it's yours!
"Well" wishes--medlib
> At least when I go for ECT they keep me well oxygenated, my muscles relaxed and keep me safe. When brain damage occurs as a result of seizures it is invariably due to the airway becoming obstructed and subsequent lack of oxygen to the brain. Another cause of damage is when a person falls and strikes their head during a siezure. I've witnessed that, and it is sad.
>
> Chris A.
> Please don't shoot me. I am feeling vulnerable and would like to find some support here for my decision to try to treat my refractory Bipolar depression/mixed states with ECT. It's not working as well as I'd like, as we're using low dose RUL, as higher dose and bilateral treatments cause more temporary confusion and temporary memory loss for me, which I don't much care for. Still, I'll go on record saying the ECT is safer than all of the medication treatment I've been through. That's a very long story. My husband says ECT and meds have probably saved my life even though neither of them are perfect. Kay Jamison has given her husband a power of attorney to authorize ECT should she become sick enough. Dr. Manning honestly recounts her experience with ECT and major depression in the book "Undercurrents".
Posted by Cam W. on May 16, 2000, at 6:55:13
In reply to To Chris A., posted by medlib on May 16, 2000, at 3:23:51
Chris and medlib - I am not good in this area, but don't epileptic seizures and one's induced by ECT have different focal points? (ie areas of the brain where that cause the seizure). I believe the two types of seizures are completely different. I don't think that all people with uncontrolled epilepsy are depression-free, due to seizures.Just a thought - Cam
Posted by Mark H. on May 16, 2000, at 9:48:36
In reply to Re: What's Wrong with Having a Seizure???, posted by Chris A. on May 16, 2000, at 0:50:21
As I said, I feel safe enough with everyone here to ask really stupid questions. I've only witnessed two seizures in my 50 years, one an insulin grand mal when a fellow dormie in college who was newly diabetic messed up her blood sugar level, and the other a friend in high school with a type of epilepsy (petit mal, other?) where she could tell it was coming, asked me to sit outside with her and catch her when she went down, and who awoke feeling great -- no movement or physical aspect to the seizure other than paralysis (is that the right word for what such a person experiences?).
MedLib, I'm sure my question deserved the epithets heaped on it by your son. It would be like someone telling me they would like to have refractive bipolar depression because it must be nice to sleep 12 hours a day!
And Chris, I do not mean to criticize your choice or anyone else's to elect ECT. I would like to think that I would never choose it, but that's just wishful thinking on my part, reflecting my hope that there would always be another thing to try first. Sometimes my writing makes it sound like I know what I'm talking about, even when I'm really just scared.
I so appreciate the friendships and resources we have here. Where else could I learn this lesson so quickly and relatively painlessly, just be trusting that it's OK to ask a stupid question?
Much love,
Mark
Posted by Chris A. on May 16, 2000, at 11:05:21
In reply to Re: What's Wrong with Having a Seizure???, posted by Chris A. on May 16, 2000, at 0:50:21
Thanks, Mark,
Can't talk much now, but your reply helped me to feel a bit better about it all and I appreciate it.Chris A.
Posted by bob on May 16, 2000, at 14:52:06
In reply to Re: Thanks, Mark, posted by Chris A. on May 16, 2000, at 11:05:21
One of the problems of even groups like Babble, where we usually see a pretty even-handed account of any treatment (or at least as many positive as negatives), is that there are still some issues on which we only hear the bad news from folks who've had disasters.
Like medlib said, you have every right to choose your own treatment -- it's the flipside of YMMV. If that acronym is true, then we have to respect each others choices.
A friend of mine has, a number of times, suggested that I try ECT. I've done some research. I've read the reassurances, and I've read about the modern nightmares as well. When it comes down to the heart of the matter, however, even if my "rational, logical" mind landed in favor of ECT's safety -- well, quite frankly, I'm just too damned scared of it to make a calm, rational judgment about it.
So, maybe you could teach the rest of us by sharing some of your experiences as you go through the treatment -- if you feel up to it.
thanks,
bob
Posted by Noa on May 16, 2000, at 15:38:31
In reply to Re: Thank You to MedLib and Chris A., posted by Mark H. on May 16, 2000, at 9:48:36
I don't know the official term, but it sounds like your friend had what people call a "drop attack." A "petit mal" seizure, now usually called "absence", pronounced the French way, is like blank stares.
I think a lot of folks with eplilepsy also have to struggle with depression, either from biological effects from seizures, or from the lack of control--uncontrolled seizures have a devastating effect on one's quality of life.
And even tho I don't know if it is a different kind of seizure with ECT, I am pretty sure that the intensity is controlled for, whereas each time a person has an uncontrolled one, not only could there be injuries as people have described (falling, injuries from muscle contractions, breathing cessation, potential effects on the heart, etc), but the level of intensity is unpredictable, and therefore the potential for brain damage is unpredictable.
Posted by stjames on May 16, 2000, at 17:58:50
In reply to Re: What's Wrong with Having a Seizure???, posted by Mark H. on May 15, 2000, at 18:00:42
James here...Often when having a seizure you are standing and fall to the ground and split your head open (it happened to me) or you are driving, ect. Sometimes there is no warning. If you are subject
to seizures your drivers licence will be pulled till you are free of them for 1 yr and get a doc to sign off.james
Posted by Arias on May 16, 2000, at 21:08:09
In reply to Re: What's Wrong with Having a Seizure???, posted by stjames on May 16, 2000, at 17:58:50
Seizures happen when a group of the brain cells are overly excited. I believe that epileptic seizures may have variable number of foci, depending on the type of seizure(absence, complex partial, grand mal) and its underlying cause; 75% adult epilepsy is idiopathic. It may or may not generalize to the entire brain or it may even start out that way. As for ECT, from what I understand, they strap on a 1-2 electrodes and briefly stimulate under controlled conditions. It may start with a specific foci but it generalizes, sort of a jumpstart. The mechanism of ECT and epilepsy is the same however, and remains to be elucidated completely.
As for the newborn seizures, Rebecca, it depends on the age of onset, whether or not you were feverish, but with (super!)normal neuro development and eventual resolution, that it's most likely benign and without sequelae. There are a bunch of pediatric epileptic syndromes and yours sounds, in my completely uninformed and unsolicited opinion, like benign neonatal seizures; they are, in a word, benign.
Of course, this is my intellectual rationalization on a frightening and personal experience! I had the seizure during some dinner full of medical personnel; from what I remember, I was extremely bored beforehand and thinking about trying out the sake. I was incoherent afterwards, very sleepy, and inexplicably wanted to cry. From what I understand, this is a common occurrence post-seizure. I can see your point about re-booting the brain Mark but of course, I'd rather be on the Wellbutrin! Epilepsy itself sounds dreadful though controllable; 20% of those with a single unprovoked seizure will suffer another and once you've had a second seizure, about 100% will have more seizures. Of course, not all seizures are physical with the flinging of the arms and legs; the aura itself is a partial seizure. I would imagine however, that it makes driving difficult among other things. Repeatedly uncontrolled seizures like status epilepticus--which happens not only in epileptics but also a possibility in ECT(some are more sensitive than others, it's a small risk) can have sequelae, not only from the respiratory distress standpoint, but cognitive/mental difficulties and long-term brain volume loss. If it's uncontrolled!
Kay Redfield Jamison wrote a beautiful book about her manic depression called "An unquiet mind." She's a prof at Hopkins School of Medicine; I recommend it highly. I remember one anecdote whereupon she first confronts the chairman of the department about her possible employment with her manic depression; he then takes his hand in hers, and says something like, "Honey, if we had to bar everyone with a mental illness, we wouldn't have a department."
I apologize for this tome of a response, you are a most interesting and voluble group :)
Posted by DeeJ on January 19, 2001, at 7:01:53
In reply to Re: What's Wrong with Having a Seizure???, posted by Mark H. on May 15, 2000, at 18:00:42
SNIP
>
> At the core of this is this basic question: is having a seizure a bad thing in itself or not?
>
> Best wishes,
>
> Mark H.Hail yes, it's a bad thing. Seizures can be damaging to the brain, body and even fatal.
Posted by Lorelia on January 11, 2004, at 20:59:15
In reply to Re: What's Wrong with Having a Seizure???, posted by Mark H. on May 15, 2000, at 18:00:42
I don't know how this will sound or if you've even talked to a person who could or has done this before but I am capable of giving myself seizures...it started off as a game...a long time ago..a friend had told me about this game where you basically choke the other person until they get light headed faint and wake up again...we decided to try it and it worked like she said it would (on her) but when she did it to me I went into a seizure...I"ve never had them before and I didn't even realize i was having it...in fact i was in my own little world in my mind it felt as if hours had passed but when i came too only a few minutes had gone by..i was very dizzy for about a minute or two when i got out of the "seizure" as people around me had described it...unsure of what it was we left it alone until a few years later i got my friend to do it on me again to see if it would still work.. well it did and on day while i was bored and still a bit curious about the seizures that i had had and the way my body felt when i got out of them... i tried it to myself..at first it didnt work because i would just let go and faint but then i tried lieing on the ground and proping myself up a certain way...it worked and i found i could actually make my body seizure...i can only describe it as a weird sort of high...when i come out of it like i said before i am dizzy for a bite my body tingles and my heart is racing sometimes while i'm coming out of it i can feel my body and legs still shaking a little bit but not as much as people have told me i shake... anyway i guess the whole point of me writing you all this is because i was wondering if anyone MIGHT know WHY this happens what causes it to happen if they don't happen on there own how is it that lack of oxygen for a few seconds can cause my body to do this... please write back even if its only to say you have no idea..i'm really confused and don't know if by doing this it is bad for me..
Posted by dragonfly25 on January 11, 2004, at 22:35:44
In reply to I can give myself seizures...how unhealthy is it?, posted by Lorelia on January 11, 2004, at 20:59:15
the brain is very sensitive to oxygen loss and a lack of oxygen to the brain can cause seizures. i have done what you described (i think, i did something where a person pounded on the chest of another- this caused us to black out etc, never to my knowledge seizure) several times when i was in high school and i was told in great detail how bad it is for you...unfortunatly i don't remember the details. be careful, i would stop doing it, it is not safe.
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