![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 195 to 219 of 434. Go back in thread:
Posted by shelliR on August 9, 2001, at 0:20:15
In reply to Re: Update -- Shelli et al., posted by Elizabeth on August 7, 2001, at 15:46:31
>> > Once I start, I can't stop, unless I am at someone's house or at a restaurant (and embarrassment saves me) and I even throw things out so I won't eat them.
>
> It sounds like there might be something wrong with the mechanism that tells you when you're full (I think the hypothalamus is supposed to be in charge of this sort of thing). I experienced something similar on Nardil, and I do think it gave me a sense of what it's like to be an addict.No it's not about being hungry or full. Because I might not eat it all at one sitting. When I'm full, I'll wait until I'm not full then start on a cake for instance, again. And I won't eat anything else, no meals, just cake.
>
> > The difference between sugar and say alcohol is that if I don't have sugar, I don't crave it.
>
> Cravings are an essential feature of anything that is truly an "addiction," IMO.
Well there is something than other than habituation. It's sort of like the alcoholic can't take one drink thing. I'm sitting here not craving, sugar, carbs. But if I start on sugar then the cravings begin. So yes there is craving, but it's got to be set off.
>
re therapy terminations.I was talking to my therapist friend today about whether she would terminate a patient, who lets say, can't control her drinking, won't go to any support groups around it, and no therapy work is really being done. All the time is spent just cleaning up the damage in her life because of her addiction (relationships, drunk driving etc.) You could either work with this person with the hope that with your influence and support she would finally get into a program for her addiction, or you could feel like this is a losing battle and I'm not going to waste my time. We both decided we would probably choose the later, because it is so frustrating to work with addicts who won't admit, or do anything about their addiction.
So I think my therapist believes that if I self-medicate, I will go straight downhill, sabotaging any therapeutic work we could do. Except I've been self-medicating for almost four years now; premenstually only for the first three; more often in the last year. And I have not as yet gone straight downhill. It must be hard for her to give up a presumption that she has invested so much in, apparently.
> I wonder why she believes that so strongly? I really do think she's crossing a professional boundary by making threats like that to you, even if it is only around that one issue. It seems to me that she might have personal issues of her own surrounding addiction.
I very much doubt that she has her own issues, but maybe in her family. Or she is just very opinionated ; on my
behalf:-)
>
>
>
> > She thinks if you're with a doctor you do exactly what he/she tells you to do, or you leave and find another doctor.
>
> See, I think that regardless of whether or not it's necessary to follow your doctor's orders to the letter, that's an issue between you and your doctor, and it's not your therapist's business.
I agree; but pdocs seem to want to communicate with therapists and vice-versa. Sometimes I think it's social, or networking., rather than a necessity for the benefit of the patient. My last pdoc and this therapist had lunch together (my pdoc told me this, not my therapist). And I thought, how nice, perhaps they'll become friends. And how odd they didn't invite me. < g >
Also, I think at this point she thinks I choose pdocs who will give me opiates and she is right. So there is some question on her part about my choices :-)good night, all.
Shelli
Posted by Elizabeth on August 9, 2001, at 9:29:29
In reply to Re: Update -- Lorraine and others » Elizabeth, posted by Lorraine on August 8, 2001, at 11:31:37
> > I started out on 10 mg q.d. That was fine, but when I started taking 20 mg in a single dose, my blood pressure would shoot up (from low-normal to 180/100 or so) about 1/2 hour after I took the Parnate.
>
> Start low, go slow might be in order sounds like. I'll keep this in mind.Well, I didn't have any problem with 10 mg, and I think the spontaneous hypertension that I got is the exception, rather than the rule. So increasing in increments of 5 mg seems at least conservative enough to me.
> Faulty keyboard, or you spilled water on it? (if so turn it upside down and let it dry out)
I think it must have just been a temporary lapse, because it's working fine now. I didn't spill anything on it (good thing since it's not my keyboard!).
> Actually, I read an article on the "self-presentational theory of social anxiety"--which predicts that the likelihood and intensity of social anxiety increases as people become more motivated to make a particular desired impression and less certain that they will do so successfully. Pretty much fit my SA to a tee.
That seems reasonable. There is definitely a temperamental aspect to it: some people are born shy.
> > What's Recovery Inc?
>
> It's a support group for people with mental illnesses. I wrote a report in the "social" section of pyschobabble describing it last week.Ahh. Mental illnesses in general? Sounds like it could be a very diverse group.
> 8 am and approximately 1pm, but I may move them closer. Woke up at 4 am last night, couldn't get back to sleep easily.
I found that spacing them as little as 2 hours apart was fine; when I was taking 60 mg/day, I would just take one every couple hours (or whenever I remembered < g >). (30 mg definitely was not enough for me, BTW.)
> that's the hard part of this illness--riding the waves up and down and mainly trying to stay afloat when things come crashing down.
It sure is. I hope the Parnate will smooth things out for you.
> > Wow, that really got mangled. :-)
>
> Yeah, but look how fast I typed it < vbg >Two words: tortoise. hare.
> It's an interesting idea anyway. He also believes that you won't get side effects if the drug is right for you.
I'm more dubious about that. Just about any active drug has side effects. My experience has been that the ones without side effects don't have much effect at all (I'm thinking specifically of the non-drowsy antihistamines).
> Addiction is widely misunderstood.
That's for sure, and you can see it even on this board. I think it's sad how some people use the word "addict" as an insult. I mean, seriously: addicts are human beings with a serious illness.
> I agree. I usually talk with my pdoc about starting doses, and normal min and max normal doses and then he sets me free to operate in that range, reporting back and getting direction as needed.
That's how my pdoc and I operate too.
> How is it [Valium] distributed?
It gets taken up into the CNS very fast, then redistributed throughout the body. So it "hits" rapidly, but it doesn't work for nearly as long as you'd expect it to based on its elimination half-life.
> My experience has been that psychologists are more gifted in talk therapy and psychiatrists or psychopharmacologists are more gifted in meds.
That's what you might expect based on their training. But my experience with "talk" therapy has been that the match between client and therapist -- the "click" is how I think of it -- is more important than the particular type of therapy being practised.
> By the way, elizabeth, what do you talk about in talk therapy? You sound like your issues are solely medical in nature. Is this right? No split personalities, no alters, no abuse--although I would think you would have social anxiety given the age of onset of your disease.
That pretty much sums it up, yes. My childhood was pretty normal (other than some peculiar sleep problems which I've had all my life), certainly there was nothing that would explain my depression.
> I just saw your response on how you don't find talk therapy useful. I go in spells with it. If I find myself being maladaptive in my responses to something, I go back in.
That seems reasonable.
> Also---and very interesting to me--one of my most successful bouts with therapy and for my husband as well--was with a social worker, who had developed a cognitive approach to issues. She ran a group like a class, giving homework and so forth.
That sounds like CBT to me, yes.
> Before my husband went to her class he believed that the way he did things was "right" and that others who failed to live up to his way of doing things were, well, flawed.
I think that's a very common world view. I'm pleased to hear that your husband was able to change; IMO, that shows a lot of character.
> elizabeth, you can add an MAO to a TCA without a washout is my understanding. This might be the ticket for you.
I've thought about it. MAOIs and TCAs can be used together, yes. In the past I've tried to add TCAs to MAOIs without serum level monitoring, but I wasn't able to tolerate the tricylics (nortriptyline and amoxapine) at anywhere near the expected dose range (I only got up to 75 mg of each of those). Now I'm thinking that this might have been in part because I wasn't metabolising them adequately. Desipramine has such mild side effects that I tolerated it fine even at very high levels.
-elizabeth
Posted by Elizabeth on August 9, 2001, at 9:59:43
In reply to Re: Update » Elizabeth, posted by shelliR on August 8, 2001, at 11:43:26
> I know I am becoming tolerant because sometimes 10mg is not enough and the depression is breaking through. Still, I don't worry too much about habituation. Life is too short to waste depressed and I have started parnate.
That's how I feel: I think that even if you needed ever-increasing doses, it would be preferable to remaining depressed. (The DEA and state medical boards may not feel the same way, however.)
> Speaking of which, today is my second day. So far no side effects or AD effects, but I am not expecting the anti-depressant effects to manifest as quickly as they did with Lorraine.
My experience has been that MAOIs work faster than ADs are "supposed" to work (with some improvement being noticeable after 1 week). I've often wondered about the assumption that all ADs will take several weeks to start working -- is that really true, or does it only apply to TCAs?
> Geez, Elizabeth. You sound exactly like a graduate of MIT who wants to go to medical school. :-)
How odd! (What would such a person sound like, anyway? < g >)
> I did placements on psych units as an undergraduate with the lamest residents.
Residents can be pretty lame. They're just starting out, after all. (IMO they really ought to be supervised, at least the 1st-year ones.)
> If I had to pick for therapy between psychiatrists vs. psychologists, (not knowing the individual), I'd go for the psychologist any time.
This is what I would have expected, but my actual experience has been different. I don't think that the specific training that psychologists, social workers, et al. get is really all that relevant to how good they are as therapists (for me, anyway).
> I can't understand why anyone would get a PhD in counseling, because that degree is not generally recognized by insurance companies.
They might have gotten the degree before managed care became widespread?
> Anyway, it is incredibly hot and I wish we would get one rain day for my flowers. Have you learned to drive yet?
I was afraid you'd ask that. :-)
> I was talking to my therapist friend today about whether she would terminate a patient, who lets say, can't control her drinking, won't go to any support groups around it, and no therapy work is really being done. All the time is spent just cleaning up the damage in her life because of her addiction (relationships, drunk driving etc.) You could either work with this person with the hope that with your influence and support she would finally get into a program for her addiction, or you could feel like this is a losing battle and I'm not going to waste my time. We both decided we would probably choose the later, because it is so frustrating to work with addicts who won't admit, or do anything about their addiction.
I think it's frustrating in general to deal with people who have problems they won't admit to or try to change; it's not unique to addictions.
-elizabeth
Posted by Lorraine on August 9, 2001, at 9:59:57
In reply to Re: Update » Lorraine, posted by Elizabeth on August 9, 2001, at 9:29:29
> > > Actually, I read an article on the "self-presentational theory of social anxiety"--which predicts that the likelihood and intensity of social anxiety increases as people become more motivated to make a particular desired impression and less certain that they will do so successfully. Pretty much fit my SA to a tee. > > > >
> That seems reasonable. There is definitely a temperamental aspect to it: some people are born shy.Yes, but people who have SA are not necessarily shy, although they can be.
>
> > > What's Recovery Inc?
> Ahh. Mental illnesses in general? Sounds like it could be a very diverse group.Could be, but my meeting only had 3 others in it and at least 2 were depressed.
> > > I found that spacing them as little as 2 hours apart was fine;
I may end up doing that and basically taking my whole dose in the am.
> > >(30 mg definitely was not enough for me, BTW.)
No, of course, not. I think I am a slow metabolizer (so drugs build up in my system quickly) and you are a slow metabolizer (or a partial non-metabolizer?) so that you need more drug to have an effect.
> > > It sure is. I hope the Parnate will smooth things out for you.Right now it is. I've also stopped taking the estratest, although I'll probably go back on it in a new formula that has progesterone in it.
> > It's an interesting idea anyway. He also believes that you won't get side effects if the drug is right for you.
>
> I'm more dubious about that.Me too.
> > Addiction is widely misunderstood.
>
> That's for sure, and you can see it even on this board. I think it's sad how some people use the word "addict" as an insult. I mean, seriously: addicts are human beings with a serious illness.Watched Traffic on Sunday--great movie.
> > How is it [Valium] distributed?
>
> It gets taken up into the CNS very fast, then redistributed throughout the body. So it "hits" rapidly, but it doesn't work for nearly as long as you'd expect it to based on its elimination half-life.Unless the effects that you want are not CNS but body effects, like breath rate?
> > > That's what you might expect based on their training. But my experience with "talk" therapy has been that the match between client and therapist -- the "click" is how I think of it -- is more important than the particular type of therapy being practised.Clicking is important especially if you need to be vulnerable to make progress, but my experience with CBT is that vulnerability and disclosure aren't as important and so "click" isn't either.
> > >My childhood was pretty normal (other than some peculiar sleep problems which I've had all my life), certainly there was nothing that would explain my depression.elizabeth, did you get SA as a result of having early onset depression?
> > > I think that's a very common world view. I'm pleased to hear that your husband was able to change; IMO, that shows a lot of character.
My husband is great. You marry one person and then 20 years later you are both different, having changed so much. The trick to marriage is to keep connected through all that change. My husband says that with all of the change I have gone through and my depression, he realizes that it is the prenumbra of me that he loves---it's like there is me and then there is who I might be at any given moment (actually he uses quantum physic metaphors to make his point).
>
> > elizabeth, you can add an MAO to a TCA without a washout is my understanding. This might be the ticket for you.I reread this--I'm wrong I think. You can add TCAs to MAOs but not visa versa, right?
When's your pdoc home? And how are you coping day to day? I see my pdoc tomorrow re sleep. Last night I upped the Neurontin from 300 to 500 and slept like a rock. Not sure this approach will last, who knows?
Posted by Elizabeth on August 9, 2001, at 16:42:05
In reply to Re: Update » Elizabeth, posted by Lorraine on August 9, 2001, at 9:59:57
> Yes, but people who have SA are not necessarily shy, although they can be.
Point taken.
> Could be, but my meeting only had 3 others in it and at least 2 were depressed.
That still leaves room for a lot of diversity. "Depression" is a big umbrella.
> > I found that spacing them as little as 2 hours apart was fine;
>
> I may end up doing that and basically taking my whole dose in the am.That might be helpful, although once you are at steady state, it shouldn't make much difference at what times you take it.
> I think I am a slow metabolizer (so drugs build up in my system quickly) and you are a slow metabolizer (or a partial non-metabolizer?) so that you need more drug to have an effect.
People who metabolise drugs slowly need to take lower doses; people who metabolise them rapidly need higher doses. Also, not all drugs are metabolised via the same pathways -- so someone who metabolises tricyclics slowly (like, say, me) might not have a problem metabolising, for example, Parnate. Usually these problems arise from drug interactions or enzyme deficiencies. Some people are just sensitive to side effects without having any sort of metabolic quirk.
> > It gets taken up into the CNS very fast, then redistributed throughout the body. So it "hits" rapidly, but it doesn't work for nearly as long as you'd expect it to based on its elimination half-life.
>
> Unless the effects that you want are not CNS but body effects, like breath rate?I think those are probably centrally mediated, actually.
> Clicking is important especially if you need to be vulnerable to make progress, but my experience with CBT is that vulnerability and disclosure aren't as important and so "click" isn't either.
Yes. I think that CBT tries too hard to take the "click" out of the picture -- to be uniform regardless of the personality of the therapist -- probably because cognitive-behavioural psychologists would like to be able to claim "objective" results. (Of course, these results are rated in a completely subjective fashion.)
> elizabeth, did you get SA as a result of having early onset depression?
No, I wouldn't say so. (I've always had some performance anxiety, though.)
> I reread this--I'm wrong I think. You can add TCAs to MAOs but not visa versa, right?
You can do either as long as you're careful. Starting with the TCA alone and then adding the MAOI is the preferred order.
> When's your pdoc home?
The important thing for me is not when he's home, but when he's back at the office. :-) (Middle of next week.)
> And how are you coping day to day?
Well enough.
> I see my pdoc tomorrow re sleep. Last night I upped the Neurontin from 300 to 500 and slept like a rock. Not sure this approach will last, who knows?
I've found that most sedating drugs stop working after a couple days, so that I need to increase the dose. Ambien is the one exception.
-elizabeth
Posted by shelliR on August 9, 2001, at 19:07:12
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 8, 2001, at 23:53:50
> Hi Lorraine, all
>>
> > > > > btw, did you read any of the thread about attachment? Do you know what I mean now?
>
> You shamed me into it.
I didn't mean to, just thought it was easier than me explaining again.>I think I understand. My kids always say "look at this", "watch this, Mommy", "come listen to my new guitar piece, Mom". It's like their life only comes fully alive when I am there to witness it. My husband is the same way. His idea of a great day is to do anything and have me watch him. These is something about this--validate me by letting me be the center of your universe. It is supposed to be (according to my therapist) very important for kids to get their fill of this. The other piece--which I have thought about a lot--is the drive toward symbiosis with another person. Symbiosis, the melding of two into one. I felt it the first time I breast fed my children. I was transported. Also--at least for me--the need to be fully known and loved. I get this stuff in other ways--not with my therapist. You see where the children come in, and symbiosis of sorts with my husband (there is something like patina that comes with time), and being fully known and loved by husband and dear friends. I think I understand what you are talking about. Do I sound on track?
>
Not really. Because some of the people writing in that thread and also many in my real life, have children, and I don't think the hole left from abuse and lack of protection/safety/mothering can be filled by parenting. It is the pain of something lost, really, developmental stages lost, and while children and spouse are very satisfying emotionally, (I hope), I think the other work is an inner work of griefing, etc. Actually I think it is best if it is worked out before motherhood, because an adult who still feels that emptiness/hurt might expect too much from her children--put too much pressure on them to "need" her. It may be that somewhere along the line, someone did mother you, or meet that need, or it may be something you worked out either with or without therapy.
> > Aside from feeling a bit depressed, I am feeling a bit down tonight (two different things for me).
> Sorry to hear this. I hope the Parnate kicks in soon.Today I had a migraine, hopefully not from the parnate. I didn't catch it early enough, like you said in a previous post, timing can matter. If I take advil, etc. at the first tiny sign, somethings that can avert the migraine. My migraines are fairly mild as far as migraines, but still annoying (pain behind my eye, sick in my stomach, but no vomiting or anything)
> > >
> > > > So you think 10mg of parnate is really making a huge difference?
>
> Bear in mind, I am almost always on puny doses of drugs. Moclobemide was 75 mg (the average dose, i think is 300 and above); Selegiline 5 mg; Wellbutrin 100 (drove me out of my skin). I understand that for most people Parnate is between 20 and 40 mg. I wouldn't be surprised if I end up here or 5 mg higher. I am biting my nails and cuticles again--an indication that I am probably a bit overstimulated. What can I say, I take small doses and I feel things quickly--Effexor took the longest for me to feel positive effects from.So are you saying "yes" ? < g >
>
>
< What's your titrating schedule? By the way, I'm seeing my pdoc on Friday and will ask him re sleeping.My pdoc wants me to go up other day by 5mg until I reach 30mg. He says he will be very happy if I can tolerate 30mg, but he doesn't have a ceiling. He's not worried about sleep; he thinks we can medicate that also. :-)
So tomorrow I will go up to 15mg and if I have another migraine I will probably go back down to 10mg for longer. He'll be away next week
later,
Shelli
Posted by Elizabeth on August 9, 2001, at 21:53:28
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 9, 2001, at 19:07:12
> Today I had a migraine, hopefully not from the parnate.
Some people do get headaches on MAOIs. Unfortunately, the triptans (which are serotonin agonists) can't be used safely with MAOIs.
A lot of the people I know who get migraines seem to have mood or anxiety disorders as well. I'm interested in the relationship, if there is one.
> My pdoc wants me to go up other day by 5mg until I reach 30mg. He says he will be very happy if I can tolerate 30mg, but he doesn't have a ceiling. He's not worried about sleep; he thinks we can medicate that also. :-)
If you have trouble tolerating meds, increasing it in increments of 5 mg is probably a good idea. It also might help to take it in divided doses to the extent that you're able.
I think he's right to be optimistic about the sleep thing. There's bound to be something that will work for you, and sedative-hypnotics are generally safe to take with MAOIs.
Best of luck to you, as always.
-elizabeth
Posted by Lorraine on August 10, 2001, at 0:21:33
In reply to Re: Update » Lorraine, posted by Elizabeth on August 9, 2001, at 16:42:05
> > > That still leaves room for a lot of diversity. "Depression" is a big umbrella.
Too broad an umbrella for drug selection efficacy, but not for CBT--which is how this group is oriented.
> > I may end up doing that and basically taking my whole dose in the am.
>
> That might be helpful, although once you are at steady state, it shouldn't make much difference at what times you take it.That should have been the case with Effexor also, but wasn't. I think sometimes there is more of a kick shortly after the drug is taken---although, honestly, if I took Effexor at 11 am I was fine with sleep at 3pm, I had difficulties.
>
> > >Some people are just sensitive to side effects without having any sort of metabolic quirk.Wouldn't you then expect that they would not reach a therapeutic dose before having side effects? You're right; it could just be sensitivity to side effects although low doses of some drugs, Effexor and Adderal, did work. I'll have to see what the break down is of drugs I've quit b/c of side effects and drugs I've abandoned b/c I could only achieve a partial response.
>
> > > Clicking is important especially if you need to be vulnerable to make progress, but my experience with CBT is that vulnerability and disclosure aren't as important and so "click" isn't either.
>
> Yes. I think that CBT tries too hard to take the "click" out of the picture -- to be uniform regardless of the personality of the therapist -- probably because cognitive-behavioural psychologists would like to be able to claim "objective" results. (Of course, these results are rated in a completely subjective fashion.)The CBT people I have seen act more like teachers than therapists.
>
> > elizabeth, did you get SA as a result of having early onset depression?
>
> No, I wouldn't say so.That's a stroke of luck, I'd say. The other kids didn't know about your depression and your depression didn't make you an odd duck socially? Good for you.
>
> I've found that most sedating drugs stop working after a couple days, so that I need to increase the dose. Ambien is the one exception.I'll keep that in mind. Thanx.
Lorraine
Posted by Lorraine on August 10, 2001, at 0:56:06
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 9, 2001, at 19:07:12
Hi Shelli:
> > You shamed me into it.
> I didn't mean to, just thought it was easier than me explaining again.You were right; it was an extensive thread. I was teasing about the shame.
>
> >I think I understand. My kids always say "look at this", "watch this, Mommy", "come listen to my new guitar piece, Mom". It's like their life only comes fully alive when I am there to witness it. My husband is the same way. His idea of a great day is to do anything and have me watch him. These is something about this--validate me by letting me be the center of your universe. It is supposed to be (according to my therapist) very important for kids to get their fill of this. The other piece--which I have thought about a lot--is the drive toward symbiosis with another person. Symbiosis, the melding of two into one. I felt it the first time I breast fed my children. I was transported. Also--at least for me--the need to be fully known and loved. I get this stuff in other ways--not with my therapist. You see where the children come in, and symbiosis of sorts with my husband (there is something like patina that comes with time), and being fully known and loved by husband and dear friends. I think I understand what you are talking about. Do I sound on track?
> >
> Not really. Because some of the people writing in that thread and also many in my real life, have children, and I don't think the hole left from abuse and lack of protection/safety/mothering can be filled by parenting.Fair enough. But what about the wanting to be at the center, wanting undiluted attention--not in a general way, but that thing that kids do "look at me"; Mommy listen to me.
> > >while children ... are very satisfying emotionally, (I hope), I think the other work is an inner work of griefing, etc.
My children forced me to do a lot of internal work in order to be a good mother---still when my youngest was turning 7 or so, I found that I had manuevered myself into a position of abandoning my children emotionally, the same way that I had been abandoned. Namely, my career was on such a hot track, that I was never home and didn't have time for them. I'm not sure I would have done the depth of work that I did without them because I would have been doing it for "me" and I'm not sure that would have been enough motivation for me. I really could not bear the thought of doing to them what had been done to me.
> > >Actually I think it is best if it is worked out before motherhood, because an adult who still feels that emptiness/hurt might expect too much from her children--put too much pressure on them to "need" her. It may be that somewhere along the line, someone did mother you, or meet that need, or it may be something you worked out either with or without therapy.
It's hard to say. I can't know your reality to know that difference. Certainly, it sounds like your abuse was more intense and deliberate than mine was. I know that I have always thought that I didn't really have a childhood. In fact, I didn't want to have children--they terrified me, plus I didn't understand "play" very well. I had my children to prevent my husband from leaving me. He desperately wanted children and would have left the relationship if I hadn't been willing to do this. Once I had my first child, everything change inside me. I used to say that it was like finding this remarkable sun roon in your house that you never knew was there. I don't know how much was hormone driven and how much was that I was so masculine in my career approach that I had blinders on the feminine. I'm glad I did it now, of course. It has given me an opportunity to build the family that I never had. I worry about the issue of enmeshment though also, it will be very hard on me when they leave home. I know that I have to start filling other pieces of my life so that there will not be so great a vacuum when they leave.
Ho, ho, shelli, here I am going on and on about the kids, well, you know that my mom and I have actually done some pretty intensive healing. she came to my therapy a couple of time and then I wrote her the letter that all mothers live in fear of receiving and read it to her. And, she, for whatever reason managed to stay with me toe-to-toe during this--it must have been very tough for her. And, then, my mother's abuse was neglect, which while not wonderful is much more forgivable than physical abuse. I do know that working through this stuff was pure he** though for me. Still, I may not have done the work without the kids pushing me from behind
> > > Today I had a migraine, hopefully not from the parnate.
Let's hope.
> > > > > So you think 10mg of parnate is really making a huge difference?
> >
>
> So are you saying "yes" ? < g >Yes.
> >
> < What's your titrating schedule? By the way, I'm seeing my pdoc on Friday and will ask him re sleeping.
>
> My pdoc wants me to go up other day by 5mg until I reach 30mg. He says he will be very happy if I can tolerate 30mg, but he doesn't have a ceiling. He's not worried about sleep; he thinks we can medicate that also. :-)Good. I have gotten a headache on this, but I think it is bruxism (teeth grinding) related--which is still med related.
>
> So tomorrow I will go up to 15mg and if I have another migraine I will probably go back down to 10mg for longer. He'll be away next weekWhat is with these guys and there vacations< vbg >?
Take careLorraine
Posted by Elizabeth on August 10, 2001, at 12:39:47
In reply to Re: Update » Elizabeth, posted by Lorraine on August 10, 2001, at 0:21:33
> > That still leaves room for a lot of diversity. "Depression" is a big umbrella.
>
> Too broad an umbrella for drug selection efficacy, but not for CBT--which is how this group is oriented.So it's a self-help CBT group as well as a support group? That's cool. There's a similar group (SMART Recovery) aimed specifically at addictions.
(I remain unconvinced that CBT has any specific effect in depression.)
> > That might be helpful, although once you are at steady state, it shouldn't make much difference at what times you take it.
>
> That should have been the case with Effexor also, but wasn't.Immediate release or XR? The immediate-release formulation can cause quite a roller coaster. Before Effexor XR was available, I remember a lot of people complaining about that.
> >Some people are just sensitive to side effects without having any sort of metabolic quirk.
>
> Wouldn't you then expect that they would not reach a therapeutic dose before having side effects?There's a good chance of that. It's just been my experience that there is wide variability in people's ability to tolerate side effects. And of course, some people are more bothered by particular side effects than others; some are more willing to wait if they believe the side effects will subside with time; etc.
> You're right; it could just be sensitivity to side effects although low doses of some drugs, Effexor and Adderal, did work.
Can you tell me more about what Effexor and Adderall did, and what doses you were on? The effective ranges for both these drugs are quite variable.
> I'll have to see what the break down is of drugs I've quit b/c of side effects and drugs I've abandoned b/c I could only achieve a partial response.
I'd be interested to see the results. :-)
> The CBT people I have seen act more like teachers than therapists.
Yes, exactly. They want to take the human element out of therapy because they're concerned with being "objective" and "scientific." But my experience has been that the human element is the most important (perhaps the *only* important) aspect of talk therapy.
> > > elizabeth, did you get SA as a result of having early onset depression?
> >
> > No, I wouldn't say so.
>
> That's a stroke of luck, I'd say. The other kids didn't know about your depression and your depression didn't make you an odd duck socially?I was an odd duck for other reasons -- I was labelled "highly gifted" when I was very young, I was reading long before most people my age, etc. I did have some social troubles when I was 10 or 11 (that was the time that I think I was depressed but didn't see a doctor or anything for it). I wasn't very interested in hanging out with other kids, so I became very isolated. Mostly I tried to immerse myself in school work as a form of distraction or sublimation.
About pdocs taking vacations: for unknown reasons, a large percentage of pdocs take a big vacation in August. I think they must all be holing up in a hotel in Paris or some kind of psychiatrists-only resort or something. :-)
Klonopin is usually effective for treating antidepressant-induced bruxism, I think. It also might help you sleep.
-elizabeth
Posted by shelliR on August 10, 2001, at 23:01:56
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 10, 2001, at 0:56:06
Hi Lorraine, etc.
.............
> Fair enough. But what about the wanting to be at the center, wanting undiluted attention--not in a general way, but that thing that kids do "look at me"; Mommy listen to me.I think obviously that is a very "filling " experience, and yes, you do get to be the center of someone's universe. So, I'm not debating how connected and "attached" that makes you feel. I just know many moms who are very connected to their kids (and husbands) still have the experience of an almost desperate attachment to their therapist, if they were abused as children. There are actually people who attend the day hospital (where I was inpatient) when their therapist goes on a vacation. So I'm not convinced that being connected to your children touches the same needs.
Having not been in a relationship for a while, I do (sometimes) miss being the center for someone else. I think it is a good balance, having that, in negotiating your way in the world. Like when something comes, even little things like car repairs, I miss not being able to say "what are we going to do this?" Luckily I have a close close friend who can be there for me, even though he is married, but not in the same way as before he got re-married, two years ago. I don't know a lot of people with good marriages. I would not trade my life for the life of some very close friends with only partially satisfying marriages, although even that relationship does add to a feeling of security in life. A very bad marriage probably doesn't. I think a good marriage is a treasure, and it is wonderful that you have one; especially such a long one.
>
> My children forced me to do a lot of internal work in order to be a good mother---still when my youngest was turning 7 or so, I found that I had manuevered myself into a position of abandoning my children emotionally, the same way that I had been abandoned. Namely, my career was on such a hot track, that I was never home and didn't have time for them. I'm not sure I would have done the depth of work that I did without them because I would have been doing it for "me" and I'm not sure that would have been enough motivation for me. I really could not bear the thought of doing to them what had been done to me.I understand that. In terms of myself, however, my creative urges really have to be played out. I have to be totally self absorbed for part of my work, and interestly, for the other part I must be totally without ego. I'll send you my website address, so I won't sound so mysterious. I'm not Van Gogh! I might have been able to give that up when I was younger, but now that would be impossible, I would not be happy. I *have* to be creating something. So maybe it is good that I am not a mom, although it was not especially by choice. I have some shame issues about that; interestingly it brings up shame, rather than loneliness for me.
>>. Once I had my first child, everything change inside me. I used to say that it was like finding this remarkable sun roon in your house that you never knew was there.
That's a really beautiful description, and again you are very lucky to have discovered that part of you because you love it so.
Back to meds: I have had a totally awful last two days, depression and very bad migraines. I have totally drugged myself up; I'm scared about that, but I can't take most of the impressive migrane remedies because of the parnate. I think it is definitely hormonal; it feels like I'm am having pms time all the time. I saw my gyn (of course on a really good day), and we both thought I should wait to add estrogen until I saw the effects of the parnate. Today I am not at all sure, and may decide to add the estrogen again and can only stop if/when the parnate takes effect. I have to remember it was a full five weeks until I felt any anti-depressant effects from nardil. Luckily, because it gave me very few side effects *and* because I had read a book saying that MAOIs may take up to six weeks, I hung in there. It was not a gradual thing; when it kicked in it was just all different for me.
Posted by shelliR on August 10, 2001, at 23:22:49
In reply to Re: Update » shelliR, posted by Elizabeth on August 9, 2001, at 21:53:28
Hi Elizabeth
> > Today I had a migraine, hopefully not from the parnate.
>
> Some people do get headaches on MAOIs. Unfortunately, the triptans (which are serotonin agonists) can't be used safely with MAOIs.
> A lot of the people I know who get migraines seem to have mood or anxiety disorders as well. I'm interested in the relationship, if there is one.
>This migraine thing is a totally new thing for me in the past year and a half. I'm positive that it's related to hormones; first it started premenstually, and now my hormones are so out of wack that it is happening much more frequently. So I don't really think it has to do with parnate, unless it is being exacerbated by it. The last two days, depression and migraine-wise, have been hellish.
FYI, many people with DID have migraines from switching, especially between parts that sap their energy. Outside of the hospital, the people who I know who get migraines do not have mood disorders (of course very small population.)
>
I posed a question to either you or Cam on the thread about parnate about a possible consequence of taking opiates on ADs, specifically parnate in my case. I think I'm being blackballed by Cam perhaps because of some (I thought) minor disagreements or some other reason I am not aware of. Could you address this question, do you have any ideas about this? I'm just wondering why a pdoc once said that to me. And now that I am becoming worried about it, my pdoc is gone for a week.BTW, in this area, not just shrinks, but almost everyone with kids takes their vacation in August. Schools are out *and* the camp sessions have ended.
> Best of luck to you, as always.
DitttoShelli
Posted by Elizabeth on August 11, 2001, at 0:02:00
In reply to Re: Update » Elizabeth, posted by shelliR on August 10, 2001, at 23:22:49
> This migraine thing is a totally new thing for me in the past year and a half. I'm positive that it's related to hormones; first it started premenstually, and now my hormones are so out of wack that it is happening much more frequently. So I don't really think it has to do with parnate, unless it is being exacerbated by it. The last two days, depression and migraine-wise, have been hellish.
MAOIs do have cardiovascular effects, and they've actually been used in the treatment of migraine. In some situations they could exacerbate it, though.
> FYI, many people with DID have migraines from switching, especially between parts that sap their energy.
Huh. What do you mean by "parts that sap their energy?"
> I posed a question to either you or Cam on the thread about parnate about a possible consequence of taking opiates on ADs, specifically parnate in my case. I think I'm being blackballed by Cam perhaps because of some (I thought) minor disagreements or some other reason I am not aware of. Could you address this question, do you have any ideas about this? I'm just wondering why a pdoc once said that to me. And now that I am becoming worried about it, my pdoc is gone for a week.
I'd be glad to answer, if I recalled what the question was!
> > Best of luck to you, as always.
> Dittto
:-)-elizabeth
Posted by Lorraine on August 11, 2001, at 1:34:14
In reply to Re: Update » Lorraine, posted by Elizabeth on August 10, 2001, at 12:39:47
> > > So it's a self-help CBT group as well as a support group? That's cool. There's a similar group (SMART Recovery) aimed specifically at addictions.
Mainly, a CBT type group.
>
> (I remain unconvinced that CBT has any specific effect in depression.)Have you tried it? I do think that there are the physical and the mental aspects. Now, when physical is the only issue, I wouldn't expect it to be of too much help. But lots of times, both mental and physical is involved.
>
> Immediate release or XR? The immediate-release formulation can cause quite a roller coaster. Before Effexor XR was available, I remember a lot of people complaining about that.Immediate Release, it is.
>
> > >Some people are just sensitive to side effects without having any sort of metabolic quirk.Turns out there are people who are insensitive to side effects also--that might be you?
>
> Can you tell me more about what Effexor and Adderall did, and what doses you were on? The effective ranges for both these drugs are quite variable.Effexor--I was at 150 XR. It seemed to completely control my depression. I was very active and really had good mood control, although in retrospect I was a bit too tranquil. The Adderal was in conjunction with Selegiline (Adderal 7.5 mg 2x day; Selegiline 2.5 2x day; Neurontin 300 3x day). During washout it was 10 mg of Adderal 2x day with the Neurontin. And, remarkably that held the course pretty steady, although I felt a bit speedy and had trouble sleeping.
> I'd be interested to see the results. :-)Actually, I'm doing a retrospective mood chart (like the one the NIMH uses) as a project right now. Just finished reviewing my files. If you are interested in the final result (which include my own cool chart in Word Format), Id be willing to share. O/w I will let you know what the results of the side effect/ partial response survey is.
>
> > The CBT people I have seen act more like teachers than therapists.
>
> Yes, exactly. They want to take the human element out of therapy because they're concerned with being "objective" and "scientific." But my experience has been that the human element is the most important (perhaps the *only* important) aspect of talk therapy.Oh. Well, I've found some of my most useful therapy in CBT. I've also found regular talk therapy useful. I think it depends on what you are trying to address.
> > > I was an odd duck for other reasons -- I was labelled "highly gifted" when I was very young, I was reading long before most people my age, etc. I did have some social troubles when I was 10 or 11 (that was the time that I think I was depressed but didn't see a doctor or anything for it). I wasn't very interested in hanging out with other kids, so I became very isolated. Mostly I tried to immerse myself in school work as a form of distraction or sublimation.It's one thing to not be interested in hanging out with the other kids; it's another to not fit in and hunger for it. I was the latter. It sounds like you were the former. That is a stroke of luck--genetic luck--to have found been inner directed rather than outer directed. That's great.
> > > About pdocs taking vacations: for unknown reasons, a large percentage of pdocs take a big vacation in August. I think they must all be holing up in a hotel in Paris or some kind of psychiatrists-only resort or something. :-)No, all the investment brokers take off in August and the therapists are forced to go on holiday out of boredom;-)
>
> Klonopin is usually effective for treating antidepressant-induced bruxism, I think. It also might help you sleep.Thanks, it's on my list.
Lorraine
Posted by Lorraine on August 11, 2001, at 2:02:50
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 10, 2001, at 23:01:56
Hi Shelli, elizabeth.
> > Fair enough. But what about the wanting to be at the center, wanting undiluted attention--not in a general way, but that thing that kids do "look at me"; Mommy listen to me.
I wasn't saying this from the mother's perspective; I meant from the child's perspective--that perhaps that's one of the things the therapists hour helps fill--this unmet need from childhood. And, of course, you're right that being the mother in this situation does not fill that void (not at all).
> > >So, I'm not debating how connected and "attached" that makes you feel.hmmm. The kids make me feel attached and connected, but, I think it's because I have always wanted a chance to be part of a family that is healthy. Shelli, it probably comes back to your point that I had already done my healing before I was able to truly connect with them in this way.
And, by the way, I wanted to be in the center as well (even though I had terrible SA)--my center was the center of success in the business world, maybe this was safer for me. I suspect that people can be similarly wounded and look to heal those wounds differently.
> > >I don't know a lot of people with good marriages.Isn't that the truth?
> > >I would not trade my life for the life of some very close friends with only partially satisfying marriages, although even that relationship does add to a feeling of security in life.
I agree.
> > >I think a good marriage is a treasure, and it is wonderful that you have one; especially such a long one.
I feel pretty lucky here. Although you know, it's like any other relationship, they all require work, tune-ups and so forth. My husband and I have gone in and out of therapy about every 5 years. People change and patterns that work for the old relationship start to fail. So we go back in to reconnect.
> > > I understand that. In terms of myself, however, my creative urges really have to be played out. I have to be totally self absorbed for part of my work, and interestly, for the other part I must be totally without ego. I'll send you my website address, so I won't sound so mysterious. I'm not Van Gogh! I might have been able to give that up when I was younger, but now that would be impossible, I would not be happy. I *have* to be creating something. So maybe it is good that I am not a mom, although it was not especially by choice. I have some shame issues about that; interestingly it brings up shame, rather than loneliness for me.
I think it's great that you have a creative outlet. It sounds wonderful. I'm glad you are able to fully explore this part of you. There is a certain focus required. It's interesting that you have shame issues surrounding this, yes. Shelli, it would be a pretty boring world if we all chose the same path. The key is to do what fits for you and it sounds like you are doing this beautifully. I'm afraid that I have sounded a bit like a poster child for motherhood. Yikes!
> > > Back to meds: I have had a totally awful last two days, depression and very bad migraines.I'm so sorry to hear this.
> > >I think it is definitely hormonal; it feels like I'm am having pms time all the time. I saw my gyn (of course on a really good day), and we both thought I should wait to add estrogen until I saw the effects of the parnate.
Does she think estrogen is the right course for hormonally related PMS? I had thought it was Progesterone for that.
> > >Today I am not at all sure, and may decide to add the estrogen again and can only stop if/when the parnate takes effect.
You can always simplify later.
> > > I have to remember it was a full five weeks until I felt any anti-depressant effects from nardil.
I have read that Parnate is quicker than Nardil in it's effects. Let's hope so.
My pdoc, by the way, decided that I should stay the course at 10 mg/day and try to take the full dose in the morning--augmenting with 2.5 mg of Adderal in the afternoon if necessary. He thinks for sleep, I should just bump up the Neurontin.
I hope things start turning up for you soon.
Lorraine
Posted by Lorraine on August 11, 2001, at 2:07:25
In reply to Re: Update » Elizabeth, posted by shelliR on August 10, 2001, at 23:22:49
Shelli; elizabeth
I asked my pdoc about drug interactions to be careful of with Parnate. He said the major ones were Demmeral and morphene. Are opiates morphene? Also, he could be wrong-he said it casually and for me it wasn't an issue.
Shelli--I thought your comment to Cam was actually a good one. It made me rethink things a bit.
Posted by Elizabeth on August 11, 2001, at 13:06:14
In reply to Re: Update » Elizabeth, posted by Lorraine on August 11, 2001, at 1:34:14
(re Recovery Inc.)
> Mainly, a CBT type group.But it's a self-help group, there isn't a psychologist or anyone like that involved?
> > (I remain unconvinced that CBT has any specific effect in depression.)
>
> Have you tried it?Yes; I was very into it for a while. I was convinced by the research that it was superior to other types of psychotherapy and that I needed to try it. And maybe it was a good idea to try, but in the end it didn't do much good for my depression. I did learn some tricks that have helped a lot with the panic attacks. I was first dx'ed with panic disorder by the psychologist I was seeing for CBT, and just knowing what it was helped a lot; I also learned some relaxation techniques. So I can't say it was completely useless. :-)
> I do think that there are the physical and the mental aspects. Now, when physical is the only issue, I wouldn't expect it to be of too much help. But lots of times, both mental and physical is involved.
What do you mean by all this? It's a little confusing to me.
> Turns out there are people who are insensitive to side effects also--that might be you?
Not especially. I notice them, but I tolerate them. It's just stoicism, nothing more.
> Effexor--I was at 150 XR. It seemed to completely control my depression.
150 is a reasonable dose, not unusually low. Why did you stop taking it?
> The Adderal was in conjunction with Selegiline (Adderal 7.5 mg 2x day; Selegiline 2.5 2x day; Neurontin 300 3x day).
Again, 15 mg/day isn't that unusual a dose of Adderall for an adult, especially with all the other stuff you were using.
> Actually, I'm doing a retrospective mood chart (like the one the NIMH uses) as a project right now. Just finished reviewing my files. If you are interested in the final result (which include my own cool chart in Word Format), Id be willing to share. O/w I will let you know what the results of the side effect/ partial response survey is.
Except for the Word part, I'd like to see that, although charting retrospectively isn't ideal. (I've seen too many viruses that are transmitted through Word to be willing to open a .doc attachment. < g >)
> Oh. Well, I've found some of my most useful therapy in CBT. I've also found regular talk therapy useful. I think it depends on what you are trying to address.
That's probably true. As I mentioned, I found some of the things I learned in CBT helpful for panic disorder.
> It's one thing to not be interested in hanging out with the other kids; it's another to not fit in and hunger for it. I was the latter. It sounds like you were the former.
Not generally, but when I was depressed I was. I usually (when not depressed) come out right in the middle when I take those tests that are supposed to rate how extroverted or introverted you are. I have friends, I like to party and so forth, but I also need quite a lot of time to myself, and a lot of my interests and hobbies are pretty solitary.
> That is a stroke of luck--genetic luck--to have found been inner directed rather than outer directed. That's great.
How so?
> No, all the investment brokers take off in August and the therapists are forced to go on holiday out of boredom;-)
< G > (I thought a joke like that needed to be made there!)
> > Klonopin is usually effective for treating antidepressant-induced bruxism, I think. It also might help you sleep.
>
> Thanks, it's on my list.Benzos, Klonopin in particular, seem to be good for a variety of sleep disorders. I take Klonopin for RBD, and it works great.
You and Shelli both agreed that there don't seem to be many successful marriages. I've been seeing that a lot. Seeing the effect that divorce has on children has made me more appreciative of my own parents, who've been together for 27 years.
[re rapid onset of effects]
Parnate has a stimulant-like action that you may notice very shortly after starting it. I think that this should be looked into further; it might be the reason why some people have spontaneous episodes of hypertension on Parnate.> I asked my pdoc about drug interactions to be careful of with Parnate. He said the major ones were Demmeral and morphene.
Demerol yes, morphine no. Morphine (the main active constituent of opium) is the treatment of choice if a person on MAOIs needs opioids for moderate-severe pain. I've taken morphine with Parnate a couple of times, as well as codeine and hydrocodone. As Shelli's experience demonstrates, oxycodone (which is comparable to morphine in its efficacy but has much better oral bioavailability) is also safe. Demerol and Ultram are the only ones that I know of that are unsafe; you might be cautious of other synthetic ones, like Darvon. The natural (codeine, morphine) and semisynthetic (oxycodone, hydrocodone, oxymorphone (NuMorphan), hydromorphone (Dilaudid), and of course heroin) ones are all okay, as is buprenorphine. I think methadone is too. I'm not sure about Stadol, Talwin, or Nubain. I think that covers most of them. :-)
-elizabeth
Posted by shelliR on August 11, 2001, at 18:48:59
In reply to Re: Update » shelliR, posted by Elizabeth on August 11, 2001, at 0:02:00
> > FYI, many people with DID have migraines from switching, especially between parts that sap their energy.
> Huh. What do you mean by "parts that sap their energy?"I had seen people (in the hospital) who have had very angry parts (alters). One woman had to work with a certain alter because she was not co-conscious with the alter and the alter was putting her life in danger. This was a very interesting case because the woman was very very conservative, but the alter was a lesbian. So she felt very humiliated when she talked about it in group therapy. She had been sexually abused by her mother, so probably this alter developed out of those experiences. Her primary "self" was a straight wife/mother. Anyway negotiations had to take place about safety. Every time this alter came out she was enraged (about something, I don't know the gritty details) and the woman always came "to" with a horrible migraine. Lucky for her, she was not on an MAOI, so she was given a shot for migraines and it did work for her.
And actually I have seen variations of this-- that the alters who are angry when out take a toll on the body. In my case when alters are out I do not feel possessed, but in cases where extremely angry alters are out, the main personaity can feel in her body that something has happened, and it sort of is like a possession in a way.
> > > Best of luck to you, as always.
> > Dittto
> :-)
:-)
Shelli
Posted by shelliR on August 11, 2001, at 19:42:11
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 11, 2001, at 2:02:50
Hi Lorraine.
> > > Fair enough. But what about the wanting to be at the center, wanting undiluted attention--not in a general way, but that thing that kids do "look at me"; Mommy listen to me.
>
> I wasn't saying this from the mother's perspective; I meant from the child's perspective--that perhaps that's one of the things the therapists hour helps fill--this unmet need from childhood. And, of course, you're right that being the mother in this situation does not fill that void (not at all).yes, I understand now. Every child does need that from someone, I think best senario from the mother. And you are the mother . :-)
>
>
> And, by the way, I wanted to be in the center as well (even though I had terrible SA)--my center was the center of success in the business world, maybe this was safer for me. I suspect that people can be similarly wounded and look to heal those wounds differently.
>
> > > > I understand that. In terms of myself, however, my creative urges really have to be played out. I have to be totally self absorbed for part of my work, and interestly, for the other part I must be totally without ego. I'll send you my website address, so I won't sound so mysterious. I'm not Van Gogh! I might have been able to give that up when I was younger, but now that would be impossible, I would not be happy. I *have* to be creating something. So maybe it is good that I am not a mom, although it was not especially by choice. I have some shame issues about that; interestingly it brings up shame, rather than loneliness for me.
>
> I think it's great that you have a creative outlet. It sounds wonderful. I'm glad you are able to fully explore this part of you. There is a certain focus required.I thought you had your e-mail listed but I don't see it. If you want just create a temp e-mail and I'll send you the url for my website. I am one of about three or four people who are well known and highly respected for this type of work in the fairly large area that is my client base. In an area of mostly attorneys, government, journalists, research (NIH), consulting, I get to be the one of the best of a few people who are well known with my style. So I guess that is the way that I kind of get to be in the center; although I had no idea that it was going to happen that way. It was a gift that came out of much turmoil in my life. I was unable to work. I had planned to become a clinical psychologist, but wasn't together enough (I knew that, but even so got a masters), so this came out of going back to take a couple of art classes at my therapist's insistance at the time that I create some structure in my life. I now have absolutely no desire to be a therapist.
> It's interesting that you have shame issues surrounding this, yes. Shelli, it would be a pretty boring world if we all chose the >same path. The key is to do what fits for you and it sounds like you are doing this beautifully. I'm afraid that I have >sounded a bit like a poster child for motherhood. Yikes!
>
Well maybe I'd feel less shame if I had *chosen* not to have children. Anyway, my therapist and I do work on that shame part, under the category of "shame of my earlier adulthood" ,different from "childhood shame" :-)
> > > >I think it is definitely hormonal; it feels like I'm am having pms time all the time. I saw my gyn (of course on a really good day), and we both thought I should wait to add estrogen until I saw the effects of the parnate.
>
> Does she think estrogen is the right course for hormonally related PMS? I had thought it was Progesterone for that.Well, it has a perimenopausal element to it; it's all very confusing to me. Today I got my period for the second time in three weeks, so that's why this has been such a hard time. This is the third day I've felt really sick, although for most of today I was okay, fell asleep and then woke up very sick in my stomach again, but at least without the migraine. I should be through this tomorrow and it probably would have helped if I had taken natural progesterone, but I didn't even realize why I felt so bad until I started spotting.
>
> > > > I have to remember it was a full five weeks until I felt any anti-depressant effects from nardil.
>
> I have read that Parnate is quicker than Nardil in it's effects. Let's hope so.
I do hope so but remembering the nardil experience helps me hang in there without any disappointmnet day to day. Plus the absence of any side effects (I think) doesn't hurt either. If I wasn't going through this woman stuff, I could easily wait for the parnate to kick in because the oxy gets me through. Today, I had no depression; it was all physical bad stuff.
>
> My pdoc, by the way, decided that I should stay the course at 10 mg/day and try to take the full dose in the morning--augmenting with 2.5 mg of Adderal in the afternoon if necessary. He thinks for sleep, I should just bump up the Neurontin.
>You sound like you have a really good doctor; I can't remember why you were thinking of changing.
> I hope things start turning up for you soon.
Moi aussi.Shelli
Posted by shelliR on August 11, 2001, at 19:57:12
In reply to Re: Update » shelliR, posted by Lorraine on August 11, 2001, at 2:07:25
Lorraine...
>
> I asked my pdoc about drug interactions to be careful of with Parnate. He said the major ones were Demmeral and morphene. Are opiates morphene? Also, he could be wrong-he said it casually and for me it wasn't an issue.Well I wasn't worried about oxycontin and parnate in terms of hypertension. I was more focusing on if the oxy could stop the parnate from full effectivenss. Obviously my pdoc didn't think so, but I don't know what the other pdoc guy meant.
>
> Shelli--I thought your comment to Cam was actually a good one. It made me rethink things a bit.I don't understand this. Do you mean about the poster that he was angry at? I sort of wanted to address this issue (lack of response when directly asked ), but I didn't want to say it in that thread or on the admin board, because the last thing I wanted was people riled up on sides! I would have emailed him if I had his address, just to ask. Because it is pretty bad, I think, not to answer a person's technical question because of prior bad feeling or just not liking someone. And I could tell it was not an oversight because questions to him were addressed both above and below my post. But whatever. I am less upset today and can wait a week until my pdoc returns.
What did my comment make you rethink?
Shelli
Posted by shelliR on August 12, 2001, at 0:40:10
In reply to Stuff » shelliR, posted by Elizabeth on August 11, 2001, at 22:20:43
> Hi Shelli. I get what you mean now about energy-sapping alters -- thanks. I'm really learning some useful things about dissociative disorders from you, I think.
>
I'm glad; it's a topic I know a lot about, unlike uh medical stuff. :-)
> [re migraines]
> If Imitrex and the other -triptans are contraindicated (e.g., if the patient is on a MAOI), morphine or Dilaudid or somesuch can always be used (just not Demerol). Of course, doctors hate to prescribe or dispense those drugs, especially injectable formulations, so many people who take MAOIs and who get migraines probably are undertreated (or just plain untreated).
>
well, I just have been loading myself with various and sundry synthetic codeine and it works for the migraine, but then I may be jeopardizing the anti-depressant effects by building up a tolerance. It doesn't seem like that yet, though. When I load up on it because of a migraine, if I don't have a migraine the next day I'm able to go back to my regular dose.> [re your career history:]
> > ... I was unable to work. I had planned to become a clinical psychologist, but wasn't together enough (I knew that, but even so got a masters), so this came out of going back to take a couple of art classes at my therapist's insistance at the time that I create some structure in my life. I now have absolutely no desire to be a therapist.
> Grad school is tough, probably even in psychology. :-) I didn't even make it through a trimester (I was briefly a math grad student; this was when I was on Nardil for the second time, and just like the first time, it pooped out on me).:-) As far as grad school in psychology, most of all I really loved my course on methodology. I think everyone should be required to take a methodology course, no matter what field they are in. It makes you a more educated reader of any study. One of my most fun research jobs was to write the methodology instrument used for evaluating results of studies funded by congress on crime and the environment. Evaluating the studies was a joke, because right off there was no control group in most of the studies. These studies were a total waste of money. One of my neighbors has a great position at a local university. She teaches one class a semester and all the rest of the time she gets to do her own research. Criminology is a good field to go into because congress always throws a lot of money into "fighting crime".
>> I love this idea that some therapists seem to have that your life will be fine if only you get some "structure," which usually means either (1)getting a job that you're way overqualified for, on the grounds that it will be easy for you -- which isn't necessarily true -- and that it's a "stepping stone" to getting where you want to be, or (2) getting involved in a day treatment or partial program (intensive group therapy). I think that in option (1) the job is usually something that's so ill-suited to the individual that s/he just can't do it (and his/her self-esteem is lowered even more over being unable to do a theoretically "easy" job), and option (2) just further isolates a person further from the real/normal/sane world (okay, maybe "sane" is a bit much < g >).
Yes, I totally agree with your analysis of options (1) and (2) and I would add regarding option (1) that one can still experience horrible boredom even when one is depressed, another major problem with that option. Boredom is worse than anything for me. Now there could be option (3) however: just going to a non-career oriented class--one of the arts, or yoga, whatever. (maybe for you, math) < vbg >
In defense of my therapist (who was about three therapists ago), I didn't ever get the impression that she thought my life would be fine if I got some structure, but I do think if you can find the right structure, it is a healthier way to go, rather than hang out at home everyday by yourself. And it doesn't have to be like all day, every day. Just sort of someway to know it's Tuesday instead of Thursday. Also I was living alone, so I really did need to get out and communicate in some way. I had no idea that it would turn out to have everything to do with my future profession. Taking art classes at a community college was perfect for me. There were your basic 18 year olds, but there were also your senior citizens, and your emotionally disabled, because classes are free for the later categories. It turned out to be a really comfortable place for me to hang out, and my evening class (drawing) was mostly working people, so taking one day class and one evening class was good. But it was good because I wasn't trying to tie it in to career at all, just trying to have a relaxing class with no homework. Some of the design and color classes had tons of homework, so I never took any of them.
> I have a question for you: in your last post, the one directed to Lorraine, you referred to some dispute in a different thread. Could you point me toward the posts in question (the ones where you had the dispute)? Just curious.
no dispute, just a difference of opinion (and one of several over the last year): starts with http://www.dr-bob.org/babble/20010725/msgs/72674.html. But I'm not sure that Lorraine even meant that, and I definitely feel strange talking about someone instead of to them. If there was any way that I could have said it to the person involved without everyones else's .02, and the possibility of a heated battle, that would have been the decent thing to do. I just I feel like I can say anything on this thread because I would assume that most people, even those who started reading it, would have given up following it out of confusion, boredom, whatever. < g >
Wow, 1:36 am est!
Goodnight.....................................
Shelli
Posted by Elizabeth on August 12, 2001, at 6:02:13
In reply to Re: Stuff » Elizabeth, posted by shelliR on August 12, 2001, at 0:40:10
> > Hi Shelli. I get what you mean now about energy-sapping alters -- thanks. I'm really learning some useful things about dissociative disorders from you, I think.
>
> I'm glad; it's a topic I know a lot about, unlike uh medical stuff. :-)I think exchanging knowledge is a good thing.
> well, I just have been loading myself with various and sundry synthetic codeine and it works for the migraine, but then I may be jeopardizing the anti-depressant effects by building up a tolerance.
Maybe. How much hydrocodone do you take for a migraine?
> It doesn't seem like that yet, though. When I load up on it because of a migraine, if I don't have a migraine the next day I'm able to go back to my regular dose.
I think intermittent, ad hoc use of opiates (like you were doing before with the hydro) is probably going to be the best for you, since the OxyContin seems to be losing effect. Since you did it for a long time without overusing and without needing to increase the dose, I don't see a problem with it. It'd be nicer if you could just keep taking oxycodone with no tolerance, but it doesn't look like that's what's happening.
> :-) As far as grad school in psychology, most of all I really loved my course on methodology. I think everyone should be required to take a methodology course, no matter what field they are in. It makes you a more educated reader of any study.
Oh, I agree thoroughly. It was something I was supposed to learn in my required lab course, and I took a probability class my freshman year that covered statistical methods somewhat, but I never really had a good grasp of that stuff, and I would like to. I'm hoping that my significant other, who originally was studying to be a neuropharmacologist, can teach me some of that sutff. I have picked up some along the way from reading critiques and so forth, but nothing really substitutes for good old-fashioned formal education.
> One of my neighbors has a great position at a local university. She teaches one class a semester and all the rest of the time she gets to do her own research.
Sounds like my dad (philosophy prof), only he writes instead of doing research (although there's a lot of research required for his writings, that's for sure).
> Criminology is a good field to go into because congress always throws a lot of money into "fighting crime".
Heh. My sister has gotten interested in criminology. (She's a film student, an area where I could see her applying what she learns about criminology!)
> Yes, I totally agree with your analysis of options (1) and (2) and I would add regarding option (1) that one can still experience horrible boredom even when one is depressed, another major problem with that option.
When I'm depressed I don't enjoy anything. It's not boredom exactly, more just flatness: things don't perk me up, I can't find the silver lining even when there's no cloud.
> Now there could be option (3) however: just going to a non-career oriented class--one of the arts, or yoga, whatever. (maybe for you, math) < vbg >
Between MIT and UCSB, I've been so traumatised by math that I don't think I could bear to do it again!
My problem is I'm just not artistic. I mean, not at all: I'm not good at it, and I don't enjoy it. And anyway, I think I'd hardly be able to do any decent art if I were depressed at the time -- jeez, that's so hard to imagine even.
> In defense of my therapist (who was about three therapists ago), I didn't ever get the impression that she thought my life would be fine if I got some structure, but I do think if you can find the right structure, it is a healthier way to go, rather than hang out at home everyday by yourself.
Well, that's true -- if it's the right structure. But the idea that *any* sort of structure is better than no structure really bothers me. I would hate to be forced into a work, school, or therapy situation that would make me feel even more miserable and down on myself.
> no dispute, just a difference of opinion (and one of several over the last year): starts with http://www.dr-bob.org/babble/20010725/msgs/72674.html.
Ahh. You mean http://www.dr-bob.org/babble/20010731/msgs/72750.html ?
I sort of feel like Sal does try to present an image of himself as someone who is an "expert," and I believe Cam is probably right that Sal doesn't have a very sophisticated or critical understanding of the articles he cites; I also get the impression (just an impression) that Sal is trying to impress people by cutting and pasting articles without much regard for the source and without really understanding the full results and implications of the articles that he is citing. A person with a healthy skepticism wouldn't take Sal's abstract/article/URL posts too seriously (although, to be fair, they often do contribute interesting ideas), but let's be real here: not everyone has a healthy skepticism, and I don't believe in gratuitously victimising people for being ignorant. You know?
In general, I would say that Cam raised some important issues, but it seemed to me that he was overreacting, almost taking it personally or something.
> But I'm not sure that Lorraine even meant that, and I definitely feel strange talking about someone instead of to them.
Fair enough (that's why I addressed Cam in the subject: line). I'd like some feedback from Lorraine as to what she was talking about, too. Lorraine? You there? :-)
> If there was any way that I could have said it to the person involved without everyones else's .02, and the possibility of a heated battle, that would have been the decent thing to do.
Okay, now I'm confused again.
> I just I feel like I can say anything on this thread because I would assume that most people, even those who started reading it, would have given up following it out of confusion, boredom, whatever. < g >
Heh. Yeah, I have trouble believing that anybody besides us 3 is really following this thread. It's kinda cool actually.
> Wow, 1:36 am est!
Much later than that, dude! (It's actually EDT, BTW.)
> Goodnight.....................................
Sweet dreams.
-elizabeth
Posted by shelliR on August 12, 2001, at 11:38:39
In reply to Shelli et al, Cam too if you're reading this » shelliR, posted by Elizabeth on August 12, 2001, at 6:02:13
>
> > well, I just have been loading myself with various and sundry synthetic codeine and it works for the migraine, but then I may be jeopardizing the anti-depressant effects by building up a tolerance.
> Maybe. How much hydrocodone do you take for a migraine?
generally about 11.25mg in addition to the 20 oyx a day.
>
> >
> I think intermittent, ad hoc use of opiates (like you were doing before with the hydro) is probably going to be the best for you, since the OxyContin seems to be losing effect. Since you did it for a long time without overusing and without needing to increase the dose, I don't see a problem with it. It'd be nicer if you could just keep taking oxycodone with no tolerance, but it doesn't look like that's what's happening.On bad days, I know 20mg of oxycontin is not enough, so that why I have a prn of 10 also. But for migraines that doesn't cut it. But I don't think that the parnate is touching me yet; it's only been five days and today I'll go up to 20mg. So I'm not really worried; I think it will eventually kick in for at least partial relief, but if it doesn't I may have a problem with the oxycontin. But, for instance, I didn't wake up depressed yesterday or today, so maybe it's having some sort of small effects, or it's just that my hormones aren't acting crazy. I have always had breakthrough depression premenstrually on nardil, that's when I started supplementing with vicodin. When I have two periods in a month, then I have more PMS and more depression. I think the parnate needs more time and probably a higher dose; my pdoc would like to get me up to 40mg.
>
> > :-) As far as grad school in psychology, most of all I really loved my course on methodology. I think everyone should be required to take a methodology course, no matter what field they are in. It makes you a more educated reader of any study.
>
> Oh, I agree thoroughly. It was something I was supposed to learn in my required lab course, and I took a probability class my freshman year that covered statistical methods somewhat, but I never really had a good grasp of that stuff, and I would like to. I'm hoping that my significant other, who originally was studying to be a neuropharmacologist, can teach me some of that sutff. I have picked up some along the way from reading critiques and so forth, but nothing really substitutes for good old-fashioned formal education.So your SO was was studying to be a neuropharmacologist: sounds like a match made in heaven. < g > So you said "originally"; what did he end up getting into? Is he an MD?
> Sounds like my dad (philosophy prof), only he writes instead of doing research (although there's a lot of research required for his writings, that's for sure).
who funds philosophy writings; the university itself? (Can't see that coming from Congress)
>
> > Criminology is a good field to go into because congress always throws a lot of money into "fighting crime".
> Heh. My sister has gotten interested in criminology. (She's a film student, an area where I could see her applying what she learns about criminology!)
So you have an artistic sister.
>
> > Yes, I totally agree with your analysis of options (1) and (2) and I would add regarding option (1) that one can still experience horrible boredom even when one is depressed, another major problem with that option.
>
> When I'm depressed I don't enjoy anything. It's not boredom exactly, more just flatness: things don't perk me up, I can't find the silver lining even when there's no cloud.When I'm depressed and I have to do something boring to me, jobwise, for someone else, it increases the depression; I just want to crawl back into bed. I don't mind doing the mindless stuff of running a business for myself; it sort of relaxes me, plus I wrote all my businesss programs which was fun and frustrating. I have to go out and get a book on filemaker, I can't figure out the if____, then_____. I want to say if tax isn't charged, then don't subtract tax from the total but no matter what I try, based on the help they give you in the help section of filemaker, it keeps giving me an error. That's one of the different things about working alone; you can't just turn to someone and have them figure it out for you. That is good in terms of really pushing myself, but bad when I get totally stuck, like now. You can call up these companies, but they charge you like $60 a hour, and I have a hard time justifying this, always thinking, I'll get this. I don't even always buy the books sometimes; I'll just go to Borders with a tablet and "research"!
>> Between MIT and UCSB, I've been so traumatised by math that I don't think I could bear to do it again!
> My problem is I'm just not artistic. I mean, not at all: I'm not good at it, and I don't enjoy it. And anyway, I think I'd hardly be able to do any decent art if I were depressed at the time -- jeez, that's so hard to imagine even.well you could paint figurines, like my SIL. < g > Anway, it's good for artistic people that not everyone is artistic. There is enough competition. Did you start grad school in math at UCSB? What made you choose that school?
>. I'd like some feedback from Lorraine as to what she was talking about, too. Lorraine? You there? :-)
>
> > If there was any way that I could have said it to the person involved without everyones else's .02, and the possibility of a >heated battle, that would have been the decent thing to do.
> Okay, now I'm confused again.
Well, I would have liked to say, in the parnate thread, can't you just get over whatever and answer my questions. The questions don't have to do with personalities. But if I did that, I'd have dozens of people coming in and giving their opinion on whether you should answer someone you don't care for , etc. I know that no one has the obligation to answer a question, but why not, if you have some information that the other person doesn't have? I just wanted the question answered, I didn't want to turn it into a philosophy thread which may end up nasty. Not worth it --I'll ask my pdoc next week.> > I just I feel like I can say anything on this thread because I would assume that most people, even those who started reading it, would have given up following it out of confusion, boredom, whatever. < g >
> Heh. Yeah, I have trouble believing that anybody besides us 3 is really following this thread. It's kinda cool actually.
>
I think so also. And all three of us participate in other threads, so I don't feel guilty. Actually Dr. Bob quoted something I said to Lorraine on this thread; he started his question does anyone want to meet him in London when he was going there, with my comment to Lorraine about what it was actually like when she met someone off the board. It was pretty funny that he did that; so I know at least Dr. Bob scans this thread!How are you doing on your half dose? Isn't it about time for your pdoc to come back? Is your plan eventually to add parnate, or do the TCA and buprenorphine? Or at your most optimistic, the TCA by itself?
>
Shelli
Posted by may_b on August 12, 2001, at 13:10:53
In reply to Re: Stuff » Elizabeth, posted by shelliR on August 12, 2001, at 11:38:39
Hi Elizabeth, ShelliR, Lorraine
> Heh. Yeah, I have trouble believing that anybody besides us 3 is really following this thread. It's kinda cool actually.Well, sorry to intrude, but I am reading this thread, and while I don't get all the references, the discussions re parnate for example, and the fall-out from a lifetime struggle with depression are fascinating and helpful.
For example, I refer to the exchanges on CBT and other therapies, and their limited impact on depression. I have found the talking interventions useful in dealing with behavioural side effects (so to speak) of long term depression, such as self-criticism, self-isolating behaviours, catastrophizing, etc.
Other features have not responded to talking therapies, such as: forgetfulness, confusion, hideous dreams, anxiety, ruminating, attention problems and for me, taste distortions or the loss of taste. These features survive all non-drug interventions.
Question:
Re your exchanges on Parnate dose increases and slow metabolizers. How does one know if they are a slow metabolizer? I have NEVER been able to tolerate a therapeutic dose on anything without getting too sick (headache, somnolence, agitation, nausea with/without vomitting). So maybe going from 10 to 20 mg in one day might have helped cause my hypertensive crisis. Maybe I should have crept up by 5 mg increments once a day - what do you think, Elizabeth?I am really thankful to find this group. You guys are a wealth of helpful info. Love the *tone* of support too. :-)
may_b
Posted by Cam W. on August 13, 2001, at 2:27:00
In reply to Shelli et al, Cam too if you're reading this » shelliR, posted by Elizabeth on August 12, 2001, at 6:02:13
Shelli and Elizabeth - Shelli, you were correct about others things bothing me when I wrote the following post to Sal, but he is pretending to be an expert. He never refutes that claim, except to say that he has taken all of these drugs (hardly an objective opinion), usually in megadoses, and has access to all of the world's medical journals.
http://www.dr-bob.org/babble/20010725/msgs/72674.html.
I feel that his statements are tantamount to the Beatles taking LSD to attain nirvana. Sorry, knowledge comes from studying the facts, and knowing how to properly read these facts. That takes training (not necessarily formal training); Sal has never shown anywhere that he has done the work to be able to substantiate his claims. He picks and chooses abstracts that might happen to be on topic. I don't think that he pays attention to the vested interests involved in the writing of the article; nor does he take into account articles with theories contrary to the abstracts he posts; and several other factors that must be kept in mind when making a choice.
Another thing that bothers me, is that Sal expounds the benefits of every drug, as he has taken all of them. If these drugs were so beneficial, why isn't he still taking them? How does he know that a person should take a specific sort of drug? He does this "prescribing", without taking into account the person's medical history (which, I know that I sometimes do and am occasionally left with egg on my face). I try to stick to answering questions which I am comfortable answering and if I make a suggestion of a drug, it is the same suggestion I would give to a doc; and I also say to ask the doc if this would the correct treatment for that person (the doc's patient; our poster).
Many of Sal's pharmaceutical suggestions are based on his limited knowledge of reductionistic neuropharmacology. When I read an article propounding certain neurotransmitters for certain conditions, I must sit back and try to see system, then the whole picture. (ie. seeing side effects as only drug effects, and how these drug effect add to or take away from treatment).
For example, if a person is not sleeping after an adequate trial of olanzapine, and still has residual effects of his/her disorder, you shouldn't say to try risperidone, instead. You look to other modalities that can be used to augment the partial efficacy of the drug that person is already on. Switching meds is by far not the first step in modifying most medication regimens.
I am not saying that subjective experience is not important; it is extremely important, but this type of information should not be given the same level of import, as longterm, naturalistic studies, until they have been shown that subjective experience can be incorporated into the theory. This is done through more scientific research, where the "subjective opinion" can be integrated into what we know on whatever disorder we are taking about, or not; thus changing (improving?) our knowledge of the disorder.
I do believe that Sal has found a place to vicariously act out his dream of being his father (a physician). He goes too far sometimes (ie the "suicide"-IM me" post. Those who have the knowledge, must read Sal's posts, to make sure that "no harm is being done." You cannot ignore Sal's posts, as you ignore a troll. This does lead to the question of what type of answers is Sal capable of giving, that will, or may not, lead to harm. The incident which scared me most was when Sal told a person with schizophrenia to stop his risperidone cold turkey, and that there would be no problems (James called him on that on).
I don't mind Sal sharing his experiences, but prescribing is beyond his and my training, especially in this environment. Shelli, I was taking it as a personal affront to the 22 years I have been learning this stuff. If he thinks that posting abstracts and links gives him knowledge into psychopharmacology, he is just taking LSD.
Also Shelli, I did not reply to your post, as I thought that you were not asking for one. I was not ignoring you, honestly.
Take Care; both you and Elizabeth. You're information is given in the context of your learning; and I appreciate that and, to no lesser extent, I appreciate the answers that you two give, especially when I end up learning something that I don't know. We may end up at loggerheads at times, but hey, that's science.
Sincerely - Cam
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