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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 249 to 273 of 434. Go back in thread:
Posted by Cam W. on August 18, 2001, at 14:09:08
In reply to Re: that other thread--Elizabeth and » Cam W., posted by jotho on August 18, 2001, at 9:20:55
Jotho - It is a small concern when using Zyprexa or Clozaril at any dose. It is best to have your blood sugars monitored when taking these meds, just in case. The blood sugar elevation doesn't happen to everyone, but they cannot predict who it will happen to. - Cam
Posted by shelliR on August 20, 2001, at 21:32:38
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 17, 2001, at 23:56:27
> Shelli:
>
> I do feel for you on this Parnate trial stuff. I figured out once that if I just kept trying drugs sequentially for the full trial period, I might well be dead without anything working. So I've become pretty insistent that some positive effects occur quickly. Anyway, when I read all of your posts in one sitting last night, it looked like it wasn't clear to you what was causing the problem (are we ever?) Sounded like maybe it was having two periods so closely spaced together and PMS in between? At one point I thought you said you felt the depression had lifted and if it weren't for the PMS stuff.... Well, it's very difficult to sort this stuff out with my own body, but at some point you made a determination that the Parnate wasn't doing it for you. Good luck getting in early. It must be terrible to be between meds. Course for me now, I suspect that I'll just pick up on the old Adderal and Neurontin combo if I need to quit Parnate. That combo really did tide me over.I looked back at my notes last week, and I never felt any anti-depressant effects from parnate--but I wasn't really expecting any so fast. I had sickness in my stomach and was really tired which I first attributed to PMS, but when it continued after I got my period, I realized then that it was the parnate. So I went down again to 10mg, felt okay, but raising to 15 made me sick again. Then I gave up after 8 days altogether, 5 days at 15mg It's hard to know when to give up, but almost everyone who succeeded with parnate, had that little blip at the beginning of energy and good feeling. And I have to take into account that my body does not seem to adjust to AD side effects. Yes, this may have been the first time, but it is hard, because my business is busy and I'm supposed to go to New Mexico around Labor Day. Have tickets, arrangements, all put into place. It's much different to do a trial when you are working--it's that added, I got nothing done *again* today. I took off ten days from work earlier this summer, and some of these same customers were involved then, also (now pictures are to be ready, then I was changing appointments.) Not that it doesn't suck either way--it feels crummy to feel bad, job or no job, I know. It's the responsibility part, and I try to convince myself that I am not building rocketships, but still it's hard to disappoint people and break promises.
I didn't go away this weekend. I felt too depressed and defeated, but at least I did get a bit of work done. But only a bit.
>> > > >so I don't mean it lightly when I say I don't have DID, although other patients in the hospital often just think I'm in denial as did my last therapist.
> Wouldn't you expect have strangers recognize you if you had DID or at least memory gaps? I don't know, my hunch is that you know yourself better than they do.
>
The wording of the DSM-IV makes it possible to fit or not fit yourself into the category if you have alters. They use very vague wording and never mention not having co-consciousness--just memory gaps. And memory gaps are never firmly connected to the present and I have lots of memory gaps in the distant past. The definition was a compromise between the hard-core definitions and some of the weaker, more open definitions.re writing:
> Sometimes I do have the urge. The problem is that I would like to write a longer work and my moods haven't stabilized to the point where I want to make the commitment to the process. For instance, I have an outline of a book--it was outlined last January, but I haven't been able to do any work on it at all. The poem was published in "On the Bus", which is edited by my teacher Jack Grapes so getting it published wasn't that hard. I had some more poems in progress. You've inspired me to turn back to them:-)Is it a novel that you have outlined?
>re therapist:
> Have you ever asked her directly to be supportive at these times? To say, "I know we have a lot of issues to work on but right now, I just need your support to get through this period?"
she knows that I felt she was was not being supportive; she sees it differently. I didn't go today, and I'm not sure about Thursday. After that I can't just keep canceling; I'll have to start again, or terminate for now. I'll see how my pdoc session goes tomorrow. I'm blocking out right now how much I like her and how much she's helped me in the past, I don't see any way to comfortably relate to her when I am going through these med changes.> > > >It's mainly letting people down on the job front.
> Think of it as a bout with the stomach flu?
yes, a recurring one, with no sure time frame.
>>
Tomorrow I'll see my pdoc and talk about going back on nardil and using that as my base. Then maybe add either concerta to the nardil or try buprenorphine (if I can tolerate it) with nardil, or stay with oxycontin with nardil. Those are the three things I see for now because I'm not willing to make any more big changes this late in the summer.
> > >
> > > Just back today from North Carolina.
That was a long way for just a few days.
>
> I'm in and out of town until the kids are back in school--a couple of weeks from now. Vacations are an effort for me though, I must admit.
The travel, or the vacation itself?What is your eleven year old daughter like? I have a wonderful 14 year old neice, but she is now, of course, fully emersed in being a teenager. Friends, boys, clothes, the whole thing. She's a pretty happy, confident kid, a complete extrovert. Foreign to me, but I'm happy that things are good for her and that it doesn't seem like such a hard age to her.
>
> PS Today Parnate was good to me.
I think it's going to be good for you; you have all the right signs. I hope soShelli
Posted by Elizabeth on August 22, 2001, at 13:00:02
In reply to Re: that other thread » Elizabeth, posted by Cam W. on August 17, 2001, at 16:59:05
> • I believe that large scale naturalistic studies, using clinical situations, in the post-marketing surveillance stage of drug development is essential. If it were done more, we would have caught the delayed weight gain with Paxil, or the withdrawl syndrome of short-acting SRI-like drugs.
Good point -- that information really needs to make it into the product labelling for these drugs. But how do we provide an incentive for the drug companies to investigate possible bad effects of their products once the products have been approved for marketing?
> > Really. That's surprising. I'm pretty sure I became insulin-resistant on Nardil; Zyprexa caused some cravings but it wasn't nearly as bad. Then again I was taking low-dose Zyprexa, and that might factor in.
> >
> • Dose does not seem to be strongly related to the incidence of the diabetes, either.Even when it's below the therapeutic dose for psychosis? I was taking 2.5-5 mg/day.
> It is probably a numbers game we are looking at. When you see 5 people taking Nardil and 100 people taking Zyprexa, it is going to look like the Zyprexa is a worse offender, because you see more of them.
Is Zyprexa really that common compared to Nardil?
> I do not know about appetite stimulation in the non-weight gainers.
I definitely experienced appetite stimulation on both Zyprexa and Nardil. I'm interested in finding out what's going on with people who say they gained weight without altering their eating patterns.
Your turn.
-elizabeth
Posted by Lorraine on August 22, 2001, at 13:12:02
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 20, 2001, at 21:32:38
> > Shelli:
> >
> > I do feel for you on this Parnate trial stuff. I figured out once that if I just kept trying drugs sequentially for the full trial period, I might well be dead without anything working. So I've become pretty insistent that some positive effects occur quickly. Anyway, when I read all of your posts in one sitting last night, it looked like it wasn't clear to you what was causing the problem (are we ever?) Sounded like maybe it was having two periods so closely spaced together and PMS in between? At one point I thought you said you felt the depression had lifted and if it weren't for the PMS stuff.... Well, it's very difficult to sort this stuff out with my own body, but at some point you made a determination that the Parnate wasn't doing it for you. Good luck getting in early. It must be terrible to be between meds. Course for me now, I suspect that I'll just pick up on the old Adderal and Neurontin combo if I need to quit Parnate. That combo really did tide me over.
>
> I looked back at my notes last week, and I never felt any anti-depressant effects from parnate--but I wasn't really expecting any so fast.This was the entry I was talking about Shelli:
"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."
But maybe I misread that and you were talking about oxycontin?
> > >It's hard to know when to give upSometimes it's more important to simply make a decision than to spend a lot of time angonizing over whether it is the "right" one while your life passes you by. I mean you never "know" with these things and sometimes movement is the best thing.
> > >Not that it doesn't suck either way--it feels crummy to feel bad, job or no job, I know. It's the responsibility part, and I try to convince myself that I am not building rocketships, but still it's hard to disappoint people and break promises.
I know what you are talking about Shelli--it's the very thing that prevents me from making a commitment to the future--making plans, deciding what to do--I have no idea whether I will be up to fullfilling the plans I make today when tomorrow comes--not until I'm stabilized. So even if someone without a mental illness takes times off for illness, I don't think it feels the same, and, you don't know how long you will be out of commission whereas the flu is a couple of days max. The uncertainty is part of it.
> > > The wording of the DSM-IV makes it possible to fit or not fit yourself into the category if you have alters.
I still think that you would know or feel or intuit if you were DID. Maybe the definition sucks and should include the coconscious component as a factor. I have memory gaps. Don't we all?
> > > Is it a novel that you have outlined?Yes.
>
> > > she knows that I felt she was was not being supportive; she sees it differently. I didn't go today, and I'm not sure about Thursday. After that I can't just keep canceling; I'll have to start again, or terminate for now.It seems like she views you as malingering in a sense--coming up with excuses not to do the hard work of therapy and that maybe what you need is a dose of "tough love". But sometimes we are not able to work at the job or with a therapist. I wonder if a hiatus would do you both good until you stabilize.
> > >I'll see how my pdoc session goes tomorrow.
And????? Drum roll please.... What happpened?
> > > >
> > > > Just back today from North Carolina.
> That was a long way for just a few days.The truth is I hate being away from home. Vacations bother me. I don't find them relaxing. And, when I planned the trip, I wasn't sure if I could depend on my mood.
> > > The travel, or the vacation itself?The vacation itself. I have a lot of comfort routines here at home.
> > > What is your eleven year old daughter like?She's wonderful. She has the "gift of mood"--she's upbeat, enthusiastic, bright, caring...really great. This summer she finally decided she was ready for a bra. Very big step. Lots of fun for me to watch her growing and changing. I'm hoping that her teenage years won't be too rough on us.
> >
> > PS Today Parnate was good to me.
> I think it's going to be good for you; you have all the right signs. I hope soWell, I've been having these terrible headaches when I wake up in the morning every day. So I have a call into my doctor to see if these headaches are precursors to a spontaneous hypertensive crises. I also am having trouble sleeping. My mood support though is pretty good--not home free but good. So we'll see.
Posted by Elizabeth on August 22, 2001, at 13:20:26
In reply to Re: I was gone but now I'm back, posted by Lorraine on August 17, 2001, at 23:23:13
> > There are other (non-serotonergically mediated) effects that can contribute to drowsiness too (such as orthostatic hypotension).
>
> then maybe remedies for orthostatic hypotension would be effective--eat more salt and drink more water?It's worth a try, sure.
> I tried it last week and I was very careful. I added less than 1 mg of Adderal to the mix, wasn't happy with it then, but the sands are still moving under my feet so who knows? I will be careful.
Good. How do you accurately measure out 1 mg of Adderall, though???
> Well a drug company's mind set is pretty easy to determine, but I think any mind set brought to the equation (notwithstanding the null hypothesis) affects the framing of the question and the interpretation of the results.
Yes, me too.
> > So many people on this board could tell stories that begin, "If my previous pdoc had been more open minded..."
>
> Isn't that the truth? How about if my SIL, my ex-boss, my son etc were more open minded? This is the frame of reference issue that I keep harping on. Course, I suppose if they agreed with me.....< g >"If _______ were more open-minded, ..."
[re "Wicked"]
> It's a very small tube so it's hard to imagine what else it could be used for. But I suppose its on label use is massageIsn't "massage" just a euphemism? < g > Seriously, can you post the ingredients? (just curious) Is it water-based?
> > That does seem like a symptom that could be exacerbated by stimulants, yes. (It's trichotillomania, BTW.)
>
> No, he believes that Adderal eradicated the symptom of hair pulling and was surprised that it had.I'd be surprised too. Stimulants tend to cause compulsive behaviours such as messing with your hair or picking at your skin, not alleviate them! But regardless of whether it makes sense or not < g >, I'm glad Adderall helped you. Might be a clue as to where the solution lies, if nothing else.
> > The phrase I was confused about was "hypertensive episodes (not hypertension)." When you said "hypertension," did you mean sustained hypertension (as in CV disease)? If not, what did you mean?
>
> I meant the "cheese" reaction to MAOs.So "hypertension" means the cheese reaction? Then what does "hypertensive episodes" mean???
> > I think Parnate and Nardil are not at all interchangeable. A person can be very tired on one and activated on the other.
>
> Right. He agrees. He says that you haven't eliminated the class of MAOs until you have tried them all b/c they are all different.That's true. Nardil and Marplan are probably the most similar two MAOIs. Parnate is completely different, as is selegiline.
> But they do have in common this hypertensive crises stuff, don't they?
The food-drug interactions are a consequence of their MAO-inhibiting action, a property they all share. But like all drugs, MAOIs probably have other pharmacologic actions in addition to the ones we know about. This is probably why they differ.
> And this is where he sees the similarity in terms of an individual's response. Those who are up-regulated would tend to be more prone to hypertensive crisis than those who are down-regulated like me.
Umm. Well, I'm still confused about your use of the expressions "up-regulated" and "down-regulated," so I'm not sure how to make sense of that one.
> > I could see that. What does it mean for people like me who tend to be slowed-down and tired but also have a hyperactive startle response?
>
> Probably he would say this indicates a need for anti-convulsants.Mmm. Too bad anticonvulsants (Depakote, Lamictal, Neurontin) never did much for me (except for the benzodiazepines).
> Take good care elizabeth, nice chatting with you as usual.
You too :)
-elizabeth
Posted by Cam W. on August 22, 2001, at 13:55:36
In reply to Re: that other thread » Cam W., posted by Elizabeth on August 22, 2001, at 13:00:02
> But how do we provide an incentive for the drug companies to investigate possible bad effects of their products once the products have been approved for marketing?
>
• That's a good question. I do believe that even if drug companies are forthcoming with information, it will still be missed. For example, that Effexor withdrawl; I knew about the withdrawl in 1997, before an XR version was made. The company, since at least 1998 (perhaps before) had the withdrawl information in it's product monograph. I guess if you don't scream it out, not everyone listens (or has the time to read the monograph fully). It would be silly for a company (who really has to answer to shareholders) to point out the bad issues of their product. That's what competitors are for.
>
>
> Even when it's below the therapeutic dose for psychosis? I was taking 2.5-5 mg/day.
>
• Pyschosis can be treated with low doses, as well. I don't think that there is an dose/effect gradient, as seen with Effexor.• I was talking to the Zyprexa rep yesterday (met him in Starbucks interviewing a new rep), and he says that the increased incidence of type II diabetes is only seen in patients with schizophrenia (he later amended that to be, that patients with schizophrenia were the only one's studied, so far). The reason he states that there increased numbers of people getting diabetes from taking Clozaril and Zyprexa is that people with schizophrenia are 4 times as likely as the general population to get diabetes. I asked if this number included unmedicated people and he didn't know. He also blamed increased appetite and poorer than normal dietary skills (eg chips & pop diets), as being risk factors. I really can't believe that we have a number of people with schizophrenia have borderline triglyceride levels and coincidentally become diabetic after starting these two atypical antipsychotics. I have seen people without schizophrenia become diabetic, but I am sorry that I never paid attention to relative numbers.
>
> Is Zyprexa really that common compared to Nardil?• Zyprexa is prescribed much more than Nardil and for numerous indications, at least here in the north. Nardil is used as a last resort in treatment-resistant depression. Zyprexa seems to be used before Nardil, even though there is little evidence of efficacy for it's long-term use in depression.
- Cam
Posted by Lorraine on August 22, 2001, at 15:16:43
In reply to Re: I was gone but now I'm back » Lorraine, posted by Elizabeth on August 22, 2001, at 13:20:26
> > I tried it last week and I was very careful. I added less than 1 mg of Adderal to the mix, wasn't happy with it then, but the sands are still moving under my feet so who knows? I will be careful.
>
> Good. How do you accurately measure out 1 mg of Adderall, though???What do you mean by accurately:-) (1.25 is 1/4 of 5 mg tablet split inaccurately give or take .25 mg). You are a stickler for accuracy aren't you< vbg >
>
> [re "Wicked"]
> > It's a very small tube so it's hard to imagine what else it could be used for. But I suppose its on label use is massage
>
> Isn't "massage" just a euphemism? < g > Seriously, can you post the ingredients? (just curious) Is it water-based?Actually, it turns out it is for "tanning"--it has "tantilizing hot action" and comes in 4 ml tubules to be added to your regular tanning lotion. But, hey, that doesn't stop me....I suppose on of the more customary lubricants like "silk" or such would be good. I just like the tantilizing hot action, what can I say? < g >
> > > The phrase I was confused about was "hypertensive episodes (not hypertension)." When you said "hypertension," did you mean sustained hypertension (as in CV disease)? If not, what did you mean?
> >
> > I meant the "cheese" reaction to MAOs.
>
> So "hypertension" means the cheese reaction? Then what does "hypertensive episodes" mean???is all of this over an "on" rather than an "ve" ending? Elizabeth, are you being accurate (in which event we are doomed b/c like Shelli, I can't even spell) or are you playing? My husband loves to play with words, but without seeing your expression or hearing the tone of your voice, I can't tell which "accuracy" vs "fun" is your focus. How about "I will not confuse hypertensive crisis with hypertension" one hundred times on the blackboard, like Bart of the Simpsons.
> > >But like all drugs, MAOIs probably have other pharmacologic actions in addition to the ones we know about. This is probably why they differ.
>
> > And this is where he sees the similarity in terms of an individual's response. Those who are up-regulated would tend to be more prone to hypertensive crisis than those who are down-regulated like me.
>
> Umm. Well, I'm still confused about your use of the expressions "up-regulated" and "down-regulated," so I'm not sure how to make sense of that one.I shouldn't insist on his language actually because it is confusing. He means over-stimulated vs under-stimulated and he determines this based on your QEEG.
>
> > > I could see that. What does it mean for people like me who tend to be slowed-down and tired"under-stimulated"
> >
> > Probably he would say this indicates a need for anti-convulsants.
>
> Mmm. Too bad anticonvulsants (Depakote, Lamictal, Neurontin) never did much for me (except for the benzodiazepines).
>Too bad, but then again maybe your brain wave activity wouldn't show spiking suggestive of temporal lobe epilepsy.
How is you med trial fairing these days? The Parnate is giving me consistent "bad" headaches when I first arise before I take any meds and continues to disrupt my sleep mercilessly. I have an appointment tomorrow. I have read that frequent bad headaches can be a prenome (?) of spontaneous hypertensi--drum roll please--ve crises.
Posted by Lorraine on August 22, 2001, at 15:23:46
In reply to Re: that other thread » Elizabeth, posted by Cam W. on August 22, 2001, at 13:55:36
Cam: Jumping in--hope you don't mind. I've been taking Parnate for about 3 weeks and have been waking up every morning with a splitting headache before taking any meds. It goes away about an hour after I get up--although sometimes I lay in bed waiting for it to lighten--it is pretty intense. I have read that frequent headaches can be a precursor of spontaneous hypertensive reactions and require immediate attention. I'm seeing my pdoc tomorrow to discuss this, but I would appreciate any thoughts you might be willing to share about this.
Thanx.Lorraine
Posted by shelliR on August 22, 2001, at 19:59:15
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 22, 2001, at 13:12:02
Hi Lorraine.
re parnate:
> > I looked back at my notes last week, and I never felt any anti-depressant effects from parnate--but I wasn't really expecting any so fast.
> This was the entry I was talking about Shelli:
> "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."wow, I don't remember that and I can't find when that was. That definitely sounds like a blip to me. Maybe I did give up too soon. But I did feel really tired and sick; I do remember that.
re commitments:
> I know what you are talking about Shelli--it's the very thing that prevents me from making a commitment to the future--making plans, deciding what to do--I have no idea whether I will be up to fullfilling the plans I make today when tomorrow comes--not until I'm stabilized. So even if someone without a mental illness takes times off for illness, I don't think it feels the same, and, you don't know how long you will be out of commission whereas the flu is a couple of days max. The uncertainty is part of it.Exactly. I have to be vague when I say I'm sick because of that time element. Last time, I told people I was in the hospital for testing. And of course, no one asks about specifics. I do assure everyone that it's nothing serious, just that there is not a definite period of time when it will be over. Because if you keep getting stomach flus, people start thinking that you're just blowing them off.
>re DID:
> > > > The wording of the DSM-IV makes it possible to fit or not fit yourself into the category if you have alters.
> I still think that you would know or feel or intuit if you were DID. Maybe the definition sucks and should include the coconscious component as a factor. I have memory gaps. Don't we all?Well, not everyone has alters. So you already know you're different from most people. And then it does really get into what the definition of DID is. I feel that I fall on the not DID side because I feel more similar to people who don't have DID, rather than those who do. Having kids inside at this point does not disrupt my life. Depression does. And then when I say I have memory gaps, I'm talking years when I remember absolutely nothing about my family. Not normal memory gaps. I can remember school, but nothing at home. I do think the definition could have been better. And as I mentioned to Elizabeth a while back, there is one psychiatrist who broke down the diagnosis of ddnos into very specific categories. I would be co-conscious DID, which says so much more than dissociative disorder, non-specified. I think that was the way to go, rather than to make the DID category so vague as to be subjective, especially since it is somewhat of a controversial diagnosis to begin with.
>
re my therapist:
> > > > she knows that I felt she was was not being supportive; she sees it differently. I didn't go today, and I'm not sure about Thursday. After that I can't just keep canceling; I'll have to start again, or terminate for now.
>
> It seems like she views you as malingering in a sense--coming up with excuses not to do the hard work of therapy and that maybe what you need is a dose of "tough love". But sometimes we are not able to work at the job or with a therapist. I wonder if a hiatus would do you both good until you stabilize.I'll see her tomorrow. I don't know. It is sort of sad to think that I can't connect with my therapist unless I am feeling stable. But maybe that's reality. I am feeling like she must not care about me very much. But maybe that's okay, or maybe not even true. I don't know; I just know I didn't want to be in touch with her last weekend when I was at my lowest.
> > > >I'll see how my pdoc session goes tomorrow.
> And????? Drum roll please.... What happpened?Okay, he upped my oxycontin, rejected any consideration of trying buprenorphine ( instead of the oxy), and put me on wellbutrin.
There's a post to Jahl from last night that gives more details. My pdoc is not a fan of buprenorphine. And he's not a big fan of MAOIs because it limits his choices of combinations. I was very suicidal, so I think the increase of oxy was to keep me alive until something else (wellbutrin, maybe) kicks in. I was there for five minutes and will see him again on Thursday--tomorrow.
I can't even discribe how low I had gotten. And tt scares me to think it is not over yet. But he did seem to be in the trenches with me, at least for now.This morning I felt stoned from the oxy, then okay with the wellbutrin, then totally crazy and hopeless. Now I am pretty calm, but untrusting that I won't feel like I *have* to die again. I'm glad that Jahl reminded me of the lability aspect of the wellbutrin, because it's enabling me to keep a minisule perspective right now. I made an appointment with someone for next week which was a crazy thing to do, (I should not be scheduling anyone that is not already scheduled before I leave on labor day) then I called back and left a message that I have to cancel (in about 500 words or more); so I am feeling off-center and very unprofessional. But at least she is off the schedule for next week.
vacations:
> The truth is I hate being away from home. Vacations bother me. I don't find them relaxing. And, when I planned the trip, I wasn't sure if I could depend on my mood.Did you used to like vacations. I mean, is this part of the depression? Do you ever just go away with your husband?
> > > > What is your eleven year old daughter like?
>
> She's wonderful. She has the "gift of mood"--she's upbeat, enthusiastic, bright, caring...really great. This summer she finally decided she was ready for a bra. Very big step. Lots of fun for me to watch her growing and changing. I'm hoping that her teenage years won't be too rough on us.I hope they won't be rough on her :-)
>
> Well, I've been having these terrible headaches when I wake up in the morning every day. So I have a call into my doctor to see if these headaches are precursors to a spontaneous hypertensive crises. I also am having trouble sleeping. My mood support though is pretty good--not home free but good. So we'll see.I 've only just heard about spontaneous hypertensive crises in the last week. (Of course, I've never had one). It's good to see what your doctor thinks. Have you taken your BP at home during these headaches? I'm glad you are feeling some support from the parnate.
Talk to you soon,
Shelli
Posted by Cam W. on August 22, 2001, at 20:09:13
In reply to Re: Waking Parnate headaches mean? » Cam W., posted by Lorraine on August 22, 2001, at 15:23:46
Lorraine - I don't think that is anything to worry about. It could just be a change in air pressure or something like that. It would be good to mention it to your doctor, though; just to see his/her reaction to this. You haven't changed anything in your diet, or aren't taking anything different at bedtime, are you?
Elizabeth may be a better person to ask this of; she has far more experience with MAOIs than I have.
FWIW - Cam
Posted by Lorraine on August 22, 2001, at 21:30:57
In reply to Re: Waking Parnate headaches mean? » Lorraine, posted by Cam W. on August 22, 2001, at 20:09:13
> Lorraine - I don't think that is anything to worry about. It could just be a change in air pressure or something like that. It would be good to mention it to your doctor, though; just to see his/her reaction to this. You haven't changed anything in your diet, or aren't taking anything different at bedtime, are you?
No, no changes at bedtime. Plus I may be getting hives. Just the start of bumps on my arms. What a mess life is sometimes.
>
> Elizabeth may be a better person to ask this of; she has far more experience with MAOIs than I have.Yeah, I always ask Elizabeth. She's great. Thanks for responding Cam.
Lorraine
Posted by Daveman on August 23, 2001, at 1:36:27
In reply to Re: that other thread » Elizabeth, posted by Cam W. on August 22, 2001, at 13:55:36
Cam:
Interesting. The thing I keep running up against is people claiming they "didn't know" about this effect or that. Whose fault is that, really? Full disclosure is part of the treating doctor's obligation, it seems to me. Each time my docs have started me on meds, they have told me about the possible side effects. I was told in very explicit terms that the SSRI's cause sexual disfunction. When I was started on Paxil, I was told of the side effects such as somnolence. With Celexa, I was cautioned I would experience nausea in the start-up. With Remeron, I was told I would probably gain weight. Each time, when this happened (and yes it all happened), I was prepared to deal with it. I also educated myself through sites such as this one, which was particulary helpful dealing with my fears of addiction when I was taking Xanax (it didn't happpen).
I'm rambling- what's my point? I guess it is that the information is out there, particularly regarding the SSRI's, pro and con. Doctors who don't choose to inform themselves thusly should not be prescribing these medications. Forewarned is forearmed.
Dave
> > But how do we provide an incentive for the drug companies to investigate possible bad effects of their products once the products have been approved for marketing?
> >
> • That's a good question. I do believe that even if drug companies are forthcoming with information, it will still be missed. For example, that Effexor withdrawl; I knew about the withdrawl in 1997, before an XR version was made. The company, since at least 1998 (perhaps before) had the withdrawl information in it's product monograph. I guess if you don't scream it out, not everyone listens (or has the time to read the monograph fully). It would be silly for a company (who really has to answer to shareholders) to point out the bad issues of their product. That's what competitors are for.
> >
> >
> > Even when it's below the therapeutic dose for psychosis? I was taking 2.5-5 mg/day.
> >
> • Pyschosis can be treated with low doses, as well. I don't think that there is an dose/effect gradient, as seen with Effexor.
>
> • I was talking to the Zyprexa rep yesterday (met him in Starbucks interviewing a new rep), and he says that the increased incidence of type II diabetes is only seen in patients with schizophrenia (he later amended that to be, that patients with schizophrenia were the only one's studied, so far). The reason he states that there increased numbers of people getting diabetes from taking Clozaril and Zyprexa is that people with schizophrenia are 4 times as likely as the general population to get diabetes. I asked if this number included unmedicated people and he didn't know. He also blamed increased appetite and poorer than normal dietary skills (eg chips & pop diets), as being risk factors. I really can't believe that we have a number of people with schizophrenia have borderline triglyceride levels and coincidentally become diabetic after starting these two atypical antipsychotics. I have seen people without schizophrenia become diabetic, but I am sorry that I never paid attention to relative numbers.
> >
>
>
> > Is Zyprexa really that common compared to Nardil?
>
> • Zyprexa is prescribed much more than Nardil and for numerous indications, at least here in the north. Nardil is used as a last resort in treatment-resistant depression. Zyprexa seems to be used before Nardil, even though there is little evidence of efficacy for it's long-term use in depression.
>
> - Cam
Posted by Elizabeth on August 23, 2001, at 10:19:33
In reply to Re: that other thread » Elizabeth, posted by Cam W. on August 22, 2001, at 13:55:36
> > But how do we provide an incentive for the drug companies to investigate possible bad effects of their products once the products have been approved for marketing?
>
> • That's a good question. I do believe that even if drug companies are forthcoming with information, it will still be missed. For example, that Effexor withdrawal; I knew about the withdrawal in 1997, before an XR version was made.I remember that Effexor XR was first marketed in fall '97 (I started taking it when Nardil pooped out the second time). I had heard about withdrawal symptoms and "ups and downs" (like people often get with short-acting drugs like Xanax or Ritalin) from Effexor long before that. (The reason I stopped taking it without giving it much of a chance was that the immediate-release formulation made me sick to my stomach about 1/2 hour after each dose.)
> The company, since at least 1998 (perhaps before) had the withdrawal information in it's product monograph.
Really. I didn't notice that. That's interesting. They probably wanted to avoid legal consequences, I guess (weren't they the same co. that marketed dexfenfluramine?).
> I guess if you don't scream it out, not everyone listens (or has the time to read the monograph fully).
All that one would have to do if one were really interested in finding that stuff out would be to look on internet discussion boards such as this one!
> It would be silly for a company (who really has to answer to shareholders) to point out the bad issues of their product. That's what competitors are for.
< g > Yeah. I sort of think of capitalism as a lesser evil compared with the alternatives, but the problem of how to get corporations to do the right thing has always been a puzzle to me.
[re Zyprexa and insulin resistance]
> > Even when it's below the therapeutic dose for psychosis? I was taking 2.5-5 mg/day.
> >
> • Pyschosis can be treated with low doses, as well. I don't think that there is an dose/effect gradient, as seen with Effexor.There is with some of the effects, at least (don't know about the diabetes thing). I found there was a huge difference in the amount of sedation and appetite stimulation (the only effects I noticed from it!) with 2.5 mg vs. 10 mg (the most I ever tried taking).
> • I was talking to the Zyprexa rep yesterday (met him in Starbucks interviewing a new rep), and he says that the increased incidence of type II diabetes is only seen in patients with schizophrenia (he later amended that to be, that patients with schizophrenia were the only one's studied, so far).
Umm...duh? :-) I'm skeptical about whether there's a relationship too. Although I have noticed that the placebo groups in controlled trials of antipsychotic drugs always seem to have a nonzero rate of EPS -- I wonder what causes that. Just expectation effect? Or something more?
> The reason he states that there increased numbers of people getting diabetes from taking Clozaril and Zyprexa is that people with schizophrenia are 4 times as likely as the general population to get diabetes. I asked if this number included unmedicated people and he didn't know.
I'm sure that all the medications used for schizophrenia, except maybe Moban, cause appetite stimulation frequently. Sounds like he was trying to play it down.
> He also blamed increased appetite and poorer than normal dietary skills (eg chips & pop diets), as being risk factors. I really can't believe that we have a number of people with schizophrenia have borderline triglyceride levels and coincidentally become diabetic after starting these two atypical antipsychotics.
Me neither. As I implied above, I do think appetite stimulation is at least part of the cause. (That's not to say that we should blame the patients for not having enough "will power" or whatever.)
> > Is Zyprexa really that common compared to Nardil?
>
> • Zyprexa is prescribed much more than Nardil and for numerous indications, at least here in the north.I'm in the north too, thank you very much. :-)
> Nardil is used as a last resort in treatment-resistant depression.
My impression is that MAOIs are making a comeback. I certainly think they should be considered before ECT, if nothing else. Personally, I found MAOIs to be much more tolerable than TCAs, with the exception of desipramine (which I'm taking now). And I think MAOIs probably work for a much broader range of conditions than TCAs do. Desipramine seems to be working about as well as Parnate did for me (nonpsychotic depression with melancholia) -- I still need buprenorphine but my mood, sleep, appetite, etc. are much improved. And I'm sure you've seen my standard rant about how the dietary restrictions have been overplayed.
> Zyprexa seems to be used before Nardil, even though there is little evidence of efficacy for it's long-term use in depression.
I tried Nardil (in Boston) before ever touching any of the antipsychotics. Most nonpsychotic depressives I've known who tried antipsychotic drugs (usually including atypicals) and who didn't have bipolar disorder or comorbid conditions (OCD, borderline personality, etc.) either got no effect from the neuroleptics, or felt worse on them. As I said, I just felt hungry and tired on Zyprexa, Risperdal, Seroquel, and Mellaril (not all at once). I also tried Moban, which had this weird effect on me that's sort of hard to describe -- I felt really heavy and immobilised, sort of. (Droperidol, which I was given as a sedative when I was in the ICU recently, had a similar effect.)
-elizabeth
Posted by Elizabeth on August 23, 2001, at 10:33:02
In reply to Re: I was gone but now I'm back » Elizabeth, posted by Lorraine on August 22, 2001, at 15:16:43
> > How do you accurately measure out 1 mg of Adderall, though???
>
> What do you mean by accurately :-) (1.25 is 1/4 of 5 mg tablet split inaccurately give or take .25 mg). You are a stickler for accuracy aren't you< vbg >Hey, amphetamine is pretty potent stuff -- +/-0.25 mg is a big range.
> > Isn't "massage" just a euphemism? < g > Seriously, can you post the ingredients? (just curious) Is it water-based?
>
> Actually, it turns out it is for "tanning"--it has "tantilizing hot action" and comes in 4 ml tubules to be added to your regular tanning lotion.Tantalizing, huh? (Is it titillating too? Sorry, I'm feeling sophomoric this morning.)
> But, hey, that doesn't stop me....I suppose on of the more customary lubricants like "silk" or such would be good. I just like the tantilizing hot action, what can I say? < g >
< Beavis >Heh heh.< /Beavis >
> > So "hypertension" means the cheese reaction? Then what does "hypertensive episodes" mean???
> is all of this over an "on" rather than an "ve" ending?
I dunno. I'm just confused! (Don't blame me, you're the one who made the distinction in the first place.)
> Elizabeth, are you being accurate (in which event we are doomed b/c like Shelli, I can't even spell) or are you playing?
I'm genuinely confused, I'm not just messing with you or something. :-)
> How about "I will not confuse hypertensive crisis with hypertension" one hundred times on the blackboard, like Bart of the Simpsons.
You can write "I will not confuse hypertensive crisis with hypertension" as many times as you want, that still doesn't mean that I will know what you're talking about!
[re "up-regulated" vs. "down-regulated" -- another one that genuinely confuses me, BTW]
> I shouldn't insist on his language actually because it is confusing. He means over-stimulated vs under-stimulated and he determines this based on your QEEG.Okay, so it has no real-world correlation?
> > I could see that. What does it mean for people like me who tend to be slowed-down and tired
>
> "under-stimulated"...but anxious and easily startled at the same time?
> > Mmm. Too bad anticonvulsants (Depakote, Lamictal, Neurontin) never did much for me (except for the benzodiazepines).
>
> Too bad, but then again maybe your brain wave activity wouldn't show spiking suggestive of temporal lobe epilepsy.I've had a couple of EEGs, they were described as "within normal limits." Never had a qEEG, tho'.
> How is you med trial fairing these days?
I'm on 225 mg of desipramine. It seems to be working about as well as Parnate did -- it's not a substitute for buprenorphine, but it does make a big difference. I'm taking a break from changing anything because my insurance coverage expired (so I need to get new insurance so I can get a primary care doc so I can have an ECG).
> The Parnate is giving me consistent "bad" headaches when I first arise before I take any meds and continues to disrupt my sleep mercilessly.
All the MAOIs I tried (Nardil, Parnate, selegiline, Marplan) caused sleep problems for me. What are the headaches like? (Where does it hurt and can you describe the pain qualitatively at all, that is?)
> I have an appointment tomorrow. I have read that frequent bad headaches can be a prenome (?) of spontaneous hypertensi--drum roll please--ve crises.
(Prodrome?) Headache is a symptom of elevated BP, but it's a very unusual sort of headache, not at all like tension headaches, sinus headaches, etc.
-elizabeth
Posted by Elizabeth on August 23, 2001, at 10:36:18
In reply to Re: Waking Parnate headaches mean? » Cam W., posted by Lorraine on August 22, 2001, at 15:23:46
> I have read that frequent headaches can be a precursor of spontaneous hypertensive reactions and require immediate attention.
Lorraine -- I had spontaneous hypertensive episodes (not related to food or drug interactions) on Parnate, but the only times I had any kind of headache on it were about half an hour after each dose, when my blood pressure peaked. (As a general rule, I don't get headaches except occasionally if I'm congested.)
Waking up in the morning with a headache sounds like a rebound thing, or maybe something related to nonrestful sleep. Have you tried checking your blood pressure when you first wake up, before taking the Parnate?
-e
Posted by Elizabeth on August 23, 2001, at 10:44:55
In reply to Re: Waking Parnate headaches mean? » Cam W., posted by Lorraine on August 22, 2001, at 21:30:57
> > Elizabeth may be a better person to ask this of; she has far more experience with MAOIs than I have.
>
> Yeah, I always ask Elizabeth. She's great.Flattery will get both of you everywhere. :-)
-e
Posted by Lorraine on August 23, 2001, at 11:31:42
In reply to Re: I was gone but now I'm back » Lorraine, posted by Elizabeth on August 23, 2001, at 10:33:02
> > > Hey, amphetamine is pretty potent stuff -- +/-0.25 mg is a big range.
I wish they had 1 mg tabs, don't you?
>
> > > Isn't "massage" just a euphemism? < g > Seriously, can you post the ingredients? (just curious) Is it water-based?It's oil based. No ingredients listed (probably olive oil and hot sauce :-)
> Tantalizing, huh? (Is it titillating too? Sorry, I'm feeling sophomoric this morning.)Sophomoric is good:-)
>
> > > So "hypertension" means the cheese reaction? Then what does "hypertensive episodes" mean???Hypertension is chronic high blood pressure and hypertensive crisis is spiking high blood pressure associated with eating certain foods on MAOs--although it has been known to occur "spontaneously" on Parnate.
> I'm genuinely confused, I'm not just messing with you or something. :-)
OK. You CAN be very funny and your homour is quite dry (and delightful).
> > > [re "up-regulated" vs. "down-regulated" -- another one that genuinely confuses me, BTW]
> > I shouldn't insist on his language actually because it is confusing. He means over-stimulated vs under-stimulated and he determines this based on your QEEG.
>
> Okay, so it has no real-world correlation?No, I think there is--I suspect that people who are up-regulated tend to be aggitated and thin and people who are down-regulated tend to be sluggish and over weight.
> > > How is you med trial fairing these days?
>
> I'm on 225 mg of desipramine. It seems to be working about as well as Parnate did -- it's not a substitute for buprenorphine, but it does make a big difference. I'm taking a break from changing anything because my insurance coverage expired (so I need to get new insurance so I can get a primary care doc so I can have an ECG).When does your new insurance kick in? I'm glad you are at least able to function in the meantime.
> > >What are the headaches like? (Where does it hurt and can you describe the pain qualitatively at all, that is?)
The headaches are very intense. They are on the right and left sides toward the front of my head just above my temples and little to the rear of the temples. They arise spontaneously--no food association. They go away on their own within about an hour. The PDR says "Therapy should be discontinued immediately upon the occurrence of palpitation or frequent headaches during Parnate therapy. These signs may be prodromal of a hypertensive crises". Later it says "Headaches without blood pressure elevation have occurred." I don't know about blood pressure elevation in my case. I wanted to measure it this morning--but, of course, no headache.
I have also developed a rash on my arms. PDR says "Rare instances of hepatitis and skin rash have been reported" I'm hoping I'm not allergic to MAOs as a class but something in the Parnate. I had an allergic reaction like this to anti-malarial medication. I hope that I am not allergic to sulfate (it's pretty common in drugs isn't it?)
Anyway, odds are I'm off Parnate. One other very odd symptom is pain radiated under my arm pit, like I have pinched a nerve. Isn't that odd?
Thanks for your generous response as usual, elizabeth. I'll let you know what the doctor says today.
Posted by Lorraine on August 23, 2001, at 22:41:08
In reply to Re: Parnate rash/headaches » Elizabeth, posted by Lorraine on August 23, 2001, at 11:31:42
Hi Shelli & elizabeth:
I saw my pdoc today and he thought the headaches were probably rebound (elizabeth, isn't this what you said--take a bow) because I take my doses before noon to try to ameliorate the sleeping problems. The rash, he wasn't so sure about. (I had been painting wearing latex gloves and using turpentine--so maybe this caused the rash.) We decided for me to watch myself over the next few days staying on the Parnate. If I wake up with a headache, I'm to take my blood pressure. And, I will see if the rash goes away or not. If I decide to abandon the Parnate, I will have a 4-5 day washout during which I can use the Adderal and Neurontin. He wrote me a script for Nardil in case I make the switch and asked me to call his office and let them know what I am doing.
elizabeth: The MAO articles that I was talking about are in Psychiatric Annals 31:6/June 2001. Apparently, the entire issue is dedicated to MAOs. The titles include: "The Use of Monoamine Oxidase Inhibitors for Treating Atypical Depression" by Patrick J. McGrath et al; A Neurochemical Perspective on Monoamine Oxidase Inhibitors by Lynn Wecker et al; A Reevaluation of Dietary Restrictions for Irreversible Monoamine Oxidase Inhibitors by Kenneth Shulman et al; Selegiline and other Atypical Monoamine Oxidase Inhibitors in Depression by J. Alexander Bodkin et al; and Monoamine Oxidase Inhibitors Revisited by Jay D. Amsterdam et al.
I have finished the first article regarding MAOs for atypical depression and found it very interesting. They give the DSM definition of atypical depression as well as the Columbia University and discuss studies correlating the criteria specified for atypical depression with efficacy of antidepressants. Very interesting stuff. Let me know if you have difficulty obtaining the studies. I know you would find them of interest--if you haven't already read them :-)
I spoke with my pdoc about upregulation and downregulation and asked him if this was his terminology or used in some area of study. It's his. He finds it descriptive of what is happening on an EEG basis. Downregulated is correlated with low voltage EEG's.
We also talked about Adderal and stopping hair picking and he said that he believes that a lot of symptoms are compensatory. Just as in ADD, kids may pick a fight to provide external stimulation to compensate for the lack of internal stimulation. So that it seems at first glance counterintuitive that ADD kids calm down when they are given stimulants, it makes sense if you view the excess activity as a compensatory mechanism for an understimulated system that is no longer required when stimulants are given. The same he believes may hold true for this woman who was a hair picker and stopped when given Adderal or for my stopping biting my cuticles on Adderal. Interesting thought.
Pleasant dreams to those who are still capable of dreaming (she said bitterly).
Lorraine
Posted by may_b on August 24, 2001, at 10:55:39
In reply to Re: Update Shelli/elizabeth, posted by Lorraine on August 23, 2001, at 22:41:08
Hi Lorraine:
I am keenly interested in these articles. How did you obtain them?
Thanks,
may_b
>The MAO articles that I was talking about are in Psychiatric Annals 31:6/June 2001. Apparently, the entire issue is dedicated to MAOs. The titles include: "The Use of Monoamine Oxidase Inhibitors for Treating Atypical Depression" by Patrick J. McGrath et al; A Neurochemical Perspective on Monoamine Oxidase Inhibitors by Lynn Wecker et al; A Reevaluation of Dietary Restrictions for Irreversible Monoamine Oxidase Inhibitors by Kenneth Shulman et al; Selegiline and other Atypical Monoamine Oxidase Inhibitors in Depression by J. Alexander Bodkin et al; and Monoamine Oxidase Inhibitors Revisited by Jay D. Amsterdam et al.
>
Posted by Elizabeth on August 24, 2001, at 12:05:17
In reply to Re: Parnate rash/headaches » Elizabeth, posted by Lorraine on August 23, 2001, at 11:31:42
> > > > Hey, amphetamine is pretty potent stuff -- +/-0.25 mg is a big range.
>
> I wish they had 1 mg tabs, don't you?Well...I tried taking 1/4 of a 5 mg Adderall, and it didn't have any noticeable effect.
> It's oil based. No ingredients listed (probably olive oil and hot sauce :-)
Yikes. :-)
> Hypertension is chronic high blood pressure and hypertensive crisis is spiking high blood pressure associated with eating certain foods on MAOs--although it has been known to occur "spontaneously" on Parnate.
OK, that's all I wanted to know. "Hypertensive crisis" is usually defined (if it is defined at all) as either diastolic BP > 120 mmHg, or abrupt elevation in blood pressure with end-stage organ damage (no, I don't know what that means). HCs sometimes happen without any connection to MAOIs, BTW; I know a guy who has essential hypertension (generic chronic hypertension) who had one a couple of years ago. (That finally convinced him to go get his hypertension treated.)
> OK. You CAN be very funny and your homour is quite dry (and delightful).
Thanks (I think :) ).
> No, I think there is--I suspect that people who are up-regulated tend to be aggitated and thin and people who are down-regulated tend to be sluggish and over weight.
Oh. (I'm sluggish and thin.)
> When does your new insurance kick in?
What new insurance? New insurance is what I need to find!
> I'm glad you are at least able to function in the meantime.
Me too.
> The headaches are very intense. They are on the right and left sides toward the front of my head just above my temples and little to the rear of the temples.
That doesn't sound like high blood pressure to me -- the headache would be at the base of your skull and/or in the back of your neck.
> The PDR says ...
CYA.
> I don't know about blood pressure elevation in my case. I wanted to measure it this morning--but, of course, no headache.
Try and get a measurement. MAOIs can cause headaches for other, unrelated reasons.
> I have also developed a rash on my arms.
That might be an allergic reaction, or it might be unrelated. In case this is of interest, I had a flare-up of eczema while I was taking Parnate. I don't know if it was caused by the Parnate, but it went away after I stopped taking Parnate.
> I had an allergic reaction like this to anti-malarial medication.
How did you come to be taking that?
> I hope that I am not allergic to sulfate (it's pretty common in drugs isn't it?)
Parnate contains the sulfate salt of tranylcypromine.
Let's see what your next post says....
> I saw my pdoc today and he thought the headaches were probably rebound (elizabeth, isn't this what you said--take a bow) because I take my doses before noon to try to ameliorate the sleeping problems.
FWIW, I tried all sorts of dose schedules and the insomnia was about the same regardless. I think that once you reach steady-state levels, it doesn't make much difference when you take it.
> The rash, he wasn't so sure about. (I had been painting wearing latex gloves and using turpentine--so maybe this caused the rash.)
What on earth posesses you to come into contact with all these weird chemicals?!
> We decided for me to watch myself over the next few days staying on the Parnate. If I wake up with a headache, I'm to take my blood pressure.
Good. I want to know what it is. :-)
> If I decide to abandon the Parnate, I will have a 4-5 day washout during which I can use the Adderal and Neurontin.
That's good. Do you have Klonopin or Xanax? Those have helped me a lot when going off MAOIs.
> He wrote me a script for Nardil in case I make the switch and asked me to call his office and let them know what I am doing.
Yeah, they usually like it if you tell them when you change something. :-}
I don't know if I've mentioned this before, but I have a book on MAOIs that might interest you. (I recognise most of the articles you listed, BTW.)
> Pleasant dreams to those who are still capable of dreaming (she said bitterly).
It's a small price to pay.... (BTW, my intense dreams are back. No abnormal movements, though. < cross fingers >)
-elizabeth
Posted by Lorraine on August 24, 2001, at 12:45:34
In reply to Re: Parnate stuff » Lorraine, posted by Elizabeth on August 24, 2001, at 12:05:17
Elizabeth:
> > No, I think there is--I suspect that people who are up-regulated tend to be aggitated and thin and people who are down-regulated tend to be sluggish and over weight.
>
> Oh. (I'm sluggish and thin.)So much for my suspicions--but do you do well on stimulants?
>
> > When does your new insurance kick in?
>
> What new insurance? New insurance is what I need to find!That does not sound easy given preexisiting condition unless it is part of a group plan. What are your options?
> > The headaches are very intense. They are on the right and left sides toward the front of my head just above my temples and little to the rear of the temples.
>
> That doesn't sound like high blood pressure to me -- the headache would be at the base of your skull and/or in the back of your neck.Thank-you--this is very helpful to me. I didn't know what occipital meant.
>
> > The PDR says ...
>
> CYA.That's what my pdoc said as well.
>
> > I don't know about blood pressure elevation in my case. I wanted to measure it this morning--but, of course, no headache.
>
> Try and get a measurement. MAOIs can cause headaches for other, unrelated reasons.Today, slight headache, blood pressure was low (93/66) with a pulse of 62. I'm feeling more confident that these are rebound headaches. I had them on Effexor, which I also had to take all in the morning. The time of day that I take the medication does have an effect on my sleeping. If I take it later than 12:30 pm I cannot go to sleep at night until very late (2am or 3am).
>
> > I have also developed a rash on my arms.
>
> That might be an allergic reaction, or it might be unrelated. In case this is of interest, I had a flare-up of eczema while I was taking Parnate. I don't know if it was caused by the Parnate, but it went away after I stopped taking Parnate.Wait what is eczema?
>
> > I had an allergic reaction like this to anti-malarial medication.
>
> How did you come to be taking that?went to Belize where malaria is still pretty common. But we actually saw very few mosquitos. You have to imagine me with the rash that pretty much covered me calling into my husband's office and asking them to go to Dr. Koop's site to make sure it wasn't a drug interaction and then to see which med was causing it. I'm sure his secretary's eye-brow was raised at the number of meds I was taking:-)
>
> > I hope that I am not allergic to sulfate (it's pretty common in drugs isn't it?)
>
> Parnate contains the sulfate salt of tranylcypromine.I know. That's why I'm concerned.
> > > FWIW, I tried all sorts of dose schedules and the insomnia was about the same regardless. I think that once you reach steady-state levels, it doesn't make much difference when you take it.I think we may respond to this differently. Could you "feel" the Parnate kick in with your doses? I can. If I take more than 5 mg at a time, I hyperventilate again.
>
> > The rash, he wasn't so sure about. (I had been painting wearing latex gloves and using turpentine--so maybe this caused the rash.)
>
> What on earth posesses you to come into contact with all these weird chemicals?!Painting a house.
> > If I decide to abandon the Parnate, I will have a 4-5 day washout during which I can use the Adderal and Neurontin.
>
> That's good. Do you have Klonopin or Xanax? Those have helped me a lot when going off MAOIs.I have Atavan. Do you think I'll need it even with the stimulant and neurontin?
> I don't know if I've mentioned this before, but I have a book on MAOIs that might interest you. (I recognise most of the articles you listed, BTW.)I would be interested in it if it interests you:-)
> It's a small price to paySee to say this you must not love to sleep. I love to sleep and I love to dream and I love to wake up in the morning feeling "refreshed" by my sleeping and dreaming.
.... (BTW, my intense dreams are back. No abnormal movements, though. < cross fingers >)
Crossed. (Do you associate dreams with abnormal movements? Do you mean restless leg syndrome?)
Lorraine
Posted by Lorraine on August 24, 2001, at 13:17:31
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 22, 2001, at 19:59:15
Hi shelli:
I am sorry that I didn't respond to this. I think I did but messed up when I posted. I've been wondering how you are and why you haven't posted recently. (ok 2 days< g >)
> > >[re parnate] But I did feel really tired and sick; I do remember that.
I felt pretty sluggish in the afternoons, which then expanded to the mornings. I gave up Neurontin during the day to help alleviate this. Shelli, mood diaries help with the "memory" problems. I'd be lost without one.
> > > Well, not everyone has alters. So you already know you're different from most people. And then it does really get into what the definition of DID is.All a bunch of group think. I think all the symptom clusters are an example of the human capacity to spot patterns where none exist.:-)
[re talk therapist]You could just view her as you "work" therapist and see her when you are capable of "work".
Wellbutrin is a great drug if it works for you. It is a puppy upper and I felt it right away. (we seem to respond differently though to drugs).
I was very suicidal
I am so sorry to hear this. And concerned. How are you now? Does it help to remember to just crawl under the desk until the storm passes?
What happened with your pdoc on Thursday?
> > > I can't even discribe how low I had gotten. And tt scares me to think it is not over yet.I know that must be really scarey. I hope you are doing ok. I feel like a heel for not responding to this sooner (you don't need to take care of me on this :-)
> > >I'm glad that Jahl reminded me of the lability aspect of the wellbutrin, because it's enabling me to keep a minisule perspective right now.
I thought I was going to crawl out of my skin on Wellbutrin. My anxiety shot through the roof. But I know a lot of people don't have that reaction and I hope you are one of them.
> > >I made an appointment with someone for next week which was a crazy thing to do
You might have thought it would make you feel more in control or that you were accomplishing something. Your work provides you with a lot of rewards usually. It must be hard to be unable to function.
> > >so I am feeling off-center and very unprofessional. But at least she is off the schedule for next week.It's like they say in an airplane, first you put the oxygen mask on yourself, then you do for others. You know this, but I will say it anyway, it is not unprofessional to take care of yourself when you are sick. It is irresponsible to not take care of yourself when you are sick. You are doing everything you can Shelli. You just can't control this disease or your response to meds. All you can do is batten down the hatches during the tough times and survive so that you will be here when times are better--moods pass. I also want to remind you that you have a serious disease. If you were having a bad spot with MS, you would go easier on yourself I think. Somehow, I think, we buy into the notion that we "ought" to be able to do better than we can even though we know it's not something we can snap out of.
> > > Did you used to like vacations. I mean, is this part of the depression? Do you ever just go away with your husband?
Hard to say if I used to like vacations. I think I thought I was supposed to enjoy vacations. I go away with my husband once a year. This is terrible to admit, but I still find I have to "manage my energy" level to make it good for him.
> > >I'm hoping that her teenage years won't be too rough on us.
>
> I hope they won't be rough on her :-)They say that the years of greatest risk for mental illness are the years of hormonal change. I share your hope for her.
> I 've only just heard about spontaneous hypertensive crises in the last week. (Of course, I've never had one). It's good to see what your doctor thinks. Have you taken your BP at home during these headaches?Just today and it was fine. Well the rash may end the Parnate trial for me. I have to see if it subsides.
Do take care of yourselfLorraine
Posted by Lorraine on August 24, 2001, at 13:18:50
In reply to Re: Update Shelli/elizabeth, posted by may_b on August 24, 2001, at 10:55:39
May_b:
My pdoc copied them for me.
> I am keenly interested in these articles. How did you obtain them?
>
> Thanks,
> may_b
>
>
> >The MAO articles that I was talking about are in Psychiatric Annals 31:6/June 2001. Apparently, the entire issue is dedicated to MAOs. The titles include: "The Use of Monoamine Oxidase Inhibitors for Treating Atypical Depression" by Patrick J. McGrath et al; A Neurochemical Perspective on Monoamine Oxidase Inhibitors by Lynn Wecker et al; A Reevaluation of Dietary Restrictions for Irreversible Monoamine Oxidase Inhibitors by Kenneth Shulman et al; Selegiline and other Atypical Monoamine Oxidase Inhibitors in Depression by J. Alexander Bodkin et al; and Monoamine Oxidase Inhibitors Revisited by Jay D. Amsterdam et al.
> >
Posted by shelliR on August 24, 2001, at 22:17:45
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 24, 2001, at 13:17:31
Hi Lorraine, Elizabeth, friendly lurkers if any
> I am sorry that I didn't respond to this. I think I did but messed up when I posted. I've been wondering how you are and why you haven't posted recently. (ok 2 days< g >)
Chapter I:What I'm doing and why I didn't write
Well, right now I am really really tired. Overstimulated, then so tired in the afternoon, unable to take a nap, so I'm in that zombie place, if you know where I mean. Especially because it's 9:30(dst--Elizabeth :-) here, so what do you do when you feel this dragged out? If ESPN was a bit more in tune with my preferences, it would be showing the second semi-final (Jennifer Capriati against Venus Williams) of the Pilot Pen Tennis Tournament (warmup for the US open, in case you're not tennis fans), and I would be watching that and doing the treadmill. (I actually don't mind doing the treadmill when I'm really tired if I am watching something that I'm really into). Instead, ESPN2 has been reserved for car racing and the semi-final will be shown recorded at midnight. Bummer. See those are the really important things in life. (I'm *not* kidding).Which moves me right into why I haven't written for 2 whole days < g >. Actually, I'm a tennis nut, especially women's tennis. So there's been some great tennis going on (deep women's field), and I am also trying to get work out in between the matches and do the treadmill 45 minutes each day. (And there weren't any questions that I hadn't answered, I don't think :-) )
Chapter II: About Therapy
> You could just view her as you "work" therapist and see her when you are capable of "work".
Well, in theory that's a good idea, but not really practical. If I want my "times" reserved then I have to go because my insurance does not pay for missed appointments. To not go would be a big change and I'm not up to making any major decisions or changes right now. But we're working with EMDR and "managing affect". Sometimes it's very helpful for your therapist to set up the agenda. Like Thursday I walked in and she said, okay, we're going to continue working on "managing affect". When my life was more active than my depression, I would then sometimes say, "but.....came up this week....", and then we'd do an agenda change. But this is fine for now.We totally stay away from the topic of medication, which feels totally bizarre, since that is the focus of what's going on now. But the opiate thing is so disturbing to her that it is best to not even mention it. And probably talking about what feelings are coming up and how to stop them from overwhelming me is more useful anyway.
>
Chapter III: Wellbutrin, Other Assorted drugs, and Addiction
> Wellbutrin is a great drug if it works for you. It is a puppy upper and I felt it right away. (we seem to respond differently though to drugs).What is a puppy upper? (Will something wag or poop in the wrong place :-) ) No really, I never heard that term.
I know that I am not feeling any good effects yet because I wake up so depressed. The extra oxycontin is helping enormously. The only problem with the wellbutrin is that it's making me verbally inarticulate (which my pdoc says comes up quite often with wellbutrin and hopefully will go away). Being verbally inarticulate is not okay for me. I will give it some time, but here's my main concern, which I will ask him about when I see him on Monday. He says, "don't worry, it's a trial", but meanwhile during these trials the oxy gets me through and I need his absolute commitment that he is willing to raise the oxy as high as it needs to be raised until I find a med that works. Because with each failed trial, I have become habituated to 10 more mg of the oxy. (It's really too bad it's not offered in 5mg--because I am actually going up 10mg more than I need to each time. Like now I take 20 bid, instead of 15bid.I asked him again about buph and he feels that it is a "dirty" drug, that it has too many side effects and causes too many complications in combinations with other drugs. He's also not convinced there is no tolerance with buprenorphine.
Elizabeth, this is just his opinion, and I didn't really get into a discussion about it because I have very little time with him and was focusing on the wellbutrin (which is also not his favorite AD because of complicated side effects). I still wouldn't mind trying buph, especially after reading posts from Neil and jojo. But I am fine with the oxy as long as the rug is not pulled from under me. I am not scared of my tolerance to it, in terms of never being able to get off or going through horrible withdrawal or anything. I can't imagine that it would be worse than effexor, for example.> I was very suicidal
> I am so sorry to hear this. And concerned. How are you now? Does it help to remember to just crawl under the desk until the storm passes?To be honest, what helped was the fact that my doctor upped the oxycontin and I started a new trial with wellbutrin. And I went back on estrogen--I'm going to try it for a new months and then rethink it. I am getting what are hot flushes, (not flashes) which is a sign of lowered estrogen (in spite of my 2 glasses of soy milk daily).
> What happened with your pdoc on Thursday?
didn't raise wellbutrin because of my experience of inarticulation.
> I thought I was going to crawl out of my skin on Wellbutrin. My anxiety shot through the roof. But I know a lot of people don't have that reaction and I hope you are one of them.Well the mental/verbal aspect is more troublesome, but I did take 5mg of valium today. I'm also not at all worried about valium addiction. (Am I sounding more and more like an addictive personality with all my denial in this posts? < g >) I've taken valium off and on through my entire adult life (that or klonopin) and I just feel it normalizes a shakey life that could be even shakier. I mean, I have PTSD, and I will have to take drugs for depression and anxiety, and do therapy. It isn't my fault and these drugs allow me to have a richer life. It feels very simple to me.
>
> > > >so I am feeling off-center and very unprofessional. But at least she is off the schedule for next week.
>
> It's like they say in an airplane, first you put the oxygen mask on yourself, then you do for others. You know this, but I will say it anyway, it is not unprofessional to take care of yourself when you are sick. It is irresponsible to not take care of yourself when you are sick. You are doing everything you can Shelli. You just can't control this disease or your response to meds. All you can do is batten down the hatches during the tough times and survive so that you will be here when times are better--moods pass. I also want to remind you that you have a serious disease. If you were having a bad spot with MS, you would go easier on yourself I think. Somehow, I think, we buy into the notion that we "ought" to be able to do better than we can even though we know it's not something we can snap out of.
>
Thanks for the lecture. Really.Chapter IV: Work, Vacations and Family Issues
I am always struggling with work issues because even when my depression is under control, I distract easily. Having a DD is part of it. It obviously does take a lot of discipline to work at home by yourself and that is always a struggle for me. Plus I am really slow at doing things; that is by temperment and it's the way I like to work. But I need to work on using work time more efficiently, so I don't feel guilty when I'm not working. Today was good because I had deadlines (post office closes, frame store closes) so I pushed myself to finish what needed to get framed and mailed before I got on the computer, for example. :-) And that is important because it makes me feel much better about myself and less out of control.
>
> > > > Did you used to like vacations. I mean, is this part of the depression? Do you ever just go away with your husband?
>
> Hard to say if I used to like vacations. I think I thought I was supposed to enjoy vacations. I go away with my husband once a year. This is terrible to admit, but I still find I have to "manage my energy" level to make it good for him.I think I understand that. Is it like his energy level is higher or different, so you feel like you are keeping the pace at his level so *he* can feel, "I had a great vacation." I can see if you do have different energy levels that it would be easier working out living together than planning time on a vacation. Is this what you mean? I guess also different types of vacations would be more suited to one energy level over another. How are your energy levels different?
>
> > > >I'm hoping that her teenage years won't be too rough on us.
> > I hope they won't be rough on her :-)
> They say that the years of greatest risk for mental illness are the years of hormonal change. I share your hope for her.Since she has the personality that you have described, I would think that she'll be fine. I can imagine that your depression makes you watch her closely, but you were also a neglected child and she is not. I mean that even if genetically she has a predisposition to depression, the circumstances usually have to be there for depression to be manifested. Not always of course, like with you, Elizabeth, but more often than not.
Schizophrenia is a strange thing, because it is often manifested in the late teen years and if I remember correctly, more often for boys. That is a strange thing that I don't know a lot about but I should. Both an old boyfriend and my friend's brother both had normal childhoods and began to show signs of schizophrenia at about age 18 or 19.
>I'm of course, wondering, about you and parnate. If the rash turns out to not be an issue, you didn't get a headache today, so I don't get why you are feeling so pessimistic? Or is the talk about nardil a just in case scenario so you'll be ready if...?
BTW, I'm getting nightmares, not awful ones, more like bad long dreams since I started wellbutrin that I really do not like.
Wishing that you wake up rested without a headache tomorrow and a rash has nothing to do with parnate.
Oh wow, I can believe it is now 11 pm and I have written this much. This was like my evening activity. I think I should go back and put in chapters, or present it as a serial. See what happens when I don't write for two days. What is the face for embarrassed?Take care,
Shelli
Posted by Lorraine on August 25, 2001, at 11:47:30
In reply to Re: Update Lorainne, Elizabeth, et. al., posted by shelliR on August 24, 2001, at 22:17:45
> > > Which moves me right into why I haven't written for 2 whole days < g >. Actually, I'm a tennis nut, especially women's tennis. So there's been some great tennis going on (deep women's field), and I am also trying to get work out in between the matches and do the treadmill 45 minutes each day. (And there weren't any questions that I hadn't answered, I don't think :-) )
I am happy you have a hobby that distracts you. My husband and son are tennis buffs--both very good players and, yes, we watch a lot of tennis. It is one of the few sports I can tolerate watching. I used to play but my lack of talant was depressing.
>
> Chapter II: About Therapy
> > >To not go would be a big change and I'm not up to making any major decisions or changes right now. But we're working with EMDR and "managing affect". Sometimes it's very helpful for your therapist to set up the agenda. Like Thursday I walked in and she said, okay, we're going to continue working on "managing affect". When my life was more active than my depression, I would then sometimes say, "but.....came up this week....", and then we'd do an agenda change. But this is fine for now.You will find a way to make it work with her; it sounds like you have the motivation. It's nice that she is so proactive.
>
> > > We totally stay away from the topic of medication, which feels totally bizarre, since that is the focus of what's going on now. But the opiate thing is so disturbing to her that it is best to not even mention it. And probably talking about what feelings are coming up and how to stop them from overwhelming me is more useful anyway.I used to walk into therapy each time and say "the meds aren't working"--it got old as a discussion topic. The more important one for me became how do I resume "life" and stop putting it on hold until the meds kick in.
> > > Chapter III: Wellbutrin, Other Assorted drugs, and Addiction
> What is a puppy upper?An activating drug. On Saturday Night Live (back when it was good), Gilda Radner (who was still alive) had a routine with a bassett hound and a cha-hau-hau. The bassett hound would come dropping in and she would say "oh, you look like you need a puppy upper" and she would give him a bisquit. The basset would turn into a cha-hau-hau and start jumping up repeatedly and nipping at her. She would then say "oh you need a doggy downer" and so forth. Pretty funny routine at the time.
> > > I know that I am not feeling any good effects yet because I wake up so depressed.
Shelli: how do stimulants work with you? Are they effective at all? It doesn't sound like they are gauging your reaction to Wellbutrin.
> > > The extra oxycontin is helping enormously. The only problem with the wellbutrin is that it's making me verbally inarticulate (which my pdoc says comes up quite often with wellbutrin and hopefully will go away). Being verbally inarticulate is not okay for me.
This didn't happen to me on Wellbutrin.
> > >during these trials the oxy gets me through and I need his absolute commitment that he is willing to raise the oxy as high as it needs to be raised until I find a med that works.
I've asked this question before. This is not in capsules you can split? Get some empty capsules at the health food store and eyeball the splitting of the capsules by holding the capsules up to the light. It will allow you to increment up more slowly on your oxy and buy you time on your habituation. I have had to do this a lot because I am so dose sensitive. It's a pain in the butt, but doesn't take that long. I'd split enough caps for a week at a time. Hey, 1/2 hour out of your life. It's worth it.
> > > I asked him again about buph and he feels that it is a "dirty" drug, that it has too many side effects and causes too many complications in combinations with other drugs. He's also not convinced there is no tolerance with buprenorphine.He likes to make his job easier, doesn't he?
> > >But I am fine with the oxy as long as the rug is not pulled from under me. I am not scared of my tolerance to it, in terms of never being able to get off or going through horrible withdrawal or anything. I can't imagine that it would be worse than effexor, for example.You are probably right. Effexor was very hard for me to come off of.
> > > To be honest, what helped was the fact that my doctor upped the oxycontin and I started a new trial with wellbutrin. And I went back on estrogen--I'm going to try it for a new months and then rethink it. I am getting what are hot flushes, (not flashes) which is a sign of lowered estrogen (in spite of my 2 glasses of soy milk daily).I met with my wholistic practitioner last week and talked about hormones. She is premenopausal (barely) and takes progesterone to help control her moods. She said too little progesterone and too much progesterone causes depression. She also said that when you first become perimenopausal, it is your progesterone level that dips first. Anyway, she will be putting me back on estrogen but adding progesterone to that. She says she can tell day to day whether she needs more progesterone and tweeks her dose accordingly. She also confirmed that for PMS, the issue is progesterone rather than estrogen. Thought I'd pass this along given that you are considering all of this stuff.
> > > What happened with your pdoc on Thursday?
> didn't raise wellbutrin because of my experience of inarticulation.You might try adding Serzone at night. I was on this combo for a while. The Serzone helped me sleep and the Wellbutrin woke me up.
> > > Well the mental/verbal aspect is more troublesome, but I did take 5mg of valium today.I used to take two extra strength Buffrin before tests when I got my MBA--it really helped with thought clarity.
> > > I'm also not at all worried about valium addiction. (Am I sounding more and more like an addictive personality with all my denial in this posts? < g >)
You sound like someone who has come to grips with the fact that you will need to take meds for life and that the meds you need to take may be meds with the potential for addiction. You are not trying to get high, which is what addiciton is about. You are trying to medicate a serious condition and you know what withdrawal is about. So, I suspect that you are pretty grounded about all of this but a bit desperate right now in your quest.
> > > Thanks for the lecture. Really.Your welcome:-)
> > > Chapter IV: Work, Vacations and Family Issues
> I am always struggling with work issues because even when my depression is under control, I distract easily. Having a DD is part of it. It obviously does take a lot of discipline to work at home by yourself and that is always a struggle for me. Plus I am really slow at doing things; that is by temperment and it's the way I like to work. But I need to work on using work time more efficiently, so I don't feel guilty when I'm not working. Today was good because I had deadlines (post office closes, frame store closes) so I pushed myself to finish what needed to get framed and mailed before I got on the computer, for example. :-)You are right on track here, I think. You need to find out what you can do when you are feeling bad. Doing the mindless errands (frame shop; post office) works. For me, at least, the trick is to get my foot out the door, then the rest follows. What about doing the artistic stuff (not the shoots) when you are down? If you actually start working on your painting the photos when you are down, are you capable of pulling in the creative energy?
> >
[re me and vacations > > > >I think I understand that. Is it like his energy level is higher or different, so you feel like you are keeping the pace at his level so *he* can feel, "I had a great vacation." I can see if you do have different energy levels that it would be easier working out living together than planning time on a vacation. Is this what you mean? I guess also different types of vacations would be more suited to one energy level over another. How are your energy levels different?Bingo! Yes, he is very very very high energy and I am not, especially when I am depressed. His idea of a great vacation would be to go someplace educational, get up crack of dawn and conquer the place step by step; roll into bed at 10pm. I can't do this. We have found ways to accommodate our different energy levels--like when we were in DC the last time, I didn't go on every excurtion with them (neither did my son). Last vacation, I planned so I could have some chill time. But even being fully aware of this--there is a constant pressure with him to "do" something. It is his own internal anxiety that drives this and, thankfully, he is aware of this. I still feel the pressure though.
[re my daughter]
> Since she has the personality that you have described, I would think that she'll be fine. I can imagine that your depression makes you watch her closely, but you were also a neglected child and she is not.My daughter tells me that she doesn't want to grow up and leave her childhood because it has been so great. Can you imagine? That is so foreign from my childhood and yours.... Plus she has no traumas--no burns; no sexual abuse, no physical abuse; no deaths; no constant moving with the stress and loss of community that goes with that.
> > >I mean that even if genetically she has a predisposition to depression, the circumstances usually have to be there for depression to be manifested.
I think this is true for her. I worry much more about my son, who is emotionally intense and more predisposed I think to mood problems.
> > > Schizophrenia is a strange thing, because it is often manifested in the late teen years and if I remember correctly, more often for boysThis doesn't run in the family so I don't worry about it.
> > >I'm of course, wondering, about you and parnate.
Well, I have response but not remission. I can't increase right now because of the side effects--which include more hyperventilation as I increase the dosage. I still have the rash and it looks worse, but my husband says "it always gets redder when it's healing" and my daughter says "mommy, this is worse". So I'm giving it a few more days. I didn't get the headache this morning either. My pessimism has to do with the tears behind my eyes I think. Break-through depression.
> > >Or is the talk about nardil a just in case scenario so you'll be ready if...?
Yeah, I want the visa for my next trip so to speak in my pocket. It makes me feel better to know the next step is at hand.
> > > BTW, I'm getting nightmares, not awful ones, more like bad long dreams since I started wellbutrin that I really do not like.
I think I had that with Wellbutrin for a while.
> > >Wishing that you wake up rested without a headache tomorrow and a rash has nothing to do with parnate.Thanx. I dreamed of kittens last night. Wouldn't have known it if I hadn't woke up. Soft kitten curled around each other in a box.
Keep in touch, shelli
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