![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 33. Go back in thread:
Posted by Chris A. on September 1, 2001, at 0:34:57
In reply to in case of an accident..., posted by v on August 30, 2001, at 8:30:10
One of my past pDocs suggested wearing a bracelet stating "Allergic to Demerol" when taking an MAOI, since that is a potentially fatal interaction. I carry my pDoc's card in my wallet. When changing and titrating meds frequently it would be hard to maintain a list.
Chris A.
Posted by v on September 1, 2001, at 5:36:03
In reply to Re: in case of an accident..., posted by Chris A. on September 1, 2001, at 0:34:57
one of the reasons i started this thread is because i'm a cyclist, among other things (when i am functioning that is). i keep a card inside the little bag under my saddle with emergency contact & current meds
but the other reason i've been thinking about this is because i recently went to the doctor for a throat and chest infection... i couldn't get in to see my primary and had to settle for the doctor's asssistant, whom i've not had good luck with in the past - i suspect him of being a recovering addict because of his refusal to dispense anything with any narcotic properties... in other words anything that works for me... i have a very low pain threshhold and a very high tolerance to opiads of any kind since my meds... btw, i am not an abuser, just someone looking for relief... which is what the damn things were designed for... but i digress, although this is somewhat pertinent to my recent experience.
now supposedly (i even asked to make sure) the doctor's assistant has "your" chart - there is supposed to be only one chart... my chart is filled with all my meds... the FIRST thing the primary does (or her nurse) is check on my current med status... this one didn't even ask (so what chart was he looking at?) and i was too sick to remember to say anything. rather than give me the cough medicine which should have been in my chart as having worked before (really nasty brown stuff, it's strong and it works) he gives me a cough medicine with dextromethorphan - basically same stuff as over the counter but stronger... now here come the fun part... i have discovered that i have a weird reaction to dextromethorphan... i've pinpionted it to either effexor or ritalin since those have been the only drugs which i have been on consistently for some time now, although at different doses. the only warning label on cough medicines with this ingredient pertain to maoi's so i wasn't too concerned... and so i accepted what was obviously just a stronger version of an over the counter that i'd have to pay more for
the first night, i took the prescription dextramethorphan, my partner said i was slurring severly like i was drunk and sent me off to bed. the next day (being too sick to go to work) when i took the next dose i found myself in bed the whole day feeling both drunk and on acid... hallucinating, not unpleasantly but enough to know it was happening and i didn't move around much... most of the time i lay fascinated by what i could see inside my eyelids when i closed my eyes... the next dose put me to what i think may have been the edge of psychosis - as i remember having this feeling that i could continue to let go and recede into this place and not come back if i wanted to but i feared still feeling physical sensation (i tested whether i could still feel the air on my skin) and would therefore know what horrible things were being done to me, obviously i returned. when i finally tried to get up i felt horrible, my motor skills severely impaired, and threw the rest of the damn stuff away
before i am chastised for having testing it 3 times, i will admit to being an old hippie and somewhat adventurous to experimentation... besides the drug labels didn't say it was toxic to me... although it obviously was
my current cocktail is faily complicated, as it contains alot of different meds
what other, possibly "benign" substances could harm me... and are they also linked to some of the same toxicity of maoi's?
what protection do i have? i've been thinking, maybe a medic-alert bracelet that says something like "check for medications listed elsewhere on card" with my pdocs phone # on it... would that help? is it a worthwhile investment - and could it protect people from being misdiagnosed like elizabeth was as having overdosed on benzos or imagine having those wonderful side effects of missing your effexor dose or whatever else becomes addictive to the body... how would they understand that? i just don't think we can assume that the medical care we receive in an emergency or any situation will be good... there are countless stories about the "practice" of medicine
i apologize for rambling for so long... i know i could've left much of out but i don't want to go back and edit myself, as i so often do in the outside world... so i appreciate anyone who reads the whole thing and maybe wants to comment or share
("edited" here so as not to go on any longer... i've psycho-babbled at you enough.. :)
blessings to all
v"those who hear not the music... think the dancers mad"
> One of my past pDocs suggested wearing a bracelet stating "Allergic to Demerol" when taking an MAOI, since that is a potentially fatal interaction. I carry my pDoc's card in my wallet. When changing and titrating meds frequently it would be hard to maintain a list.
>
> Chris A.
Posted by susan C on September 1, 2001, at 12:36:44
In reply to Re: in case of an accident... LONG, posted by v on September 1, 2001, at 5:36:03
I have been keep a msword document, I update it before I go to any doctor. I list everything I am taking or expect to take, what it is for, when I started, how much and possible side effects, who prescribed it when and their name address and phone number. I keep reducing the font size and margins to fit on one page (lol) At the top in big letters I state what I am allergic to and what my reactions are. I put this with my wallet, my collection of medicines and vitamins I take, my pocket, the car and my spouse. And, of course, everytime I go in to the gp (or other doc) I hand them a new one. The intake nurse is always so appreciative, as she then does not need to write all this down.
This is all qualified, by sometimes I am too confused to keep track of anything, but it does get done before I go to doc, as I am very tired of telling them everything I take.
Just my way. Susan C.
one of the reasons i started this thread is because i'm a cyclist, among other things (when i am functioning that is). i keep a card inside the little bag under my saddle with emergency contact & current meds
>
> but the other reason i've been thinking about this is because i recently went to the doctor for a throat and chest infection... i couldn't get in to see my primary and had to settle for the doctor's asssistant, whom i've not had good luck with in the past - i suspect him of being a recovering addict because of his refusal to dispense anything with any narcotic properties... in other words anything that works for me... i have a very low pain threshhold and a very high tolerance to opiads of any kind since my meds... btw, i am not an abuser, just someone looking for relief... which is what the damn things were designed for... but i digress, although this is somewhat pertinent to my recent experience.
>
> now supposedly (i even asked to make sure) the doctor's assistant has "your" chart - there is supposed to be only one chart... my chart is filled with all my meds... the FIRST thing the primary does (or her nurse) is check on my current med status... this one didn't even ask (so what chart was he looking at?) and i was too sick to remember to say anything. rather than give me the cough medicine which should have been in my chart as having worked before (really nasty brown stuff, it's strong and it works) he gives me a cough medicine with dextromethorphan - basically same stuff as over the counter but stronger... now here come the fun part... i have discovered that i have a weird reaction to dextromethorphan... i've pinpionted it to either effexor or ritalin since those have been the only drugs which i have been on consistently for some time now, although at different doses. the only warning label on cough medicines with this ingredient pertain to maoi's so i wasn't too concerned... and so i accepted what was obviously just a stronger version of an over the counter that i'd have to pay more for
>
> the first night, i took the prescription dextramethorphan, my partner said i was slurring severly like i was drunk and sent me off to bed. the next day (being too sick to go to work) when i took the next dose i found myself in bed the whole day feeling both drunk and on acid... hallucinating, not unpleasantly but enough to know it was happening and i didn't move around much... most of the time i lay fascinated by what i could see inside my eyelids when i closed my eyes... the next dose put me to what i think may have been the edge of psychosis - as i remember having this feeling that i could continue to let go and recede into this place and not come back if i wanted to but i feared still feeling physical sensation (i tested whether i could still feel the air on my skin) and would therefore know what horrible things were being done to me, obviously i returned. when i finally tried to get up i felt horrible, my motor skills severely impaired, and threw the rest of the damn stuff away
>
> before i am chastised for having testing it 3 times, i will admit to being an old hippie and somewhat adventurous to experimentation... besides the drug labels didn't say it was toxic to me... although it obviously was
>
> my current cocktail is faily complicated, as it contains alot of different meds
>
> what other, possibly "benign" substances could harm me... and are they also linked to some of the same toxicity of maoi's?
>
> what protection do i have? i've been thinking, maybe a medic-alert bracelet that says something like "check for medications listed elsewhere on card" with my pdocs phone # on it... would that help? is it a worthwhile investment - and could it protect people from being misdiagnosed like elizabeth was as having overdosed on benzos or imagine having those wonderful side effects of missing your effexor dose or whatever else becomes addictive to the body... how would they understand that? i just don't think we can assume that the medical care we receive in an emergency or any situation will be good... there are countless stories about the "practice" of medicine
>
> i apologize for rambling for so long... i know i could've left much of out but i don't want to go back and edit myself, as i so often do in the outside world... so i appreciate anyone who reads the whole thing and maybe wants to comment or share
>
> ("edited" here so as not to go on any longer... i've psycho-babbled at you enough.. :)
>
> blessings to all
> v
>
> "those who hear not the music... think the dancers mad"
>
>
> > One of my past pDocs suggested wearing a bracelet stating "Allergic to Demerol" when taking an MAOI, since that is a potentially fatal interaction. I carry my pDoc's card in my wallet. When changing and titrating meds frequently it would be hard to maintain a list.
> >
> > Chris A.
Posted by v on September 3, 2001, at 13:56:03
In reply to Re: in case of an accident... LONG, posted by susan C on September 1, 2001, at 12:36:44
hi susan... thanks for taking the time to reply...
your solution is a good one as it obviously works for you but i tweak my meds often and don't always know what my reactions would be... who could've predicted that dextramethorphan would be toxic to me? are doctors aware of such toxicities? it only mentions maois on the bottle...
is there an authority out there for whether certain classes of drugs have other interactions like i experienced? Dr.Bob, what would you suggest?
on the other hand i will definitely be more diligent and will keep a list (even if i have to change it) to present to physicians... although my current primary freaked when she saw my list from last year... i can't imagine what she's going to do when she hears about the new stuff... i have found that most medical doctors don't really understand the concept of "cocktails" - that brain chemistry differs so widely that we each must find our own relief ... my primary has become very reluctant to prescribe pain killers if i need them (i have degenerative disc disease in both my neck and lower back) or much of anything really as she thinks i'm in such an "altered" state from so many drus to begin with
so does someone - a pdoc - (Dr. Bob again?) need to write articles explaining this to others doctors in their own journals... how do we achieve the greater understanding we all crave... how to educate those in particular who already think they know everything
blessing to you all... hope you weekend was a good one
v
"those who hear not the music... think the dancers mad"> I have been keep a msword document, I update it before I go to any doctor. I list everything I am taking or expect to take, what it is for, when I started, how much and possible side effects, who prescribed it when and their name address and phone number. I keep reducing the font size and margins to fit on one page (lol) At the top in big letters I state what I am allergic to and what my reactions are. I put this with my wallet, my collection of medicines and vitamins I take, my pocket, the car and my spouse. And, of course, everytime I go in to the gp (or other doc) I hand them a new one. The intake nurse is always so appreciative, as she then does not need to write all this down.
>
> This is all qualified, by sometimes I am too confused to keep track of anything, but it does get done before I go to doc, as I am very tired of telling them everything I take.
>
> Just my way. Susan C.
Posted by susan C on September 3, 2001, at 14:44:24
In reply to Re: in case of an accident... LONG » susan C, posted by v on September 3, 2001, at 13:56:03
Hi, V,
Yes, I am tweeking things too, I have also found my reactions different than what is listed on the enclosures. For me, it is antihistamines, they toss me into suicidal depression within 48 hours, but no one, here, nor the Pharmacist, can find any reference to my experience. The closest is a listed 2% experience of drowsiness in the research of the new types like Allegra. I have found only two people one, a good friend and on another on another posting place, that have experience a similar experience with antihistamines, even the new ones that supposedly do not cross the blood brain barrier. One pdoc described me as saying 'she believes Allegra to have caused ....' arrrrrgh. I think this common thread of trying things and getting unusual, diverse reactions and trying combinations of things centering around depression and manic draws me to this board. There are many of us who have tried and tried to find solutions and are attentively watching for the next possible solution. Thank you for your post. It reminds me that if an emergency happens I need to be extra prepared.
Susan C.
Posted by Elizabeth on September 8, 2001, at 21:54:48
In reply to Re: in case of an accident... » Elizabeth, posted by Zo on August 31, 2001, at 15:42:26
> What would you suggest carrying, by way of info?
How about one of those dogtags (gets in the way less than a bracelet), inscribed "see wallet card?" (Don't forget the card, of course. < g >)
-elizabeth
Posted by Elizabeth on September 8, 2001, at 21:56:19
In reply to Re: in case of an accident... LONG, posted by susan C on September 1, 2001, at 12:36:44
> I have been keep a msword document, I update it before I go to any doctor.
That's smart (well, except for the Word part < VBG >).
-anti-microsoft elizabeth
Posted by Elizabeth on September 8, 2001, at 22:05:32
In reply to Re: in case of an accident... LONG, posted by v on September 1, 2001, at 5:36:03
> i couldn't get in to see my primary and had to settle for the doctor's asssistant, whom i've not had good luck with in the past - i suspect him of being a recovering addict because of his refusal to dispense anything with any narcotic properties...
Naw, lots of clinicians have that sort of attitude. Nurses and "mid-level providers" might be worse than physicians.
> in other words anything that works for me... i have a very low pain threshhold and a very high tolerance to opiads of any kind since my meds...
"Intrinsic tolerance" as opposed to acquired tolerance? That's me too. (Chronic musculoskeletal pain, hypersensitivity to cold, etc.)
> btw, i am not an abuser, just someone looking for relief... which is what the damn things were designed for... but i digress, although this is somewhat pertinent to my recent experience.
If you'd been born 100 years ago you'd have no problem getting them. Sad, n'est-ce pas?
> now supposedly (i even asked to make sure) the doctor's assistant has "your" chart - there is supposed to be only one chart...
I ran into this problem when I was in the hospital (medical, not psych) this spring. There seemed to be very poor communication and documentation among the hospital staff.
> i have discovered that i have a weird reaction to dextromethorphan... i've pinpionted it to either effexor or ritalin since those have been the only drugs which i have been on consistently for some time now, although at different doses.
DXM can definitely interact with Effexor. (I have weird reactions to it by itself, in recommended doses. Anyway, it's not a very effective cough suppressant IMO.)
> the first night, i took the prescription dextramethorphan, my partner said i was slurring severly like i was drunk and sent me off to bed.
Bingo! Slurred speech, ataxia, etc. are symptoms of DXM overdose.
> what other, possibly "benign" substances could harm me... and are they also linked to some of the same toxicity of maoi's?
Hmm. Ultram comes to mind.
-e
Posted by susan C on September 8, 2001, at 23:19:12
In reply to Re: in case of an accident... LONG » susan C, posted by Elizabeth on September 8, 2001, at 21:56:19
> > I have been keep a msword document, I update it before I go to any doctor.
>
> That's smart (well, except for the Word part < VBG >).
>
> -anti-microsoft elizabethbut I got it for free because of friends of son interning there....
Posted by v on September 9, 2001, at 5:46:41
In reply to Re: in case of an accident... LONG » v, posted by Elizabeth on September 8, 2001, at 22:05:32
thanks for replying
ultram - that's the only painkiller this idiot will ever give me... i haven't had any reactions to it although i've taken as much as 15 in a day seeking relief... imho, it's worthlesss, for me at least
regards,
v> > i couldn't get in to see my primary and had to settle for the doctor's asssistant, whom i've not had good luck with in the past - i suspect him of being a recovering addict because of his refusal to dispense anything with any narcotic properties...
>
> Naw, lots of clinicians have that sort of attitude. Nurses and "mid-level providers" might be worse than physicians.
>
> > in other words anything that works for me... i have a very low pain threshhold and a very high tolerance to opiads of any kind since my meds...
>
> "Intrinsic tolerance" as opposed to acquired tolerance? That's me too. (Chronic musculoskeletal pain, hypersensitivity to cold, etc.)
>
> > btw, i am not an abuser, just someone looking for relief... which is what the damn things were designed for... but i digress, although this is somewhat pertinent to my recent experience.
>
> If you'd been born 100 years ago you'd have no problem getting them. Sad, n'est-ce pas?
>
> > now supposedly (i even asked to make sure) the doctor's assistant has "your" chart - there is supposed to be only one chart...
>
> I ran into this problem when I was in the hospital (medical, not psych) this spring. There seemed to be very poor communication and documentation among the hospital staff.
>
> > i have discovered that i have a weird reaction to dextromethorphan... i've pinpionted it to either effexor or ritalin since those have been the only drugs which i have been on consistently for some time now, although at different doses.
>
> DXM can definitely interact with Effexor. (I have weird reactions to it by itself, in recommended doses. Anyway, it's not a very effective cough suppressant IMO.)
>
> > the first night, i took the prescription dextramethorphan, my partner said i was slurring severly like i was drunk and sent me off to bed.
>
> Bingo! Slurred speech, ataxia, etc. are symptoms of DXM overdose.
>
> > what other, possibly "benign" substances could harm me... and are they also linked to some of the same toxicity of maoi's?
>
> Hmm. Ultram comes to mind.
>
> -e
Posted by Rach on September 9, 2001, at 11:43:30
In reply to Re: in case of an accident... LONG » Elizabeth, posted by v on September 9, 2001, at 5:46:41
been thinking of you lately. how's it all going?
(apologies for being on the wrong board)
Posted by Elizabeth on September 12, 2001, at 3:32:06
In reply to Re: in case of an accident... LONG » Elizabeth, posted by v on September 9, 2001, at 5:46:41
> ultram - that's the only painkiller this idiot will ever give me... i haven't had any reactions to it although i've taken as much as 15 in a day seeking relief... imho, it's worthlesss, for me at least
Me too. But anyway, try to get some citations about the serotonin syndrome from Ultram with ADs and show them to the PA who's your "mid-level provider." :-P (Which AD are you taking, BTW?)
-elizabeth
Posted by v on September 12, 2001, at 6:19:09
In reply to Re: in case of an accident... LONG » v, posted by Elizabeth on September 12, 2001, at 3:32:06
good morning elizabeth
i was in the middle of a long explanation of my meds when my computer crashed.... so here's a somewhat truncated version (turning rather long anyway... )
what a great idea about getting some documentation... would a search for seratonin syndrome show up the dextramethorphan as well? what about the high tolerance to pain meds? i go for a "physical" with my primary next week who has no understanding of "cocktails" to suit each individual's needs... all she sees are lots of drugs and she freaks on me and then doesn't want to give me anything else i need (particularly pain killers which i sorely need for my neck and back)
last year all she would say was that i was already in such an "altered" state... she just doesn't get it... i'm actually dreading having to tell her about the current cocktail and have even thought about leaving some of them out (i know, it's probably not that great an idea)my current cocktail is:
• 36mg concerta
• 200mg wellbutrin 2x daily
• 75mg effexor
• 1mg klonopin 3x daily (i only take .5 with my morning meds)
• 10mg buspar (this is something i've recently snuck back in - pdoc says its worthless, which was true for me regarding any anti-anxiety effects but it did have an anti-depressant effect for me which i feel i need - i figured i'd give it a trial run and then tell him when i see him next month - i think it's helping although with me, it's sometimes hard to tell.. :)
• valium, xanax & ambien on an as needed basis only, usually when i am particularly stressed (like yesterday) or am having difficulty falling asleepi still have alot of trouble getting out of the house initially... or initiating doing the things i enjoy... in fact, there is still a lack of joy in my life (hence the buspar trial), i am still easily stressed out & can become resentful (which can be the norm for me and something i dislike intensely)
i'm also turning into a scatter brained idiot from some of the meds... memory problems & sometimes it feels as if the add is worse instead of better... it's complicated by the fact that my personality is so fragmented. my current pdoc thinks EVERYTHING wrong with me is due to add (it's like he stamped it on my forehead) but i also suffer from ptsd, did and depression and have gone back into therapy to try and deal with not wanting to deal with life... for me yesterday was an extreme example of it: why should i want to remain in a world so full of hate? i can't bear the human capacity for cruelty (to each other, to animals, to the planet) it hurts, it hurts, it hurts....
sorry this turned into such a long winded answer...
btw, what ad's are you taking if you don't mind my asking? i've really appreciated your posts on this board...
blessings,
v
> Me too. But anyway, try to get some citations about the serotonin syndrome from Ultram with ADs and show them to the PA who's your "mid-level provider." :-P (Which AD are you taking, BTW?)
>
> -elizabeth
Posted by Elizabeth on September 12, 2001, at 21:30:50
In reply to Re: in case of an accident... LONG...LONG » Elizabeth, posted by v on September 12, 2001, at 6:19:09
> what a great idea about getting some documentation... would a search for seratonin syndrome show up the dextramethorphan as well?
Searching for "serotonin" and "dextromethorphan" might get you what you're looking for (be sure to spell them right < g >).
> what about the high tolerance to pain meds?
Have you used opioids a lot in the past? Some people (such as myself) seem to be resistant to opioids before ever having tried them. It's tough convincing a doctor that you're not a drug addict, isn't it?
> my current cocktail is:
> • 36mg concerta
> • 200mg wellbutrin 2x daily
> • 75mg effexor
> • 1mg klonopin 3x daily (i only take .5 with my morning meds)
> • 10mg busparThe Concerta (and maybe Klonopin) are the only things that stand out. I would suggest seeing a psychiatrist, though. Get a referral from your GP.
Buspar can augment the Effexor, BTW.
> • valium, xanax & ambien on an as needed basis only, usually when i am particularly stressed (like yesterday) or am having difficulty falling asleep
I think you could possibly leave those out if you only use them occasionally and familiarise yourself with possible interactions.
> i still have alot of trouble getting out of the house initially... or initiating doing the things i enjoy... in fact, there is still a lack of joy in my life (hence the buspar trial), i am still easily stressed out & can become resentful (which can be the norm for me and something i dislike intensely)
I understand. Have you ever tried Remeron? I know a few people who've described similar problems to yours who've found it extremely helpful.
> btw, what ad's are you taking if you don't mind my asking? i've really appreciated your posts on this board...
Thank you. Since you ask:
desipramine 50 mg 4x/day
buprenorphine 1 mL (= 0.3 mg) 3x/day
Klonopin 1 mg morning, 1 mg afternoon, 2 mg bedtimeAnd some other stuff to counteract side effects. < g >
-elizabeth
Posted by v on September 13, 2001, at 6:37:46
In reply to Re: in case of an accident... LONG...LONG » v, posted by Elizabeth on September 12, 2001, at 21:30:50
good morning elizabeth
> Searching for "serotonin" and "dextromethorphan" might get you what you're looking for (be sure to spell them right < g >).
it worked wonders... i've gotten all this information about dextromethorphan & ultram, all the junk they give me to avoid - oh horrors! - opiads - which, of course, work without bad interactions. and i got some stuff about opiads and why they can or should be used as well
> Have you used opioids a lot in the past? Some people (such as myself) seem to be resistant to opioids before ever having tried them. It's tough convincing a doctor that you're not a drug addict, isn't it?i've used opiads for pain off and on for years and usually was responsive to smaller doses than now... i think the ritalin may be responsible but i'm not sure... and i also used to be one of those people who broke a 5mg valium in half to go to sleep but i know that tolerance is due to the klonopin
and yes!, it is impossible to get a doctor to see that you are not a drug addict!!! they're all so worried about "addiction" rather than relief. well, i'm already addicted to half the stuff i take - can't just stop the effexor or the klonopin now can i... so what's the difference? these medications were made to be used because they work
> The Concerta (and maybe Klonopin) are the only things that stand out. I would suggest seeing a psychiatrist, though. Get a referral from your GP.
>
> Buspar can augment the Effexor, BTW.i do see a psychiatrist for my meds... he's the one who sees ADD stamped on my forehead for some reason. and i know that the buspar augments the effexor, that's why i take it... it's far more benign to me than a higher effexor dose
so i'm thinking of telling my primary only about the concerta, klonopin and effexor - that's enough to make her think i'm "altered" as it is
> > i still have alot of trouble getting out of the house initially... or initiating doing the things i enjoy... in fact, there is still a lack of joy in my life (hence the buspar trial), i am still easily stressed out & can become resentful (which can be the norm for me and something i dislike intensely)
>
> I understand. Have you ever tried Remeron? I know a few people who've described similar problems to yours who've found it extremely helpful.i'll look into remeron but i seem to recall that it carries the dreaded "weight gain" which is not an option for me as i've been eating disordered all my life. since i started the wellbutrin, i have had better impulse control and am s-l-ow-l-y losing some of the weight i've gained the past couple of years. for me being overweight is downright hell... i've been an athlete of sorts off and on in different sports over the years and like and need to feel strong and lean... makes me feel more grounded and better able to deal with the hellish world out there
> > btw, what ad's are you taking if you don't mind my asking? i've really appreciated your posts on this board...
>
> Thank you. Since you ask:
> desipramine 50 mg 4x/day
> buprenorphine 1 mL (= 0.3 mg) 3x/day
> Klonopin 1 mg morning, 1 mg afternoon, 2 mg bedtime
>
> And some other stuff to counteract side effects. < g >
> -elizabethis this combo working well for you?
btw, you have me somewhat interested in the buprenorphine as i've read several posts about itthanks again & again for all your support... you've been of tremendous help
blessings,
v
Posted by Elizabeth on September 13, 2001, at 10:58:34
In reply to Re: in case of an accident... LONG...LONG » Elizabeth, posted by v on September 13, 2001, at 6:37:46
> good morning elizabeth
hiya.
> > Have you used opioids a lot in the past? Some people (such as myself) seem to be resistant to opioids before ever having tried them. It's tough convincing a doctor that you're not a drug addict, isn't it?
>
> i've used opiads for pain off and on for years and usually was responsive to smaller doses than now...You might be developing tolerance, or some other dysfunction of your endogenous opioid system. I don't know -- opioid receptors were the first ones discovered, but we still don't really know how they work, interact with other systems, etc.
> i think the ritalin may be responsible but i'm not sure...
Hmm. Why do you think that?
> and yes!, it is impossible to get a doctor to see that you are not a drug addict!!! they're all so worried about "addiction" rather than relief.
Well, what they're really worried about is losing their licenses. But seriously, the attitude in this country toward drug addicts is like the attitudes in the '50s toward Communists.
> well, i'm already addicted to half the stuff i take - can't just stop the effexor or the klonopin now can i... so what's the difference?
Uh-uh. That's not addiction. The definition of addiction -- "substance dependence," is the official name for it -- can be found on many websites. Here's one: http://www.behavenet.com/capsules/disorders/subdep.htm
> these medications were made to be used because they work
You'd *think* that, wouldn't you?!
> i do see a psychiatrist for my meds... he's the one who sees ADD stamped on my forehead for some reason.
IMO, some doctors have pet diagnoses that they see in everybody they encounter.
> and i know that the buspar augments the effexor, that's why i take it... it's far more benign to me than a higher effexor dose
You know, one thing you could try doing to see if it helps would be raising the Buspar dose, to something like 60 mg or even more.
> so i'm thinking of telling my primary only about the concerta, klonopin and effexor - that's enough to make her think i'm "altered" as it is
A friend of mine tells me that when he asked to try adding stimulants to his Xanax, he was told that "stimulants and benzodiazepines are only seen together in abuse."
> i'll look into remeron but i seem to recall that it carries the dreaded "weight gain" which is not an option for me as i've been eating disordered all my life.
It might be worth a try. I tried it for a month or so and didn't gain any weight. I started out on 30 mg and rapidly increased it to 60. I think that the weight gain is more of a problem at the lower doses.
> since i started the wellbutrin, i have had better impulse control and am s-l-ow-l-y losing some of the weight i've gained the past couple of years.
Hey, congratulations. I don't know why they don't try to market Wellbutrin as a diet pill. (Maybe it's because diet pills are assumed to have "abuse potential.") I know it's a slow process, but I think that if you are gradually losing weight rather than going on a major diet and losing it all at once, you're probably less likely to regain it. (Does that make sense?)
> is this combo working well for you?
> btw, you have me somewhat interested in the buprenorphine as i've read several posts about itYes, I think it's working well. I'm feeling more interested in life than I have in a long time.
> thanks again & again for all your support... you've been of tremendous help
Flattery will get you everywhere. :-)
-elizabeth
Posted by Zo on September 13, 2001, at 17:42:08
In reply to Re: in case of an accident... LONG...LONG » v, posted by Elizabeth on September 13, 2001, at 10:58:34
> A friend of mine tells me that when he asked to try >adding stimulants to his Xanax, he was told that >"stimulants and benzodiazepines are only seen together >in abuse."
One positive effect Buprenorphine I've noticed is that I can read infuriating statements like this one without becoming furious.
Zo
Posted by Elizabeth on September 14, 2001, at 8:15:39
In reply to Re: positive effect of buprenorphine, posted by Zo on September 13, 2001, at 17:42:08
Posted by v on September 16, 2001, at 6:43:51
In reply to Re: in case of an accident... LONG...LONG » v, posted by Elizabeth on September 13, 2001, at 10:58:34
good morning elizabeth
> You know, one thing you could try doing to see if it helps would be raising the Buspar dose, to something like 60 mg or even more.
does buspar need to be taken in divided dosages?
i seem to remember that when i tried taking it twice a day i couldn't fall asleep at night... it was a very weird feeeling... my mind was just "on" and sleep was out of the question... i had no desire to to anything - didn't feel stimulated but there was definitely no sleep in my futureso how high could i raise my a.m. dose? this would of course, only be an option if my pdoc agrees to prescribe it- otherwise i'll be running out so will stay on 10mg until i see him next month and see how he even reacts to my little experiment...
hope you're doing well in the midst of all this tragedy
blessings,
v
Posted by Elizabeth on September 16, 2001, at 18:24:36
In reply to Re: in case of an accident... buspar » Elizabeth, posted by v on September 16, 2001, at 6:43:51
> does buspar need to be taken in divided dosages?
At least at first, it probably should be taken in 2-3 divided doses per day.
> i seem to remember that when i tried taking it twice a day i couldn't fall asleep at night...
At what times did you take the two daily doses?
> so how high could i raise my a.m. dose?
"As tolerated." Buspar has been found to be safe in doses much higher than the recommended doses for anxiety or depression.
> hope you're doing well in the midst of all this tragedy
It could have been much worse. Thanks for your concern -- I hope you are well, too.
-elizabeth
Posted by v on September 17, 2001, at 7:22:29
In reply to Re: in case of an accident... LONG...LONG » v, posted by Elizabeth on September 13, 2001, at 10:58:34
good morning elizabeth... i know it's taken me some time to finish responding, but for what it's worth, here goes.. :)
> i think the ritalin may be responsible but i'm not sure...
>
> Hmm. Why do you think that?i's the only thing that seems to make sense is my opiad tolerance increased when i added ritalin to my meds... now painkillers don't really do a good job for me on the pain, so much as allowing me to just not mind it as much... perhaps it's the dopamine? i really don't know much about this stuff... but i have a VERY low threshold for pain, probably due to the pain in my past, the traumas and the depression itself
>
> > well, i'm already addicted to half the stuff i take - can't just stop the effexor or the klonopin now can i... so what's the difference?
>
> Uh-uh. That's not addiction. The definition of addiction -- "substance dependence," is the official name for it -- can be found on many websites. Here's one: http://www.behavenet.com/capsules/disorders/subdep.htmnow this one's been bothering me since you wrote it because that is the "therapeutic" definition...what they are really saying is addiction is substance abuse and i stress the word abuse since in the explanation for substance dependence they were talking about abuse... not dependence
the dictionary definiton of addiction is: compulsive physiological need for a habit forming drug
i'd say anything that causes withdrawal symptoms when removed fits the definition... i'm addicted to effexor & klonopin in that my body requires that i maintain the dosages... but i don't need to continually increase that dose , nor am i seeking out more from other sources.... nonetheless, i am addicted.
> > these medications were made to be used because they work
>
> You'd *think* that, wouldn't you?!their "definition" or rather their distortion of the definition is self-serving and is the very reason it is so hard for people to often get the drugs they need... substance use and substance abuse are such different things.
> > i do see a psychiatrist for my meds... he's the one who sees ADD stamped on my forehead for some reason.
>
> IMO, some doctors have pet diagnoses that they see in everybody they encounter.this is a bit of a problem for me particularly as my personality is so fragmented, he right is some ways but not in all... my add actually seems worse lately
> A friend of mine tells me that when he asked to try adding stimulants to his Xanax, he was told that "stimulants and benzodiazepines are only seen together in abuse."what can i say to that, it's so idiotic... makes me angry to even hear it
> Hey, congratulations. I don't know why they don't try to market Wellbutrin as a diet pill.
(Maybe it's because diet pills are assumed to have "abuse potential.")they already use it for quitting nicotine but i don't know if it would really work as a diet pill, because although it does help my impulse control, i must make a concerted effort to use it that way - it might help for compulsive overeaters but only if they also sought help for the need to compulsively overeat.. and they would probably also benefit from an ad to help their seratonin levels so you end up back with just us "admitted nut cases" - the magic pill it ain't... :)
well, enough babbling for now... as always i hope you are well
BTW, is there anything that can be done to help with the short term memory loss, word finding difficulty - even spelling! and general stupidity that seems to accompany these drugs? it frustrates the hell out me...
blessings,
v
Posted by Elizabeth on September 17, 2001, at 9:22:57
In reply to Re: in case of an accident... LONG...LONG » Elizabeth, posted by v on September 17, 2001, at 7:22:29
> good morning elizabeth... i know it's taken me some time to finish responding, but for what it's worth, here goes.. :)
No problem. I was away for a while, so I've posted a couple of very-late responses (much later than yours!).
> i's the only thing that seems to make sense is my opiad tolerance increased when i added ritalin to my meds... now painkillers don't really do a good job for me on the pain, so much as allowing me to just not mind it as much... perhaps it's the dopamine?
I don't know. Let me ask my in-house consultant < g > when he comes home. Opioids, of course, have effects on dopamine, thought to be linked to the observable behavioural reinforcement that makes them so hard to stay off for people (and other animals) who've been addicted. In animals, acute administration elevates extracellular dopamine levels in the nucleus accumbens (NA) (an effect also associated with stimulant administration). Increased firing rates of dopamine neurons in the NA and the ventral tegmental area (VTA) are associated with activation of opioid receptors in these areas.
(Of note, pharmacologic or "physical" dependence is not necessary for behavioural reinforcement to occur.)
> i really don't know much about this stuff... but i have a VERY low threshold for pain, probably due to the pain in my past, the traumas and the depression itself
That's interesting. I'm very curious to learn what my pharmacologist friend will have to say about this.
> now this one's been bothering me since you wrote it because that is the "therapeutic" definition...what they are really saying is addiction is substance abuse and i stress the word abuse since in the explanation for substance dependence they were talking about abuse... not dependence
The key difference between the "physiological dependence" caused by these drugs and "substance dependence" as defined in DSM-IV is drug cravings. Do you have cravings for Effexor or Klonopin (similar to cravings for food when you're really hungry)?
> the dictionary definiton of addiction is: compulsive physiological need for a habit forming drug
That's silly. Pharmacologic dependence isn't a result of psychopathology -- it's a normal, expected response to chronic drug administration. Most people who take opioids, stimulants, alcohol, etc. do not become addicated. Use of stimulants in the treatment of childhood ADHD is associated with a *decreased* risk of later substance abuse, in fact.
> i'd say anything that causes withdrawal symptoms when removed fits the definition...
That depends how broadly you define "withdrawal symptoms." Lots of drugs -- including plenty that aren't even psychoactive -- cause specific withdrawal symptoms (e.g., antihypertensive drugs often cause rebound hypertension if they're discontinued too fast). Only the "drugs of abuse," for want of a better term, cause "cravings" and drug-seeking behaviour, which are *not* specific effects associated with any particular mechanism of drug action (that is, they're caused by a wide variety of drugs with a variety of mechanims).
> their "definition" or rather their distortion of the definition is self-serving and is the very reason it is so hard for people to often get the drugs they need... substance use and substance abuse are such different things.
And so are pharmacologic dependence and addiction. Don't conflate them.
> > IMO, some doctors have pet diagnoses that they see in everybody they encounter.
>
> this is a bit of a problem for me particularly as my personality is so fragmented, he right is some ways but not in all... my add actually seems worse latelyHow do you mean that when you say your personality is fragmented?
> > A friend of mine tells me that when he asked to try adding stimulants to his Xanax, he was told that "stimulants and benzodiazepines are only seen together in abuse."
>
> what can i say to that, it's so idiotic... makes me angry to even hear itMe too. I broached the subject of trying psychostimulants (which were somewhat helpful to me in the past), and my pdoc didn't seem to think that adding them to clonazepam was a problem.
re Wellbutrin:
> they already use it for quitting nicotine but i don't know if it would really work as a diet pill, because although it does help my impulse control, i must make a concerted effort to use it that way - it might help for compulsive overeaters but only if they also sought help for the need to compulsively overeat.. and they would probably also benefit from an ad to help their seratonin levels so you end up back with just us "admitted nut cases" - the magic pill it ain't... :)No, Wellbutrin really decreases appetite. SSRIs don't necessarily, and I don't think they would be a great treatment for binge-eating. Wellbutrin (which is related to a marketed diet pill, Tenuate (diethylpropion), BTW) might even help long-term. It just occurred to me, though, that based on a single, possibly skewed study, there's a warning in the labelling and Wellbutrin isn't "supposed" to be used in treating *any* eating disorder. An alarmingly high percentage of bulimic patients (4/55, or about 7%) given WB in the study in question had seizures. Somehow, based solely on this single result, it was concluded that bulimics (and by extension all eating disorder patients!) are more susceptible to the seizure threshold-lowering effects than are non-eating-disordered people.
> well, enough babbling for now... as always i hope you are well
Same back atcha. :-)
> BTW, is there anything that can be done to help with the short term memory loss, word finding difficulty - even spelling! and general stupidity that seems to accompany these drugs? it frustrates the hell out me...
Umm...Aricept? Amisulpride? I dunno, this is a common problem with antidepressants but there hasn't been much research into what causes it or how it can be alleviated.
-elizabeth
Posted by v on September 18, 2001, at 17:11:02
In reply to Re: in case of an accident... LONG...LONG » v, posted by Elizabeth on September 17, 2001, at 9:22:57
> I don't know. Let me ask my in-house consultant < g > when he comes home. Opioids, of course, have effects on dopamine, thought to be linked to the observable behavioural reinforcement that makes them so hard to stay off for people (and other animals) who've been addicted. In animals, acute administration elevates extracellular dopamine levels in the nucleus accumbens (NA) (an effect also associated with stimulant administration). Increased firing rates of dopamine neurons in the NA and the ventral tegmental area (VTA) are associated with activation of opioid receptors in these areas.
>
> (Of note, pharmacologic or "physical" dependence is not necessary for behavioural reinforcement to occur.)please bear with me if i ask dumb questions as i am MUCH more ignorant than you about the scientific stuff but is it possible for the domanine levels to top out - i don't know if i'm explaining myself clearly as i am sooo out of my depth here, also i don't really know if it's the ritalin... it just felt like it might be related... it could also be the wellbutrin - doesn't that also affect dopamine? Probably it could be that since i feel some stimulation from the ritalin, i just don't feel the effects of the painkillers as much and that's what leads me to believe they are not working as well.
and as i found out yesterday from my doctor, i take hydrocodone... she just freaked out when i asked her for opiad painkillers, and when i mentioned having used lortab in the past, she asked me why i was asking for opiads when i was talking about hyrocodone which she doesn't mind prescribing. so am i talking about 2 totally different things here or are we talking different composites? - hydrocodone having other stuff in it and obviously being a weaker version
> > i really don't know much about this stuff... but i have a VERY low threshold for pain, probably due to the pain in my past, the traumas and the depression itself
> That's interesting. I'm very curious to learn what my pharmacologist friend will have to say about this.i'm really curious to hear what she/he will say about it...
> The key difference between the "physiological dependence" caused by these drugs and "substance dependence" as defined in DSM-IV is drug cravings. Do you have cravings for Effexor or Klonopin (similar to cravings for food when you're really hungry)?> > the dictionary definiton of addiction is: compulsive physiological need for a habit forming drug
> That's silly. Pharmacologic dependence isn't a result of psychopathology -- it's a normal, expected response to chronic drug administration. Most people who take opioids, stimulants, alcohol, etc. do not become addicated. Use of stimulants in the treatment of childhood ADHD is associated with a *decreased* risk of later substance abuse, in fact.
>
> > i'd say anything that causes withdrawal symptoms when removed fits the definition...
>
> That depends how broadly you define "withdrawal symptoms." Lots of drugs -- including plenty that aren't even psychoactive -- cause specific withdrawal symptoms (e.g., antihypertensive drugs often cause rebound hypertension if they're discontinued too fast). Only the "drugs of abuse," for want of a better term, cause "cravings" and drug-seeking behaviour, which are *not* specific effects associated with any particular mechanism of drug action (that is, they're caused by a wide variety of drugs with a variety of mechanims).
>
> > their "definition" or rather their distortion of the definition is self-serving and is the very reason it is so hard for people to often get the drugs they need... substance use and substance abuse are such different things.
>
> And so are pharmacologic dependence and addiction. Don't conflate them.well, i think we'll have to agree to disagree here... as the definition existed way before the DSM-IV started using it to decribe abuse... i think we're up against the connotation of a term and the denotation of the term... personally i think there should be classifications of addiction, ranging from the dictionary's version (what you call pharmacologic dependence), then on to describe the many levels of abuse. i recently read an article that stated that there were alot of people (many of them elderly) who refused painkillers because they were afraid of becoming "addicted". i think we need to de-stigmatize the damn word & see it for what it is, as well as what it can become... many more people stand a chance of being helped by drugs that were initially made to serve a purpose - to help with pain. and it's just possible that by making the concept more understandable, people like us would have an easier time getting the help we're asking for
> > this is a bit of a problem for me particularly as my personality is so fragmented, he right is some ways but not in all... my add actually seems worse lately
>
> How do you mean that when you say your personality is fragmented?i have did - dissociative identity disorder - meaning that there are alot of me's in here...there being a huge continuum in the disorder - i'm not full blown multiple - my personality is broken into many subpersonalities - some have names, some remain hidden, many talk at once and i don't know if i actually have a core personality or if we're just run by a bunch of us... different ones at different times. it makes some things funny... i'll read a book and not remember anything about it... i've bought books i already have in my library. my partner has to constantly tell me "we've already seen it" when looking at movie videos - i've even accused him of just telling me that when he isn't interested in seeing something since i wouldn't know the difference, but he swears he doesn't... i often won't remember ever being somewhere before... i don't remember alot of things in the past, which drives some of my friends crazy.. but do remember alot too....although what i remember can change depending on who was present... i do have many, many memories, although very little re: my childhood. a new personality emerged when i recently changed all my meds - new to me, mind you... not new to life inside me, but it was weird for me and alittle scary. they hold the memories i couldn't at the time deal with... and i suppose the "splitting" is what kept me alive at one time. survival tactics take all forms... i'm back in therapy trying to get feel what i must, what they know... i dissociate very easily... sit perched in my mind. it's hard for me to really cry... i did, however, cry hysterically last tuesday due to human capacity for cruelty and evil. i find life here very difficult... with dailiness being the hardest... living does not come easily to me...obviously. and integration is of no interest to me... there are alot of things i enjoy about us... we sometimes have alot of fun together and i feel alot of love for some of the children i know. now if we can just learn to live! as well, as it is probably obvious, i also suffer from ptsd.
> No, Wellbutrin really decreases appetite. SSRIs don't necessarily, and I don't think they would be a great treatment for binge-eating. Wellbutrin (which is related to a marketed diet pill, Tenuate (diethylpropion), BTW) might even help long-term. It just occurred to me, though, that based on a single, possibly skewed study, there's a warning in the labelling and Wellbutrin isn't "supposed" to be used in treating *any* eating disorder. An alarmingly high percentage of bulimic patients (4/55, or about 7%) given WB in the study in question had seizures. Somehow, based solely on this single result, it was concluded that bulimics (and by extension all eating disorder patients!) are more susceptible to the seizure threshold-lowering effects than are non-eating-disordered people.
i wasn't suggesting that ssri's would help with weight loss, particularly as they so often cause weight gain.. what i did mean what that most compulsive overeaters need more than a diet pill to make themselves well... let's face it, if diet pills worked, americans wouldn't be continuing to become more and more obese. btw, i was on wellbutrin before - by itself - and it had absolutely no noticeable effect on my appetite... i do however remember tenuate; it was a mild diet pill and it did decrease my appetite
> > BTW, is there anything that can be done to help with the short term memory loss, word finding difficulty - even spelling! and general stupidity that seems to accompany these drugs? it frustrates the hell out me...
>
> Umm...Aricept? Amisulpride? I dunno, this is a common problem with antidepressants but there hasn't been much research into what causes it or how it can be alleviated.
that's something i'll look into...btw, i don't want you to feel you have to continue this exchange... i have, however, enjoyed conversing with you immensely, as i think of you as one of the most "knowledgable" people on this board. i recently listed the things that were sorely missing in my life and conversation was one of them... i live in an area where there isn't much to say to people who don't understand, nor want to... it's rather backwards here, to say the least, but it is beautiful. my conversations with you has been a blessing
so i have thoroughly enjoyed this exchange and would be interested in probably anything you had to say... and i've appreciated the time you've given me as well, so i thank you for that
i hope i get to know you better
blessings,
v
Posted by v on September 22, 2001, at 6:57:56
In reply to Re: in case of an accident... LONG...LONG » Elizabeth, posted by v on September 18, 2001, at 17:11:02
elizabeth...
of course my first concern to make sure you are alright... then my secondary concern is that i chased you away with the information about myself... paranoid? of course... afraid of rejection? of course...but also aware that the world doesn't revolve around me ( well only parts of me understand that) and that there may be perfectly resonable reasons why i haven't heard from you..
but since i am a little worried about you, please let me know if you are alright and if you are not, what i can do to help...
v
Posted by Elizabeth on September 25, 2001, at 17:03:53
In reply to Re:Elizabeth?, posted by v on September 25, 2001, at 5:16:24
Hi! I must have missed this thread...sorry about that. See http://www.dr-bob.org/babble/20010917/msgs/79454.html for the story on what I was doing for the week or so that I wasn't posting.
I forgot to ask my consultant about opioids and dopamine, and my books aren't anywhere I can get to them. (Neither is my consultant, for that matter.)You mentioned Wellbutrin. How that works is a mystery; IMO, it might be a prodrug (i.e., one or more of its metabolites are responsible for its effects). Bupropion itself doesn't seem to have much effect at prescribed doses (or at least, no effect has been found that would explain its clinical effects).
About the word "addiction:" a standard pharmacology text actually suggests dropping the word altogether because it's become so loaded. The dictionary definition you gave isn't really consistent with the way the word is used in real life. In the past, the definition that you gave was used both in medicine and in the lab (my pharmacologist buddy and I used to argue about this all the time, since he studied the subject 20 years ago < g >), but scientists no longer speak of "addicted" rats. Doctors still use the word, but it's only clear to me what they mean by it based on the context: they could be talking about what DSM-IV calls "substance dependence" (this definition, as well as the DSM-III-R and ICD-10 definitions, can be found at http://www.drugabuse.gov/DSR.html and many other sites), or they could be talking about pharmacologic or "physical" dependence (i.e., your definition). The DSM and ICD definitions are basically the same, and "physical dependence" is neither necessary nor sufficient to warrant a diagnosis of substance dependence by their definitions (which seems reasonable to me since pharmacologic dependence is a *normal*, not pathological, response to regular use of many psychoactive drugs). The authors of these newer definitions were trying to eliminate the word "addiction" by using the word "dependence," but this only seems to have caused more confusion, since "dependence" is also used to mean "physical" dependence. I don't know how to go about dealing with this ambiguity. I'd love it if everybody could just drop the stigma associated with "addiction," but when's that going to happen?
Thanks for elaborating on what you described as personality fragmentation. I don't know much about dissociative disorders, and it's helpful to hear about them from someone who knows what it's like from the inside, so to speak.
Anyway...apologies again for not responding sooner. When I got out of the hospital I had a lot of posts and emails to answer, and I probably missed a lot of them. So please don't take it personally, because it has nothing to do with you or with our conversation (which I've enjoyed).
-elizabeth
This is the end of the thread.
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