![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 45. Go back in thread:
Posted by JohnX on October 23, 2001, at 0:52:34
In reply to Looking for some advice before I see the psydoc, posted by JGalt on October 22, 2001, at 12:40:09
Here is my advice, just tell the doctor what
worked for you (Selegiline) and tell him you
didn't click to well with your prior doctor or
he died or you moved or whatever.
You can even play stupid and mispronounce
the medication, or bring in a bottle with a
prescription on it and say here "this is what
worked". If the pdoc is any good he will write
you a prescription for what you claim already
worked. If the pdoc is "stuck" on a particular
medicine path, then he/she is not a good pdoc.
Your other med picks are also good ones for
your symptoms (Wellbutrin and maybe Parnate).
Don't bring up the other stuff (the dlpa)
etc, the psych will think you are neurotic.
Also, I *don't* recommend taking the pseudo-ephedrine
or mentioning it to the doctor.Selegiline is not the most typical med for depression,
but for atypical a lot of people have had success.
I would bring up your atypical symptoms. Mention
that you would prefer not to take an addictive
stimulant as it caused you to be to irratable and
tired over time (but maybe keep your past history
on stims to yourself for the 1st few visits).
Make the doctor feel like he is in control
and curing you. You get what you
want and he gets what he wants from the transaction.
Doctors like easy to manage patients. They
charge the same amount of money for your
visit with less hassle than the tricky patients.Some people may disagree with my suggestions,
but you know what works, so I'm telling you how
to persuade the doctor in a "passive aggressive"
manner. The doctor is there to help you, you
are not there to debate with the doctor. Believe
me I know what you are feeling.On subsequent visits to the doctor, feel free
to *slowly* divulge more information in a manner
that shows your intellegence (and not neurotic)
personality. The doctor will gain more confidence
on your suggestions.PS. you are not boring. You are obviously
intelligent and we hope you will add value
to this newsgroup in the future also.good luck,
john> Hello. This is my 1st post here though I've read for hours the past few days.
>
> 2 yrs ago I started to slip into atypical depression and/or perhaps dysthymia. Lack of energy, motivation, will to live...sleeping well over 10hrs a day...usually feeling little emotion but occassionally really down, to the point of considering (on a daily basis for many weeks), and sometimes planning suicide. Also had problems w/ bulemia (not throwing up, taking illegal diet pills instead). I started to self medicate back then, beginning with every conceivable stimulant and continuing with most everything legal and illegal imaginable so long as I did not find evidence that it would harm cognitive abilities, be addictive, or kill me. Most of them worked, but the inevitable tolerance problems would eventually force me to find something new. Incidentally I'm a pharmacology major (wasn't back then), I do more than my share of studying on anything I choose to take.
>
> What I eventually found that worked was a combination of 10mg Selegiline (which I should have reduced to 5mg once I had received full MAOi-B inhibition, learned that here), Up to 500mg D-Phenylaline a day, Up to 2.5g L-Phenylaline a day, several times the FDA requirements of the B vitamins and vitamin C (you need these for the Phenylalines to be able to convert to Dopamine, PEA, etc.), as well as 1,4 Butanediol when needed (which converts to GHB, a very interesting drug) to get rid of social anxiety and for its very pleasant antidepressive effects as well as to get me to sleep if I needed help and reduce aggression(BTW, GHB+MAOi's do have a very definite potentiating effects on each other, requiring a lessening of dosage in one, or likely both, I've seen it said on this board that they don't, but remember that GHB effect endogenous amines and GABA, also affected by MAOi's), as well as occassional very low doses of caffiene+ephedrine if still managed to get tired during the day. I had been on this combo a little over the month and it was much better than any other I had ever tried. I was also just beginning to experiment with modafinil in place of the ephedrine + caffeine and seemed to be having some positive results. Using this I got rid of the depression, social anxiety, dysthmia, and also was only having to sleep 7 hrs average a night. Unfortunately I got caught with these and many other drugs I had collected over the 2 years, and so now I'm going to be seeing a psychiatrist to try to get things sorted out.
>
> What I'd like to know is, how should I approach this matter with the doc? I doubt he's going to be gung-ho for the selegiline, as I doubt many pdoc's have even heard of it used in combination w/ DLPA for atypical depression. Should I print out some medline abstracts for him or just tell him my experiences? I am unwilling to try any tricyclics due to their effects on memory and really would by far prefer to be on selegiline or perhaps experiment with Parnate (I have high blood pressure as it is so that's not an issue w/ the parnate). I would be willing to try Wellbutrin or Effexor but, still, it seems logical to go with that which worked fairly well before. Considering that the normal fatigue I have now is something I find in and of itself depressing, I am completely unwilling to try anything that is sedating. Do you think there's any good ways to get my pdoc to try the selegiline even if he never has done so before and should I come right out and tell him that's what I want to do? If Pdocs don't typically go along with that then should I perhaps lobby instead exclusively for Parnate?
>
> Hope I didn't bore everybody to death on my 1st post.
>
> Thanks in advance for advice,
> JGalt
Posted by JGalt on October 23, 2001, at 9:43:08
In reply to Re: Looking for some advice before I see the psydoc » JGalt, posted by JohnX on October 23, 2001, at 0:52:34
Thanks for the advice John. I think you're right about just informing him of what was working and staying away from the extended details of my drug use history. The pdoc is already aware of some of the brief details of why I am going to him, but not much.
Only problem I'm going to have is that I don't have any prescription for selegiline, I never did, and I've never seen anyone for any of my symptoms. I was simply buying various meds from overseas and domestically, experimenting and reading everything I could find on drugs, and then modifying my approach as needed. Many of my drug choices were illegal. Unfortunately I decided to help a friend struggling with similiar problems, got him out of alcohol+cocaine addiction, but then he slipped up, the police found out, and they seized everything I had. Obviously I have slipped back into the depression that I was previously doing quite well against. Avoiding the legal details, I am now just trying to get a psychiatrist to prescribe what I found worked for me.
Still, I think you are right on how I should approach this. Would you, or anyone else, agree that if he does not choose to go with the selegiline (if he happens to be one of those pdocs that thinks that any MAOi (especially one he's never heard of likely) is the last line of defense before ECT) or a similiarly non-sedating choice, that I should find another Pdoc?
Also, I can see the logic in not telling the doc my drug history on the 1st few visits, but if I were to, why would that lead him to believe I was neurotic? Not trying to disagree with you, just trying to follow the line of thought.
Thanks,
JG
Posted by JohnX on October 23, 2001, at 11:26:39
In reply to Re: Looking for some advice before I see the psydoc, posted by JGalt on October 23, 2001, at 9:43:08
JG,
There was one thing I was concerned about and
that was your statements about bulemia. If you
are having problems with this i really think it
is important to approach an experienced professional.I have been to 4 pdocs, and they all had their
own personalities. I liked 2 and 2 sucked. I think
I'm a pretty smart guy and for the most part I
haven't found a pdoc who would suggest a treatment
plan that was inconsistent with what I was already
thinking. IN FACT, the only place I have been
elightened to possible alternatives is on this
very newsgroup, and this has helped a lot. I probably
wouldn't be doing well on Zyprexa had I not listed
to people on this news group. Nor Lamictal.Anyways, the good PDOCS are usually booked for
months, but most of them will be open minded.
Please try to be very calm with the doctor. I tend
to get impatient with them if they won't agree with
my suggestions and this just makes them less likely
to take my approach. I usually entertain their ideas
and then bring up my own. Beleive me though, if
you tell the doctor that you did well on a non-addictive
substance and it is safe for your health, then he
will most likely prescribe it to you. You can come
clean with the doctor in a compassionate way
begging him to please help you end your misery.
This is another approach, requires a little acting
if you are generally stoic like me. But the doctor
gets their thrills from successfully treating
patients. They also like patients who pay their
bills.Anyways here were my experienced with 4 pdocs.
I was very nervous going into see the 1st, but
now I play them like a piano.Texas:
# 1) This was unusual for a start. This doctor
hated meds, but would prescribe them. He was so
much into therapy, very contrary to most pdocs.
Thought I was neurotic and overfocused on using meds
to solve my problem (this is the scenario I worry
about for you). However the doctor would prescribe
meds anyways as that is his obligation. After many
therapy sessions with the doctor and failed medicine
trials and my feeling that he was incompetent,
I broke my reltaionship with the doctor. He actually
at one point in time told me "you tell me what to
prescribe and I'll write the prescription". That's
how good I am at manipulating the weak.
(Sorry learned it from a manipulative father who
probably messed me up). The doctor told me "no on
in my life has ever made me feel more worthless
and ineffectual". I laughed (that was my last
session with him).#2) An older gentelmen. I really liked this guy.
He was like the grandfather I never had. He made
me feel very comfortable and was extremely open
minding about my medications. He would listen carefully
to my mental health and physical concerns. He
told me that I was his favorite patient! What a
change from doctor #1. He said he really appreciated
having intellectually stimulating conversations
with me and that it was not something he got with
his other patients. Unfortutantely he passed away
from sudden onset of bone cancer.California:
#3) This guy sucked. He was hyperfocused on a few
meds to prescribe. He wouldn't listen to me. I wanted
to take lamictal, so I told him I was already taking
it and told him that the other doctor said to watch
our for such and such reactions (which was bs on
my behalf). But then he felt more comfortable precribing
the meds. The doctor seemed not to care to listen
to my personal issues until after a few visits, then
he seemed to enjoy my company like doctor #2. He
still was an ignoramus, but at least he worked with
me. He refused to write prescriptions for controlled
meds like Adderall. (May have been a CA thing).Back to Texas:
#4) My current doctor. He is probably in his upper
thirties. I think he is typical of better psychiatrists
but he is more into the meds than the psychology.
He listens to me very carefully and was willing to
prescribe meds that I suggested, although I did try
his suggestions as he was able to back them up with
good reasons why. He is extremely nice and
personally calls me off hours if I have concerns.Hope this helps. I really think you will do
well. It is scary the 1st few times, but you'll
get the hang of it. You are clearly really intellegent
and you no what your problems are and that they
need to be addressed.Please keep us posted on your progress!
Regards,
John> Thanks for the advice John. I think you're right about just informing him of what was working and staying away from the extended details of my drug use history. The pdoc is already aware of some of the brief details of why I am going to him, but not much.
>
> Only problem I'm going to have is that I don't have any prescription for selegiline, I never did, and I've never seen anyone for any of my symptoms. I was simply buying various meds from overseas and domestically, experimenting and reading everything I could find on drugs, and then modifying my approach as needed. Many of my drug choices were illegal. Unfortunately I decided to help a friend struggling with similiar problems, got him out of alcohol+cocaine addiction, but then he slipped up, the police found out, and they seized everything I had. Obviously I have slipped back into the depression that I was previously doing quite well against. Avoiding the legal details, I am now just trying to get a psychiatrist to prescribe what I found worked for me.
>
> Still, I think you are right on how I should approach this. Would you, or anyone else, agree that if he does not choose to go with the selegiline (if he happens to be one of those pdocs that thinks that any MAOi (especially one he's never heard of likely) is the last line of defense before ECT) or a similiarly non-sedating choice, that I should find another Pdoc?
>
> Also, I can see the logic in not telling the doc my drug history on the 1st few visits, but if I were to, why would that lead him to believe I was neurotic? Not trying to disagree with you, just trying to follow the line of thought.
>
> Thanks,
> JG
Posted by Gracie2 on October 24, 2001, at 0:39:26
In reply to Re: Looking for some advice before I see the psydoc » JGalt, posted by JohnX on October 23, 2001, at 11:26:39
I disagree about not being totally honest with your psychiatrist. In the first place, doctors
have no reputation for being stupid. In the second place, you are there to establish a relationship with him on which he will base your treatment; a dishonest relationship will result in treatment that may be unneccessary for you.
When you walk into a new doctor's office, you are a blank slate to him; once you tell him about your experience and education, he can talk to you on your own level; otherwise, he must assume you know nothing about psychiatric medication or treatment. Once he is familiar with your knowledge, you can ask him for a specific medication and have a reasonable conversation with him if he disagrees.
You may or may not find this a relevant example:
a couple of years ago, my son hurt his knee. I took him to a doctor at the orthopedic office where I worked, and he told me immediately that my son needed surgery, that therapy and medication would not help. Normally, if we had been regular patients, he would have recommended an MRI to confirm his finding of a torn meniscus.
However, since I was a medical professional and familiar with the symptoms (known as a "locked knee") and knew this doctor to be an excellent surgeon, I consented to surgery without an MRI, which would have cost me quite a bit out-of-pocket
after insurance.
My point is, because he knew that I had the education and experience to understand him, he
explained everything to me instead of recommending a very expensive procedure that would only confirm what he was sure of in the first place. Although he wasn't quite sure what to do when I burst into tears - any surgery involving anesthesia cannot be considered minor-
I knew my son would be alright, and he was.I would be truthful, if I were you. I would be proud of my education and my capability to discuss medication, and I would consider any previous drug usage as an indication and starting point for continuing medication.
-Gracie
Posted by JohnX on October 24, 2001, at 1:30:48
In reply to Re: Looking for some advice before I see the psydoc, posted by Gracie2 on October 24, 2001, at 0:39:26
Thanks for playing Angel's advocate. ;)I was hoping someone would chime in with
a different viewpoint.I think it really depends
on what you really need from the doctor. The
1st visit is really tough. I have found that
if they ask me any question pertaining to
learning *anything* from the internet, then
I am almost immediately dismissed as neurotic.
I have doctors tell me "wow, you know a lot
about medications" and then refuse to treat me
when I suggested that their treatment outline was
not best for me (and trust me I was right and
the doctor was wrong).
However, *THE GOOD* doctors have not had this
problem. But they are not usually the ones with
closed apointment books. That's why I recommend
balance. Give the symptoms he needs to make a
good diagnosis, but don't overload with your own
analysis. I never believe in being dishonest to
the doctor, just in being careful on rate of
disclosure.regards,
john>
> I disagree about not being totally honest with your psychiatrist. In the first place, doctors
> have no reputation for being stupid. In the second place, you are there to establish a relationship with him on which he will base your treatment; a dishonest relationship will result in treatment that may be unneccessary for you.
> When you walk into a new doctor's office, you are a blank slate to him; once you tell him about your experience and education, he can talk to you on your own level; otherwise, he must assume you know nothing about psychiatric medication or treatment. Once he is familiar with your knowledge, you can ask him for a specific medication and have a reasonable conversation with him if he disagrees.
> You may or may not find this a relevant example:
> a couple of years ago, my son hurt his knee. I took him to a doctor at the orthopedic office where I worked, and he told me immediately that my son needed surgery, that therapy and medication would not help. Normally, if we had been regular patients, he would have recommended an MRI to confirm his finding of a torn meniscus.
> However, since I was a medical professional and familiar with the symptoms (known as a "locked knee") and knew this doctor to be an excellent surgeon, I consented to surgery without an MRI, which would have cost me quite a bit out-of-pocket
> after insurance.
> My point is, because he knew that I had the education and experience to understand him, he
> explained everything to me instead of recommending a very expensive procedure that would only confirm what he was sure of in the first place. Although he wasn't quite sure what to do when I burst into tears - any surgery involving anesthesia cannot be considered minor-
> I knew my son would be alright, and he was.
>
> I would be truthful, if I were you. I would be proud of my education and my capability to discuss medication, and I would consider any previous drug usage as an indication and starting point for continuing medication.
> -Gracie
Posted by JohnX on October 24, 2001, at 1:41:01
In reply to Re: Looking for some advice before I see the psydoc, posted by Gracie2 on October 24, 2001, at 0:39:26
>
> I disagree about not being totally honest with your psychiatrist. In the first place, doctors
> have no reputation for being stupid.I'm sorry but I must *disagree whole heartedly
here*. I attended a fairly competivite university
and new a lot of friends that were pre-med that
went on to medical school. A lot of these friends
had connections in families in the medical community
or lots of money and bought their way into medical
school. These were people who graduated with
english and history majors undergrad.
I'm sorry, but I really liked these friends, but
I would not trust them treating my cat.I did have friends with really good science and engineering
backgrounds that went to med school and I would
trust any one of these guys with my life.I do believe there are a lot of "stupid"
doctors. Frankly I think most are at best
walking encyclopedias. There are good ones though
and they have the ability to use deductive thinking
to solve problems efficiently instead of follow
flow-chart treatments and throwing darts at
boards (shot-gun approach of meds).-john
Posted by Hattree on October 24, 2001, at 8:42:16
In reply to Re: Looking for some advice before I see the psydoc, posted by JGalt on October 23, 2001, at 9:43:08
Find a doc who came of age in the early seventies :).
Seriously, if at all possible shop around till you can find a well-informed, open minded doc you can trust. You know you're not an easy prozac 'n go case.
> Thanks for the advice John. I think you're right about just informing him of what was working and staying away from the extended details of my drug use history. The pdoc is already aware of some of the brief details of why I am going to him, but not much.
>
> Only problem I'm going to have is that I don't have any prescription for selegiline, I never did, and I've never seen anyone for any of my symptoms. I was simply buying various meds from overseas and domestically, experimenting and reading everything I could find on drugs, and then modifying my approach as needed. Many of my drug choices were illegal. Unfortunately I decided to help a friend struggling with similiar problems, got him out of alcohol+cocaine addiction, but then he slipped up, the police found out, and they seized everything I had. Obviously I have slipped back into the depression that I was previously doing quite well against. Avoiding the legal details, I am now just trying to get a psychiatrist to prescribe what I found worked for me.
>
> Still, I think you are right on how I should approach this. Would you, or anyone else, agree that if he does not choose to go with the selegiline (if he happens to be one of those pdocs that thinks that any MAOi (especially one he's never heard of likely) is the last line of defense before ECT) or a similiarly non-sedating choice, that I should find another Pdoc?
>
> Also, I can see the logic in not telling the doc my drug history on the 1st few visits, but if I were to, why would that lead him to believe I was neurotic? Not trying to disagree with you, just trying to follow the line of thought.
>
> Thanks,
> JG
Posted by JohnX on October 24, 2001, at 11:46:43
In reply to Re: Looking for some advice before I see the psydoc, posted by Hattree on October 24, 2001, at 8:42:16
Thanks for the backup.I would like extend my appreciation to all
the practicing physicians who may be reading my posts
amd who are skilled in their art and work well
with patients. This is a combination of brilliance,
compassion, and persistance that few doctors much
less human beings have, and I have great respect
for these pdocs.I still recommend the following advice, and I
hope others may agree. Not following this advice
cost me some valuable treatment time as I was
referred to one of the best pdocs in my town with
a 3 month waiting list but opted for the quicky
appointment, and then couldn't get to see the
good pdoc as he stopped taking appts.My advice and it still stands, is to find out
through the rumor mill , and a good general
practitioner is an excellent source, who the
finest pdocs in town are. Pdocs and other medical
specialists are like fine restaurant. The parking
lot is always full. (You can actually use this
parking lot trick as a guauge in a new town as
to where is a good restaurant to eat).Anyways, go ahead and make the far-out apointments
with the top-tier recomendations but still pursue the
earlier appts. If you are lucky the 1st doctor
will be good. This would occur if by chance their
was a cancellation and a slot opened, you some
how begged your way in the door or used a connection,
or the pdoc is fresh from school but an intelligent
person buildling a patient base.The reason this is complicated for JG is I believe
JG is not the typical patient and will probably
work better with a more reputed pdoc (as I have).
Its a catch 22 that the 1st pdoc with an open
appointment is likely not to be the "best restaurant".
So a lot of people will experience frustration with
their 1st doctor but might hit gold with a later
doctor. That's why its good to go ahead and book
the appts that are months away with the good doctors
you can always cancel them if things work out with
your initial doctor.Does anyone agree with me on this philosophy?
Regards and good luck
-john> Find a doc who came of age in the early seventies :).
>
> Seriously, if at all possible shop around till you can find a well-informed, open minded doc you can trust. You know you're not an easy prozac 'n go case.
>
> > Thanks for the advice John. I think you're right about just informing him of what was working and staying away from the extended details of my drug use history. The pdoc is already aware of some of the brief details of why I am going to him, but not much.
> >
> > Only problem I'm going to have is that I don't have any prescription for selegiline, I never did, and I've never seen anyone for any of my symptoms. I was simply buying various meds from overseas and domestically, experimenting and reading everything I could find on drugs, and then modifying my approach as needed. Many of my drug choices were illegal. Unfortunately I decided to help a friend struggling with similiar problems, got him out of alcohol+cocaine addiction, but then he slipped up, the police found out, and they seized everything I had. Obviously I have slipped back into the depression that I was previously doing quite well against. Avoiding the legal details, I am now just trying to get a psychiatrist to prescribe what I found worked for me.
> >
> > Still, I think you are right on how I should approach this. Would you, or anyone else, agree that if he does not choose to go with the selegiline (if he happens to be one of those pdocs that thinks that any MAOi (especially one he's never heard of likely) is the last line of defense before ECT) or a similiarly non-sedating choice, that I should find another Pdoc?
> >
> > Also, I can see the logic in not telling the doc my drug history on the 1st few visits, but if I were to, why would that lead him to believe I was neurotic? Not trying to disagree with you, just trying to follow the line of thought.
> >
> > Thanks,
> > JG
Posted by JGalt on October 24, 2001, at 20:09:54
In reply to Re: Looking for some advice before I see the psydoc, posted by JohnX on October 24, 2001, at 11:46:43
Well I think I certainly agree with what you are saying. It certainly makes sense, the best have the most appointments. Hadn't thought of asking a general doc. about what pdoc to go to, but then again I don't like my general doc either so maybe it wouldn't be the best idea (his laziness and belief that 18 yr olds can't have serious medical problems almost cost me my life).
I'm really hoping I don't have to resort to going for a long off appointment. As you realize from my post, the only reason I'm doing this is so I have a legal prescription. I could have some selegiline and parnate and modafinil and 1000 other drugs at my door in 2 weeks, and I am a rather impatient person, especially when I know what works, so I'm very hopeful that I don't have to do much searching to find docs that are somewhat openminded. I can't imagine having to go to several different docs to get what I know works, but given my present circumstances, it is probably in my best interest to not order anything without a doctors prescription for a while. Anyway, I am planning on going with your suggestion I believe, laying low with drug experiences for a while. I don't see it as dishonest, it's just witholding certain information until a time when it would be more acceptable for the doctor to know.
Sounds like you and I have a lot in common, at least knowledge wise from your other posts JohnX. Just curious, what is your Dx?
Best Regards,
John Galt
Posted by JohnX on October 24, 2001, at 22:51:19
In reply to Re: Looking for some advice before I see the psydoc, posted by JGalt on October 24, 2001, at 20:09:54
Sorry for my ignorance, but what is a Dx?-john
> Well I think I certainly agree with what you are saying. It certainly makes sense, the best have the most appointments. Hadn't thought of asking a general doc. about what pdoc to go to, but then again I don't like my general doc either so maybe it wouldn't be the best idea (his laziness and belief that 18 yr olds can't have serious medical problems almost cost me my life).
>
> I'm really hoping I don't have to resort to going for a long off appointment. As you realize from my post, the only reason I'm doing this is so I have a legal prescription. I could have some selegiline and parnate and modafinil and 1000 other drugs at my door in 2 weeks, and I am a rather impatient person, especially when I know what works, so I'm very hopeful that I don't have to do much searching to find docs that are somewhat openminded. I can't imagine having to go to several different docs to get what I know works, but given my present circumstances, it is probably in my best interest to not order anything without a doctors prescription for a while. Anyway, I am planning on going with your suggestion I believe, laying low with drug experiences for a while. I don't see it as dishonest, it's just witholding certain information until a time when it would be more acceptable for the doctor to know.
>
> Sounds like you and I have a lot in common, at least knowledge wise from your other posts JohnX. Just curious, what is your Dx?
>
> Best Regards,
> John Galt
Posted by JGalt on October 25, 2001, at 9:34:59
In reply to Re: Looking for some advice before I see the psydoc » JGalt, posted by JohnX on October 24, 2001, at 22:51:19
Sorry, just saw it somewhere else on this board and figured it meant diagnosis.
Posted by JohnX2 on October 25, 2001, at 12:40:27
In reply to Re: Looking for some advice before I see the psydoc, posted by JGalt on October 25, 2001, at 9:34:59
> Sorry, just saw it somewhere else on this board and figured it meant diagnosis.
I had to register because this server is
all messed up JohnX2 = JohnX.First off, I wouln't mess with dxm and
the potential for olney's lesion. I did post
an interesting patent to a neurologist that was
using dxm in conjunction with a med that inhibited
the liver enzyme cyp-450 2d6 (which breaks in down)
in order to increase its 1/2 life (the time to
escape your body). Check my prior posts with
SLS (JohnX).Ok, Dx = diagnosis. That's what I figured.
Well, lately I have had chronic dysthymia (a lower
than normal mood, but functional) accompanied
with atypical depression symptoms (sleeping to
much, lack of interest, anhedonia).In the past 14 yrs I have had 2 trips into manic-depressive
cycling. My symptoms are closest to bipolar II.
I have been struggling the past 2.5 years with
major depression which persistant ruminations
about suicide, major anhedonia (inability to
experience any pleasure) and physical ailments
such as tension headaches and bruxism (teeth
grinding). A few times I have broken out of the
major depression and held onto a dysthymic state,
or slipped into hypo-mania (just below textbook
manic).I've taken over 23 meds (check the "levity thread").
Part of my problem was not being diagnosed as
bipolar over unipolar depression. With the aid of
anti-convulsants (epilepsy meds that also treat bipolar), I have
stabilized my mood into dysthymia. Lamictal has been
of greatest utility. I recently added Zyprexa to
help with the residual anhedonia.I did get good responses to other anti-depressants
primarily St. John's wort,Zoloft, and Wellbutrin.
Wellbutrin worked best (and btw is good for
treatment of stimulant addiction). But I always
had a problem with the meds driving me a little
hypomanic (slighly manic) followed by pooping out
after a few days. I also tried Adderall which is
basically flavors of d-amphetamine, and it helped
with the depression, but I would grow tolerant in
a few days, and on the 1st days I would be really
manic and do stupid things like make wild trades
in the stock market and lose a lot of wealth.
One time I sent out a hilarious email to a large
number of co-workers asking them to help me watch
out for manic symptoms since I didn't want to make
a fool out of myself. The day I wrote it I was
manic. The next day I read it, saw it was over
*10* full pages of typing filled with outrageous
drivel and overdisclosure about personal issues.
Man, I was so embarrassed.Before the major depression hit me I had a strange
addiction to caffeine (I drank like 1-2 cases of
dietcoke a day), and would chase that with a 6-pack
of beer everynight. Not exactly good for my health.
I also had weird symptoms of severe inability to
sit still, which would go away with walking around
or driving my car (which I typically drive > 30k
miles a year). I don't think it is a compulsive
disorder, but more a slightly ADD symptom which can
be induced by any stimulant abuse.
Anyways, I was a
compulsive overachiever in school and attended
a fairly competitive univerisity where I obtained
a degree in electrical engineering. I currently
am employed by a semi-conductor company as a chip
designer.As part of my compulsive overachieving, I abused
caffeine (since my predisposition to hypomania would
give it a "better than average" boost), to help me
achieve my career and scholastic goals.I've sinces learned that my family has a history
of depression, a cousin has attempted suicide,
sister now takes anti-depressants, lots of
alcoholics.If I could do my life over, I would have gotton
my problem treated a long time ago. I think by
abusing my body for so many years with poor diet,
alcohol, and stimulants that it has made it more
difficult for me to recover. The stimulants will
fry dopamine neurons, and they don't grow back.
My better pdoc was quite schocked that I was never
exposed to stronger stims like d-amphetamine.
This was just because I never hung around anyone
in that type of circle.I hope you can learn from the people on this
groups experiences and save your brain before things
slide any further. Feel free to say whatever you
want about your condition that you may not feel
comfortable confiding in personal acquaintances.
That is the beuty of this group. We all have problems
and can discuss them openly in an anonymous fashion.Regards,
john
Posted by JGalt on October 26, 2001, at 11:18:45
In reply to Re: Looking for some advice before I see the psydoc » JGalt, posted by JohnX2 on October 25, 2001, at 12:40:27
Interesting, so right now you're basically are same I am diagnosis wise, except I've never had bipolar symptoms. Obviously you've been through an incredible amount more than me, it is amazing how difficult it is to find the right combinations. I imagine with your education and research on antidepressant combo's you're in a better boat than you might otherwise be.
Overachievement through college years, we have that in common, though personally I view that as an asset to my personality (which reminds me, I know it is not the most accurate, but did you ever get into Meyer-Briggs typecasting?). Of course, if it was leading you to abuse drugs, that's not a positive thing, though I did not think that caffeine was capable of damaging the dopamine system? Was there something else you don't mind mentioning that was?
We also both have the family history thing going for both of us. My mom is the only one who was ever diagnosed with depression, but panic/anxiety attacks seem common on my dad's side, and we believe many on both sides do have depression but refuse to seek help.
You mention overdisclose of personal issues during your manic state. I have that as well, though without the manic state. The only information I have on why that may be (I used to be extremely shy) for me is one of my friends from another board in pharmacy school said they were taught that long term ephedrine use wrecks havoc (long lasting) with the GABA system. I don't claim to understand the GABA system very well, but he suggested that people with long term ephedrine use may suffer (in some cases benefit depending upon the extremity) from lack of some (perhaps mostly verbal) inhibitions. I have to wonder, if GHB does affect the gaba system significantly (as opposed to the other theory that it only effects dopamine release), then why am I still the same way. I don't know, it doesn't particularly bother me, and my friends repeatedly telling me that I disclose way too much, especially if on ghb (1,4 butanediol, GHB is illegal and I don't use it), has made me fake a bit of modesty, but still probably more disclosure than average, particularly in the area of drug use (if someone mentions drugs I'm willing to talk for hours about my experiences a theories, its fun on this board, but dangerous and perhaps damaging to ones image by those holding antidrug views in real life).
Hopefully no one minds the fact that my sentences run on. I write papers much better, but am obviously only writing off the top of my head here, and include the full train of thought often without interruption.
Best Regards,
JGalt
Posted by Elizabeth on October 26, 2001, at 11:45:51
In reply to Re: Looking for some advice before I see the psydoc, posted by Gracie2 on October 24, 2001, at 0:39:26
> I disagree about not being totally honest with your psychiatrist. In the first place, doctors
> have no reputation for being stupid.You've probably heard this one before, but...
What do you call the guy who graduated at the bottom of his class in medical school? "Doctor."Yes, they're generally smarter than the average person. That doesn't mean they're perfect or above prejudice. They're human beings; they have weaknesses like the rest of us. And they're not all alike; two doctors can be as different as any two people.
> In the second place, you are there to establish a relationship with him on which he will base your treatment; a dishonest relationship will result in treatment that may be unneccessary for you.
It's sad, but total honesty may result in mistreatment also.
> When you walk into a new doctor's office, you are a blank slate to him; once you tell him about your experience and education, he can talk to you on your own level; otherwise, he must assume you know nothing about psychiatric medication or treatment.
A lot of psychiatrists talk down to patients uniformly. I've even encountered a few who assume that a knowledgeable patient must be a drug addict or otherwise non-trustworthy.
When I was in the hospital for ARDS (adult respiratory distress syndrome -- I was comatose) back in February-March, the doctors in the hospital decided it must have been a benzodiazepine overdose after they heard about my history of depression and since I had tested positive for benzodiazepines. (I had taken Klonopin the night before, *and* the paramedics had given me Ativan at the scene!) My boyfriend (who is a neuropharmacologist by training, and who also, of course, knows me very well) felt that this was not what had happened, since I hadn't been depressed (and I don't hesitate to talk to him when I am feeling depressed). He told them that he thought they should not jump to that conclusion, but instead should do a quantitative tox screen that would show how much of what I had taken. They refused, and the diagnosis of benzodiazepine overdose remained. As a result, when I woke up I was treated as though I was suicidal and could not be trusted (even though I was obviously doing fine emotionally and there was no reason to believe that I was depressed). I wasn't allowed any privacy except when I had to go to the bathroom -- even when my family was visiting me. (And yet they refused to give this supposedly dangerous suicidal patient any sort of antidepressant. As a result, I started getting depressed -- not suicidal, just sad and anergic -- before I was able to go home and start taking my meds again.)
I've been able to get doctors to trust me and to accept that I'm more sophisticated than the average patient, but it often takes a lot of time and effort. As such, I'm cautious about what I say to a new doctor until I get to know him/her better (and until s/he gets to know me better, too).
Just my personal approach (and FWIW, it's always worked for me).
-elizabeth
Posted by Gracie2 on October 26, 2001, at 18:23:55
In reply to Re: Looking for some advice before I see the psydoc » Gracie2, posted by Elizabeth on October 26, 2001, at 11:45:51
Hoo! Got jumped on that time!
In my own defense, I did state in another thread
(about "flakey" patients) that I absolutely believe in "doctor shopping" and have no compunction about doing so with GPs, pdocs, specialists or dentists. Obviously some professionals are more skilled than others, and even many competent docs lack "people skills" (in and out of the exam room in 10 seconds, you practically have to grab them by the coat to ask a question), which nobody appreciates. A lot of patients tolerate it but I figure, with so many doctors around - why put up with that?
So, sure, some doctors are better than others. No argument there.
-Gracie
Posted by JohnX2 on October 27, 2001, at 1:15:47
In reply to Re: Looking for some advice before I see the psydoc, posted by JGalt on October 26, 2001, at 11:18:45
JG,
Don't worry about the rambling. I am the king
and I think that Cam may come in 2nd. ;)
My case history of treatment refractory
depression (now bpii) is not typical for most
people. Most people will find relief from depression after 1 or 2 trials. A lot of times
people can get depression relief but will switch
meds from the side effects.My problem has mainly been misdiagnosis. My
list of meds, which I laugh about now, would be
much shorter had I gotton the right diagnosis. I think if I researched my problem better *before*
seeing the doctor I would have been able to give
him the right symptoms to make an accurate diagnosis. You are in that boat and seem to have
a really good head start on treating your issues.
I think your treatment will be smooth.No-one in my family has symptoms of bp disorder
,but lots of depression and alcoholism.
I believe that my bp is actually a subset
of PTSD (post traumatic stress disorder). PTSD
is tricky to treat, it involves complicated
disruptions to the hpa axis and the "fight-or-flight" feeback mechanisms in the locus coerulus
area of the brain. Anyways, to make an ugly story
short, I had some bad years as a kid with a depressed alcoholic mother, divorce,
family businesss near bankruptcy, blah, blah.
It was after this that i developed non-text book cases symptoms
of bp ii (but text book major depression). The best meds to treat ptsd are actually called crf antagonists,
but these are still experimental and not available. Curiously
nmda antagonists are indirectly crf antagonists and can thus
be anxyiolitic.Anyways, my goal is to reach logical conclusions
as to how to treat my problems in a manner with least side-effects
and most cure. I do not like "dirty" drugs. I
do not like meds who's "mechanism of action are
unknown". I refuse to use this dart-board approach my early physicians had. So I
think if I can nail down why I get AD poop-out and
find a good treatment (crossing my fingers on memantine and a few
others) then I believe I may see a full remission.Anyways, my left-brained,mr.spock, stoic, unemotional thought process
are also symptoms of ptsd (emotions get
blunted). I would like to recapture my emotions
(feelings of well-being and being "attached").
I can experience wild euphoria, but this is
different from feeling "well". I wish I could
describe what I mean. i have had a few full remissions
where my emotions came back and i can not describe the feeling.As far as the brain frying goes, I do believe
that kindled states I experienced on simple
substances like caffeine inducing mania could have
over the long haul bantered noradrenaline and
dopamine neurons. This would definately be analogous
for people abusing strong stims like meth.
I really wish you the best of luck.
Keep us posted on your progress.Oh yeah, forgot to mention that you are correct
about gaba agonists being neuroprotective agains
nmda hypoactivity. Anaesthesiologists are well aware
of this as are their insurance carriers.-john
> Interesting, so right now you're basically are same I am diagnosis wise, except I've never had bipolar symptoms. Obviously you've been through an incredible amount more than me, it is amazing how difficult it is to find the right combinations. I imagine with your education and research on antidepressant combo's you're in a better boat than you might otherwise be.
>
> Overachievement through college years, we have that in common, though personally I view that as an asset to my personality (which reminds me, I know it is not the most accurate, but did you ever get into Meyer-Briggs typecasting?). Of course, if it was leading you to abuse drugs, that's not a positive thing, though I did not think that caffeine was capable of damaging the dopamine system? Was there something else you don't mind mentioning that was?
>
> We also both have the family history thing going for both of us. My mom is the only one who was ever diagnosed with depression, but panic/anxiety attacks seem common on my dad's side, and we believe many on both sides do have depression but refuse to seek help.
>
> You mention overdisclose of personal issues during your manic state. I have that as well, though without the manic state. The only information I have on why that may be (I used to be extremely shy) for me is one of my friends from another board in pharmacy school said they were taught that long term ephedrine use wrecks havoc (long lasting) with the GABA system. I don't claim to understand the GABA system very well, but he suggested that people with long term ephedrine use may suffer (in some cases benefit depending upon the extremity) from lack of some (perhaps mostly verbal) inhibitions. I have to wonder, if GHB does affect the gaba system significantly (as opposed to the other theory that it only effects dopamine release), then why am I still the same way. I don't know, it doesn't particularly bother me, and my friends repeatedly telling me that I disclose way too much, especially if on ghb (1,4 butanediol, GHB is illegal and I don't use it), has made me fake a bit of modesty, but still probably more disclosure than average, particularly in the area of drug use (if someone mentions drugs I'm willing to talk for hours about my experiences a theories, its fun on this board, but dangerous and perhaps damaging to ones image by those holding antidrug views in real life).
>
> Hopefully no one minds the fact that my sentences run on. I write papers much better, but am obviously only writing off the top of my head here, and include the full train of thought often without interruption.
>
> Best Regards,
> JGalt
Posted by JGalt on October 27, 2001, at 13:14:50
In reply to Re: Looking for some advice before I see the psydoc » JGalt, posted by JohnX2 on October 27, 2001, at 1:15:47
Post Traumatic Stress Disorder, your brief discussion on it will probably lead me to research it some later. I have heard it before in reference to police brutality, but never anywhere else. So basically it can apply to any situation that your body stays in the fight-flight response much longer than it should and no amount of "thinking yourself down" from the event will help. I've had that a lot at times, in fact, I believe part of my problem is that when I need to get something done, I not only have some lack of motivation do it, there's also a certain fear response that my body produces. Like fear of getting started and then fear of continuing. I don't know why, I succeed at most things I try at, but I never even thought about it until reading your post, that that, in combination with low energy, is why I have trouble setting out on projects that would probably provide me with pleasure, and perhaps increased energy. At times this feeling of fear can also lead me to decide to not do something I know I should do that would help to ensure the success of something I'm trying at.
Adderal, the 6 total times I've tried it, helps wonderfully, but even though I never have taken it on consecutive days, the next day I will always be low on energy and motivation, which is why I know it is addictive and has a high tolerance building potential. But Adderal, in addition to providing me with motivation, seems to completely eliminate this, whatever the heck it is.
GHB (or things that convert to GHB) is the only other drug that does so, but of course it also has some negative things about it too. While it does NOT produce tolerance, if you have ever used it several weeks in a row without break, and to help get to sleep at times too (resulting in no REM sleep), you know its effects on memory and causing ADD like behavior...it does need to be stopped every once in a while or else you will have trouble focusing on tasks, and short+long term memory will be reduced, and connections between things in your mind are reduced too. This is of course if you abuse it, which I now know where the line between abuse and use is. It produces a feeling of love+trust towards everything, which can sometimes be a negative aspect. Enough about that, the fact is, it, and Adderal, both are able to eliminate this fear of doing, though adderal obviously has many more positive things about it until you develop complete tolerance. Still, GHB is a very theraputic chemical (it is present in your body and food too) when used properly, and its lack of tolerance is very nice.
Still, Selegiline does not eliminate this problem really, it simply provides some more motivation to do things, and also is stimulating. This allows one to use GHB effectively, as it helps to keep one more alert while on it, and reduces the effective dosage quite nicely.
Well after all that ranting, can you give me any insight or advice into my problem? Since you mentioned the NMDA antagonists being helpful in this regard, I think I may eventually try a combination of lamictal+adderal. I would think that if lamictal reduces NMDA receptor sensitivity, that it would work roughly the same, do you think I am correct?
I personally would love to try my idea mentioned before of adderal+low dose dxm+prozac+1,4 butanediol (GHB precursor), but I know that no psych doctor is going to go for a such a combination. Of course, then again, if I were to do such a combination, I would obviously not mention the rationale behind it or either of the two non-mainstream chemicals.
Your approach seems like a logical one to the problem. I cannot understand why someone would not research a drug or drug combination that some person had given them or the disease for which they are taking it. Even GHB can't make me that trusting!
I can understand why wild euphoria is not what you're looking for. One should desire their emotional state to have connection with real life events. Having wild euphoria while washing off an apple would not be particularly pleasurable because one knows that one's pleasure is not stemming from what one is doing. That is why I would question a drug that kept a person very happy all the time, or a person who would want to be. While I would certainly have no qualms about a majority of the people being on a drug that increased the capacity of their pleasure, or perhaps simply multiplied all positive emotions by 2 and divided all negative emotions by 2, I would have a problem with a drug that made all emotions more positive by a factor of 2 being used for anyone that wasn't truly depressed.
I see what you mean about true mania being induced by caffeine having the potential to damage dopamine receptors.
Also interesting that my thoughts about gaba agonists working to protect from NMDA hypoactivity have already been proven. I'll have to do some research to find out just what the gaba agonists are, and whether ghb or precursors are amongst them. If that is unknown, perhaps I'll also have to find out if drugs which are specific gaba antagonists exist outside of a chemical lab, evaluate their safety, and see if they prevent GHB's effects. This could take a while, but it might pay off. Sometimes I wonder why the same people that prescribe the drugs aren't the ones that go through pharmacy school to learn how drugs work and how to make interesting combinations of them.
JGalt
Posted by JohnX2 on October 27, 2001, at 15:41:06
In reply to Re: Post Traumatic Stress Disorder and etc., posted by JGalt on October 27, 2001, at 13:14:50
This is long, but you are such a good listener
and have interesting retorts, so here I go
again:I'll try to get you some more info on ptsd
later. basically it can occur if one is under
substantial oncontrolled and unpredictable duress
for prolonged periods of time. But usually this
has to be *quite severe*. What happens is 1 of 2
things, A) the body maintains toxic level of
cortisol, which can goof up the hippocampus
B) the body is habitually releasing
adrenaline, and this causes neuroadaptive changes
(feeback breakdown) in the locus coerulus.The meds to treat ptsd are usually clonodine,
tenex,inderal, but the crf antagonists are most
likely to help the most (and I see utility in the
nmda antagonists). The ADs generally give
spotty results . I'll
let you do the rest of the research. Usually
after the trauma there may be nightmares and flashbacks,
which there was for me, but this was like 15 years
ago. So I don't have that now, but my brain has
adapted to the situation in a way that blunts my
emotions, makes me sensitive to stimulants (which
could most definately be related to the breakdown
in the locus coerulus). I'm leaning towards an LC
breakdown theory for me. It could explain manic
responses too.Also I have this jaw and tension
headache problem and I get a weird response on
the AD's that worked well. I'll give Wellbutrin
as an example (it is similar in structure to
ephedrine,amphetamine..). After taking WB at
a therapeutic dose for about 1 week, I usually
get a depression lift, sometimes into severe mania.
Then, it very quickly fades at the drop of a coin,
and all of a sudden my emotions go *DEAD NUMB*, I can't
even feel a deep breath and I get this excrucitating
pain in my jaw and head which is directly proportional
to the emotional numbing. It is like I am ping
ponging from positive to negative psychosis (read
up about schizophrenia), the negative psychosis
(complete lack of emotions), occurs with too little
dopamine in the frontal cortex.
I have tracked the bruxism down
to an area of the brain called the prefrontal
cortex. A hypodopaminergic state of dopamine projected
from the VTA to the medial prefrontal cortex would
cause disinhibition of the muscles of the face.
The prefrontal cortex is where dopamine stops
acetylcholine from sending muscle spasm signals to
the jaw/face.
Those dopamine neurons have no feedback receptors,
which makes them unique. They are gated directly
by 5ht-2a receptors and the dopaminergic firing
from the VTA (the center for sensitization to
medications like stimulants and opiods). The
dopaminergic firing (whether it is pacemaker or
burst) is also linked by gaba and nmda innervations
in the VTA. The nmda innervations in the VTA are
linked to 5ht-2a receptors. Scientists have found that
by directly antagonizing nmda receptors in the vta
(i.e. by taming them to be more pace-maker), the
sensitization to amphetamine is reduced. I have
an interesting article on amphetamine sensitization,
search through my old posts for summaries.I have found before my depression experience, that
when I was in college if I stayed up for very long
and drank gobs of caffeine, the caffeine would wear
off and i would get a tension headache similar to
the one I describe. But back then, a good night
of sleep would make it go away. So I have lots of
correlations, I also found a lot of data recently
regarding 5ht2a antagonists treating tension headaches
and attenuating the locomotor effects of prolonged
amphetamine stimulation.Regarding your potential cocktail, I don't know
much about anything related to ghb or precursors,
except that ghb is illegal, so I'll stop short
of there. The idea behind the dxm enzyme inhibition
if you read the patent disclosures was to
increase its 1/2 life so that a low dose can be
taken and with fewer dosing.
It could be done with xxx-dm from the local
pharmacy without a prescription.
Again, the drug level of dxm would probably need
to be monitored, not a good idea to mess with getting
a leasion. Anyways, the meds that would prevent
nmda hypoactive toxicitiy (and you probably would
have to be having dissaciative effects to reach
the level to be honest), are alpha-2 agonists,
potential 5ht-2a agonists, and primarily GABAa
agonists. Do a patent search on the subject of
nmda antagonists and you will get a lot of interesting
information. memantine is probably the safest
nmda antagonist, but dxm is well studied and
older. There are some patent write ups by Olney
describing the biological underpinnings of
nmda hypoactivity lesions (he suggests anti-cholinergics
as a post condition treatment). I also found
some patents by someone showing how alpha-2 agonists
could prevent the hypoactivity.I have most of these patents with all the diagrams
in a nice compressed format called cpc. If you
download the cpc viewer I'd be happy to mail them
to you.good luck,
john> Post Traumatic Stress Disorder, your brief discussion on it will probably lead me to research it some later. I have heard it before in reference to police brutality, but never anywhere else. So basically it can apply to any situation that your body stays in the fight-flight response much longer than it should and no amount of "thinking yourself down" from the event will help. I've had that a lot at times, in fact, I believe part of my problem is that when I need to get something done, I not only have some lack of motivation do it, there's also a certain fear response that my body produces. Like fear of getting started and then fear of continuing. I don't know why, I succeed at most things I try at, but I never even thought about it until reading your post, that that, in combination with low energy, is why I have trouble setting out on projects that would probably provide me with pleasure, and perhaps increased energy. At times this feeling of fear can also lead me to decide to not do something I know I should do that would help to ensure the success of something I'm trying at.
>
> Adderal, the 6 total times I've tried it, helps wonderfully, but even though I never have taken it on consecutive days, the next day I will always be low on energy and motivation, which is why I know it is addictive and has a high tolerance building potential. But Adderal, in addition to providing me with motivation, seems to completely eliminate this, whatever the heck it is.
>
> GHB (or things that convert to GHB) is the only other drug that does so, but of course it also has some negative things about it too. While it does NOT produce tolerance, if you have ever used it several weeks in a row without break, and to help get to sleep at times too (resulting in no REM sleep), you know its effects on memory and causing ADD like behavior...it does need to be stopped every once in a while or else you will have trouble focusing on tasks, and short+long term memory will be reduced, and connections between things in your mind are reduced too. This is of course if you abuse it, which I now know where the line between abuse and use is. It produces a feeling of love+trust towards everything, which can sometimes be a negative aspect. Enough about that, the fact is, it, and Adderal, both are able to eliminate this fear of doing, though adderal obviously has many more positive things about it until you develop complete tolerance. Still, GHB is a very theraputic chemical (it is present in your body and food too) when used properly, and its lack of tolerance is very nice.
>
> Still, Selegiline does not eliminate this problem really, it simply provides some more motivation to do things, and also is stimulating. This allows one to use GHB effectively, as it helps to keep one more alert while on it, and reduces the effective dosage quite nicely.
>
> Well after all that ranting, can you give me any insight or advice into my problem? Since you mentioned the NMDA antagonists being helpful in this regard, I think I may eventually try a combination of lamictal+adderal. I would think that if lamictal reduces NMDA receptor sensitivity, that it would work roughly the same, do you think I am correct?
>
> I personally would love to try my idea mentioned before of adderal+low dose dxm+prozac+1,4 butanediol (GHB precursor), but I know that no psych doctor is going to go for a such a combination. Of course, then again, if I were to do such a combination, I would obviously not mention the rationale behind it or either of the two non-mainstream chemicals.
>
> Your approach seems like a logical one to the problem. I cannot understand why someone would not research a drug or drug combination that some person had given them or the disease for which they are taking it. Even GHB can't make me that trusting!
>
> I can understand why wild euphoria is not what you're looking for. One should desire their emotional state to have connection with real life events. Having wild euphoria while washing off an apple would not be particularly pleasurable because one knows that one's pleasure is not stemming from what one is doing. That is why I would question a drug that kept a person very happy all the time, or a person who would want to be. While I would certainly have no qualms about a majority of the people being on a drug that increased the capacity of their pleasure, or perhaps simply multiplied all positive emotions by 2 and divided all negative emotions by 2, I would have a problem with a drug that made all emotions more positive by a factor of 2 being used for anyone that wasn't truly depressed.
>
> I see what you mean about true mania being induced by caffeine having the potential to damage dopamine receptors.
>
> Also interesting that my thoughts about gaba agonists working to protect from NMDA hypoactivity have already been proven. I'll have to do some research to find out just what the gaba agonists are, and whether ghb or precursors are amongst them. If that is unknown, perhaps I'll also have to find out if drugs which are specific gaba antagonists exist outside of a chemical lab, evaluate their safety, and see if they prevent GHB's effects. This could take a while, but it might pay off. Sometimes I wonder why the same people that prescribe the drugs aren't the ones that go through pharmacy school to learn how drugs work and how to make interesting combinations of them.
>
> JGalt
Posted by JGalt on October 27, 2001, at 21:59:18
In reply to Re: Post Traumatic Stress Disorder and etc. » JGalt, posted by JohnX2 on October 27, 2001, at 15:41:06
I looked up the DSM-IV for PSTD, clearly is not me. I cannot think of a single event that was extremely traumatic at a young age. I had tons of mild to moderate things, but nothing in particular burned into my memory. No flashbacks or nightmares from my childhood that I remember either. I never have had good long term memory. The DSM-IV stated in such a case the cause was likely simple depression. Still might be worth it to look at the crf antagonists just for curiousity's sake.
The second you said jaw and headache problems, dopamine overload popped in my mind. Here's why. GHB greatly slows down (or perhaps stops) the release of dopamine in the brain. However, dopamine continues to be produced in the brain. After the GHB is metabolized, dopamine release resumes, but guess what, you got more dopamine there. No problem, just a pleasant stimulant effect. But never come all the way down from GHB and the dopamine keeps on building up and up to whatever limit there is. I know this because I've done it, twice. Logically what happens is then all that dopamine is released, you have less hunger, and more noticeably, painful headaches and jaw clamping. Too much dopamine. I'm guessing what is happening with you is you're having too much dopamine, then you take an AD such as wellbutrin, dopamine is released to the point that you have practically none left and you are left with the hypodopaminergic state. This would tend to suggest that you have 1. low dopamine storage capacity or 2. are very sensitive to dopamine agonists. Before you used the wellbutrin, the dopamine kept building up and up. Extreme excess of dopamine is hallmark of schizophrenia and mania. The interim period when taking the AD's that you feel relief is when dopamine is at a reasonable level of storage and being released at the same time, as happens in the theoretical normal person. Make sense or did I miss something? You know, now that I write this it occurs to me, why wasn't ghb ever used to treat bipolar syndrom? Since it prevents dopamine from being released, that gets rid of the mania as far as I understand it, and since during mania I don't believe your body stores more dopamine, it simply releases more. Just come down from it every 6 hours and all would be well, then use AD's while in the depressive state.
By the way, I did my research on GABA antagonists. It turns out that all the GABA antagonists we currently have are either non-specific, or carry a rather high risk of seizures, or they are not incredibly easy to purchase or store. All of them except for two. Adrafinil and Modafinil, though both of those are not complete antagonists except at inhuman dosages, I think 500-700mg would be sufficient as that is their believed method of action. So I guess my next theoretical mission if I were to want to pursue that regimine would be to take a 500-700mg dose of modafinil , then take some 1,4 butanediol. That much modafinil would easily be able to give me a headache due. If the 1,4 butanediol prevents this headache then 1,4 butanediol is a gaba agonist. Simple enough if I were to want to find out. I don't think I'd bother unless the curiousity strikes me hard enough someday. Really after I wrote out what I did above about GHB and dopamine, it would probably be a bad redundant to combine it with a dopamine agonist I would imagine if the uncompletely tested pharmacodynamics of ghb are correct.
I understand the idea behind lengthening DXM's effects. A drug with such powerful effects needs something to lengthen its halflife to be useful theraputically.
Hmm, if alpha-2 agonists were to help prevent onley's lesions, then logically beta-2 agonists would exacerbate them. Guess I have to throw out the ephedrine if I were to try it using a different gaba agonist such as one of the benzodiazapines.
I'll check up on that cpc reader and see if it works on a mac and get back to you.
Thanks again,
JGalt
Posted by judy1 on October 27, 2001, at 22:50:33
In reply to Re: Post Traumatic Stress Disorder and etc. » JGalt, posted by JohnX2 on October 27, 2001, at 15:41:06
Just curious- have you been prescribed klonopin? A really decent drug for bp and ptsd too. I am dxed bp1, ddNOS, ptsd (panic) and others almost daily All ad's make me manic, with wellbutrin causing convulsions (I do have a history of bulemia). Re: pdocs- this is my 16th and best, prefers therapy over the 6+ drugs I was on and is willing to treat manic episodes until they resolve with no hospitalization (for that alone I love him). Unfortunately there are a lot of poor pdocs out there and I agree that there is an art to telling them your theories w/o being labeled 'difficult' or neurotic. Unless you're fortunate and find someone secure enough to listen (like I was) Sorry for the rambling, just found this an interesting thread- Judy
Posted by JohnX2 on October 28, 2001, at 0:59:34
In reply to Re: Post Traumatic Stress Disorder and etc. » JohnX2, posted by judy1 on October 27, 2001, at 22:50:33
Klonopin was the 1st med that stablized my condition,
got rid of all pain syndromes, etc. I have been taking
it for on/off almost 2 years and am definately addicted
at this stage. I need 6 mg to get a therapeutic effects.The following meds relieve my jaw tension/bruxism:
-serzone (probably from 5ht-2a antagonism)
-zyprexa (probably from 5ht-2a antagonism)
-adderall (when it works)
-klonopin (always)good klonopin guess on your behalf.
I stumbled onto klonopin by accident to treat
sleaping problems on effexor. Majically it got
rid of all my facial pain. My pdoc was an ideot.
He had a degree in neurology but couldn't understand
my jaw pain and response to meds.Thanks for your interest.
-john> Just curious- have you been prescribed klonopin? A really decent drug for bp and ptsd too. I am dxed bp1, ddNOS, ptsd (panic) and others almost daily All ad's make me manic, with wellbutrin causing convulsions (I do have a history of bulemia). Re: pdocs- this is my 16th and best, prefers therapy over the 6+ drugs I was on and is willing to treat manic episodes until they resolve with no hospitalization (for that alone I love him). Unfortunately there are a lot of poor pdocs out there and I agree that there is an art to telling them your theories w/o being labeled 'difficult' or neurotic. Unless you're fortunate and find someone secure enough to listen (like I was) Sorry for the rambling, just found this an interesting thread- Judy
Posted by JohnX2 on October 28, 2001, at 1:15:56
In reply to Re: Post Traumatic Stress Disorder and etc., posted by JGalt on October 27, 2001, at 21:59:18
> I looked up the DSM-IV for PSTD, clearly is not me. I cannot think of a single event that was extremely traumatic at a young age. I had tons of mild to moderate things, but nothing in particular burned into my memory. No flashbacks or nightmares from my childhood that I remember either. I never have had good long term memory. The DSM-IV stated in such a case the cause was likely simple depression. Still might be worth it to look at the crf antagonists just for curiousity's sake.
>
> The second you said jaw and headache problems, dopamine overload popped in my mind. Here's why. GHB greatly slows down (or perhaps stops) the release of dopamine in the brain. However, dopamine continues to be produced in the brain. After the GHB is metabolized, dopamine release resumes, but guess what, you got more dopamine there. No problem, just a pleasant stimulant effect. But never come all the way down from GHB and the dopamine keeps on building up and up to whatever limit there is. I know this because I've done it, twice. Logically what happens is then all that dopamine is released, you have less hunger, and more noticeably, painful headaches and jaw clamping. Too much dopamine. I'm guessing what is happening with you is you're having too much dopamine, then you take an AD such as wellbutrin, dopamine is released to the point that you have practically none left and you are left with the hypodopaminergic state. This would tend to suggest that you have 1. low dopamine storage capacity or 2. are very sensitive to dopamine agonists. Before you used the wellbutrin, the dopamine kept building up and up. Extreme excess of dopamine is hallmark of schizophrenia and mania. The interim period when taking the AD's that you feel relief is when dopamine is at a reasonable level of storage and being released at the same time, as happens in the theoretical normal person. Make sense or did I miss something? You know, now that I write this it occurs to me, why wasn't ghb ever used to treat bipolar syndrom? Since it prevents dopamine from being released, that gets rid of the mania as far as I understand it, and since during mania I don't believe your body stores more dopamine, it simply releases more. Just come down from it every 6 hours and all would be well, then use AD's while in the depressive state.
>Damn you are smart. It took me a long time to figure
this out. I found most of my interesting information
from an article called "buspirone as an antidote
to SSRI induced bruxism". Here it discussed 2 states
which could cause jaw tension, one is hypo-dompaminergic
and the other is hyper-dopaminergic. Since the
pain is gone with the depression and positive
(and or manic) responses, I have to be lead to
believe that the pain is caused by a hypodopaminergic
state. This also correlates so very well with my
thoughts on the concurrent severe emotional numbing,
and my responses to Serzone,Zyprexa,Adderall,Zoloft,
Wellbutrin. The article was specifically dealing
with SSRI induced bruxism and stated cases of Zoloft
causing this. I had this problem with zoloft quite
severly and zoloft seriously obliterated my emotions
to. I think its pinging of the 5ht-2a receptor causes
the problem. The drug buspar is a 5ht-1a partial
agonist and a slight d2 antagonist. The paper
cited cases where buspar cured the zoloft induced
bruxism and theorized that buspar reduced serotonin
levels, and the 5ht-1a agonism does the opposite
of 5ht-2a agonism (they somehow balance each other).
So anti-anxiety meds often try to antagonize
5ht-2a and or agonize 5ht-1a receptors. Most
SSRIS taken chronically will downregulate the
5ht-2a receptors. But they aren't always all that
efficient and this leads to sexual side effects,
emotinal numbing, muscle tension. The pharmaceutical
companies figured this out and scrambled to find
meds that could antagonize the 5ht-2a receptor.
The 1st new-age anti-depressant that did this
was Serzone and it was touted for its lack of
sexual side effects. But it is a dirty med and
screws with too many other receptors making people
like me crash my car. Anyways, the buspar paper
suggested serzone as another alternative to the
bruxism and it did work for me. But now I'm leaning
towards not beating around the bush and testing
one of these nmda antagonists (memantine). Since
Lamictal is working and zyprexa, it seems like
a logical choice. Sorry for the harangue. But
you come back with great insight. If AndrewB
was still posting to this group he would be having
a field day with you!.Ps. there is a cpc viewer for mac. I get patents
downloaded from a service called www.getthepatent.com.
the images are avaliable at the official us patent
site, put this service has a mirror copy of the full
patent images in this very compressed formats. The
web site has links to the CPC viewer.-john
Posted by judy1 on October 28, 2001, at 10:43:52
In reply to Re: Post Traumatic Stress Disorder and etc. » judy1, posted by JohnX2 on October 28, 2001, at 0:59:34
>
> Klonopin was the 1st med that stablized my condition,
> got rid of all pain syndromes, etc. I have been taking
> it for on/off almost 2 years and am definately addicted
> at this stage. I need 6 mg to get a therapeutic effects.John,
I also take 6mg/day of klonopin (2mg tid) for 4+ years and my pdoc and I certainly don't consider me 'addicted'. He has some patients that have taken more for over a decade. Are you tolerant? How long have you taken 6 mg? Klonopin was something of a miracle drug for me also; I just hope you don't get negative feedback from your pdoc about your dose. Take care- Judy
Posted by JGalt on October 28, 2001, at 15:01:23
In reply to Re: Post Traumatic Stress Disorder and etc. » JGalt, posted by JohnX2 on October 28, 2001, at 1:15:56
Interesting about the hypodopaminergic state also causing teeth grinding. Obviously while on GHB you go to a much lower than normal dopamine release rate, but I've never noticed the bruxism. Probably because at any dosage in which you feel the effects, the drug is also serving as a mild muscle relaxer, inhibits obsessive-compulsive behavior, and recurring thoughts/movements, all postulated to be through the GABA system. Thus it makes sense that teeth grinding would occur.
Interesting on the 5ht-xx drugs. I've never read deeply on the specific receptors, but from your brief explanation, I agree that an experiment wtih memantidine seems in order. Oh, and I'll warn anyone I know going on Serzone to increase car insurance.
By the way, what did you think about what I said with using GHB for mania? Obviously well under pass out doses, just enough to curtail dopamine release sufficiently for the patient to live normally. From what I understand, mania is almost completely dopamine driven, but I do not know for sure if the body is 1. also producing more dopamine or just releasing what it has and producing at a normal rate or 2. if the body has a definite reachable capacity for dopamine storage which isn't sky high beyond what a normal person is storing. If the body is producing and releasing an incredible amount more of dopamine during mania and if it has a very high amount of storage capacity, and the storage capacity does not greatly lower when they go back to normal or depressive, then my idea wouldn't work very well. Otherwise it would seem like it would, at worst the person might have to go through a simple dopamine reduction program, wherein they take an extra hour or two between doses of GHB, to let those high levels come back to normal, which shouldn't take too long. Of course, finding the right dosage here would be tricky, and the person would have to know how long their eposides generally last and/or allow themselves to come down competely once in a while, so that they aren't taking ghb during the depressive state, which might have the potential to produce another manic state (too much dopamine in storage, can that do it?). It'd just seem like it'd be nicer to the patient to exchange their wild euphoria for something better than having dead emotions as many of the antipsychotics seem to do, provided that not both of the aforementioned conditions were true.
By the way, found this interesting, maybe you've already read it:
Adaptation of N-methyl-D-aspartate (NMDA) receptors following antidepressant treatment: implications for the pharmacotherapy of depression
by
Skolnick P; Layer RT; Popik P; Nowak G; Paul IA; Trullas R
Laboratory of Neuroscience, NIDDK,
National Institutes of Health, Bethesda, USA.
Pharmacopsychiatry, 1996 Jan, 29:1, 23-6ABSTRACT
NMDA antagonists mimic the effects of clinically effective antidepressants in both preclinical tests predictive of antidepressant action and procedures designed to model aspects of depressive symptomatology. These findings led to experiments demonstrating that chronic administration of NMDA antagonists to rodents results in a downregulation of cortical beta-adrenoceptors, a phenomenon also observed following chronic treatment with many antidepressants. These neurochemical and behavioral similarities between antidepressants and NMDA antagonists prompted us to examine the impact of chronic antidepressant treatment on NMDA receptors. Chronic (14 days) but not acute (1 day) administration of seventeen different antidepressants to mice produced adaptive changes in radioligand binding to NMDA receptors. Detailed studies with three antidepressants (imipramine, citalopram, and electroconvulsive shock) show that these changes develop slowly, persist for some time after cessation of treatment, and (for imipramine and citalopram) are dose dependent. Moreover, following chronic treatment with imipramine, these changes in radioligand binding to NMDA receptors appear restricted to the cerebral cortex. Based on the consistency of these effects across antidepressant treatments, we propose that adaptive changes in NMDA receptors may be the final common pathway for antidepressant action. The recent demonstration (Nowak et al., 1995) that radioligand binding to NMDA receptors is altered in frontal cortex of suicide victims (compared to age and post-mortem interval matched controls) is consistent with the hypothesis (Trullas and Skolnick, 1990) that this family of ligand gated ion channels is involved in the pathophysiology of depression.
---------Of course, they find a lot of things low in suicide victims, but the interesting part is the other antidepressants role on NMDA receptor.
Anyway, I found the cpc viewer page, I'll download it later. I'll make up an email later today so that you can send them over.
Best Regards,
JGalt
Posted by JohnX2 on October 29, 2001, at 0:44:48
In reply to Re: Post Traumatic Stress Disorder and etc. » JohnX2, posted by judy1 on October 28, 2001, at 10:43:52
My pdoc is very open about my dosing, although
he tells me that he starts to get nervous around
6 mg. I have tapered up-down on klonopin from between
2-6 mg. 2mg is the minimum to alleviate my facial
pain. The point is that there are better alternatives
to treat my pain. I am not generally taking klonopin
for anxiety or panic attacks, just mainly the pain.
Other meds help with the anxiety.I haven't had a problem with any of my pdocs and klonopin.
I've tried to taper klonopin in the past with
little success, except while on Serzone, where
I almost stopped it cold turkey. The Serzone
alleviated the pain that I was having in my
face and the klonopin was just making me drowsy
on top of it. Zyprexa seems to be helping in a
similiar manner, so the pdoc would like for me
to slowly taper the klonopin if I feel drowsy.I did grow tolerant to klonopin about last year
Oct, ever since then the dose I take is the minimum
to cure most of my pain, but still leave me
a bit anxious.Thanks for your concern.
Sometimes I just say screw it and take a whopper
dose to have an enjoyable few days in my life.
Maybe that isn't helping things any.-john
> >
> > Klonopin was the 1st med that stablized my condition,
> > got rid of all pain syndromes, etc. I have been taking
> > it for on/off almost 2 years and am definately addicted
> > at this stage. I need 6 mg to get a therapeutic effects.
>
> John,
> I also take 6mg/day of klonopin (2mg tid) for 4+ years and my pdoc and I certainly don't consider me 'addicted'. He has some patients that have taken more for over a decade. Are you tolerant? How long have you taken 6 mg? Klonopin was something of a miracle drug for me also; I just hope you don't get negative feedback from your pdoc about your dose. Take care- Judy
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