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Dr. Bob is Robert Hsiung, MD,
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Posted by nightlight on November 23, 2001, at 9:06:29
In reply to Re: Methadone/opiates for depression » nightlight, posted by Elizabeth on November 19, 2001, at 17:12:19
>
> > I am now on a very low-dose narcotic, 60 mgs. stimulent, 2 mgs. klonopin and apotent muscle relaxer.
>
> Again...which narcotic and which muscle relaxant, and what are the doses? (just curious)
>
> > I haave only recently been diagnosed ADD w/endogenous depression,
>
> Did the doctor call it "endogenous depression," or was the exact diagnosis something else. I'm curious because "endogenous depression" is an expression that's not used much anymore in psychiatry. Do you live in the USA?
>
> > Stimulents are what I have needed all along, but, couldn't seem to convince docs why (another story).
>
> For me, opioids act like I would expect stimulants to act!
>
> -elizabethDear Elizabeth~
Present regimen:
Darvocette 100-2x's a day
clonazepam 1mg a.m-1mg pm
carisoprodal 350 mgs. prn daily
propanolol 40 mgs. 2 x's a day
Zoloft 50 mgs. nightly
Adderall 30 mgs. a.m. and mid-dayWill answer more about diagnoses later, it's still a bit fuzzy, my therp is not big on labeling, & I am a bit of a 'mix'.
But, pdoc said ADD straight out, altho that may have been in order to get me on the stims I needed immediately and out of the dark hole I was mired in at the time.
More later~
nightlight
Posted by nightlight on November 23, 2001, at 16:33:45
In reply to Re: Methadone/opiates for depression » Elizabeth, posted by nightlight on November 23, 2001, at 9:06:29
Elizabeth~
Darvocette 100-2x's a day
clonazepam 2mgs a day usually am & pm, as needed
propanolol 80mgs a day, 40 in the am the rest prn
carisoprodal 350mgs *3* x's a day, also prn, but usually take at least 2.(Soma-muscle relaxer)
These are rx'd by my g.p.for chronic pain, and I can play with the dosages, depending upon need, up to these designated dosages. Darvocette is a lightweight narcotic, and would not be sufficient in an acute pain phase. But, for now, while pain is on lower end of the scale, I can deal with this small dosage of actual narcotic painkiller..
My pdoc has prescribed:
Adderall (mixed amphetamine salts)30 mgs. 2x's a day
Zoloft 50 mgs nightlyHe is aware of my other meds, of course. I saw him Wed. and mentioned I was STILL fairly useless, brainwise and physically after 2p.m.
So, he is switching me to dexedrine, in 5 mg. tabs, so I can dose more often, as needed, accordingly, and titrate as needed. Don't know what the difference will be, but, for me, the Adderall was a definite improvement, but maybe too subtle. I could take 20-30 mgs. an hour before getting up in the morning, and still sleep thru the alarm sometimes! Now I have 2 alarms.
I had tried ritalin in the past, but HATED it. It did not stimulate anything in me except irritable agitation which lasted about 45 minutes and then I needed a nap & that was only at max daily dosing, otherwise, I was just mean and tired at lower dosing.> > > I am now on a very low-dose narcotic, 60 mgs. stimulent, 2 mgs. klonopin and apotent muscle relaxer.
> >
> > Again...which narcotic and which muscle relaxant, and what are the doses? (just curious)
> >
> > > I haave only recently been diagnosed ADD w/endogenous depression,> > Did the doctor call it "endogenous depression," or was the exact diagnosis something else. I'm curious because "endogenous depression" is an expression that's not used much anymore in psychiatry. Do you live in the USA?
e.~
Yes, 'endogenous', simply, I believe, to let me know that he believed that there was something off-balance in my physical chemistry and had been, for a very long time. He knew that my previous pdoc thought I was experiencing 'situational' depression and dysfunction and that, even tho no A-D's were working for me, (or ever had, in the many years of drug trials), I'd get better when my environment became less stressful.(My father had recently died of a sudden heart attack and my mom was diagnosed w/organic brain syndrome soon after-I was her caregiver and I had a 4-yr old running around-she was a 40th birthday surprise-my only child-and the backpain situation which had forced me to quit work, leaving all financial responsibility to my husband, etc, etc....). It was a plateload, but so is life, and I was depressed when everything around me had been close to perfect. Former p-doc was downright belligerent.I had been ill for years, but just had not been able to convince him of that. I quit him after 6 months. That was one yr. ago.
I've only seen my present therapist twice. But, we covered a lot of ground. He is perceptive, kind, insightful, *happy* and very intelligent, in an unassuming way-a pleasure to 'visit'.
I'm supposed to see him every 3 wks., but the NYC disaster and another event have interfered w/our seeing each other more often.
He says, at this time, no clear-cut diagnosis, except depression, anxiety and God knows what else.
But, was optimistic about the future, as am I.Interestingly, I have found out that propoxyphene, the narcotic componenent of darvocette, is a potentiator of amphetamine. I guess even drugs can get a little help from their friends! (However, this is a characteristic that can be quite dangerous in some situations..)
> > > Stimulents are what I have needed all along, but, couldn't seem to convince docs why (another story).
> >
> > For me, opioids act like I would expect stimulants to act!
> >
> > -elizabethYES! That is how the F#3 affected me, not a downer, but a depression lifter and motivator to work. I could concentrate better and get things accomplished.
nightlight
ps: yes, I do live in the good ol' U. S. of A.
>
> Dear Elizabeth~
>
> Present regimen:
>
> Darvocette 100-2x's a day
> clonazepam 1mg a.m-1mg pm
> carisoprodal 350 mgs. prn daily
> propanolol 40 mgs. 2 x's a day
> Zoloft 50 mgs. nightly
> Adderall 30 mgs. a.m. and mid-day
>
> Will answer more about diagnoses later, it's still a bit fuzzy, my therp is not big on labeling, & I am a bit of a 'mix'.
>
> But, pdoc said ADD straight out, altho that may have been in order to get me on the stims I needed immediately and out of the dark hole I was mired in at the time.
>
> More later~
> nightlight
Posted by Elizabeth on November 23, 2001, at 19:40:05
In reply to Re: Fiorinal and Fioricet, posted by nightlight on November 23, 2001, at 8:55:12
> Yes, ya just don't see those bottles of seconal, nembutal, tuinal, etc..... the way u used too!
I'm afraid that was before my time!
> Plain codeine did nothing for my depression, nor did any of the other many painkillers I have used in search of relief from intense cervical pain. Not even the beloved Vicodins from which I have known so many to find tremendous depression relief. ONLY the F#3's for me.
That's weird. Did you ever take Fiorinal (or Fioricet) without the codiene?
> Darvocette 100-2x's a day
Propoxyphene, the main ingredient in Darvocet, is a *really* weak synthetic opioid. ("Darvocet" is how it's spelled, BTW. The "-cet" ending just means it has Tylenol (aCETaminophen) in it, as with Fioricet -- plain propoxyphene is Darvon.) Propoxyphene is pretty comparable to codeine, in terms of how well it relieves pain, I think (the doses are different, of course).
> carisoprodal 350 mgs. prn daily
Soma is a good muscle relaxant (although not "potent"). I tried this one for back pain ("myofascial pain syndrome") as well as Fioricet; the Soma worked much more reliably.
> propanolol 40 mgs. 2 x's a day
What's this one supposed to be for? I don't think I've ever heard of beta-blockers being used for pain (twice-a-day dosing of propranolol is pretty unusual too).
> Yes, 'endogenous', simply, I believe, to let me know that he believed that there was something off-balance in my physical chemistry and had been, for a very long time. He knew that my previous pdoc thought I was experiencing 'situational' depression and dysfunction and that, even tho no A-D's were working for me, (or ever had, in the many years of drug trials), I'd get better when my environment became less stressful.
Ah. The expression "endogenous depression" is used more in the UK and some other places than here, but the UK definition is different from what your pdoc meant (they use it to mean what DSM-IV calls "major depression with melancholic features" -- helpful to know if you're ever reading European psychiatric literature).
I don't think it's very useful to say that a case of depression is "situational" or "non-situational" since "situational" depression often responds to meds and "non-situational" depression can be very hard to treat (with meds or otherwise). Also the distinction isn't always that clear. (IMO, it usually isn't clear at all.)
-elizabeth
Posted by shelliR on November 23, 2001, at 20:08:47
In reply to Re: Morphine for depression. » shelliR, posted by Lorraine on November 19, 2001, at 9:12:48
Hi Lorraine,
>
>
>... his preference would be for me to try Naltroxone (which I am not wild about because there seems to be little research to support it) and then Methadone.My experience with Naltroxone is that I took it one day and felt awful. It may be one of those one day drugs. If you try it you could potentially feel wonderful in one day also.
It's nice to know that he is thinking this way (and I have been bringing him in articles from time to time--just because that's what I do generally). He's retesting me today with a QEEG to see if he can detect why I am having these sublevel panic attacks and to see if he can figure out why my meds aren't working.
It seems to be that some of your meds were working, but they have too many side effects. Nardil was workng very well; it was the side effects.
His first testing said that amphetamine and mood stabilizer ought to work. I maintain fairly well on Adderall and Neurontin--of course it's only been 10 days since I stopped the Nardil, so I may not have "fallen off the cliff" into depression yet. I maintained well on Adderall and Neurontin during my Parnate washout as well.
Are there any mood stablizers that you haven't tried yet?
Aside from the panic attack stuff, I only seem to be lacking mood support. But I can think and act with just the Adderall and Neurontin. I have more mood lability and I can dip pretty low.
>
> > Is methodone one of the opiates that you are considering? I wish I had more time to read about it. Do you want me to send you the link to the info that I found?That would be great, thanks.
> >
> > Let me know your next strategy. Either the adderall and neurotin are keeping you afloat, or you are the most patient person I know. Maybe bot
ÿI've never been hospitalized. I hate hospitals (bad experiences when a child) plus I have never been suicidal and I think a lot about the impact of my illness on my children so I don't think I'll go that route (on the other hand, that's easy to say as I don't have suicidal ideations as a symptom--the thing that happens is just that all the lights go out in me and I hybernate, slumped in a chair).
Well yes, your depression does not sound as painful as many others have been, at least when you are stable on neurotin and adderall. The same person who would never ever to anything to hurt her children can get stuck in suicidal thinking. And sometime the thinking can get so distorted that she begins to believe that her children would be better off without her.
Sometimes the hospital can just provide an atmosphere where you can be absolutely you for a while, slumped in that chair. I think at times to really act like you feel, releases some of your energy back to you. I used to feel that with my business. If I was here I had to be totally "on" all the time, to go into the hospital gave me a break from responsibility and excuses. During my last short stays, I sort of had the opposite feelings. I didn't want to go to groups and talk about how I felt and how I wanted to change, or make collages about depression in art therapy. I just wanted to find a AD that worked.
Anyway, I am excited that the methodone seems positive (although not perfect) and I find myself looking forward to things that may be around the corner. It would be interesting after all of this searching we both ended up with methodone as the pain mood stabilizer after all these other trials.
Shelli
Posted by Elizabeth on November 23, 2001, at 20:51:25
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 23, 2001, at 20:08:47
> My experience with Naltroxone is that I took it one day and felt awful. It may be one of those one day drugs. If you try it you could potentially feel wonderful in one day also.
FWIW, I've never heard of any depressed person feeling better on naltrexone except for a couple of people who had been taking SSRIs that had pooped out.
-e
Posted by SLS on November 24, 2001, at 8:15:12
In reply to naltrexone » shelliR, posted by Elizabeth on November 23, 2001, at 20:51:25
> > My experience with Naltroxone is that I took it one day and felt awful. It may be one of those one day drugs. If you try it you could potentially feel wonderful in one day also.
>
> FWIW, I've never heard of any depressed person feeling better on naltrexone except for a couple of people who had been taking SSRIs that had pooped out.
>
> -e
One person here described a robust response to naltrexone while taking Nardil.
- Scott
Posted by Elizabeth on November 25, 2001, at 16:10:54
In reply to Re: naltrexone, posted by SLS on November 24, 2001, at 8:15:12
> One person here described a robust response to naltrexone while taking Nardil.
That's interesting. Do you remember any details?
-elizabeth
Posted by nightlight on November 25, 2001, at 16:52:00
In reply to barbs, opioids, etc. » nightlight, posted by Elizabeth on November 23, 2001, at 19:40:05
>
> > Plain codeine did nothing for my depression, nor did any of the other many painkillers I have used in search of relief from intense cervical pain. Not even the beloved Vicodins from which I have known so many to find tremendous depression relief. ONLY the F#3's for me.
> That's weird. Did you ever take Fiorinal (or Fioricet) without the codiene?Elizabeth~
Yes, did not get the same effect, on my pain or depression.
> > Darvocette 100-2x's a day
>
> Propoxyphene, the main ingredient in Darvocet, is a *really* weak synthetic opioid. ("Darvocet" is how it's spelled, BTW. The "-cet" ending just means it has Tylenol (aCETaminophen) in it, as with Fioricet -- plain propoxyphene is Darvon.) Propoxyphene is pretty comparable to codeine, in terms of how well it relieves pain, I think (the doses are different, of course).Propoxyphene napsylate is the main ingredient in Darvocet. (Thanks for the spelling lesson) and propoxyphene hydrochloride is the main ingredient in Darvon. Altho, there is Darvon-N, which is actually propoxyphene napsylate! Darvon 65mgs. is equal in strength to propoxyphene napsylate 100 mgs. Due to that difference (I would think) propoxyphene is considered to be 2/3 to equal the strength of codeine phosphate 30mgs (what u get in Tyl #3, Fiorinal #3, or Fioricet #3).
> > carisoprodal 350 mgs. prn daily
>
> Soma is a good muscle relaxant (although not "potent"). I tried this one for back pain ("myofascial pain syndrome") as well as Fioricet; the Soma worked much more reliably.My description of Soma as potent is strictly empirically based. I tried I had tried Skelaxin, Robaxin, Flexeril & others I cannot remember w/no relief. One doc prescribed finally prescribed clonazepam. Bingo! It worked well for about 2 yrs. I still take it for anxiety and mood regulation, but my myofascial pain got outta hand again. I had asked about soma in the past, but was denied it due to its *supposed* recreational properties. (It had been recommended by ny hairdresser who also had a herniated cervical disc).An ortho finally asked if I had ever tried it, put me on that & the darvocet, and I eased out of a pain flare that had lasted for weeks. I had been taking the Fiorinal #3 but it really had begun to affect me adversely, made me feel worse, like I had more toxins building up in my muscle tissues and more pain.
By the way, what would you consider to be a *potent* muscle relaxer?> > propanolol 40 mgs. 2 x's a day
>
> What's this one supposed to be for? I don't think I've ever heard of beta-blockers being used for pain (twice-a-day dosing of propranolol is pretty unusual too).Why is twice daily dosing unusual? I starting using Inderal/propanolol abbout 4 yrs. ago to helpw/migraine preventio & hypertension that I experienced in the yr. or 2 after my baby was born. I first took 120mgs.extended release once a day. But, my blood pressure was lowish on that, so I went down to 80mgs a day, but,I took it in 2 40mg tabs9immediate release) that were scored. Eventually, my high blood pressure disappeared, don't know why, so now, I only take the propanolol as needed. I can break the tablets easily into 20 or even 10 mgs, as needed. But, some every day. Sometimes only 20 and sometimes up to 80. It is quite good for the squeezing chest pressure I feel when particularly anxious, and if I feel headachey, have visual auras, etc. I use it to help w/potential migraine.
> > Yes, 'endogenous', simply, I believe, to let me know that he believed that there was something off-balance in my physical chemistry and had been, for a very long time. He knew that my previous pdoc thought I was experiencing 'situational' depression and dysfunction and that, even tho no A-D's were working for me, (or ever had, in the many years of drug trials), I'd get better when my environment became less stressful.
>
> Ah. The expression "endogenous depression" is used more in the UK and some other places than here, but the UK definition is different from what your pdoc meant (they use it to mean what DSM-IV calls "major depression with melancholic features" -- helpful to know if you're ever reading European psychiatric literature).I have not delved much into the DSM-IV, I've had way too little free time in the past few yrs., so my grasp of psychiatric argot is weak. I want to learn a lot more. You must be educated in order to be an activist for and protector of your own body/brain and it's 'idiosyncracies' (to put it benignly).
> I don't think it's very useful to say that a case of depression is "situational" or "non-situational" since "situational" depression often responds to meds and "non-situational" depression can be very hard to treat (with meds or otherwise).And, I have read some articles that say otherwise, that they both respond almost equally well to medication (and time). Weird.
Also the distinction isn't always that clear. (IMO, it usually isn't clear at all.)
I have to agree w/you there! Thanks for your response.
nightlight
Posted by Lorraine on November 25, 2001, at 19:31:49
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 23, 2001, at 20:08:47
Shelli:
I am so glad that the Methadone seems to be helping you. What a long struggle you've had; it would be nice if this piece of the puzzle was solid. The site that I referred to that has a lot of stuff on Methadone is this one:
http://www.addict.f2s.com/sitecontents.html
> > He's retesting me today with a QEEG to see if he can detect why I am having these sublevel panic attacks and to see if he can figure out why my meds aren't working.
My redone QEEG confirms pretty much his earlier assessment--that amphetamine and mood stabilizer are the ticket, but that Adderall is not doing the job. So he switched me to ritalin (I've tried dexidrine before). My initial reaction was increased anxiety, but I cut the dose down to 1/4 of a 10 mg tab 4x a day and that helps. I suspect we are going to try Ritalin SR next. He says the amplitude (or voltage) of alpha waves is low--to him this suggests amphetamines. We did a hyperventilating QEEG also, which showed that when I hyperventilate my voltage goes even lower (it should go higher), which he said indicates that under stress I have no power (voltage) to cope--which certainly is true. It is also true that I feel as though I am always trying to manage my power or energy level.
Meanwhile, my alternative medicine doctor tested my amino acid levels and found low levels of several that are implicated with depression (methionine, phenylalinine, tryptophan, tyrosine, and glutamine) so a custom blend of amino acids reflecting my test results is being made. I will try these for 2 months to see if there is any improvement. I have tried a number of these individually, but she believes it is the combination that is important.
>
> >It seems to be that some of your meds were working, but they have too many side effects. Nardil was workng very well; it was the side effects.You are right. I am making up a chart showing meds tried and whether they were abandoned because I had only a partial response to them or because of side effects.
depression yet. I maintained well on Adderall and Neurontin during my Parnate washout as well.
> > Are there any mood stablizers that you haven't tried yet?Yes, I haven't tried Lithium, Tegretol or Topamax.
>> > > Let me know your next strategy. Either the adderall and neurotin are keeping you afloat, or you are the most patient person I know. Maybe both
I don't know, Shelli, you seem pretty patient to me:-)
> > Well yes, your depression does not sound as painful as many others have been, at least when you are stable on neurotin and adderall. The same person who would never ever to anything to hurt her children can get stuck in suicidal thinking. And sometime the thinking can get so distorted that she begins to believe that her children would be better off without her.
Well, I've certainly thought this before, but I've never acted on it. And, I don't seem to ruminate about it generally. I get the sense some people ruminate about it alot and that some people feel compelled to act on the thought--like maybe these things are different parts of the problem. I think that I think about suicide like someone with MS or some other chronic illness might think about it (this can't be solved, it's no use, i'm just a burden on everyone, they'd be better off without me) and it's worse when I am down. I just know that for some people this is a much tougher problem that can't be thought out of or that feels like it can't be waited out.
>
> Sometimes the hospital can just provide an atmosphere where you can be absolutely you for a while, slumped in that chair. I think at times to really act like you feel, releases some of your energy back to you. I used to feel that with my business. If I was here I had to be totally "on" all the time, to go into the hospital gave me a break from responsibility and excuses.I can really see the appeal to this, Shelli. Family expectations of performance go up when my mood stabilizes and then when my mood falls apart, don't adjust back down, which makes it hard.
>
> Anyway, I am excited that the methodone seems positive (although not perfect) and I find myself looking forward to things that may be around the corner. It would be interesting after all of this searching we both ended up with methodone as the pain mood stabilizer after all these other trials.It would be pretty funny if all roads did lead to Rome for both of our depressions. I'm glad that you have something that is working for you, that your transition wasn't that bad and that the price is right.
Lorraine
Posted by shelliR on November 28, 2001, at 0:02:48
In reply to Re: Morphine for depression. » shelliR, posted by Lorraine on November 25, 2001, at 19:31:49
Lorraine
>
>
>
> > > He's retesting me today with a QEEG to see if he can detect why I am having these sublevel panic attacks and to see if he can figure out why my meds aren't working.Is this paragraph below about the retest the same day, or is this from your last test?
> My redone QEEG confirms pretty much his earlier assessment--that amphetamine and mood stabilizer are the ticket, but that Adderall is not doing the job. So he switched me to ritalin (I've tried dexidrine before). My initial reaction was increased anxiety, but I cut the dose down to 1/4 of a 10 mg tab 4x a day and that helps. I suspect we are going to try Ritalin SR next. He says the amplitude (or voltage) of alpha waves is low--to him this suggests amphetamines. We did a hyperventilating QEEG also, which showed that when I hyperventilate my voltage goes even lower (it should go higher), which he said indicates that under stress I have no power (voltage) to cope--which certainly is true. It is also true that I feel as though I am always trying to manage my power or energy level.I don't know the difference between concerta and ritalin SR. Both are long-lasting ritalin.
>
> Meanwhile, my alternative medicine doctor tested my amino acid levels and found low levels of several that are implicated with depression (methionine, phenylalinine, tryptophan, tyrosine, and glutamine) so a custom blend of amino acids reflecting my test results is being made. I will try these for 2 months to see if there is any improvement. I have tried a number of these individually, but she believes it is the combination that is important.
>
> >
How does your pdoc feel about changing things from your alternative doctor; he doesn't worry that a change of enzymes might affect his tests and sort of muddy the field?> > >It seems to be that some of your meds were working, but they have too many side effects. Nardil was workng very well; it was the side effects.
>
> You are right. I am making up a chart showing meds tried and whether they were abandoned because I had only a partial response to them or because of side effects.
> depression yet. I maintained well on Adderall and Neurontin during my Parnate washout as well.
>
>
> > > Are there any mood stablizers that you haven't tried yet?
>
> Yes, I haven't tried Lithium, Tegretol or Topamax.I did a long trial of Topomax, because at the time I was working with a pdoc who believed in long trials. I pretty much sleep six weeks of my life away, some of it in the hospital. They kept making me get up to go to these stupid groups and I just couldn't stay up. I had to take a 2 hour nap before gropup therapy to get through it.It reminded me of when I used to work in a psychiatric hospital when I first go out of college. It was a heavy duty unit (called intensive care) and they'd give some of these patients enormous amounts of anti-psychotics, then yell at them because they were not paricipating in the group. i gave them credit for even making it to the groups.
> >
>
> > > > Let me know your next strategy. Either the adderall and neurotin are keeping you afloat, or you are the most patient person I know. Maybe both
>
> I don't know, Shelli, you seem pretty patient to me:-)Well, sort of what choice do we have? Although I was quite ready to try opiates before anyone gave it to me because my depression was so painful, sometimes unbearable. It's always hard for me to explain why it is unbearable . And I don't even know what's exactly happening. Like where the hurt eminated from, except from my chest.
>
> > > Well yes, your depression does not sound as painful as many others have been, at least when you are stable on neurotin and adderall. The same person who would never ever to anything to hurt her children can get stuck in suicidal thinking. And sometime the thinking can get so distorted that she begins to believe that her children would be better off without her.
>
> Well, I've certainly thought this before, but I've never acted on it. And, I don't seem to ruminate about it generally. I get the sense some people ruminate about it alot and that some people feel compelled to act on the thought--like maybe these things are different parts of the problem. I think that I think about suicide like someone with MS or some other chronic illness might think about it (this can't be solved, it's no use, i'm just a burden on everyone, they'd be better off without me) and it's worse when I am down. I just know that for some people this is a much tougher problem that can't be thought out of or that feels like it can't be waited out.Before the codeine, I was in the worst place really stuck. Actually, it was when I was already on the oxy and bit stopped working and I didn't think my pdoc would raise it again. I was in horrible pain and I knew I absolutely couldn't kill myself because it would totally mess up the rest of their lives. I can't believe I actually called them and asked them if I could kill myself. It was probably the stupidest thing I ever did because of course I knew what they would say and I also made them feel so bad. And so I couldn't live and I couldn't die. I felt that at least if I went into the hospital no one could be mad at me for not finishing their work. But I really didn't want to go. Then my pdoc increased my dose and things were okay again.
That's why my pdocs threats are so scary to me; I can't control when I reach the end of the helpfulness of a dose.> >
> > Sometimes the hospital can just provide an atmosphere where you can be absolutely you for a while, slumped in that chair. I think at times to really act like you feel, releases some of your energy back to you. I used to feel that with my business. If I was here I had to be totally "on" all the time, to go into the hospital gave me a break from responsibility and excuses.
>
> I can really see the appeal to this, Shelli. Family expectations of performance go up when my mood stabilizes and then when my mood falls apart, don't adjust back down, which makes it hard.Can your family always tell when you're depressed? Is there that big a difference in your behavior toawrd everyone?
>
> >
> > Anyway, I am excited that the methodone seems positive (although not perfect) and I find myself looking forward to things that may be around the corner. It would be interesting after all of this searching we both ended up with methodone as the pain mood stabilizer after all these other trials.Now I am less excited. I want to go back on oxy I think, and I just never know when I'll reach the end of effectiveness. But thers's really no point in not living in the now. I can't control what happens with my body chemistry.
>
> It would be pretty funny if all roads did lead to Rome for both of our depressions. I'm glad that you have something that is working for you, that your transition wasn't that bad and that the price is right.
>
shelli
Posted by Elizabeth on November 28, 2001, at 15:58:17
In reply to Re: barbs, opioids, etc. » Elizabeth, posted by nightlight on November 25, 2001, at 16:52:00
> Propoxyphene napsylate is the main ingredient in Darvocet. (Thanks for the spelling lesson)
And thank *you* for the propoxyphene salts lesson! :-)
> My description of Soma as potent is strictly empirically based.
"Potent" just means that it works in low doses (it's a relevant thing, of course). I usually find that 700 mg of carisoprodol is optimal for my back pain. Compared with, say, 0.3 mg of buprenorphine, that seems like a lot. < g >
> I tried I had tried Skelaxin, Robaxin, Flexeril & others I cannot remember w/no relief.
Those are what I call "fake muscle relaxants" -- the only reason they seem to work at all is because they're sedating (I think they're all antihistamines and/or anticholinergics). Flexeril, for example, is similar to amitriptyline, which works for neuropathic pain but not for musculoskeletal pain.
> One doc prescribed finally prescribed clonazepam. Bingo! It worked well for about 2 yrs. I still take it for anxiety and mood regulation, but my myofascial pain got outta hand again.
Yeah, I've tried using various benzos as muscle relaxants too. Valium worked pretty well the first few times I took it but now it doesn't work at all. (I tried up to 40 mg -- nothing.) I wasn't taking it regularly -- not every day or even every week, just every once in a while. I think that with benzos, as with most of the drugs marketed as muscle relaxants, a lot of the apparent effect is due to sedation.
> I had asked about soma in the past, but was denied it due to its *supposed* recreational properties.
It's related to meprobamate (Miltown, the benzos' predecessor) and I think a small amount is metabolized to meprobamate. Meprobamate was supposed to be a bit of a party drug (compared with the benzos, anyway) and I guess some people get a kick out of Soma too. (It's definitely not something you should take if you're planning on drinking or operating heavy machinery, anyway.) Glad you were able to get it. I always feel like doctors are playing games trying to see if I'm a "drug seeker," so when they recommend something that I know won't work initially, I just go ahead and give it a try. (In this case, I had to take baclofen for a month before I was able to get Soma. Then the doctor in question wrote a script for me to take Soma 3 times a day, which is much more than I use it in real life.)
> I had been taking the Fiorinal #3 but it really had begun to affect me adversely, made me feel worse, like I had more toxins building up in my muscle tissues and more pain.
I know the feeling.
> By the way, what would you consider to be a *potent* muscle relaxer?
Hmm. Well, barbiturates are usually effective at around 100 mg, but I wouldn't count that as much more potent than the typical 350 mg dose of Soma (same order of magnitude). Valium, with doses starting at 5 mg, would be considered more potent. Even Valium is considered "low potency" for a benzo, though. Potency isn't generally the most relevant characteristic to consider when you're picking out a med, IMO.
> Why is twice daily dosing unusual?
I was wrong about that, sorry. I was thinking of something else. Propranolol is usually given 2-3 times daily.
I seem to recall that it's not all that unusual for women to develop hypertension when they're pregnant. I don't know why, though -- you might ask your doctor about it if you're planning on having any more kids.
> It is quite good for the squeezing chest pressure I feel when particularly anxious, and if I feel headachey, have visual auras, etc. I use it to help w/potential migraine.
It's effective for preventing migraines and also, often, for the peripheral manifestations of anxiety, like chest pain, shakes, tachycardia, etc. (I use it for essential tremor. Good stuff.)
> I have not delved much into the DSM-IV, I've had way too little free time in the past few yrs., so my grasp of psychiatric argot is weak.
"Endogenous depression" isn't used in DSM-IV anyway.
> And, I have read some articles that say otherwise, that they both respond almost equally well to medication (and time). Weird.
Yes, that's true. You can try to label someone "situationally" or "nonsituationally" depressed, but it isn't much of a predictor of how they will respond to treatment.
-elizabeth
Posted by Elizabeth on November 28, 2001, at 16:06:52
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 28, 2001, at 0:02:48
> I don't know the difference between concerta and ritalin SR. Both are long-lasting ritalin.
They use different controlled-release technologies. Concerta is supposed to be better (i.e., lasts longer).
> Can your family always tell when you're depressed? Is there that big a difference in your behavior toawrd everyone?
You make it sound like you can usually "fake it." Can you? I can up to a point, but when the depression gets really bad, I can't really hide it (and often I don't even care about hiding it by the time it's that bad).
-elizabeth
Posted by Lorraine on November 28, 2001, at 18:47:52
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 28, 2001, at 0:02:48
Shelli:
> >
> Is this paragraph below about the retest the same day, or is this from your last test?My most recent QEEG (done last week).
> > My redone QEEG confirms pretty much his earlier assessment--that amphetamine and mood stabilizer are the ticket, but that Adderall is not doing the job. So he switched me to ritalin (I've tried dexidrine before). My initial reaction was increased anxiety, but I cut the dose down to 1/4 of a 10 mg tab 4x a day and that helps. I suspect we are going to try Ritalin SR next. He says the amplitude (or voltage) of alpha waves is low--to him this suggests amphetamines. We did a hyperventilating QEEG also, which showed that when I hyperventilate my voltage goes even lower (it should go higher), which he said indicates that under stress I have no power (voltage) to cope--which certainly is true. It is also true that I feel as though I am always trying to manage my power or energy level.
>
> I don't know the difference between concerta and ritalin SR. Both are long-lasting ritalin.They're the same--my mistake.
>
> >
> > Meanwhile, my alternative medicine doctor tested my amino acid levels and found low levels of several that are implicated with depression (methionine, phenylalinine, tryptophan, tyrosine, and glutamine) so a custom blend of amino acids reflecting my test results is being made. I will try these for 2 months to see if there is any improvement. I have tried a number of these individually, but she believes it is the combination that is important.
> >
> > >
> How does your pdoc feel about changing things from your alternative doctor; he doesn't worry that a change of enzymes might affect his tests and sort of muddy the field?I have to talk to him about it. It's hard to keep static though, you know. I'd like to get someplace stable for the holidays even if it is not permanent. The good thing is I don't have to wait weeks to find out if a stimulent is working.
> I did a long trial of Topomax, because at the time I was working with a pdoc who believed in long trials.Did you also lose weight on it like some people report? (That would be pretty odd to lose weight while sleeping.)
> >
> > I don't know, Shelli, you seem pretty patient to me:-)
>
> Well, sort of what choice do we have? Although I was quite ready to try opiates before anyone gave it to me because my depression was so painful, sometimes unbearable. It's always hard for me to explain why it is unbearable . And I don't even know what's exactly happening. Like where the hurt eminated from, except from my chest.
> > I can't believe I actually called them and asked them if I could kill myself. It was probably the stupidest thing I ever did because of course I knew what they would say and I also made them feel so bad.Maybe you needed to have them say it to you. On my birthday (just passed) I asked my husband and each of the kids to write me a note about why they loved me. It was great to read them, great (particularly for the kids) to think about why they loved me and I learned a lot about the entire family. But, part of the reason I had them write the notes was so that I could store them in my suicide file (where I keep letters that would stop me if I got to that point).
> That's why my pdocs threats are so scary to me; I can't control when I reach the end of the helpfulness of a dose.
This would really scare me also.
> >
> > I can really see the appeal to this, Shelli. Family expectations of performance go up when my mood stabilizes and then when my mood falls apart, don't adjust back down, which makes it hard.
>
> Can your family always tell when you're depressed? Is there that big a difference in your behavior toawrd everyone?Oh, yeah. They all know when I dip. I'm either weepy, lethargic or brittle. Plus I try to tell them so they won't think my behavior is because of something they did or didn't do. Sometimes I just ask to be left alone (when I want to sit and cry--I can comfort myself well enough with stacks of books and I don't want to be bringing everyone else down, though they feel the void anyway).
> > I want to go back on oxy I think, and I just never know when I'll reach the end of effectiveness. But thers's really no point in not living in the now. I can't control what happens with my body chemistry.
And you can bear the cost? If the methadone doesn't quite do it, can you combine the two (oxy and methadone)? or augment the methadone?
I hope things pick up again for you.
Lorraine
Posted by shelliR on November 28, 2001, at 19:36:13
In reply to Re: Morphine for depression. » shelliR, posted by Elizabeth on November 28, 2001, at 16:06:52
>
> > Can your family always tell when you're depressed? Is there that big a difference in your behavior toawrd everyone?
>
> You make it sound like you can usually "fake it."That seems like a strange thing to say to me.. I've never used the term fake it and I don't even think in those terms.
*Can you?
I can up to a point, but when the depression gets really bad, I can't really hide it (and often I don't even care about hiding it by the time it's that bad).
There are times that I am so severely depressed that I stay in bed all day, mostly sleeping. My cat loves it, I am like a big cat mom. But the stimulents make that a lot more difficult now (for better and worse). I find it amazing how I am able to come out of my depression (like when I am shooting, or even clients are over). I don't feel like I'm faking it; something happens, perhaps it's a good dissociation, where I don't feel anything about myself, including the depression. There were a few photo sessions before I went into the hospital in July, that that I could feel my depression (actually more of an irritation) for the first time, I thought that could never happen. That was shortly before I went on oxyconton.
Mostly I am able to come out of my depression enough to be civil, like if I had to run out to the store and see someone. But I live alone, so that makes things very different. When I asked the question to Lorraine, I meant do her children always notice the depression, or do they go right on chatting about themselves like teenagers generelly do.(Actually, I get the idea that her son is not a chatterer. And I waw also imaging that her husband knows but maybe you just go on many times as if you were not depressed.
>
What about your SO, Elizabeth? Do you consciously make an attempt to separate sometimes from the depression with him, not to fake your mood, but just to avoid, sort of let your relatiohship distract from the depression. Does he *want* to knew all your moods.Are you still doing well on your meds? And is your SO's depression still pretty much in remission since he started, was it remeron?
Shelli
Posted by SLS on November 29, 2001, at 17:51:19
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 28, 2001, at 0:02:48
> But I really didn't want to go. Then my pdoc increased my dose and things were okay again.
Hi Shelli.I'm not good for more than a few sentences, but a thought occurred to me as I read your post. Have you ever tried amantadine (Symmetrel)? It's a long shot, but if Lamictal helped a little, perhaps amantadine could help augment or reduce the induction of tolerance to opioids via NMDA receptor antagonism. Get one of the real brainiacs to look into it for you.
See 'ya.
- Scott
Posted by Elizabeth on November 30, 2001, at 1:17:51
In reply to Re: Morphine for depression. » Elizabeth, posted by shelliR on November 28, 2001, at 19:36:13
> > > Can your family always tell when you're depressed? Is there that big a difference in your behavior toawrd everyone?
> >
> > You make it sound like you can usually "fake it."
>
> That seems like a strange thing to say to me.. I've never used the term fake it and I don't even think in those terms.I just meant pretending not to be depressed.
> There are times that I am so severely depressed that I stay in bed all day, mostly sleeping.
Me too except for the sleeping part. (You know things are bad when you start thinking about abusing Zyprexa just so you can escape. :-} )
> But the stimulents make that a lot more difficult now (for better and worse).
Well...is it just more difficult to sleep, or is it also more difficult to lie around not caring about anything?
> I find it amazing how I am able to come out of my depression (like when I am shooting, or even clients are over). I don't feel like I'm faking it; something happens, perhaps it's a good dissociation, where I don't feel anything about myself, including the depression.
That sounds like more than what I mean by "faking it." It sounds like your depression is amenable to distraction -- a useful thing to know.
> What about your SO, Elizabeth? Do you consciously make an attempt to separate sometimes from the depression with him, not to fake your mood, but just to avoid, sort of let your relatiohship distract from the depression. Does he *want* to knew all your moods.
He's been depressed himself, and I don't feel I have to hide it from him, which is good because I'm a pretty crappy liar. < g > I'm not sure how trying to "separate" from the depression would be different from trying to feel better or pretend to feel better, but I've certainly attempted the latter two approaches without success.
Now, whether I *talk* to him about it or not is another story. Actually when I think about it, that depends more on him than on me, because I don't like to talk about it and that's not something I would do spontaneously. I don't try to hide it from him (like I said, bad liar), but when he's troubled about something, even if I'm depressed I will do my best to be supportive. I do make an active effort not to bring other people down, especially him.
> Are you still doing well on your meds? And is your SO's depression still pretty much in remission since he started, was it remeron?
He was taking CA Rocket Fuel+++ (he's the one who got me psyched about that), Remeron + Celexa + Provigil + Wellbutrin SR, but he was able to drop the Remeron (worried about weight gain, it was making him hungry) and is still doing well.
As for me -- comme ci, comme ca. My health insurance lapsed a couple months ago and I've been sort of in limbo trying to work something out in that regard.
-elizabeth
Posted by Elizabeth on November 30, 2001, at 1:18:38
In reply to Re: Morphine for depression. » shelliR, posted by SLS on November 29, 2001, at 17:51:19
> Have you ever tried amantadine (Symmetrel)? It's a long shot, but if Lamictal helped a little, perhaps amantadine could help augment or reduce the induction of tolerance to opioids via NMDA receptor antagonism.
I didn't know that about Lamictal or amantadine. I believe that the current thinking is that NMDA blockers don't really prevent tolerance, they just augment the opioid, alas. I've known a few people who used DXM to that end, although I'm not sure about the effective dose range.
-elizabeth
Posted by SLS on November 30, 2001, at 7:43:58
In reply to Re: Morphine for depression. » SLS, posted by Elizabeth on November 30, 2001, at 1:18:38
> > Have you ever tried amantadine (Symmetrel)? It's a long shot, but if Lamictal helped a little, perhaps amantadine could help augment or reduce the induction of tolerance to opioids via NMDA receptor antagonism.
>
> I didn't know that about Lamictal or amantadine.Lamotrigine inhibits the release of glutamate, thereby reducing NMDA stimulation. Amantadine (a relative of memantine) blocks NMDA receptors. It was probably a dumb idea.
> I believe that the current thinking is that NMDA blockers don't really prevent tolerance, they just augment the opioid, alas.
I see.
> I've known a few people who used DXM to that end,
For opioid enhancement or for the prevention of desensitization? Did it work?
- Scott
Posted by Elizabeth on November 30, 2001, at 14:50:18
In reply to Re: Morphine for depression. » Elizabeth, posted by SLS on November 30, 2001, at 7:43:58
> For opioid enhancement or for the prevention of desensitization? Did it work?
Sure it works, and like I said, they don't prevent tolerance; they just augment.
Thanks for the info about Lamictal and Symmetrel.
-e
Posted by shelliR on December 3, 2001, at 12:48:07
In reply to Re: Morphine for depression. » shelliR, posted by Lorraine on November 28, 2001, at 18:47:52
Lorraine,
> My most recent QEEG (done last week).
Are there changes in the QEEG since last time you had the test?
>I did a long trial of Topomax, because at the time I was working with a pdoc who believed in long trials.
> Did you also lose weight on it like some people report? (That would be pretty odd to lose weight while sleeping.)Right,no weight loss.
>
>
> weepy, lethargic or brittle. Plus I try to tell them so they won't think my behavior is because of something they did or didn't do. Sometimes I just ask to be left alone (when I want to sit and cry--I can comfort myself well enough with stacks of books and I don't want to be bringing everyone else down, though they feel the void anyway).That makes a lot of sense. Sort of like you were feeling sick in any other way. How is your son doing, and your daughter with her "new" sense of herself in the family after seeing his therapist?
And your next trial is to change the stimulent or try another mood stablizer, I can't remember. what's going on with your meds?Shelli
Posted by Lorraine on December 4, 2001, at 10:01:21
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on December 3, 2001, at 12:48:07
Shelli:
I'm on a trial of concerta and neurontin. I was on ridalin and neurontin--but that was too much up and down. I've only been on the concerta a short time (2 days) so too early to tell. I've been a bit down but then I am withdrawing from a shorter term amphetamine (ritalin) so my body may be adjusting. Anyway I haven't been posting much b/c it just seems like this is "process" work, try one drug and then another and then another. I don't see magic bullets, just one foot in front of the other until things work.
Lorraine
Posted by shelliR on December 4, 2001, at 21:30:34
In reply to Re: Morphine for depression. » shelliR, posted by Lorraine on December 4, 2001, at 10:01:21
> Shelli:
>
> I'm on a trial of concerta and neurontin. I was on ridalin and neurontin--but that was too much up and down. I've only been on the concerta a short time (2 days) so too early to tell. I've been a bit down but then I am withdrawing from a shorter term amphetamine (ritalin) so my body may be adjusting. Anyway I haven't been posting much b/c it just seems like this is "process" work, try one drug and then another and then another. I don't see magic bullets, just one foot in front of the other until things work.
>
> LorraineHi Lorraine,
Well, I like to know where you're walking, so let me/us know, okay? Is the plan to find the right stimulent with the right mood stabilizer, and leave ADs out of the picture? I am on cercerta. I couldn't adjust to any of the stimulents until I was on with a narcotic. And now I really don't know whether it makes a difference whether or not I take it, even though I'm up to 54mg a day.
Actually, you could probably take away most of my other drugs and it wouldn't make a difference. I am also up to 400 mg of wellbutrin, but I'm still very very tired late afternoon. I have this theory that life is just too much to last a full day, and if I take a 30minute nap, everything feels better. I'm going to try spliting the concerta to twice a day, try to get around that theory. The only reason I care is when I am not home, or when people want to pick up stuff in the late afternoon, I can't take a nap, and then I almost fall asleep sitting up at about 8pm. (and wake up at 9 or 10, because my body thinks it's a nap, not time to sleep)Take care,
Shelli
Posted by manowar on December 5, 2001, at 13:05:26
In reply to Re: Methadone for depression. » Lorraine, posted by shelliR on December 4, 2001, at 21:30:34
> I'm going to try spliting the concerta to twice a day, try to get around that theory.
Hi Shelly,
From what my pdoc told me, Concerta is just Ritalin XR that works a lot better than the drug Ritalin XR. He told me that 1/3 of it is released immediately, 1/3 is released 3 hours later and the last 1/3 is released 3 hours later. I found that it works great and it is effective for me for 8-10 hours.Since the Concerta is a timed-release preparation, I don't think it would be a good idea to split it in half. You may need a higher dose for it to be effective.
This is what I'm doing:
Since the Concerta (72 mg) wears off for me around 4-6 in the afternoon, my pdoc gave me a script for regular Ritalin (20 mg) so that I could take one when the Concerta starts to wear off. The Ritalin last for 3-4 hours.
--Tim
Posted by shelliR on December 5, 2001, at 13:59:03
In reply to Re: Methadone for depression. » shelliR, posted by manowar on December 5, 2001, at 13:05:26
Hi Tim,
> From what my pdoc told me, Concerta is just Ritalin XR that works a lot better than the drug Ritalin XR. He told me that 1/3 of it is released immediately, 1/3 is released 3 hours later and the last 1/3 is released 3 hours later. I found that it works great and it is effective for me for 8-10 hours.
>Is Ritalin XR still available? If it is, it might be related to a paten release. Or a way to get around a name that seems to be so associated with ADD?
> Since the Concerta is a timed-release preparation, I don't think it would be a good idea to split it in half. You may need a higher dose for it to be effective.Sorry, you're right. I did come across as if I meant splitting the pill. I actually meant splitting the dose-2 morning, 1 early afternoon.
>
> This is what I'm doing:
> Since the Concerta (72 mg) wears off for me around 4-6 in the afternoon, my pdoc gave me a script for regular Ritalin (20 mg) so that I could take one when the Concerta starts to wear off. The Ritalin last for 3-4 hours.I think that's a good plan. I didn't want to have to keep track of one more pill (to get a prescription of, renewal, etc, of ritalin.) It's already scary (to me) how many different drugs I'm taking for depression.
Shelli
Posted by JahL on December 6, 2001, at 11:34:15
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 28, 2001, at 0:02:48
> > > Anyway, I am excited that the methodone seems positive (although not perfect) and I find myself looking forward to things that may be around the corner. It would be interesting after all of this searching we both ended up with methodone as the pain mood stabilizer after all these other trials.
> Now I am less excited. I want to go back on oxy I think, and I just never know when I'll reach the end of effectiveness. But thers's really no point in not living in the now. I can't control what happens with my body chemistry.Hi Shelli.
Don't presently have the motivation to trawl thru long threads. Was wondering why you wanted to return 2 Oxy. Methadone not doing the trick? Can you tell me why you prefer the 'real' opiates (or is that a silly Q??)? What dose are you taking?
That specialist guy I was telling you about as good as told me to try anything I can get my hands on. He told me they're currently 'burying bodies' which might otherwise be saved were it not for restrictive, draconian govt. legislation concerning opioids and the like. It would seem his hands are tied...
I think Methadone low-dose is helping a little. Now I've got the green (in both senses of the word) light.......
Hope you're doing OK,
J.
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