![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Ron Hill on May 12, 2002, at 0:56:34
?
Posted by 3 Beer Effect on May 12, 2002, at 6:12:51
In reply to 3BE, what is the status of your SAM-e trial?, posted by Ron Hill on May 12, 2002, at 0:56:34
I have no response so far after about 2 weeks at 800 mg SAM-e. I take 2 tablets at 6 am & 2 at 11 am along with vitamin B6, sublingual b12, & 400mcg folic acid each time on an empty stomach. I take a centrum multivitamin the night before.
I wonder if SAM-E supplementation only works during middle-age or later when your body doesn't produce as much of it- I am 23.I also currently take Dextrostat 20 mg 2x per day & Klonopin 1 mg breakfast, 1 mg lunch, & the worthless hypnotic Sonata 10 mg to sleep (plan to switch to Ambien).
It seems my depression is totally lifted for the 4 or 5 hours after each Dexedrine dose, but the other 6 hours of the day that i'm awake my depression seems to be getting pretty severe & progressively worse with no forseeable end in sight. Feels almost like I'm falling down some dark well except there is no bottom.
I was on Lamictal for the last 3 months with no effect except acne and worse vision- I was just starting on 200 mg when I just got fed up with how lousy it made me feel & its lack of any perceptible effect. Right now I have enough money saved up to get an eye exam & the Lasik Laser vision correction surgery sometime at the end of May or Early June, & so I could not have continued to take Lamictal even if it had been working, because it did decrease my vision & can do strange things to your eyes (such as binding to melanin in eye tissue) which could botch my eye exam & lasik laser vision correction surgery.
After the surgery, i'm probably going to have to take one of the 'old guard' antidepressants since I haven't had any luck with the new ones. I am returning to college at the end of August, & I do not plan to take an anti-depressant then since last fall, sedation from Remeron 45 mg, & then chest pain/rapid heartbeat from Effexor left me unable to study & I had to get a medical withdrawl- so basically $8,000 for tuition, room, & board went down the tubes from anti-depressants.
At college, i'll just stick to Dextrostat and Klonopin.But with these old drugs, it looks like most people only take them for three months & then for some unknown reason reduce the dosage substantially (toxicity?) & so I figured maybe three months on one of these ADs would correct whatever chemical imbalance or neurotransmitter deficiency that is causing this depression, or atleast start to kick start it into some kind of path towards recovery. I think I can make great gains at college at curing my depression even without an anti-depressant because I reserved my own private room w/ private bathroom at the nicest/best food/best-looking girls private high-rise dorm on campus, all my friends are there (at college), hopefully i'll find a girlfriend which I think would help alot, & also most everything is a novel experience at college, not just the same get up commute to work & sit in a cubicle while they frown at my productivity for a lousy $8.50 an hour existence I have here back at my parents house.
I don't know that much about the old antidepressants, but I seem to have a lethargic/chronic fatigue type of severe depression that responds well to stimulants like Dexedrine & even somewhat to Caffeine. I was thinking of asking my psychiatrist to put me on one of the following, which I think are about the most activating, most effective (especially Parnate) anti-depressants out there: Norpramin (Desipramine), Vivactil (Protriptyline), or the MAOI Parnate.
However, I don't really know what "anti-cholinergic" side effects really mean- do these old drugs have a negative "dumb drug" effect on acetylcholine/memory or does anti-cholinergic just mean they feel like you are taking Benadryl all of the time? Or are the side effects of these old drugs much worse than that? I've only taken SSRIs, Remeron, & Effexor so I don't know if I have any kind of idea of how bad the side effects of these old but more effective anti-depressants are. (I have never taken the "activating" AD Wellbutrin SR but can't because a few years ago I had 3 siezures in the emergency room after I took a 'recreational dose' of the muscle relaxer Soma, blacked out, forgot I had taken any & took a bunch more & ended up accidentally overdosing quite badly.
How bad is this orthostatic hypotension thing with these drugs?-In my office job I have, I have to stand up from my desk walk over to a book case & grab a stack of maps, & then sit down about every 15 mins all day long. Does that mean I might pass out when I stand up at work? Is it hard or even possible to keep a job & put up with the side effects of Norpramin (desipramine), Vivactil (protriptyline), or Parnate?
Thanks, 3 Beers......
Posted by Zo on May 12, 2002, at 6:32:42
In reply to No resp.=Depress-severe/Need help w/ old ADs!, posted by 3 Beer Effect on May 12, 2002, at 6:12:51
I assume you've thought of Wellbutrin and rejected it?
It's the most stimulating of the ADs. . could provide a nice stable background for the Dextrostat. No orthostatic, no anti-cholinegeric, no waiting. . .
Zo
Posted by Lia Mason on May 12, 2002, at 23:18:01
In reply to No resp.=Depress-severe/Need help w/ old ADs!, posted by 3 Beer Effect on May 12, 2002, at 6:12:51
3 Beer...
You probably already know this, but... it is not uncommon to require high doses of sam-e for depression. I did great with sam-e, but not til I got to 1200. That's expensive, but it did work.
I'm of the fatiguing depression type, too. The MAO's were great, but I couldn't take the side effects. I'm on a combo of sam-e and imipramine now. Re: orthostatic hypo... I had it bad on Nortriptyline and Nardil and it's very minor on imipramine. I hardly notice it. Imipramine is also a lot less sedating than Nortriptyline for me. The drag with these drugs (tricyclics) is that you can bypass side effects by going up very slowly, but that means you take A LONG time to reach a therapeutic dose.
If you can tolerate Wellbutrin it's worth a shot. It made me jittery, but most reports I've heard are quite positive.
Hang in. Good Luck.
Lia
Posted by Ritch on May 13, 2002, at 9:50:37
In reply to Re: No resp.=Depress-severe/Need help w/ old ADs!, posted by Lia Mason on May 12, 2002, at 23:18:01
>........ I'm of the fatiguing depression type, too. The MAO's were great, but I couldn't take the side effects. I'm on a combo of sam-e and imipramine now. Re: orthostatic hypo... I had it bad on Nortriptyline and Nardil and it's very minor on imipramine. I hardly notice it. Imipramine is also a lot less sedating than Nortriptyline for me. The drag with these drugs (tricyclics) is that you can bypass side effects by going up very slowly, but that means you take A LONG time to reach a therapeutic dose.
>
> If you can tolerate Wellbutrin it's worth a shot. It made me jittery, but most reports I've heard are quite positive.
>
> Hang in. Good Luck.
>
> Lia
Lia,Hope you don't mind my asking a question, but how much imipramine are you taking? I am curious, because it is a possibility for me and I had taken nortriptyline before and wonder if imipramine might work better. You said you had *less* orthostatic hypotension on imipramine-nortrip. usually causes less not the other way around (which makes imipramine more interesting to me). Wellbutrin and desipramine made me too nervous, and pstims work but they are too much of a headache with the CII crap.
Mitch
Posted by Lia Mason on May 13, 2002, at 10:36:37
In reply to Re: No resp.=Depress-severe/Need help w/ old ADs! » Lia Mason, posted by Ritch on May 13, 2002, at 9:50:37
Hi Mitch,
I know, I was told Nortrip would be better tolerated and it wasn't. More sedation more orthostatic h.
I'm on 150 imipramine. I'm told the dose for depression ranges 150-300. As I said, the orthostatic h. is minor. I had it but it's faded. Other than that... I'm sun sensitive and mildly constipated, but those things I can manage. A little dry mouth. Some sedation that's fading. I don't feel spaced out like I did on Nortrip.
Lia
Posted by IsoM on May 13, 2002, at 14:53:37
In reply to No resp.=Depress-severe/Need help w/ old ADs!, posted by 3 Beer Effect on May 12, 2002, at 6:12:51
3 Beers, what ever happened with your taking Provigil (or was it adrafinil)? I know you were taking it from previous posts. Did it pan out or did you have other problems with it?
When I didn't have my adrafinil, Dexedrine would only work a short while too & then I'd feeling crappy & cranky again. I hated the ups & downs. Let me know, okay?
Posted by johnj on May 13, 2002, at 15:59:15
In reply to imipramine-Mitch, posted by Lia Mason on May 13, 2002, at 10:36:37
Hi Mitch:
I saw your question regarding imipramine and thought I would respond. I take 50 mg of nortryptline and have had some problmes with orth h. and also problems excercising. So, I tried remeron(too harsh), and now am at 20 mg of imipramine. I can say it has helped me sleep and feel better with no side effects. I think this may be because the norty. has always given me trouble so any light side effects at such a low dose probably are not noticable. I will be slowing weaning off the nort and switching to imip. I have like it thus far and I think is worth a trail. take care.
Posted by 3 Beer Effect on May 13, 2002, at 21:29:52
In reply to Re: No resp.=Depress-severe/Need help w/ old ADs! » 3 Beer Effect, posted by IsoM on May 13, 2002, at 14:53:37
IsoM,
The Provigil worked good for getting me out of bed in the morning at 200 mg/day. It didn't work that well for ADD/concentration, nowhere near as well as Ritalin & didn't help that much socially as it does some- It felt to me, exactly like extended release No-Doz (caffeine).At first it lasted a very long time (all day), but eventually it started losing efficacy after a little over 2 months & soon after that it only worked for 4 hours, then zero.
So I switched to Dextrostat & am doing much better on that. Currently take 20 mg 2x per day. Dexedrine/Dextrostat is a wonderful anti-depressant, social disinhibitor, ADD medication but unfortunately it only lasts 4-5 hours. So during the 6 hours per day that i'm awake & its not working I feel severly depressed. In other words, the Dextrostat isn't enough of an anti-depressant on its own.
None of the new ADs have worked for me (Celexa, Effexor, Remeron, Lamictal, Neurontin) except Zoloft 100 mg which worked wonderfully for both depression & social phobia but made me an insomniac & I think because of the sleep deprivation eventually manic- but the psychiatrist could have fixed that with a benzo or ambien or Remeron for sleep &/or by lowering the dose to 75 mg, but he didn't, suffice to say he is no longer my psychiatrist.
I can't take Wellbutrin SR because I had a Soma muscle relaxer overdose a few years ago & had three small siezures- I don't think your supposed to take Wellbutrin if you've ever had a seizure.
I've read sometimes AD non-responders/severe depressives have to turn to the "old guard" antidepressants like tricyclics or MAOIs to get relief. It seems like the MAOIs especially have a very high cure rate compared to SSRIs.
So I'm thinking of asking the psychiatrist for Desipramine or Vivactil (protriptyline) or the MAOI Parnate. All three of these are supposed to be stimulating, & I seem to respond to stimulating ADs best (Remeron was a nightmare for me). The side effects of these old drugs though, sound pretty severe & I don't know much about them.
Thanks,
3 Beers.........
Posted by Ritch on May 13, 2002, at 22:31:14
In reply to Re: imipramine-(Mitch), posted by johnj on May 13, 2002, at 15:59:15
> Hi Mitch:
> I saw your question regarding imipramine and thought I would respond. I take 50 mg of nortryptline and have had some problmes with orth h. and also problems excercising. So, I tried remeron(too harsh), and now am at 20 mg of imipramine. I can say it has helped me sleep and feel better with no side effects. I think this may be because the norty. has always given me trouble so any light side effects at such a low dose probably are not noticable. I will be slowing weaning off the nort and switching to imip. I have like it thus far and I think is worth a trail. take care.John,
Thanks for responding. I doubt if I could tolerate 150mg of imipramine because of bipolar (thanks for the info Lia)-that is interesting John that you also are finding the imipramine more tolerable as well as Lia. I never got to 50mg of NT/day, but I did get to 30mg/day with Zoloft boosting it (via CYP2D6 inhibition). I have two quibbles about TCA's: 1) they tend to cause hiatal hernias (which I first got from high dose doxepin long ago), and 2) they elevate my heart rate quite a bit sometimes (with OH on the doxepin). I hope I can get 10mg *tablets* generic (probably caps-like nortripytline though). That way I can cut a tab in half and start off that way (I am sensitive to anticholinergic sfx big time). My next major depressive episode is going to start kicking in sometime between 3-6 weeks from now and I have got to get prepared (batten down the hatches!). It will have to be TCA, Provigil, or a sustained release pstim it appears, in addition to Depakote/Neurontin, etc.
thanks again for responding,
Mitch
Posted by JohnX2 on May 13, 2002, at 23:30:50
In reply to Re: Thanks Lia and John for info, posted by Ritch on May 13, 2002, at 22:31:14
>My next major depressive episode is going to start kicking in sometime between 3-6 weeks from now and I have got to get prepared (batten down the hatches!). It will have to be TCA, Provigil, or a sustained release pstim it appears, in addition to Depakote/Neurontin, etc.
>Mitch,
Wow, I'd have better luck predicting the Dow Jones 3 weeks
from now than my mood swing 3 hrs from now! :-)Is your mood cycle very chartable and predictable, even
while taking medicines?John
> thanks again for responding,
>
> Mitch
Posted by IsoM on May 14, 2002, at 1:40:47
In reply to re: Provigil pooped out 2 months/ old guard ADs, posted by 3 Beer Effect on May 13, 2002, at 21:29:52
Sure is hell when you find something that helps but then fizzles out. I'm not sure if that's not more discouraging than finding nothing. You get your hopes so high, only to have them squashed again. I'll be continuing to read your future posts, hoping to see that you find what you need.
Posted by Ritch on May 14, 2002, at 10:05:22
In reply to Re: Thanks Lia and John for info » Ritch, posted by JohnX2 on May 13, 2002, at 23:30:50
>
> >My next major depressive episode is going to start kicking in sometime between 3-6 weeks from now and I have got to get prepared (batten down the hatches!). It will have to be TCA, Provigil, or a sustained release pstim it appears, in addition to Depakote/Neurontin, etc.
> >
>
> Mitch,
>
> Wow, I'd have better luck predicting the Dow Jones 3 weeks
> from now than my mood swing 3 hrs from now! :-)
>
> Is your mood cycle very chartable and predictable, even
> while taking medicines?
>
> John
Oh yeah! This is a phenomenon that I have noticed and charted for decades. The first recollection of a "major" depression was the early winter of either 1967 or 1968. I was just a little kid and I remember everything was blue/black/sleepy/weepy. My Dad was snoring on the couch with a football game on while my Mom was cooking and I didn't feel like going out to play I just wanted to ....sleep. In the spring I remember super exuberant times. I rounded up all of the kids on the block and asked them to bring their transistor radios and we would have a "party" on my Dad's flatbed truck. We would tune all of the radios to the same station at the same time (there weren't boomboxes back then). Yeah, I have had two major depressions a year, every year (varying intensity) as long as I can remember. The first one kicks in anywhere from the first week of November (start feeling fatigued) to being full blown by the 3rd week of Nov. It deepens rapidly to about the 2nd week of December and finally "breaks" (like a fever!) about the 2nd-3rd week of January. By the first of Feb. it usually is gone. Then I usually have one or two hypomanic spells in April/May (a few days each), then I start to grow a little tired (not a "crash" interestingly). That is where I am at now-I don't feel too up or down and I am sleeping fine. I even skipped Depakote yesterday and still slept fine. Then I just gradually start to notice some unusual fatigue (like the winter episode), usually the last week of May at the earliest sometimes not until 2nd or 3rd week of June. That gradually progresses until last week of June and then WHAM! I get early-morning awakenings, then I sleep every time I get a chance. Absolutely zero interest in going anywhere or doing anything at all. I can't focus or think and I get really super cranky. Then that one peaks pretty quick, but hangs in there through most of August. Usually, just before Labor Day I feel some lifting. But, the 2nd episode lifts more slowly and gradually. I do not get full remission from that one until 2nd week of September (usually when it starts to get noticeably cooler). Then, I usually will get *one* hypomanic episode (just a few days)in early-mid October. Then the creeping fatigue starts coming back (not a "crash"). The only time I had a complete remission of a major depression was the winter I tried Adderall. Prozac came close to abolishing one or two at higher doses-but it was nearly intolerable for me to take.Mitch
Posted by manowar on May 14, 2002, at 16:55:53
In reply to re: Provigil pooped out 2 months/ old guard ADs, posted by 3 Beer Effect on May 13, 2002, at 21:29:52
Hello 3 beers,
Unfortunately, it seems as if the Adrafinil is pooping out for me also. I take Wellbutrin IR-150 mg 2x a day, 72 mg Concerta in the morning and 10 mg Focalin in the late afternoon. This combo seems to work pretty well for ADD inattentive type, but doesn't do much at all for my depression. I never had any luck at all with the SSRIs or any of the new ADs, so I asked my doctor if I could try a TCA. He did an ECT on me and since that checked out he decided to start me on Nortriptyline.
I've taken it for a week at a very low dose (25 mg), and so far I haven't had any side effects. I did a little research on the drug at www.mentalhealth.com (Didn't you rave about this site?) and I thought this was interesting:
"The mechanism of mood elevation of tricyclic antidepressants is at present unknown. Nortriptyline is not an MAO inhibitor. It inhibits the activity of such diverse agents as histamine, 5-hydroxytryptamine, and acetylcholine. It increases the pressor effect of norepinephrine but blocks the pressor response of phenethylamine. Studies suggest that Nortriptyline interferes with the transport, release, and storage of catecholamines.
Indications
The relief of symptoms of depression. Endogenous depressions are more likely to be alleviated than are other depressive states. "Wow, it affects phenethylamine, dopamine, nor adrenalin, histamine, 5-hydroxytryptamine, and acetylcholine! Now that's what I call "shotgun effect"!
Since I definitely have "Endogenous" Depression, I'm hopeful that this drug might give me some relief.
BTW: Can someone tell me what this means:
"It increases the pressor effect of norepinephrine but blocks the pressor response of phenethylamine."?
What does pressor effect and pressor response mean?--Tim
> IsoM,
> The Provigil worked good for getting me out of bed in the morning at 200 mg/day. It didn't work that well for ADD/concentration, nowhere near as well as Ritalin & didn't help that much socially as it does some- It felt to me, exactly like extended release No-Doz (caffeine).
>
> At first it lasted a very long time (all day), but eventually it started losing efficacy after a little over 2 months & soon after that it only worked for 4 hours, then zero.
>
> So I switched to Dextrostat & am doing much better on that. Currently take 20 mg 2x per day. Dexedrine/Dextrostat is a wonderful anti-depressant, social disinhibitor, ADD medication but unfortunately it only lasts 4-5 hours. So during the 6 hours per day that i'm awake & its not working I feel severly depressed. In other words, the Dextrostat isn't enough of an anti-depressant on its own.
>
> None of the new ADs have worked for me (Celexa, Effexor, Remeron, Lamictal, Neurontin) except Zoloft 100 mg which worked wonderfully for both depression & social phobia but made me an insomniac & I think because of the sleep deprivation eventually manic- but the psychiatrist could have fixed that with a benzo or ambien or Remeron for sleep &/or by lowering the dose to 75 mg, but he didn't, suffice to say he is no longer my psychiatrist.
>
> I can't take Wellbutrin SR because I had a Soma muscle relaxer overdose a few years ago & had three small siezures- I don't think your supposed to take Wellbutrin if you've ever had a seizure.
>
> I've read sometimes AD non-responders/severe depressives have to turn to the "old guard" antidepressants like tricyclics or MAOIs to get relief. It seems like the MAOIs especially have a very high cure rate compared to SSRIs.
>
> So I'm thinking of asking the psychiatrist for Desipramine or Vivactil (protriptyline) or the MAOI Parnate. All three of these are supposed to be stimulating, & I seem to respond to stimulating ADs best (Remeron was a nightmare for me). The side effects of these old drugs though, sound pretty severe & I don't know much about them.
>
> Thanks,
> 3 Beers.........
Posted by manowar on May 14, 2002, at 18:25:29
In reply to No resp.=Depress-severe/Need help w/ old ADs!, posted by 3 Beer Effect on May 12, 2002, at 6:12:51
Hello again,
Good question about what anti-cholinergic side effects are. I forgot to mention in my last post that I used to take Desipramine, but it stopped working for me. The only side effect I had was dry mouth. And yes- it kinda made me feel like I was taking a very low dose of Benadryl. I never felt a dumbing effect, though.
So to answer your question, I think anti-cholinergic side effects for a TCA are like dry-mouth (common), heart palpitations (very rare), cold sweat (sometimes), feeling dizzy or faint (rare), sleepiness (common), blurry vision (rare) etc... But honestly I don't know what the Webster's definition is, or what the full range of those side effects are.
Since the Alzheimer’s drug Aricept (donepizil), which is supposed to help people with memory, is an acetylcholine inhibitor, I would venture to say that anti-cholinergic side effects have nothing to do with memory or overall cognitive functioning. But, I don't know that for certain.
The side effects I got from SSRIs were much worse than the Desipramine side effects. I read somewhere or heard a Dr. tell me that Desipramine has the most benign side-effect profile of all the TCAs. So, that may be a good choice to start with. I don't believe that Protriptyline is available in the US.
As far as SAMe goes, I took it for over a month at the recommended dosage, and it never did anything for me.
I have a lethargic, anhedonic, cyclothymic type of depression along with inattentive ADD features. As for the ADD meds, I personally favor the Ritalin type drugs (Concerta, Medidate, Focalin) over the Adderall/Dexadrine type drugs. The Dexedrine and Adderall seem to exacerbate my depressive symptoms, while the Concerta seems to at least help me concentrate and get my work done.
Tim
> I have no response so far after about 2 weeks at 800 mg SAM-e. I take 2 tablets at 6 am & 2 at 11 am along with vitamin B6, sublingual b12, & 400mcg folic acid each time on an empty stomach. I take a centrum multivitamin the night before.
> I wonder if SAM-E supplementation only works during middle-age or later when your body doesn't produce as much of it- I am 23.
>
> I also currently take Dextrostat 20 mg 2x per day & Klonopin 1 mg breakfast, 1 mg lunch, & the worthless hypnotic Sonata 10 mg to sleep (plan to switch to Ambien).
>
> It seems my depression is totally lifted for the 4 or 5 hours after each Dexedrine dose, but the other 6 hours of the day that i'm awake my depression seems to be getting pretty severe & progressively worse with no forseeable end in sight. Feels almost like I'm falling down some dark well except there is no bottom.
>
> I was on Lamictal for the last 3 months with no effect except acne and worse vision- I was just starting on 200 mg when I just got fed up with how lousy it made me feel & its lack of any perceptible effect. Right now I have enough money saved up to get an eye exam & the Lasik Laser vision correction surgery sometime at the end of May or Early June, & so I could not have continued to take Lamictal even if it had been working, because it did decrease my vision & can do strange things to your eyes (such as binding to melanin in eye tissue) which could botch my eye exam & lasik laser vision correction surgery.
>
> After the surgery, i'm probably going to have to take one of the 'old guard' antidepressants since I haven't had any luck with the new ones. I am returning to college at the end of August, & I do not plan to take an anti-depressant then since last fall, sedation from Remeron 45 mg, & then chest pain/rapid heartbeat from Effexor left me unable to study & I had to get a medical withdrawl- so basically $8,000 for tuition, room, & board went down the tubes from anti-depressants.
> At college, i'll just stick to Dextrostat and Klonopin.
>
> But with these old drugs, it looks like most people only take them for three months & then for some unknown reason reduce the dosage substantially (toxicity?) & so I figured maybe three months on one of these ADs would correct whatever chemical imbalance or neurotransmitter deficiency that is causing this depression, or atleast start to kick start it into some kind of path towards recovery. I think I can make great gains at college at curing my depression even without an anti-depressant because I reserved my own private room w/ private bathroom at the nicest/best food/best-looking girls private high-rise dorm on campus, all my friends are there (at college), hopefully i'll find a girlfriend which I think would help alot, & also most everything is a novel experience at college, not just the same get up commute to work & sit in a cubicle while they frown at my productivity for a lousy $8.50 an hour existence I have here back at my parents house.
>
> I don't know that much about the old antidepressants, but I seem to have a lethargic/chronic fatigue type of severe depression that responds well to stimulants like Dexedrine & even somewhat to Caffeine. I was thinking of asking my psychiatrist to put me on one of the following, which I think are about the most activating, most effective (especially Parnate) anti-depressants out there: Norpramin (Desipramine), Vivactil (Protriptyline), or the MAOI Parnate.
>
> However, I don't really know what "anti-cholinergic" side effects really mean- do these old drugs have a negative "dumb drug" effect on acetylcholine/memory or does anti-cholinergic just mean they feel like you are taking Benadryl all of the time? Or are the side effects of these old drugs much worse than that? I've only taken SSRIs, Remeron, & Effexor so I don't know if I have any kind of idea of how bad the side effects of these old but more effective anti-depressants are. (I have never taken the "activating" AD Wellbutrin SR but can't because a few years ago I had 3 siezures in the emergency room after I took a 'recreational dose' of the muscle relaxer Soma, blacked out, forgot I had taken any & took a bunch more & ended up accidentally overdosing quite badly.
>
> How bad is this orthostatic hypotension thing with these drugs?-In my office job I have, I have to stand up from my desk walk over to a book case & grab a stack of maps, & then sit down about every 15 mins all day long. Does that mean I might pass out when I stand up at work? Is it hard or even possible to keep a job & put up with the side effects of Norpramin (desipramine), Vivactil (protriptyline), or Parnate?
>
> Thanks, 3 Beers......
Posted by IsoM on May 15, 2002, at 1:53:38
In reply to re: Provigil pooped out 2 months/ old guard ADs » 3 Beer Effect, posted by manowar on May 14, 2002, at 16:55:53
> > "BTW: Can someone tell me what this means:
'It increases the pressor effect of norepinephrine but blocks the pressor response of phenethylamine.'?
What does pressor effect and pressor response mean?"It basically means that nortriptyline constricts small blood vessels, raises blood pressure, speeds heart rate, & similar effects that one gets from noradrenaline, or norepinephrine, (the pressor effect) & blocks the elevated blood pressure & quickened heart rate (the pressor response) caused by phenethylamine-type drugs like MDMA. So strangely, while it works with nortriptyline to raise blood pressure, etc, it'll also block these same effects caused by MDMA.
An 'effect' is what's expected from normal hormones.
A 'response' is the effects from certain meds.
Posted by manowar on May 15, 2002, at 13:04:07
In reply to Pressor effects and response » manowar, posted by IsoM on May 15, 2002, at 1:53:38
> > > "BTW: Can someone tell me what this means:
> 'It increases the pressor effect of norepinephrine but blocks the pressor response of phenethylamine.'?
> What does pressor effect and pressor response mean?"
>
> It basically means that nortriptyline constricts small blood vessels, raises blood pressure, speeds heart rate, & similar effects that one gets from noradrenaline, or norepinephrine, (the pressor effect) & blocks the elevated blood pressure & quickened heart rate (the pressor response) caused by phenethylamine-type drugs like MDMA. So strangely, while it works with nortriptyline to raise blood pressure, etc, it'll also block these same effects caused by MDMA.
>
> An 'effect' is what's expected from normal hormones.
> A 'response' is the effects from certain meds.Hello IsoM,
Thanks, and nice to 'see' you again. I hope all is well. I'm sorry for my ignorance, but I'm totally confused by your response. Excuse me for being a complete DA, but here goes:First off, I thought the mechanism of MDMA is a release of Serotonin flooding the brain, not Phenethylamine. No?
Secondly, are you saying that the effects of increased phenethylamine (due to reuptake inhibition-I assume) is the opposite of the effects of increased noradrenalin (constricts small blood vessels, raises blood pressure, speeds heart rate, & similar effects), therefore canceling each other out?
Thirdly, it seems as if the pressor effect and the pressor response do the same thing, just that the ‘effect’ is natural and the ‘response’ is attributed to the drug. Correct?
All I really know about neurotransmitters and their role in depression is this:
1) The neurotransmitters that are mostly implicated in depression are (in order of importance)- Serotonin, Noradrenaline, Dopamine.
2) Also, phenethylamine and acetylcholine to some extent.
1) That their reuptake can be blocked, which keeps them in the synapse longer which in theory helps alleviate depression.
2) A MAOI does the same thing-just a different mechanism.
Is this correct?Thanks,
Tim
BTW: I know—‘there are no stupid questions, just stupid people’:)
Posted by IsoM on May 16, 2002, at 2:59:56
In reply to Re: Pressor effects and response » IsoM, posted by manowar on May 15, 2002, at 13:04:07
Hi Tim, so you're not on Provigil (or was it adrafinil) anymore? It pooped out for you? Rats, that's awful - especially when you think you've found an answer to some of your problems. Happily, I can still say I love my adrafinil.
Now about your questions, I wish Cam could answer them onstead. It's the difference between understanding what I've read & then trying to explain it to someone else; and then Cam, who knows it inside/outside & can explain it more simple & clear than me. But I'll give it a try again. Do remember, I understand it but not with the clarity he does. I hope this is an improvement, not more confusing.
1. The phenethylamine-type class of drugs include a fair amount of different ones, just as benzodiazepines are a class of drugs. Ecstasy (MDMA) belongs in this phenethylamine family. It does act on serotonin alright, but also on dopamine. So that's why I mentioned the related drugs & their effects.
2 (a). But there is a natural hormone/neurotransmitter called phenylethlamine (PEA, or the 'cuddle' hormone) that makes us feel good from its release of dopamine. But phenethylamine (& related drugs) do bind to serotonin reuptake transporters acting as an inhibitor.2 (b). Now norepinephrine (or noradrenaline) does cause a rise in heart rate & blood pressure, but so does PEA (or PEA-type drugs) too. But for reasons I don't understand, norepinephrine blocks the rise in heart rate & blood pressure that PEA causes. So, no, the effect of norepinephrine & PEA *both* have parasympathetic system effects (rise in heart rate & blood pressure among other effects) but norepineprine WILL strangely block the further effects of PEA if both are released at the same time. It's not that norepinephrine has an opposite effect than PEA, cancelling each other but only that norepinephrine "blocks" the pressor response of PEA. (Haven't a clue why & don't even know if scientists know why.)
3. I'm still not certain why sometimes it's said "pressor effect" & other times "pressor response". Just terminology perhaps? Effect is what you get & response, what you expect?
The difference between an SSRI which is to inhibit the reuptake of serotonin & that of a MAO inhibitor is the first only acts on serotonin usually (one specific monamine neurotransmitter) while MAO inhibitors block the enzyme (called monoamineoxidase) that break down monoamine neurotransmitters such as serotonin, dopamine, norepinephrine, & epinephrine thereby leaving more of these neurotransmitters in the synaptic gap. So again, yes, both MAO inhibitors & SSRIs have similar effects but just in different ways & an MAO inhibitor isn't as specific for certain neurotransmitters as an SSRI is.
Posted by manowar on May 16, 2002, at 8:36:41
In reply to Re: Pressor effects and response » manowar, posted by IsoM on May 16, 2002, at 2:59:56
IsoM,
Thanks for your timely response as always.
Psychopharmacology is quite interesting, or shall we say quite baffling, eh?To answer your question about the Adrafinil:
In hindsight, I don’t think it really pooped out, I may just have overestimated the anti-depression effects of the drug.I was doing pretty well for a time, but I started cycling down more and more frequently and for longer periods of time. I also wasn't getting much help with my 54 mg daily of Concerta for my ADD (of course, lack of concentration is also a symptom of depression). I never did stop taking the Adrafinil, because I still felt that it played an important role in my drug therapy (increased ability to socialize-even though depressed, also it seems that it does enhance my ability to concentrate a bit). But, because the 54 mg a day of Concerta wasn’t helping me anymore, I started doubling my dose to 108 mg in the morning. This clearly, was too high a dose, but my doctor was on vacation at the time and I was functioning a hell of a lot better on 108 than 54, though it did seem to make me feel cranky. But, I called my doctor and made an appointment (whom I wasn't due to see for another month or two).
Anyway, I never have stopped taking the Adrafinil. When I visited with my doctor (he's an ADD specialist and an expert in psych drugs-not a shrink), I expressed my doubt in the Adrafinil and he wisely (I think) told me that he thought the drug was indeed beneficial and wanted me to continue taking it. So I do. Secondly, I told him about doubling my dose of Concerta, and he decided to increase my morning dose to 72 mg which seems to be perfect. Unfortunately, the Concerta effect seems to fizzle around 5-7 PM, therefore he added the Focalin (10 mg) around 5 PM. The Focalin is great. To me it is worth the extra expense over plain old Methylphenidate (Ritalin) because it seems to work better, and it certainly last longer for me (4-5 hrs as opposed to Ritalin – 2-3 hours). But I’ve only been taking it for a week and a half, so we’ll see.
With the complex nature of my problems, it seems that no ‘one pill’ or even two or three is going to complete my drug regimen. At the present, I take Wellbutrin, Klonipin, Adrafinil, Concerta ( augmented with a late afternoon dose of Focalin), along with the new flavor of the month- the tricyclic Nortriptyline. I hate having to take 5 drugs daily!
I’m currently on a damn good upswing (don’t worry, I’m not a bipolar- just a cyclothymic depressive). I just had my latest swing about two days ago, and I hope that at least some of the reason why I’m feeling this well is because of the Nortryp that I just started taking a week and a half ago. But I doubt that very much because I’m on such a substandard therapeutic dose (25 mg a day), and because it has only been a week and a half. But one never knows, does one?
Again IsoM, it’s nice to hear from you, and thanks as always for your articulate and thoughtful insights. BTW: Do you have another pseudo-name other than IsoM? And, I thought that Cam was a lady, and that she quit posting several months ago because of some futile dispute with an idiotic flamer. No? Do tell… I love gossip:)
Tim
Posted by IsoM on May 16, 2002, at 19:47:38
In reply to Re: Pressor effects and response » IsoM, posted by manowar on May 16, 2002, at 8:36:41
Glad to hear that adrafinil is still working for you. I was surprised initially that only 1 tablet worked for me considering I have narcolepsy. But after a while, it wasn't enough. I think that's when people think they have a drug poop-out. But that's not what I believe happens. I think the initial release of natural PEA from noticing any improvement contributes to the elation felt. After the levels of PEA taper off as they should, the true effects of the med is then felt. Sometimes the dose just isn't high enough. I had to raise my adrafinil to 3 tablets a day. I wish it could be lower, it would be cheaper, but that's what works for me long term.
Nope, IsoM is the only username I use. Cam W. definitely is a male, very much so, who lives in a diff province of Canada. He knows far more than I ever do (or will) about meds & their pharmacology. He's no ordinary pharmacist but one who's gone far beyond what's normally required out of intellectual curiousity. He doesn't post too often now as he had hit a severe slump. He's back posting but infrequently. I hope he feels good soon. His insight is very valuable.
Cute the way we need to take meds, hey? I take most in the morning with my tea (not all are psychotropic either). I shake out the required pills into my palm & then look them over to make sure I have all the right ones. Sometimes I'll think "nope - one of the colours is missing" & have to recheck. Between them & supplements, I've become very good at swallowing large numbers of pills in one mouthful. :-)
Posted by manowar on May 17, 2002, at 16:01:54
In reply to Re: Pressor effects and response » manowar, posted by IsoM on May 16, 2002, at 19:47:38
> Glad to hear that adrafinil is still working for you. I was surprised initially that only 1 tablet worked for me considering I have narcolepsy. But after a while, it wasn't enough. I think that's when people think they have a drug poop-out. But that's not what I believe happens. I think the initial release of natural PEA from noticing any improvement contributes to the elation felt. After the levels of PEA taper off as they should, the true effects of the med is then felt. Sometimes the dose just isn't high enough. I had to raise my adrafinil to 3 tablets a day. I wish it could be lower, it would be cheaper, but that's what works for me long term.
>
> Nope, IsoM is the only username I use. Cam W. definitely is a male, very much so, who lives in a diff province of Canada. He knows far more than I ever do (or will) about meds & their pharmacology. He's no ordinary pharmacist but one who's gone far beyond what's normally required out of intellectual curiousity. He doesn't post too often now as he had hit a severe slump. He's back posting but infrequently. I hope he feels good soon. His insight is very valuable.
>
> Cute the way we need to take meds, hey? I take most in the morning with my tea (not all are psychotropic either). I shake out the required pills into my palm & then look them over to make sure I have all the right ones. Sometimes I'll think "nope - one of the colours is missing" & have to recheck. Between them & supplements, I've become very good at swallowing large numbers of pills in one mouthful. :-)^So sad, but so true, as a matter of fact, I can't even remember the last time I gagged:)
I take four Adrafinil a day. My doctor is very impressed with Provigil and its effect on the prefrontal cortex. He doesn’t care that I get the Adrafinil from England, because he realizes that it practically does the same thing as the Provigil. I still can’t believe that Cephalon has the audacity to charge their prohibitive price for basically a copycat drug.
IsoM, I think you are absolutely correct regarding the so called 'poop out' effect. We pitiful depressives: we keep searching for the ‘Holy Grail’- the one or two meds to ‘fix’ our problems. It just ain’t that easy for the most part. We’re looking for 'The' drug that works, when indeed many times, especially for hard to treat cases, it may take a combination of five to ten meds to get the brain functioning the way it should! Therefore, in hard to treat cases (like my own), I’m beginning to believe that if a certain drug is not causing too many unwanted side effects, yet it doesn’t ‘seem’ to be working, we and our pdocs need to be patient and deliberate with our ‘game plan’ before we give up on one drug to go to the next. Hey, that drug is doing something (hopefully a good something), whether we can tell or not.
For way too many years my doctor would try me on this and if it 'didn't work', he would switch me to 'that', and so on, and so on, ad nauseum...
What I have ascertained from experts in the field of psychopharmacology, is that especially with the co morbid type conditions-- SEVERAL areas of the brain may not be working correctly. In other words, if a person has a low functioning prefrontal cortex, AND has an over active Basil Ganglia, AND has an under functioning left temporal lobe—let’s face it—that poor soul is going to need A) Lots of counseling B) A good overall support system C) Most importantly-- a well devised combination of psych meds, good nutrition, and exercise.
I’m glad I had the balls to plunk down the dough, fly to CA to get my scans done. Because, by looking at how pitifully different areas of my brain were functioning, it finally dawned on me (and the doctors) that it would take a very well thought out, aggressive game plan for any hope for me to get better.
BTW: I've made a lot of progress since then, but it takes a lot of patience and time when you're working with an array of meds. I was even thinking about getting another set of scans done as my condition improves. It’s like getting a tune-up. -- Okay, we've made some major improvements, can we tweak some things and make it work even better?I’ll end my speech by saying this. I think that not only patients, but doctors many times underestimate the complexity of the human brain. For doctors, it may be because that most other organs in the human body are quite simple in function, therefore they may think of the brain in the same one dimensional way. I know from personal experience that many pdocs use this method:
1) Interview patient
2) Take an educated guess of what the problem is.
3) Take an educated guess of what the best meds (and/or counseling) for this condition would be
4) Write script(s).
5) In a few weeks or so, if med(s) are not working adequately, repeat process.The problem is that without regarding where brain malfunctions may be occurring, this doctor may well be wasting the patients time, money, hope, AND LIFE. This educated guessing game may work well for a kidney or a heart, but I contend that it is completely inadequate for the brain, in many cases.
‘The significant problems we have cannot be solved at the same level of thinking with which we created them.’- Einstein
I know the above quote doesn’t quite fit, but its one of my favorites.
Tim
P.S. I hope to go to Toronto in a month or so for business. I love your country, and I can't wait! I heard it's a lot like NYC.
Posted by IsoM on May 18, 2002, at 1:44:33
In reply to The search for the Holy Grail » IsoM, posted by manowar on May 17, 2002, at 16:01:54
So true, Tim. One psychiatrist told me that treating patients was more an art than a science. Psychiatry wasn't a quantitative science like regular medicine but had to be qualitative. It's slowly becoming more quantitative but it may never really be. Even with all things being equal, each person will perceive the same conditions differently.
All the different parts in your brain not working to full par sounds much like me. That's why I was excited by adrafinil & its ability to improve overall brain metabolism. I always score so very high on IQ tests (top 0.25% of population) but can't seem to get my 'act' together to do something that would lead to anything concrete. Like a handful of loose little gems that can't be strung together into a necklace. I'd be great a century ago when a Jill-of-all-trades would be valued. I, too, am always looking for just a little more to fine tweak that brain of mine to make it more productive.
Another pdoc I spoke with once said something similar to what you believe - that few people will stick with a med long enough to realise its full effect & then add another when needed. He's a teaching pdoc too, so he keeps very up-to-date & I found him very sensible - something not always found in pdocs like it should be.
Take care, Tim. I can't speak about Toronto as it's been many, many years since I was last there. I was in Montreal not too long ago but I prefer the West Coast where I live now - considered Canada's "banana belt". (And yes, we can really grow banana plants here but only as ornamentals; not a long enough growing season to ripen the fruit.)
Posted by manowar on May 21, 2002, at 16:03:47
In reply to The Holy Grail(s) of Meds » manowar, posted by IsoM on May 18, 2002, at 1:44:33
> So true, Tim. One psychiatrist told me that treating patients was more an art than a science. Psychiatry wasn't a quantitative science like regular medicine but had to be qualitative. It's slowly becoming more quantitative but it may never really be. Even with all things being equal, each person will perceive the same conditions differently.
>
> All the different parts in your brain not working to full par sounds much like me. That's why I was excited by adrafinil & its ability to improve overall brain metabolism. I always score so very high on IQ tests (top 0.25% of population) but can't seem to get my 'act' together to do something that would lead to anything concrete. Like a handful of loose little gems that can't be strung together into a necklace. I'd be great a century ago when a Jill-of-all-trades would be valued. I, too, am always looking for just a little more to fine tweak that brain of mine to make it more productive.
>
> Another pdoc I spoke with once said something similar to what you believe - that few people will stick with a med long enough to realise its full effect & then add another when needed. He's a teaching pdoc too, so he keeps very up-to-date & I found him very sensible - something not always found in pdocs like it should be.
>
> Take care, Tim. I can't speak about Toronto as it's been many, many years since I was last there. I was in Montreal not too long ago but I prefer the West Coast where I live now - considered Canada's "banana belt". (And yes, we can really grow banana plants here but only as ornamentals; not a long enough growing season to ripen the fruit.)^I'd bet they're small. Small bananas would look cute as Christmas tree ornaments:)
IsoM,
Thank you for your kind words.Actually, I wasn't citing my own neuro-functional problems in my last post, I was just using an example.
But it did take me a long time to figure out the fact that it would take several medications before my condition would begin to really improve.
I found an ADD doctor, and he's better than any pdoc I ever saw (just personal experience). He's an expert in psychopharmacology, and he also lectures. So I guess we're both very lucky with our drs.
He has a very strong "good brain function through good psychopharmacology = good mental health" type attitude which I really appreciate. And, when I see him, we don't have a set time. Frankly, I’m just glad that I no longer have to sit in an oversize chair and blather on and on to some nitwit for a half hour...
He normally only costs $45-$60 a visit and he's way more aggressive in his pharmaceutical approach than any pdoc I’ve ever had.
But anyway, I just wanted you to know that over the last week I’ve felt better than I have in years. I’m Cyclothymic, so I don’t know how long this ‘upswing’ will last. I just started taking the Nortriptyline two weeks ago and I definitely feel a difference. At this point, whether I’m experiencing the ‘placebo effect’ or not, I don’t really give a damn. I just want it to last:)
Isn’t it interesting that it's normally the bright people that suffer the most with mental health issues? I guess great minds do think alike:)
Go Red Wings!
Tim
This is the end of the thread.
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