![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 85. This is the beginning of the thread.
Posted by UgottaHaveHope on May 1, 2006, at 21:44:08
It all started with fear. In 1997, I had a tightness in my chest and the docs told me it was probably stress, but it bothered me 24/7. Because it bothered me 24/7, it was all I dwelled on and my mind just started racing and racing. I couldn't calm down. The pdoc gave me Xanax, BuSpar, Paxil, and about 30 other meds. None really seemed to calm me down.
Over the next few years, I had other physical symptoms that were anxiety-induced (now that I look back upon), but just tore me apart from the standpoint of anxiety.
Finally in about 2001, I realized that it was me against anxiety and not all of these funky symptoms (numbness in toes, shakes, head sores, night sweats). In the summer of 2005, I found the first med that calmed me down: It was Seroquel (25mg + 1mg Klonopin). It took the edge off. However, about three weeks ago, I had some business things happen and I got all jacked up again. Even regular Seroquel doses of 250mg really did not do much. That's where I am now.
Here is how I describe it: You know how you are walking through a haunted house and you know you are going to get scared but don't know when? That's how I feel. My mind is so divided. When I really get anxious (per last three weeks), I want to retreat and go to sleep or something (my escape). Then I get depressed. I do as little as I can do to get by. Fortunately I have been able to continue my job (work out of home) and am temporarily staying with parents (I hate to be alone).
My grandmother was Bipolar, and no other family illness than that. I have been tested for Bipolar, and the pdoc said no. She diagnosed me with Generalized Anxiety Disorder. I have a feeling a lot of my healing will have to do with my thought processes. Right now, I can't calm down enough to re-train my mind. I feel kind of hopeless.
It's like I am here, but my mind is a thousand miles away. It is hard for me to stay in the present moment. My mind has gotten so twisted that really the thing I fear is ... fear. Does that make sense?
If anyone has any input on my situation, I would be blessed to hear it. I try as much as possible to help others, and would appreciate any feedback. Thanks for caring, Michael
Posted by Phillipa on May 1, 2006, at 21:51:09
In reply to THIS IS MY STORY, CrazyHorse, anybody, posted by UgottaHaveHope on May 1, 2006, at 21:44:08
Michael right now I'm in the same place you are let's hope people have some answeres for us. Love Phillipa
Posted by UgottaHaveHope on May 1, 2006, at 23:34:23
In reply to Re: THIS IS MY STORY, CrazyHorse, anybody » UgottaHaveHope, posted by Phillipa on May 1, 2006, at 21:51:09
nm
Posted by RobertDavid on May 2, 2006, at 0:05:06
In reply to THIS IS MY STORY, CrazyHorse, anybody, posted by UgottaHaveHope on May 1, 2006, at 21:44:08
I can totally relate. I have SAD and GAD. Nothing worked for me until klonopin (including other benzo's). Once I got some relief the key for me was finding the right dose (which took a while to figure out). 1mg of klonopin was helpful, but I still had the uneasy anxious feeling you describe. Finally I got up to 2mgs which did the trick for the majority of my anxiety and was very comfortable for the first time (though I still was dealing with a dysthimic condition).
In my opinion benzo's offer the quickest and best relief for anxiety and can be used long term (12 years now for me). I would suspect that if you went up say .5mgs once a week you'd find a dose that would significantly help you from where you are now. The initial sedation wears off, but not the anxiety relief (for most people). To treat an anxiety disorter with klonopin most seem to end up on a dose between 1 and 5 mgs.
Because of it's long half life I take it at bedtime which helps me sleep and the anti anxiety benefits last through the day. Of course everyone is different and there are other benzo's to consider like xanax and ativan (but shorter half lifes require multiple daily dosing). And some find relief with valium.
I've also recently added EMSAM for the dysthimia which is really helping. Klonopin is probably helping with any inital side effects I may have felt that a few others are getting, but I'm not.
Anyway, that's my take. I'd go up on klonopin and try to find the right dose (particularly since your familiar with klonopin). And though I know there is much debate about this issue it's my experience that brand works best. My doctor told me when klonopin went generic many people suddenly complained. He writes "brand only" on my perscriptions. I know it cost's more, but I choose to pay it and have noticed a difference. Again, just my take.
I truly believe the major cause for failure to respond to klonopin for anxiety as a primary disorter is not finding the right dose. I hope that helps and good luck! Rob
Posted by yxibow on May 2, 2006, at 2:26:03
In reply to THIS IS MY STORY, CrazyHorse, anybody, posted by UgottaHaveHope on May 1, 2006, at 21:44:08
The tightness in your chest is flight or fight sensations. Anxiety is a powerful feeling and it activates what is known as the autonomic nervous system, the primitive part of our brain that controls bodily pathways. Sweats, hot flashes, all sorts of things happen with things like GAD, OCD, and the like. Its also worth knowing that almost all of the serotonin receptors in your body are in your gut. Why they are is up to evolution, who knows. Perhaps to protect against bad food.
Its hard to say exactly what it is but besides GAD I'd bet you are suffering from sporadic somatiform disorder. The focus on the symptoms -- numbness, sweats, etc, becomes circular and its all about the body. Its not your fault, its a psychiatric condition. People used to think it as malingering but I can tell you its definately not.
I can relate with the escape -- its very easy to go to sleep and forget about the world. You dont want to actually commit suicide or something drastic but you want to not feel anything. And waking up from such a sleep can be depressing because you're back where you started from.
Its heartening to hear that you've been able to work out of home. That's something I should be able to do but I'm not there yet. And I've been temporarily staying with my parents for quite a temporary period so I understand that.I hate to be alone too. I feel like I might do something to myself. Its a human instinct, or desire to be social. Some people like the total opposite and can't stand to be around others, but most are gregarious. Its not a pathology, don't worry about that. We all want to be with someone, maybe a friend, maybe a roommate, maybe a significant other. They're all on the spectrum of relationships. I cannot for the life of me remember what book or movie this quote came from, but I remember it alot and it is quoted alot -- In the end, we're all alone. Meaning we are in control of our own destiny, in a sense.
Now as for your situation, 250mg of Seroquel is not quite a clinical dose for some people but may be enough for you. But for GAD, I guess I would second the idea of a continual dose of a long acting benzodiazepine such as Klonopin or Valium as a first resort, leaving other aforementioned esoteric drugs on the backburner, including Seroquel. Its not that Seroquel couldn't be of use but I also agree its not of primary use in GAD.
Lyrica (one of those esoteric drugs) can also be used offlabel for that purpose but it has a variety of side effects and I would discuss that with your doctor if long term dosage of Klonopin does not work. Neurontin, almost similar to Lyrica, does not have quite the side effects.
My 2cI hope you feel better
Tidings
-- Jay
Posted by SLS on May 2, 2006, at 8:04:00
In reply to THIS IS MY STORY, CrazyHorse, anybody, posted by UgottaHaveHope on May 1, 2006, at 21:44:08
> It all started with fear.
I really can't add much to the great advice you have already been given. The one other drug that comes to mind is propranalol. It might reduce some of the autonomic stuff - fight or flight.
- Scott
Posted by Crazy Horse on May 2, 2006, at 10:08:21
In reply to THIS IS MY STORY, CrazyHorse, anybody, posted by UgottaHaveHope on May 1, 2006, at 21:44:08
Hi Michael,
I'm sorry you are suffering so terribly. I know what you mean about being afraid of fear, and also your haunted hse. analogy was good...been there too.
My advice is different, because your story sounds a lot like mine, especially when i first started having probs many years ago. I think an MAOI could be extremely helpful, moai's have significant efficacy in anxiety disorders, such as social phobia, panic disorder with agoraphobia and obsessive compulsive disorder. For me the maois (Nardil and especially Parnate) have worked when everything else has failed. I used to have horrible gut wrenching anxiety, panic attacks, ruminations, and with Parnate these symptons are gone. I've gone from useing 10-12 mgs of ativan a day (very high dose) to only taking 1.5 mgs a day..this in 3 months on parnate. Also, now there is EMSAM to consider, look at what it has done for Robert.
Anyway, something to consider and maybe talk to your pdoc about. Also, i would increase your Klonopin for now...you need it. And seroguel is also excellent if it still works for you. I wish you the very best Michael...feel free to ask me anything! May God bless you.
Monte
Posted by UgottaHaveHope on May 2, 2006, at 12:23:36
In reply to Re: THIS IS MY STORY, CrazyHorse, anybody » UgottaHaveHope, posted by Crazy Horse on May 2, 2006, at 10:08:21
For GAD, I was taking 200mg Seroquel at night, and then 1-2mg Klonopin per day.
She suggested I take 300mg Seroquel at night, and 1-2mg of Klonopin per day. She also wrote me a prescription of 20mg Paxil per day.
I asked pdoc about Wellbutrin (she said it wouldn't be good for me, or would probably make me more anxious) MAOIs (she said too many restrictions) and ENSAM (never heard of it). I didn't know if I needed to try those meds, but I thought I would ask.
Thoughts, please?
Posted by yxibow on May 2, 2006, at 14:25:06
In reply to Re: Went to pdoc today ... what do you think?, posted by UgottaHaveHope on May 2, 2006, at 12:23:36
> For GAD, I was taking 200mg Seroquel at night, and then 1-2mg Klonopin per day.
>
> She suggested I take 300mg Seroquel at night, and 1-2mg of Klonopin per day. She also wrote me a prescription of 20mg Paxil per day.There's more than one way to solve or mitigate some psychiatric disorders. She may have a reason for using an atypical antipsychotic. It might not be my first choice for GAD but if it is at least partially working than there is some cause for it. Seroquel is the least likely to cause side effects of them and the least likely for TD. Mainly have to watch your weight (as I do with it) a little bit. Not nearly as bad in that arena as Zyprexa which also has positive benefits but raises lipid profiles differently. Zyprexa may not make you as sleepy as Seroquel but it can give some people major cholesterol problems and myself it gave bad tremors. Otherwise I'd still use it.
Paxil is one of the more sedating SSRIs before Luvox (most sedating), and has a more appealing profile for anxiety than other SSRIs. It does require that you adhere to the dose because the half life isn't as good and coming down off of it requires slow attention. Some people will say that's horrid and I'm sure they've had bad experiences but if you taper properly it shouldn't be as bad an issue. Everything has its tradeoff.
Not increasing the Klonopin instead of the Seroquel -- mm... not quite 6 of one and half a dozen of the other but somewhere inbetween.
> I asked pdoc about Wellbutrin (she said it wouldn't be good for me, or would probably make me more anxious)If you have anxiety like me but also have some mild depression, Wellbutrin will eventually set your head on fire and cause you to ruminate at night. Its loosely based on a long unused diet drug called Tenuate which is loosely connected to amphetamines.
MAOIs (she said too many restrictions)
Yes, some people on here -- in fact a suprisingly large number -- but I recognize that some people have bad depression and sometimes you hear the worst, take MAOIs. They're dangerous without supervision and attention to detail and don't let people who take them let you think they're candy for the brain. They require a special diet, and pills to keep around in case you have a hypertensive crisis on some kind of cheese (example).
and ENSAM (never heard of it)She may not be in the most up to date circle. ENSAM is another MAOI but in patch form. It is seligiline, Eldepryl, based in a transdermal absorption package. At low doses it is supposed to be less but not fully restrictive of diet. At higher doses, that is not the case.
. I didn't know if I needed to try those meds, but I thought I would ask.
Leave the MAOIs for when you've been through others. My 2c anyhow. Do you really want to not take cough syrup, sudafed, and various OTC meds?
>
> Thoughts, please?
Tidings-- Jay
Posted by Crazy Horse on May 2, 2006, at 14:40:22
In reply to Re: Went to pdoc today ... what do you think?, posted by UgottaHaveHope on May 2, 2006, at 12:23:36
> I asked pdoc about Wellbutrin (she said it wouldn't be good for me, or would probably make me more anxious) MAOIs (she said too many restrictions) and ENSAM (never heard of it). I didn't know if I needed to try those meds, but I thought I would ask.
>
> Thoughts, please?She's right about the Wellbutrin. Paxil is a good med, it helped me for a couple of years. She sounds like she is not "up to date" on maoi's however. The restrictions are not burdensome at all..the only thing i miss is Cheddar Cheese. And never even heard of EMSAM...Hmmmmm.
Go with the Paxil Michael...i think it could help you a lot. Best wishes!
Monte
Posted by ed_uk on May 2, 2006, at 15:54:53
In reply to Re: Went to pdoc today ... what do you think?, posted by yxibow on May 2, 2006, at 14:25:06
Hi J
>Do you really want to not take cough syrup, sudafed, and various OTC meds?
J, OTC cough syrups don't work. At best, they are minimally useful. Having to avoid dextromethophan is a trivial concern for someone who is severely depressed. Sudafed is not very effective. Moreover, nasal congestion is a minor issue compared with severe anxiety or depression.
Regards
Ed
Posted by ed_uk on May 2, 2006, at 15:57:27
In reply to Re: Went to pdoc today ... what do you think?, posted by yxibow on May 2, 2006, at 14:25:06
None of the most useful OTC drugs are contra-indicated with MAOIs eg. acetaminophen, ibuprofen, loratadine, beclomethasone nasal spray, clotrimazole cream etc.
Ed
Posted by yxibow on May 3, 2006, at 1:00:23
In reply to Re: Went to pdoc today ... what do you think? » yxibow, posted by ed_uk on May 2, 2006, at 15:54:53
> Hi J
>
> >Do you really want to not take cough syrup, sudafed, and various OTC meds?
>
> J, OTC cough syrups don't work. At best, they are minimally useful. Having to avoid dextromethophan is a trivial concern for someone who is severely depressed. Sudafed is not very effective. Moreover, nasal congestion is a minor issue compared with severe anxiety or depression.Sudafed is not very effective for some but its better than Sudafed PE. If I have severe sinus congestion, it's better than nothing.
True, for severe depression, I agree that an MAOI can be useful, but its a last resort, at the level of ECT. You just don't start there, its not just OTC stuff that can affect your body on such a drug. The thought of a medication in your body that could cause hypertensive crisis and a hospital visit which here would put you back $1000 just to walk in, is mind boggling. This isn't social medicine, you have to remember, Ed.
And you're right, some of the OTC medications are not as effective as prescribed ones -- but we don't have the luxury any more unlike you in England of going into a pharmacy and getting codeine for a bad cough. The last time that was available was in the late 60s in some of the states here. So DXM is all there is, to be able to get into work and function at half capacity.Tidings
-- Jay
Posted by ed_uk on May 3, 2006, at 10:33:59
In reply to Re: Went to pdoc today ... what do you think? » ed_uk, posted by yxibow on May 3, 2006, at 1:00:23
Hi J
>Sudafed is not very effective for some but its better than Sudafed PE.
OK, but neither med is particularly useful. Pseudoephedrine is minimally effective as best. Other, more effective treatments are available for allergic rhinitis. If you have a cold, buy some tissues and drink some hot lemon :) The cold will go away on its own. Medication is not required!
>True, for severe depression, I agree that an MAOI can be useful, but its a last resort, at the level of ECT
MAOIs should be tried before ECT in all severely depressed patients who are able to understand the restrictions, assuming that they have no contra-indications. Don't forgot Jay, that ECT involves the application of a large electric shock to the head.....repeatedly. When used carefully, MAOIs are relatively safe. The only time things start to go wrong is when patients are not properly informed RE the diet and drug interactions etc.
http://www.thymatron.com/main_home.asp
>The thought of a medication in your body that could cause hypertensive crisis.....
Right, so don't take the meds which interact. Ensure that all care-providers understand that you are taking an MAOI and that drug interactions may occur. Although MAOIs have some very major drug interactions (eg. with SSRIs), many of the alleged drug interactions do not exist. MAOIs do not, for example, interact with the epinephrine used in local anesthetic mixtures in dentistry.
>You just don't start there
No, you can try several other meds first. Patients should not, however, be forced to try every other drug in existence before being prescribed an MAOI. Nardil and Parnate are too effective to be ignored.
>we don't have the luxury any more unlike you in England of going into a pharmacy and getting codeine for a bad cough. The last time that was available was in the late 60s in some of the states here. So DXM is all there is, to be able to get into work and function at half capacity.
Dextromethorphan is minimally effective. In most people it is probably completely ineffective, it is highly unlikely to help you get to work. Dextromethorphan is not an especially valuable medication. Severe coughs due to bacterial pneumonia require antibiotics. Cough suppressants like dextromethorphan should not be used in pneumonia. Mild coughs not associated with pnemonia do not benefit from antibiotics - medication is not required. The cough will go away on its own. Back to the hot lemon......
OTC codeine is rarely used in the UK. Not a great loss. Low doses of codeine are relatively ineffective as a cough supressant. As is the case with dextromethorphan, codeine must not be used in patients with pneumonia. Mild coughs are best left untreated. They don't normally last long anyway.
Ed
Posted by ed_uk on May 3, 2006, at 11:00:54
In reply to Re: Went to pdoc today ... what do you think? » ed_uk, posted by yxibow on May 3, 2006, at 1:00:23
Hi J
As someone who's had many coughs and colds, I can safely say that although annoying, colds are hardly comparable in importance to major mental illness!
Ed
Posted by yxibow on May 3, 2006, at 23:19:54
In reply to Re: Went to pdoc today ... what do you think? » yxibow, posted by ed_uk on May 3, 2006, at 11:00:54
> Hi J
>
> As someone who's had many coughs and colds, I can safely say that although annoying, colds are hardly comparable in importance to major mental illness!
>
> EdI didnt -- but hypertensive crises are real. And deadly, potentially. I didnt say every last hoop had to be gone through, but they're serious medication.
It's not just MAOIs that contraindicate OTC medications -- warfarin, and other drugs too. My Dad has to use Nasonex for his use of doxazosin for BPH because he can't take anything else.
And ECT has never killed a patient in its modern use here at UCLA. Yes, there is a chance of short term memory loss because it is a controlled (emphasis on control, this isnt 1950) seizure and there are always risks of general anaesthesia (which I'm paranoid I'll admit -- never have taken), but it may be even more effective than any drug itself because of its immediacy in changing of body chemistry.
As far as codeine, well, when my Dad was a professor when they still handed it out, he could go to class and actually teach on it. We're not talking complicated pneumonic infections, just a bad hoarse throat.
Sure, if your life depended on what is essentially adult supervision and your doctor was sure you were going to jump out of the window, you couldn't exist in life otherwise, then an MAOI is awfully appropriate. But the casual use of them I think is personally dangerous.
Thats just my 2c-- J
Posted by yxibow on May 3, 2006, at 23:34:29
In reply to MAOIs » yxibow, posted by ed_uk on May 3, 2006, at 10:33:59
> OK, but neither med is particularly useful. Pseudoephedrine is minimally effective as best. Other, more effective treatments are available for allergic rhinitis. If you have a cold, buy some tissues and drink some hot lemon :) The cold will go away on its own. Medication is not required!
Of course it will go away on its own, I'm talking about people with severe sinusits for which it helps and it is now making these people feel like criminals with restrictions in some states because of the meth lab idiots.
Blowing a tissue a hundred times is hard on the nose.
I agree there are other treatments that can work -- I find that preservative free saline (sometimes pressurized) is quite effective for sinus passage clearance without the jumpiness of pseudoephedrine. Doesn't mean that some people haven't been helped by it though.
> MAOIs should be tried before ECT in all severely depressed patients who are able to understand the restrictions, assuming that they have no contra-indications. Don't forgot Jay, that ECT involves the application of a large electric shock to the head.....repeatedly.Repeatedly, to whatever level necessary, this is true. ECT is a controlled seizure.
>
> http://www.thymatron.com/main_home.aspActually the FAQ on the link with the ECT machine you showed points out the positive benefits that I aforementioned in the other reply and the rarity of severe complications.
>
> >The thought of a medication in your body that could cause hypertensive crisis.....
>
> Right, so don't take the meds which interact. Ensure that all care-providers understand that you are taking an MAOI and that drug interactions may occur.And suppose you've been hit by a car? I'd highly suggest a medical wristband that says MAOI.
> >we don't have the luxury any more unlike you in England of going into a pharmacy and getting codeine for a bad cough. The last time that was available was in the late 60s in some of the states here. So DXM is all there is, to be able to get into work and function at half capacity.
>
> Dextromethorphan is minimally effective. In most people it is probably completely ineffective, it is highly unlikely to help you get to work. Dextromethorphan is not an especially valuable medication.For a mild cough I'll again say its all we have without having to go fill out forms and see doctors and waste time. It works, for a mild cough that would interfere with an average daily workday where you have to talk alot.
Severe coughs due to bacterial pneumonia require antibiotics. Cough suppressants like dextromethorphan should not be used in pneumonia. Mild coughs not associated with pnemonia do not benefit from antibiotics - medication is not required. The cough will go away on its own. Back to the hot lemon......
Where did I asy antibiotics or pneumonia? If you have strep, you have strep -- Augmentin, Penicillin V, etc.> OTC codeine is rarely used in the UK. Not a great loss. Low doses of codeine are relatively ineffective as a cough supressant.
Hmm... I seem to remember you using OTC codeine :)
Just my 2c from this side of the pond
-- Jay
Posted by ed_uk on May 4, 2006, at 13:56:18
In reply to Re: MAOIs » ed_uk, posted by yxibow on May 3, 2006, at 23:34:29
>I'm talking about people with severe sinusits
OK, but how is this relevent? The vast majority of patients who are considering taking an MAOI do not suffer from sinusitis.
>ECT is a controlled seizure.
That would be a euphemism. Potent muscle relaxants are necessary during ECT to prevent violent convulsions. People used to break their back during ECT, the convulsions were so severe. I think this gives you a good idea of what sort of seizure is being induced.
>Actually the FAQ on the link with the ECT machine you showed points out the positive benefits that I aforementioned in the other reply and the rarity of severe complications.
Well of course! Manufacturers of ECT machines will inevitably downplay the risks!
>And suppose you've been hit by a car? I'd highly suggest a medical wristband that says MAOI.
Indeed, such wristbands can be obtained easily, and cheaply. Only a minority of drugs used in emergency medicine need to be avoided - Demerol being the obvious example. Epinephrine is not contra-indicated.
>For a mild cough I'll again say its all we have without having to go fill out forms and see doctors and waste time. It works, for a mild cough that would interfere with an average daily workday where you have to talk alot.
Let's compare: mild cough versus severe untreated mental illness. Which is most likely to lead to people needing to take time off work? Given dextromethorphan's minimal effectiveness, it is not likely to help someone go to work. Simple linctus would do just as well.
>Hmm... I seem to remember you using OTC codeine :)
Yep, I took it because it makes me feel better, not to treat a cough.
Ed
Posted by ed_uk on May 4, 2006, at 14:45:25
In reply to Re: Went to pdoc today ... what do you think? » ed_uk, posted by yxibow on May 3, 2006, at 23:19:54
>And deadly, potentially.
Yes, but death is extremely unlikely. An MAOI-induced hypertensive crisis can be treatment relatively easily. A lot more people will have died of heart attacks, strokes etc following the use of atypical APs such as Zyprexa.
>It's not just MAOIs that contraindicate OTC medications - warfarin, and other drugs too
I'm not quite sure what you're saying here. MAOIs do not interact with warfarin.
>Yes, there is a chance of short term memory loss
There is a chance of long term memory loss, as many patients who've had ECT will tell you.
>risks of general anaesthesia
Modern anesthesia is very safe. The anesthesia used for ECT is brief, and relatively 'light'. The main risks come from having an electric shock to the head.
>Sure, if your life depended on what is essentially adult supervision and your doctor was sure you were going to jump out of the window, you couldn't exist in life otherwise, then an MAOI is awfully appropriate. But the casual use of them I think is personally dangerous.
At what point did I suggest that MAOIs should be used casually? In order to take an MAOI safely, the patient requires knowledge, not 'adult supervision'. If a patient was about to 'jump out of the window', admission to hospital would probably be appropriate. MAOIs are particularly suitable for severe atypical depression and/or social phobia. You do not need to be suicidal to take an MAOI.
Ed
Posted by Crazy Horse on May 4, 2006, at 17:29:20
In reply to Re: MAOIs » yxibow, posted by ed_uk on May 4, 2006, at 13:56:18
> >I'm talking about people with severe sinusits
>
> OK, but how is this relevent? The vast majority of patients who are considering taking an MAOI do not suffer from sinusitis.
>
> >ECT is a controlled seizure.
>
> That would be a euphemism. Potent muscle relaxants are necessary during ECT to prevent violent convulsions. People used to break their back during ECT, the convulsions were so severe. I think this gives you a good idea of what sort of seizure is being induced.
>
> >Actually the FAQ on the link with the ECT machine you showed points out the positive benefits that I aforementioned in the other reply and the rarity of severe complications.
>
> Well of course! Manufacturers of ECT machines will inevitably downplay the risks!
>
> >And suppose you've been hit by a car? I'd highly suggest a medical wristband that says MAOI.
>
> Indeed, such wristbands can be obtained easily, and cheaply. Only a minority of drugs used in emergency medicine need to be avoided - Demerol being the obvious example. Epinephrine is not contra-indicated.
>
> >For a mild cough I'll again say its all we have without having to go fill out forms and see doctors and waste time. It works, for a mild cough that would interfere with an average daily workday where you have to talk alot.
>
> Let's compare: mild cough versus severe untreated mental illness. Which is most likely to lead to people needing to take time off work? Given dextromethorphan's minimal effectiveness, it is not likely to help someone go to work. Simple linctus would do just as well.
>
> >Hmm... I seem to remember you using OTC codeine :)
>
> Yep, I took it because it makes me feel better, not to treat a cough.
>
> Ed
>
>LOL...Ed you are too good, i don't know why people would even challenge you. Your pharmacology knowledge FAR EXCEEDS MINE, but i do know enough to know that you are absolutely correct in what you said. And as a former (Yuck!) ECT participant...you nailed that on the head also. It's only because they temporarily paralyze you that you don't thrash around violently with the induced seizure. The extremely severe headache after the treatment indicates to me that the electricity isn't just a mild dose as they tell you that it is. Misconceptions and lack of education about MAOI's are the #1 reason people and Doctors are afraid to use them..i think anyway. It's unfortunate and sad because they can be, and are so effective for some people...myself included. :)
Monte
Posted by yxibow on May 4, 2006, at 20:18:27
In reply to Re: MAOIs » yxibow, posted by ed_uk on May 4, 2006, at 13:56:18
> >I'm talking about people with severe sinusits
>
> OK, but how is this relevent? The vast majority of patients who are considering taking an MAOI do not suffer from sinusitis.Is there a study ? One will never know. There are few other things that will control it other than saline or steroidal use which is always an iffy thing even if nasal steroids are relatively harmless, they can still cause HPA axis issues and that is nothing good to add to severe depression.
>
> >ECT is a controlled seizure.
>
> That would be a euphemism. Potent muscle relaxants are necessary during ECT to prevent violent convulsions. People used to break their back during ECT, the convulsions were so severe. I think this gives you a good idea of what sort of seizure is being induced.No, its not a euphemism, its exactly what it is according to my doctor who has I think two decades more experience than myself as an MD. I didn't say it was something to take lightly... I wouldnt go there any more than I would an MAOI.
> >Actually the FAQ on the link with the ECT machine you showed points out the positive benefits that I aforementioned in the other reply and the rarity of severe complications.
>
> Well of course! Manufacturers of ECT machines will inevitably downplay the risks!So why post it, I was lost ?
> >And suppose you've been hit by a car? I'd highly suggest a medical wristband that says MAOI.
>
> Indeed, such wristbands can be obtained easily, and cheaply. Only a minority of drugs used in emergency medicine need to be avoided - Demerol being the obvious example. Epinephrine is not contra-indicated.Good, we agree here.
> Let's compare: mild cough versus severe untreated mental illness. Which is most likely to lead to people needing to take time off work? Given dextromethorphan's minimal effectiveness, it is not likely to help someone go to work. Simple linctus would do just as well.
Mm... ask the millions of Americans who use it daily. I agree, its not a great drug. Its not terribly powerful. In fact its quite weak, deliberately so, almost punitively, to discourage abuse which does still exist (yuck).
> >Hmm... I seem to remember you using OTC codeine :)
>
> Yep, I took it because it makes me feel better, not to treat a cough.Hmm.. I won't go there because that's character assasination.
Posted by yxibow on May 4, 2006, at 20:28:45
In reply to Re: Went to pdoc today ... what do you think? » yxibow, posted by ed_uk on May 4, 2006, at 14:45:25
> >And deadly, potentially.
>
> Yes, but death is extremely unlikely. An MAOI-induced hypertensive crisis can be treatment relatively easily. A lot more people will have died of heart attacks, strokes etc following the use of atypical APs such as Zyprexa.And death with ECT is also extremely likely when done at proper research institutions who have been practicing it for years. And as far as Zyprexa -- the lipid profile issues can be detected at your doctors office a lot quicker than would cause deadly heart and brain issues with simple tests, as opposed to something that requires the golden hour to the hospital if you're about to have a heart attack from an MAOI.
> >It's not just MAOIs that contraindicate OTC medications - warfarin, and other drugs too
>
> I'm not quite sure what you're saying here. MAOIs do not interact with warfarin.No, I was implying that other drugs besides MAOIs are also a problem with OTC medication. It was just a side tangent.
> >Yes, there is a chance of short term memory loss
>
> There is a chance of long term memory loss, as many patients who've had ECT will tell you.Again -- that comes back to the argument of what is better, severe depression, or the chance, whatever it is, of cognition issues. It may be worse with ECT, but you're still balancing risky things with MAOIs.
> >risks of general anaesthesia
>
> Modern anesthesia is very safe. The anesthesia used for ECT is brief, and relatively 'light'. The main risks come from having an electric shock to the head.It is -- about 1 in 10000 die, usually from improper monitoring, idiopathic reactions, or lack of monitoring medications that may interfere.
> >Sure, if your life depended on what is essentially adult supervision and your doctor was sure you were going to jump out of the window, you couldn't exist in life otherwise, then an MAOI is awfully appropriate. But the casual use of them I think is personally dangerous.
>
> At what point did I suggest that MAOIs should be used casually? In order to take an MAOI safely, the patient requires knowledge, not 'adult supervision'.I was being a bit overboard, and didnt mean it pejoratively. Serious knowledge though.
If a patient was about to 'jump out of the window', admission to hospital would probably be appropriate.
...where an MAOI might be administered in a safe environment.
MAOIs are particularly suitable for severe atypical depression and/or social phobia. You do not need to be suicidal to take an MAOI.
No... but that's one criteria. Exhaustion of other less dangerous choices are others.
Its really tomato, tomahto, because I just can't see the idea of a medication that you have to carry along the equivalent of an anti-hypertensive, a nitroglycerin like tablet necklace to stop a crisis that could kill you in rush hour traffic. Alot who have had their lives changed around will disagree, and that's fine. Its just not my choice and I dont think it should be any doctor-patient relationship's first choice either.
Posted by Caedmon on May 5, 2006, at 12:47:58
In reply to Re: Went to pdoc today ... what do you think?, posted by yxibow on May 4, 2006, at 20:28:45
> >And death with ECT is also extremely likely when done at proper research institutions who have been practicing it for years. And as far as Zyprexa -- the lipid profile issues can be detected at your doctors office a lot quicker than would cause deadly heart and brain issues with simple tests, as opposed to something that requires the golden hour to the hospital if you're about to have a heart attack from an MAOI.>>
Dying from an MAOI-related hypertensive reaction is extremely rare.
http://www.acnp.org/G4/GN401000046/CH046.html
states that:"The actual morbidity associated with administration of the irreversible MAOIs is difficult to determine. However, it has been estimated that, of the 3.5 million patients that had used tranylcypromine by 1970, about 50 persons reportedly had cerebrovascular accidents and 15 of these individuals died."
>> Its really tomato, tomahto, because I just can't see the idea of a medication that you have to carry along the equivalent of an anti-hypertensive, a nitroglycerin like tablet necklace to stop a crisis that could kill you in rush hour traffic. Alot who have had their lives changed around will disagree, and that's fine. Its just not my choice and I dont think it should be any doctor-patient relationship's first choice either.>>See, I'm used to carrying around tablets and medicines. I generally have an albuterol inhaler in my backpack in case I have an asthma attack. I also have a bottle with a few diazepam 5mg tablets in them, for anxiety. I just add the nifedipine tablets to the diazepam bottle - they're pretty distinct: the former are small, flat, orange, and round and the latter are oblong, oval-shaped pink capsules.
So far on Parnate it's been amazingly easy to adjust. Eating out is the area that requires the most vigilance - having to ask "what kind of cheese is it" is embarrassing for this social phobic. Well, I'll live. :-)
- C
Posted by ed_uk on May 5, 2006, at 13:46:08
In reply to Re: MAOIs » ed_uk, posted by Crazy Horse on May 4, 2006, at 17:29:20
Hi Monte
You're right. The electric shock used in ECT is *not* small :( I dread to think what such as large electric shock does to the delicate neural tissue. It doesn't bear thinking about.
Ed
Posted by ed_uk on May 5, 2006, at 14:06:46
In reply to Re: MAOIs, posted by yxibow on May 4, 2006, at 20:18:27
>Is there a study?
I think it's pretty obvious than most people do not suffer from severe sinusitis on a regular basis.
>No, its not a euphemism, its exactly what it is according to my doctor who has I think two decades more experience than myself as an MD.
There's nothing controlled about delivering an electric shock to the head. Sorry, anyone who thinks otherwise is just deluding themself. ECT is a very crude procedure, even with EEG monitoring etc. Unsurprisingly, psychiatrists who have been involved will have convinced themselves that it is safe - for their own peace of mind if nothing else.
>I wouldnt go there any more than I would an MAOI.
Neither MAOIs nor ECT are established treatments for OCD or somatoform disorders.......so I wouldn't really blame you.
>So why post it, I was lost ?
I posted it because it gave information RE the voltage and current used in ECT - which is enough to make my eyes water.
>Mm... ask the millions of Americans who use it daily.
I work in a pharmacy, I am well aware that many people are happy to buy what are effectively placebos (eg. expectorant cough medicines, Sudafed PE) on a regular basis. It is not, therefore, surprising that people should be happy to buy dextromethorphan. It is very easy to convince people that a medication is effective, even when it is not. The recommendation of a friend, the pharmacist or an advertisement.........
>Hmm.. I won't go there because that's character assasination.
I find your remark offensive. Codeine is effective in making me feel better. I find that it causes very mild side effects, which is more than can be said for the drugs you take. A lot of people take meds to feel better. A lot of people enjoy a glass of wine on an evening. I guess you've been brainwashed by the 'war on drugs' etc, which is particularly interesting considering that amount of diazepam you take.
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