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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 102. This is the beginning of the thread.
Posted by linkadge on July 22, 2010, at 20:15:37
Great, so nortriptyline apprently f's up the blood brain barrier. Well, it was good while it lasted.
Linkadge
Posted by morgan miller on July 22, 2010, at 20:51:30
In reply to toxic crap, posted by linkadge on July 22, 2010, at 20:15:37
I'm confused, were both drugs tested together? So how do we know if Nortriptyline alone had the same impact?
Posted by violette on July 22, 2010, at 20:59:55
In reply to toxic crap, posted by linkadge on July 22, 2010, at 20:15:37
Hey Linkadge,
Are you sure you don't have some sort of reverse placebo effect going on, where you'd start taking the drug..before/during/after continously seek out scientific information about that same drug--then find a reason the drug might not work, then it ends up not working? Similar to a self-fulfilling prophecy?
Sort of like questioning whether or not its working, feeling slightly disappointed, thinking about it more, looking into it more, then spiraling into major disappointment, which ends up spiraling into depression again?
Maybe not as specific to your case, but I wonder if this is true for people in general, like the placebo affect is common?
Reverse placebo affect:
-previous drugs stop working/don't work
-need to change that, but past experience leads to (unconsciously) questioning if this is gonna not work too
-research drug, weigh pros and cons (doubts in back of mind)
-decide to take new drug (and consciously hopeful)
-suspicous of drug as many others haven't worked
-mild one-time sad thought leads to greater suspicion and more thinking about it not working
-suspicious thought spirals to mild disappointment as one starts to consider if this drug isn't going to work
-disappointment leads to finding concrete reasons drug doesn't work, thinking this researched aspect found might be what's happening
-reasons drug doesn't work leads to more disappointing thoughts-this must be what's happening (thought just one little thought spiraled into this disappointment)
-disappointing thoughts multiply and become depression againIf drugs can have a placebo affect, can't we (drug takers) also have reverse placebo effects?
Posted by Phillipa on July 22, 2010, at 21:16:31
In reply to Re: toxic crap, posted by violette on July 22, 2010, at 20:59:55
I feel we sure can. Phillipa
Posted by morgan miller on July 22, 2010, at 21:35:38
In reply to Re: toxic crap, posted by violette on July 22, 2010, at 20:59:55
I don't think the issue is whether Nortriptyline works or not.
Posted by SLS on July 23, 2010, at 5:38:14
In reply to toxic crap, posted by linkadge on July 22, 2010, at 20:15:37
"it appears that the concentrations of nortriptyline and chlorpromazine which produced barrier changes were in the toxic range. "
Is your dosage of nortriptyline in the toxic range?
Has this experiment been repeated since 1972?
Nitroglycerine and digitalis are "toxic", yet they save lives every day. This is true of oodles and oodles of drugs.
I don't get it. Since the 1950s, people have been made well their whole lives using TCAs. People take these drugs for decades. In real life, where is the BBB toxicity? What are you afraid of that will happen if your BBB permeability is changed in the manner described by the study you cited?
Perhaps you have more evidence of an effect of TCA on BBB and what that effect has on one's quality of life. I would like to know it. I take nortriptyline, too. For now, I would love to be confronted with your dilemma.
- Scott
Posted by morgan miller on July 23, 2010, at 9:40:25
In reply to toxic crap, posted by linkadge on July 22, 2010, at 20:15:37
Link, are you sure want to stop Nortriptyline? Do you think there might be ways to counteract or protect yourself from any negative effects on toxicity or BBB permeability? I mean, I think Scott pointed this out too, you are taking quite a low dose. If I read that study correctly, the effect on BBB permeability was dose dependent.
I think sometimes we just have to weigh the benefits with the risks. Feeling good should be the priority, then over time we can try to evaluate the effects on our health and see if the "Feeling Good" is worth continuing the medication. The way I see it, if your health continues to be good over time-using blood tests, doctor's visits, physicals, and your own assessment to measure the state of your health, it may be worth it to take a risk on Nortriptyline for a while.
Posted by morgan miller on July 23, 2010, at 9:49:21
In reply to Re: toxic crap, posted by morgan miller on July 23, 2010, at 9:40:25
I think about the time when I was on Zoloft and felt pretty darn good most of the time. I slept great, had great workouts, had plenty of energy, had a great libido, didn't gain weight, and had zero noticeable side effects other than maybe being a little more dehydrated than normal. I thought taking a medication that might be toxic was not a good idea in the long run and I didn't want to be a slave to taking medication so I stopped one day when I thought I was ready. I totally regret doing this. Six months later the perfect storm came together to send me into a severe mixed episode and eventual hospitalization. Since this time my life has been pure hell. Zoloft no longer stabilizes me and works the same magic at 100 mg. In the past few years I've been on 12 different medications and went through the worst depression of my life and another mixed episode and hospitalization-the combination of which I know has done more damage to my psyche, brain, and body than just staying on Zoloft ever would have done.
Posted by linkadge on July 23, 2010, at 10:15:25
In reply to Re: toxic crap, posted by violette on July 22, 2010, at 20:59:55
Probably. Either way, whenever I read something like this, I just simply can't take the drug anymore.
Linkadge
Posted by linkadge on July 23, 2010, at 10:19:38
In reply to Re: toxic crap » linkadge, posted by SLS on July 23, 2010, at 5:38:14
The concentrations used (I calculated) were only about 10 times a normal human concentration. And, they produced immediate deterioration to BBB permiability. I can imagune taking lower doses for longer periods of time would do the same thing.
Compromised BBB permiability is seen to some degree in old age but is associated with enhanced brain absorbtion of a variety of neurotoxins.
Linkadge
Posted by linkadge on July 23, 2010, at 10:24:15
In reply to Re: toxic crap, posted by morgan miller on July 23, 2010, at 9:49:21
I was starting to feel posessed on Nortriptyline anyway. Not able to finish my sentence,.. getting lost in the fog, major short term memory loss.
Feeling dumb (rightly) and then just getting angry about it.
Sorry, I wasted your time.
Linkadge
Posted by morgan miller on July 23, 2010, at 11:05:21
In reply to Re: toxic crap, posted by linkadge on July 23, 2010, at 10:24:15
> I was starting to feel posessed on Nortriptyline anyway. Not able to finish my sentence,.. getting lost in the fog, major short term memory loss.
>
> Feeling dumb (rightly) and then just getting angry about it.
>
> Sorry, I wasted your time.
>
> Linkadge
>No waste of time. Sounds like Nortriptyline may not have been making you feel that great anyway. Now you've got me scared away from trying it : ). I'm hoping my doubling dose of Synthroid and Lithium will start to make a difference along with maybe trying to go back to Zoloft again.
I really hope you find something that helps. I guess at least your getting some relief from the other things you are taking. Maybe you can find other natural treatments on top of fish oil that help some. Either way, good luck.
Morgan
Posted by violette on July 23, 2010, at 11:16:21
In reply to Re: toxic crap » violette, posted by linkadge on July 23, 2010, at 10:15:25
:(
Wish we could 'block you' from reading scientific journal articles about a drug's adverse effects...
(((Lindadge))))
Posted by violette on July 23, 2010, at 13:59:00
In reply to Re: toxic crap » violette, posted by linkadge on July 23, 2010, at 10:15:25
Linkadge, could you do something like start a new thread "Linkadge's Positive Medication Trial Thread" or something...and everytime you get the urge to 'check' scientific research on a particular drug--you could come here instead and ask a question about that drug to replace the resaarch urge...
Meanwhile, the rest of the med board, in response to each time you get the urge, could submit a post of something positive about the drug, like a quote from a research article, or another's positive experience with that same drug?
At least till you stay on something that works....and when you might be feeling well again, for say a few weeks, maybe feeling better will negative the effects of future adverse research findings?
Posted by inanimate peanut on July 23, 2010, at 14:15:49
In reply to toxic crap, posted by linkadge on July 22, 2010, at 20:15:37
"From the LD50 values, it appears that the concentrations of nortriptyline and chlorpromazine which produced barrier changes were in the toxic range"
so, don't take toxic doses for nortriptyline. Check. I wasn't planning on taking toxic doses anyway.
Posted by SLS on July 23, 2010, at 14:32:17
In reply to Re: toxic crap, posted by morgan miller on July 23, 2010, at 11:05:21
> Now you've got me scared away from trying it : )
I'm glad you are smiling.
- Scott
Posted by TenMan on July 23, 2010, at 14:52:50
In reply to Re: toxic crap, posted by SLS on July 23, 2010, at 14:32:17
Personally, I would be more concerned about the toxicity lifelong chronic depression can have on quality of life.
Posted by linkadge on July 23, 2010, at 15:58:41
In reply to Re: toxic crap » linkadge, posted by violette on July 23, 2010, at 13:59:00
Thats part of who I am though. I need to know. Thats the only way I can ever self actualize. For me, this is not about feeling a little improvement. This is about getting well. Part of feeling *well* will inevitably involve beleving that the path I am on is not distructive to my mind or body.
When I find my cure, its going to be simple, effective and safe. There will be no tradoff. No exhaustive consideration of whether I can really tollerate feeling wonked out for the rest of my life.
Linkadge
Posted by linkadge on July 23, 2010, at 16:12:44
In reply to Re: toxic crap, posted by TenMan on July 23, 2010, at 14:52:50
I don't have lifelong chronic depression. I probably have either bipolar disorder or recurrent brief depression. I can go weeks at a time feeling ok, only to lapse for a few weeks.
If a drug gets me well, I just end up saying "wait a minute, I felt normal like this 3 weeks ago, and I wasn't taking anything. Then I stop the med, because it seems crazy to be ingesting something with these side effects.
My profession demands that I simply can't be forgetting what I am saying mid sentence.
The nortriptyline was also really screwing up my field of vision. First of all, it makes colors look faded and less vibrant. Nextly it makes objects lose their shape (I know this sounds weird, but it made objects look like they were colapsing). Also it makes things look like they are coming in on me, kind of how salvia felt, perhaps cause nortriptyline interacts with kappa receptors.
Anyhow, it just does not feel healthy. I keep saying this can't be good for my brain. Other effects invlude: Strange food cravings, flatulance that smells like lumburgar cheese, sleep attacks, the feeling of being controlled by an external force, the feeling of being watched, sleeping 13 hours a day, irritability, feeling heavy, stupor (blank staring for like 10 min).
Sure, it'd be great if I was trying to pass the time in prison, or a retirement home.
Linkadge
Posted by SLS on July 23, 2010, at 16:15:35
In reply to Re: toxic crap, posted by TenMan on July 23, 2010, at 14:52:50
> Personally, I would be more concerned about the toxicity lifelong chronic depression can have on quality of life.
...and the entire central nervous and endocrine systems.
Personally, I would take the risk with nortriptyline and this BBB stuff, should one even exist. I would want to see some corroborative evidence of such risks produced since the 1972 report was published for me to contemplate discontinuing nortriptyline. That is just me, though. Even if one were to take the authors at their word, they state quite firmly that anomalies in BBB were not seen with therapeutic concentrations of nortriptyline. Similarly, there are cardiotoxic effects that do not emerge until dosages above the therapeutic range are reached.
The problem I have with nortriptyline is that it doesn't work for me monotherapeutically. I find that it is somewhat helpful when combined with other drugs. My only robust drug responses have been in association with combinations of MAOI and TCA. Perhaps it is a matter of the magnitude of pain and debilitation that motivates some people to choose to take risks, known and unknown.
- Scott
Posted by ed_uk2010 on July 23, 2010, at 16:50:07
In reply to Re: toxic crap, posted by linkadge on July 23, 2010, at 16:12:44
Link, I've noticed that whatever meds(s) you take, you always report unusual side effects or worry about toxicity. I don't think you will ever be comfortable with taking medication because you are too worried about adverse effects... either now or potential adverse effects in the future. Perhaps you should take no medication at all?
Posted by linkadge on July 23, 2010, at 17:11:51
In reply to Re: toxic crap » linkadge, posted by ed_uk2010 on July 23, 2010, at 16:50:07
>Perhaps you should take no medication at all?
Sounds ok to me.
Linkadge
Posted by SLS on July 23, 2010, at 18:55:20
In reply to Re: toxic crap, posted by linkadge on July 23, 2010, at 17:11:51
> >Perhaps you should take no medication at all?
>
> Sounds ok to me.
>
> LinkadgeIt might not be a bad idea for you to familiarize yourself with your drug-free baseline illness so that you can more easily differentiate between the cognitive effects of the illness and drug side effects. If you should decide to return to pharmacotherapy, it might be interesting to try lithium monotherapy first, seeing as how drug responses are often familial. I would then add back nortriptyline, with or without the escitalopram.
If I were you, I would simply take the leap of faith and continue with the nortriptyline and go on to euthymia. Once you are euthymic for a few months, you can reevaluate your treatment history, quality of response, and remaining alternatives. One of the alternatives you will always have available to you is to discontinue the nortriptyline and feel like crap again.
- Scott
Posted by emmanuel98 on July 23, 2010, at 20:16:19
In reply to Re: toxic crap, posted by linkadge on July 23, 2010, at 17:11:51
Seriously, if your problem is brief, recurrent depressions rather than chronic severe depression (which was my problem), CBT or DBT are the way to go. Learn how to manage your response to it. Tell yourself this will end, you won't always feel this way. I agree. Why mess with potential side effects if you can manage your emotions with therapy?
Posted by linkadge on July 23, 2010, at 21:02:05
In reply to Re: toxic crap, posted by emmanuel98 on July 23, 2010, at 20:16:19
Therapy doesn't seem to do anything for me to prevent the episodes, or really modify their sevarity for that matter.
My mother is bipolar, so that diagnosis has been thrown around.
I think I'm just going to continue with meds on an as needed basis. They've been working fairly well that way.
Linkadge
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