![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by porkpiehat on March 19, 2018, at 11:33:27
Nortiptyline is proving a good add on to Marplan in terms of mood and anxiety, but the NE in my brain makes it impossible to sleep! I don't feel stimulated, but I am so hyperfocused my brain can't wander off into sleep.
I'm hoping that something can help block the NE in the central nervous symptom...I was thinking prazosin or propranolol but I think they work peripherally.
SLS if you're out there your pharmacological wisdom might help!
please and thank you!
Posted by ed_uk2010 on March 19, 2018, at 13:02:58
In reply to insomnia on Nortrip! Help me block the NE SLS, posted by porkpiehat on March 19, 2018, at 11:33:27
How much nortriptyline do you take? Have you tried reducing?
Posted by porkpiehat on March 19, 2018, at 13:26:24
In reply to Re: insomnia on Nortrip! Help me block the NE SLS » porkpiehat, posted by ed_uk2010 on March 19, 2018, at 13:02:58
> How much nortriptyline do you take? Have you tried reducing?
first night I did 25mgs before bed...sleep was not awful.
then I took half of that in the afternoon hoping to move into a daytime dose. That's when the sleep got terrible (last night) I think taking half a klonopin and 2mgs prazosin may have helped me get some sleep 5-11am.This morning I took half a capsule and will take none tonight, tomorrow I will take full capsule am. Maybe I don't need 25mgs.
Posted by ed_uk2010 on March 19, 2018, at 15:25:08
In reply to Re: insomnia on Nortrip! Help me block the NE SLS » ed_uk2010, posted by porkpiehat on March 19, 2018, at 13:26:24
>Maybe I don't need 25mgs.
Maybe not. Tricyclic doses are variable at the best of times. For someone taking an MAOI, response to tricyclics could be changed a great deal.
Some people, like SLS, need 'standard' antidepressant doses of tricyclics even when taking an MAOI, but that won't apply to everyone.
I think it's too early to be planning to add more meds. Perhaps the dose of nortriptyline you're taking is too much for you right now.
Maybe try 10mg for a bit?
Posted by SLS on March 19, 2018, at 16:16:39
In reply to insomnia on Nortrip! Help me block the NE SLS, posted by porkpiehat on March 19, 2018, at 11:33:27
> Nortiptyline is proving a good add on to Marplan in terms of mood and anxiety, but the NE in my brain makes it impossible to sleep! I don't feel stimulated, but I am so hyperfocused my brain can't wander off into sleep.
>
> I'm hoping that something can help block the NE in the central nervous symptom...I was thinking prazosin or propranolol but I think they work peripherally.
>
> SLS if you're out there your pharmacological wisdom might help!
>
> please and thank you!Total insomnia?
Insomnia can be a good predictor of a positive response. I'm not sure that I would try to block NE. It might be precisely the NE effect that is responsible for your feeling better.
You can try adjusting the nortriptyline dosage downwards as was suggested by Ed_UK. However, if you lose the improvement, you will probably need to maintain a higher dosage. In this event, you can add sleep aids - hopefully on a temporary basis. The insomnia might resolve on its own. If all else fails, you can switch from nortriptyline to amitriptyline. Amitriptyline tends to be soporific, so I doubt sleep would be a problem. Unfortunately, anticholinergic side effects are pronounced. You cannot take imipramine or clomipramine in combination with Marplan because of the risk of serotonin syndrome.
A few ideas:
1. Ambien for problems with sleep initiation.
2. Ativan or Restoril for problems with sleep maintenance.
3. Seroquel at low dosages.Stay away from trazodone. It is unpredictable and is capable of producing serotonin syndrome when combined with a MAOI.
No caffeine! You might want to give things a few more days before making a move.
I'm guessing that you are close to finding a treatment that works well for you.
- Scott
Posted by linkadge on March 19, 2018, at 18:33:16
In reply to Re: insomnia on Nortrip! Help me block the NE SLS » porkpiehat, posted by SLS on March 19, 2018, at 16:16:39
Unfortunately, I had the same problem. At first it wasn't an issue, but I was finding nortriptyline was leading to increased instability.
I ended up switching back to mirtazapine. It doesn't help my depression as much, but I feel more stable.
Some nights on nortriptyline felt like I was waking up 50+ times (microwakenings)
Linkadge
Posted by porkpiehat on March 20, 2018, at 14:20:25
In reply to Re: insomnia on Nortrip! Help me block the NE SLS » porkpiehat, posted by SLS on March 19, 2018, at 16:16:39
> > Nortiptyline is proving a good add on to Marplan in terms of mood and anxiety, but the NE in my brain makes it impossible to sleep! I don't feel stimulated, but I am so hyperfocused my brain can't wander off into sleep.
> >
> > I'm hoping that something can help block the NE in the central nervous symptom...I was thinking prazosin or propranolol but I think they work peripherally.
> >
> > SLS if you're out there your pharmacological wisdom might help!
> >
> > please and thank you!
>
> Total insomnia?
>
> Insomnia can be a good predictor of a positive response. I'm not sure that I would try to block NE. It might be precisely the NE effect that is responsible for your feeling better.
>
> You can try adjusting the nortriptyline dosage downwards as was suggested by Ed_UK. However, if you lose the improvement, you will probably need to maintain a higher dosage. In this event, you can add sleep aids - hopefully on a temporary basis. The insomnia might resolve on its own. If all else fails, you can switch from nortriptyline to amitriptyline. Amitriptyline tends to be soporific, so I doubt sleep would be a problem. Unfortunately, anticholinergic side effects are pronounced. You cannot take imipramine or clomipramine in combination with Marplan because of the risk of serotonin syndrome.
>
> A few ideas:
>
> 1. Ambien for problems with sleep initiation.
> 2. Ativan or Restoril for problems with sleep maintenance.
> 3. Seroquel at low dosages.
>
> Stay away from trazodone. It is unpredictable and is capable of producing serotonin syndrome when combined with a MAOI.
>
> No caffeine! You might want to give things a few more days before making a move.
>
> I'm guessing that you are close to finding a treatment that works well for you.
>
>
> - Scott
>
>thanks for your thoughts, Scott. Long story short(ish) ...Trazodone was the only effective thing for sleep first on parnate and now on Marplan. But I found It was impossible to wake up in the morning, and I was finding increased agitation (slight paranoia, seething irritability) that i remembered from past times I took trazodone for sleep.
On a whim I stopped the trazodone and so much changed. irritability gone: nagging feeling that I'm in trouble and need to explain everything I am doing, gone; waking up feeling "blah" about everything. sex drive returned
surprisingly my compulsive drinking smoking and fishing stopped too. My cravings for booze and obsessive focus on fishing/avoiding friends was bad enough I asked my parents and pdoc for help.
Unfortunately within a week of stopping trazodone my concentration and social anxiety started to worsen, and my mind would start to spiral into suicidal plans. My sleep on doxylamine and ativan and gabapentin was "ok." Serotonin side effects such as night sweats and GI problems from the Marplan were back and embarrassing; my voice also became too tight for me to speak confidently.
So I started Nortriptyline (reluctantly) hoping that the 5th2 inhibtion would address the anxiety concentration and physical symptoms. Like every NRI i've taken I knew it would ruin my sleep. NRI's also typically put me into a bored, zoned, detached place. That happened last night and the lack of connection spun me into a sense of hopelessness/depression.
That is why I don't want NE reuptake inhibition on top of the increased NE from the MAOI. More often than not my issues with anger, paranoia, and nervousness, are solved with a beta blocker...so again, NE seems counterintuitive.
I'm guessing the irritability, detachment, and obsessive focus (plus the beneficial ability to foucs) on the trazodone came from 5ht1a agonism, as buspar, viibryd, seroquel, etc. gave me the similar experience. If I could take a pure 5ht2 antagonist I would.
It makes me wonder how well Marplan was handling my symptoms given that I seem to stumble when I change my sleep meds or lamictal brand.
questions: Trazodone has negligable SERT activity below 100mgs and is frequently used for MAOI sleep issues...Doesn't Amitriptyline have more SERT activity? I think I would have trouble selling my doctor on it...
What are the nasty side effects like?Wouldn't I end up with the same NE issues as Ami metabolizes into Nort?
thanks for reading this is as condense a description as I could manage.
Posted by SLS on March 21, 2018, at 10:41:37
In reply to Re: insomnia on Nortrip! Help me block the NE SLS » SLS, posted by porkpiehat on March 20, 2018, at 14:20:25
Hi, Porkpiehat.
I'll need to think about this for a bit. My initial thoughts are to explore Abilify and Saphris. Abilify is a partial 5-HT1a agonist and D2/3 partial agonist, whereas Saphris is a 5-HT1a, 5-HT7 and is D2 receptor antagonist. Both drugs are 5-HT2a antagonists. Both drugs have antidepressant activity. Neither drug influences NE directly. Abilify causes weight gain generally. Saphris does not.
To the best of my recollection...
Abilify:
D2 partial agonist
D3 partial agonist
5-HT1a partial agonist
5-HT2a antagonistSaphris:
D2 antagonist
5-HT1a antagonist
5-HT7 antagonist
5-HT2a antagonist
I read not too long ago that amitriptyline was okay with MAOI. I used it in combination with Nardil 45 mg/day. I cannot predict how it would have affected me if the Nardil dosage was higher.I'll give more thought to this.
- Scott
--------------------------------------------------------------------
> > > Nortiptyline is proving a good add on to Marplan in terms of mood and anxiety, but the NE in my brain makes it impossible to sleep! I don't feel stimulated, but I am so hyperfocused my brain can't wander off into sleep.
> > >
> > > I'm hoping that something can help block the NE in the central nervous symptom...I was thinking prazosin or propranolol but I think they work peripherally.
> > >
> > > SLS if you're out there your pharmacological wisdom might help!
> > >
> > > please and thank you!
> >
> > Total insomnia?
> >
> > Insomnia can be a good predictor of a positive response. I'm not sure that I would try to block NE. It might be precisely the NE effect that is responsible for your feeling better.
> >
> > You can try adjusting the nortriptyline dosage downwards as was suggested by Ed_UK. However, if you lose the improvement, you will probably need to maintain a higher dosage. In this event, you can add sleep aids - hopefully on a temporary basis. The insomnia might resolve on its own. If all else fails, you can switch from nortriptyline to amitriptyline. Amitriptyline tends to be soporific, so I doubt sleep would be a problem. Unfortunately, anticholinergic side effects are pronounced. You cannot take imipramine or clomipramine in combination with Marplan because of the risk of serotonin syndrome.
> >
> > A few ideas:
> >
> > 1. Ambien for problems with sleep initiation.
> > 2. Ativan or Restoril for problems with sleep maintenance.
> > 3. Seroquel at low dosages.
> >
> > Stay away from trazodone. It is unpredictable and is capable of producing serotonin syndrome when combined with a MAOI.
> >
> > No caffeine! You might want to give things a few more days before making a move.
> >
> > I'm guessing that you are close to finding a treatment that works well for you.
> >
> >
> > - Scott
> >
> >
>
> thanks for your thoughts, Scott. Long story short(ish) ...Trazodone was the only effective thing for sleep first on parnate and now on Marplan. But I found It was impossible to wake up in the morning, and I was finding increased agitation (slight paranoia, seething irritability) that i remembered from past times I took trazodone for sleep.
>
> On a whim I stopped the trazodone and so much changed. irritability gone: nagging feeling that I'm in trouble and need to explain everything I am doing, gone; waking up feeling "blah" about everything. sex drive returned
>
> surprisingly my compulsive drinking smoking and fishing stopped too. My cravings for booze and obsessive focus on fishing/avoiding friends was bad enough I asked my parents and pdoc for help.
>
> Unfortunately within a week of stopping trazodone my concentration and social anxiety started to worsen, and my mind would start to spiral into suicidal plans. My sleep on doxylamine and ativan and gabapentin was "ok." Serotonin side effects such as night sweats and GI problems from the Marplan were back and embarrassing; my voice also became too tight for me to speak confidently.
>
> So I started Nortriptyline (reluctantly) hoping that the 5th2 inhibtion would address the anxiety concentration and physical symptoms. Like every NRI i've taken I knew it would ruin my sleep. NRI's also typically put me into a bored, zoned, detached place. That happened last night and the lack of connection spun me into a sense of hopelessness/depression.
>
> That is why I don't want NE reuptake inhibition on top of the increased NE from the MAOI. More often than not my issues with anger, paranoia, and nervousness, are solved with a beta blocker...so again, NE seems counterintuitive.
>
> I'm guessing the irritability, detachment, and obsessive focus (plus the beneficial ability to foucs) on the trazodone came from 5ht1a agonism, as buspar, viibryd, seroquel, etc. gave me the similar experience. If I could take a pure 5ht2 antagonist I would.
>
> It makes me wonder how well Marplan was handling my symptoms given that I seem to stumble when I change my sleep meds or lamictal brand.
>
> questions: Trazodone has negligable SERT activity below 100mgs and is frequently used for MAOI sleep issues...Doesn't Amitriptyline have more SERT activity? I think I would have trouble selling my doctor on it...
> What are the nasty side effects like?
>
> Wouldn't I end up with the same NE issues as Ami metabolizes into Nort?
>
> thanks for reading this is as condense a description as I could manage.
Posted by bleauberry on March 22, 2018, at 6:13:34
In reply to insomnia on Nortrip! Help me block the NE SLS, posted by porkpiehat on March 19, 2018, at 11:33:27
I had terrible insomnia on Nortriptyine. I fell asleep ok. But I would sleep only for a short time and then wake up electrified.
With the benefit of hindsight I would not resort to more drugs to counter that side effect, which should improve over weeks and months. I would instead resort to insomnia herbs and calming herbs. A combo of 3 or 4 of them works wonders, even against powerful pharmaceuticals. I'm thinking things like Valerian, Passion flower, American Skullcap, Lemon Balm, and others. These offer additional health benefits over prescriptions.
Posted by SLS on March 22, 2018, at 6:43:58
In reply to Re: insomnia on Nortrip! Help me block the NE SLS, posted by bleauberry on March 22, 2018, at 6:13:34
> I had terrible insomnia on Nortriptyine. I fell asleep ok. But I would sleep only for a short time and then wake up electrified.
>
> With the benefit of hindsight I would not resort to more drugs to counter that side effect, which should improve over weeks and months.I agree that this might happen. Broken sleep is distressing and, of course, affects daytime function. However, total insomnia must not be allowed to continue beyond a week. I remember sleeping for days after the initiation of nortriptyline for the first time. This is a good example of how the same drug can have opposite effects on different people.
> I would instead resort to insomnia herbs and calming herbs. A combo of 3 or 4 of them works wonders, even against powerful pharmaceuticals. I'm thinking things like Valerian, Passion flower, American Skullcap, Lemon Balm, and others. These offer additional health benefits over prescriptions.
Good idea.
These are reasonable alternatives. Valerian root is supposed to be effective, and likely works on GABA-A receptors. Just remember: Regardless of its source, a substance that exerts pharmacological effects and is being used medicinally is a drug. I don't know how these herbal substances interact with other drugs. I would spend some time on Google today researching this stuff - including drug interactions.
- Scott
Posted by SLS on March 22, 2018, at 7:52:18
In reply to Re: insomnia on Nortrip! Help me block the NE SLS » SLS, posted by porkpiehat on March 20, 2018, at 14:20:25
Posted by bleauberry on March 22, 2018, at 8:03:56
In reply to Re: insomnia on Nortrip! Help me block the NE SLS, posted by SLS on March 22, 2018, at 6:43:58
> > I would instead resort to insomnia herbs and calming herbs. A combo of 3 or 4 of them works wonders, even against powerful pharmaceuticals. I'm thinking things like Valerian, Passion flower, American Skullcap, Lemon Balm, and others. These offer additional health benefits over prescriptions.
>
> Good idea.But I would like to add to that - single or duo herbs are usually much less effective than 3-5 herbs. That's because unlike medications, these plants have multifaceted mechanisms and actions, often dozens or even hundreds per plant. Almost as if God planned it that way, or a miracle of Mother Nature, most herbs synergise with each other and make each other better.
>
> These are reasonable alternatives. Valerian root is supposed to be effective, and likely works on GABA-A receptors. Just remember: Regardless of its source, a substance that exerts pharmacological effects and is being used medicinally is a drug. I don't know how these herbal substances interact with other drugs. I would spend some time on Google today researching this stuff - including drug interactions.While it's true plants have medicinal properties, many of them are eaten as foods in other countries. In my opinion, all psychiatric patients should do a 3 month trial of Cordyceps mushroom - the dose is 6000mg and up. Maca Root is another one. It has amazing medicinal properties, especially for psychiatric use, but is eaten like a food in its native land. They eat it like potatoes.
Most herbs have extremely low toxicity risk even at massive doses. There are studies on most of them. The only drug-drug reaction I encountered in many dozens of herbs was that the herb Chinese Skullcap seemed to speed up CYP-3A4 enzyme and chew up my Viagra. I had to use a higher dose of Viagra while on that herb.
When I was my sickest it was difficult to even get started on something simple and basic, such as Vitamin C. I was sensitive even to that! I had to start herbs at tiny doses. Opening capsules was common. But now, a couple years later, I can take full doses no problem. It was the systemic inflammation the whole time that was making me so sensitive.
I just think it makes sense to try a handful of herbal medicines before committing to a chemical medication. But I would also add to that, anyone with insomnia, needs sleep now, not next week or the week after - now! So while they are setting themselves up to experiment with herbs combos, they may need temporary assistance from meds just to get a decent night of sleep immediately.
Posted by SLS on March 22, 2018, at 14:16:18
In reply to Re: insomnia on Nortrip! Help me block the NE SLS » SLS, posted by bleauberry on March 22, 2018, at 8:03:56
Hi, Bleauberry.
> > > I would instead resort to insomnia herbs and calming herbs. A combo of 3 or 4 of them works wonders, even against powerful pharmaceuticals. I'm thinking things like Valerian, Passion flower, American Skullcap, Lemon Balm, and others. These offer additional health benefits over prescriptions.
> > Good idea.
> But I would like to add to that - single or duo herbs are usually much less effective than 3-5 herbs.How can you make such a generalized statement like that? That's like saying 1-2 antidepressants are less effective than 3-5 antidepressants. Perhaps you could provide scientific evidence of this? I find this kind of generalization counterproductive, if not dangerous.
> That's because unlike medications, these plants have multifaceted mechanisms and actions
How can you say this? There is a panoply of medications that have multifaceted mechanisms of action. Todays drug research involves refining molecules so that they perform multiple actions.
> often dozens or even hundreds per plant.
Can you name one plant that has revealed hundreds of medicinal mechanisms of action as delineated by science?
> Almost as if God planned it that way
Uh, oh.
> or a miracle of Mother Nature
Don't look now, but man is a miracle of Mother Nature. Is it unnatural for man to fashion a tool from flint using the hands and brain that he was endowed with? Is it unnatural to plant and harvest herbs agriculturally? Is it unnatural to refine herbs and concentrate them into oils? Is it unnatural to refine oil and produce drugs from it?
> Most herbs synergise with each other and make each other better.
This is not a fact. It is an overgeneralization. It sounds wonderful, though. Well, perhaps you are right. Belladonna and Hemlock can be combined to produce a synergistic effect - death.
> While it's true plants have medicinal properties, many of them are eaten as foods in other countries.
The point being? Do you mean that if eaten as a food, there will be no pharmacological effect from the substances contained in it? It doesn't matter what the source of a pharmacological substance is. If enough of it is introduced into the body per unit time, it will produce a change in biological function.
> In my opinion, all psychiatric patients should do a 3 month trial of Cordyceps mushroom - the dose is 6000mg and up.
It is interesting that you should have such an opinion. Lucky caterpillars.
Not all psychiatric patients have bipolar disorder. Not all psychiatric patients have schizophrenia. Not all psychiatric patients have OCD... etc. All psychiatric patients should understand that a drug that works for one person will not work for another. Now, can you give any foundation for why this mushroom is a panacea for all psychiatric patients? Do you happen to know what the mechanisms of action are? It is not necessary to know this, of course. If it works, it works. If it has no adverse effects, so much the better. Cordyceps is contraindicated in pregnancy, by the way.
> I just think it makes sense to try a handful of herbal medicines before committing to a chemical medication.
In other words, you think it makes sense to take a handful of herbs, each containing an array of chemicals that can yield hundreds of mechanisms of action.
No thank you.
- Scott
Posted by Porkpiehat on March 22, 2018, at 15:40:03
In reply to Re: insomnia on Nortrip! Help me block the NE SLS » bleauberry, posted by SLS on March 22, 2018, at 14:16:18
Update:
Day five of nortriptyline with Marplan and lamictal. I take it during the day and the addition of alpha and beta blockers at night has taken the sleep issue away.
Unfortunately Im finding it hard to make conversation during the first part of the day, becoming socially apathetic, and have zero sex drive. 25 mgs currently. The agitation/anger and oversleeping from the trazodone is gone. Not having the anxiety and concentration problems that I had the week I was on nothing. Compulsive drives have retuned also.
Not sure if this is the way to go :/
Posted by bleauberry on March 23, 2018, at 6:02:09
In reply to Re: insomnia on Nortrip! Help me block the NE SLS » bleauberry, posted by SLS on March 22, 2018, at 14:16:18
SLS I say this with utmost respect. No ill feelings are intended. But the fact is, when it comes to medicinal herbal science, you have minimal knowledge or experience. There is no credibily for any of the 'challenges' you aimed at me.
You are trying to compare the herbal medicinal approach to psychiatry as if it was a medicinal approach which is sort of like comparing a football game to a basketball game. The strategies are different if you want to score points. It requires a book to explain that. I don't have enough space here to do that. I cannot effectively answer your questions without a lot of time and writing.
Western medicine and Eastern medicine are very different. In America science is primarily concerned with how things work. The Chinese don't care about that. They care about WHAT works. They view medical issues in terms of bizarre analogy's of liver, kidney, spleen, lungs, ying and yang, hot and cold, dampness, dryness. Pharmacies have countless drawers filled with medicinal leaves, stems, twigs, roots and flowers. They also have medicines.
The best healing on earth - in my opinion - is when Eastern medicine and Western medicine are married together into a hybrid. That's how I got better - some antibiotics and some roots, leaves and twigs.
I almost got the sense you were being hostile and bullying towards me. Not sure. If yes, that's ok. I understand. If no, then I just interpreted your words wrong.
I can help you with specific herb-herb questions if you have any curiosity on this one or that one or whatever.
But if you want a good grasp of how the two different approaches to treating disease work, it will take some effort on your part. There is no better way to do that, that I am aware of, than these two books:
1. WHY CAN'T I GET BETTER - SOLVING THE MYSTERIES OF LYME AND CHRONIC DISEASE. Richard Horowitz
Another book also - HOW CAN I GET BETTER? - Horowitz
(just ignore the 'lyme' part of it - pretend you don't have lyme - that is the way for you to read this book - read it as a critic, as a pessimist - this is a great book for you, in my opinion, because it is written by a nationally renowned expert and answers every question you have asked me.2. HEALING LYME - SOLVING THE MYSTERIES OF LYME AND CHRONIC DISEASE - Stephen Buhner.
Both of these books have a good potential to cause remission in medically failed patients with long standing treatment resistant depression, bipolar, anxiety and schizo-affective syndromes. My case is not rare. My case is common. My psychiatric response to blanket shotgun strategies of anti-systemic inflammation, anti-brain inflammation, antimicrobials, and anti-toxins is not unusual. It was profoundly successful but not unusual. You can expect a different game and different results than the DSM manuals.
Hope this helps.
> Hi, Bleauberry.
>
> > > > I would instead resort to insomnia herbs and calming herbs. A combo of 3 or 4 of them works wonders, even against powerful pharmaceuticals. I'm thinking things like Valerian, Passion flower, American Skullcap, Lemon Balm, and others. These offer additional health benefits over prescriptions.
>
> > > Good idea.
>
> > But I would like to add to that - single or duo herbs are usually much less effective than 3-5 herbs.
>
> How can you make such a generalized statement like that? That's like saying 1-2 antidepressants are less effective than 3-5 antidepressants. Perhaps you could provide scientific evidence of this? I find this kind of generalization counterproductive, if not dangerous.
>
> > That's because unlike medications, these plants have multifaceted mechanisms and actions
>
> How can you say this? There is a panoply of medications that have multifaceted mechanisms of action. Todays drug research involves refining molecules so that they perform multiple actions.
>
> > often dozens or even hundreds per plant.
>
> Can you name one plant that has revealed hundreds of medicinal mechanisms of action as delineated by science?
>
> > Almost as if God planned it that way
>
> Uh, oh.
>
> > or a miracle of Mother Nature
>
> Don't look now, but man is a miracle of Mother Nature. Is it unnatural for man to fashion a tool from flint using the hands and brain that he was endowed with? Is it unnatural to plant and harvest herbs agriculturally? Is it unnatural to refine herbs and concentrate them into oils? Is it unnatural to refine oil and produce drugs from it?
>
> > Most herbs synergise with each other and make each other better.
>
> This is not a fact. It is an overgeneralization. It sounds wonderful, though. Well, perhaps you are right. Belladonna and Hemlock can be combined to produce a synergistic effect - death.
>
> > While it's true plants have medicinal properties, many of them are eaten as foods in other countries.
>
> The point being? Do you mean that if eaten as a food, there will be no pharmacological effect from the substances contained in it? It doesn't matter what the source of a pharmacological substance is. If enough of it is introduced into the body per unit time, it will produce a change in biological function.
>
> > In my opinion, all psychiatric patients should do a 3 month trial of Cordyceps mushroom - the dose is 6000mg and up.
>
> It is interesting that you should have such an opinion. Lucky caterpillars.
>
> Not all psychiatric patients have bipolar disorder. Not all psychiatric patients have schizophrenia. Not all psychiatric patients have OCD... etc. All psychiatric patients should understand that a drug that works for one person will not work for another. Now, can you give any foundation for why this mushroom is a panacea for all psychiatric patients? Do you happen to know what the mechanisms of action are? It is not necessary to know this, of course. If it works, it works. If it has no adverse effects, so much the better. Cordyceps is contraindicated in pregnancy, by the way.
>
> > I just think it makes sense to try a handful of herbal medicines before committing to a chemical medication.
>
> In other words, you think it makes sense to take a handful of herbs, each containing an array of chemicals that can yield hundreds of mechanisms of action.
>
> No thank you.
>
>
> - Scott
>
Posted by SLS on March 23, 2018, at 12:19:05
In reply to Re: insomnia on Nortrip! Help me block the NE SLS » SLS, posted by bleauberry on March 23, 2018, at 6:02:09
Hi, Bleauberry.
> SLS I say this with utmost respect. No ill feelings are intended. But the fact is, when it comes to medicinal herbal science, you have minimal knowledge or experience. There is no credibily for any of the 'challenges' you aimed at me.
I dont know why you should assume that I have no knowledge or belief in the utility of herbs and the phenomenology of tick-borne disease.
My questions demonstrate my lack of credibility? Youre not answering questions might demonstrate your lack of credibility. The few challenging questions I asked you deserve answers. I dont have to know anything to ask them. They are rather common sense questions. You write copiously and flood pages with words. My questions really dont require much space to answer.
> You are trying to compare the herbal medicinal approach to psychiatry as if it was a medicinal approach which is sort of like comparing a football game to a basketball game.I dont know how many times I have to make the point to you that herbs are chemicals. This is science. It is fact. It is extremely scientific and also disposed to common sense to acknowledge this.
> The strategies are different if you want to score points. It requires a book to explain that. I don't have enough space here to do that.
Yes, Bleauberry. I dont have enough space or time to explain fully the absurdity of the statements you made in the post I responded to previously. I asked only questions that do not require much space to answer. I would like to see you answer them. Lets try this. I believe that plants contain molecules that have pharmacological propertites. They are and used as drugs. Atropine is no less a drug just because it is contained in the Atropa belladonna plant. Correct? THC is no less a drug just because it is contained in cannabis plants. Your distinction is merely semantic and arbitrary. There has been much work performed in Israel on marijuana to identify those substances that have medicinal properties. Part of their research involves how these molecules may act in concert to produce the observed clinical effects. Hopefully, this research will be able produce preparations for human consumption that enhances the therapeutic effects while reducing unwanted side effects.
> I cannot effectively answer your questions without a lot of time and writing.
Yes. You already mentioned this. You dont need to write a book to address my questions.
> Western medicine and Eastern medicine are very different. In America science is primarily concerned with how things work. The Chinese don't care about that. They care about WHAT works.Not so different, really. Thats how drugs are discovered in western medicine. There is a science to determine what works before determining how things work. Thousands of compounds are screened for clinical activity without regard to their pharmacology. If you notice, most psychiatric drugs are accompanied by a label that states that the mechanism of action is not understood. Fortunately, science is uncovering much of what these molecules do physiologically in an effort to elucidate how they work so that more efficient drugs can be designed.
> They view medical issues in terms of bizarre analogy's of liver, kidney, spleen, lungs, ying and yang, hot and cold, dampness, dryness. Pharmacies have countless drawers filled with medicinal leaves, stems, twigs, roots and flowers. They also have medicines.I know this to be true. So, what is your point? During the thousands of years that the Chinese have practiced medicine, microscopes and purified organic compounds were not available to progress beyond using the only things available botanicals. It is only recently that the practice of medicine in Europe and North America has included synthesized molecules many of which came from botanicals. I believe that Traditional Eastern Medicine progressed far beyond that of the Western world through the centuries. However:
> The best healing on earth - in my opinion - is when Eastern medicine and Western medicine are married together into a hybrid. That's how I got better - some antibiotics and some roots, leaves and twigs.
I agree with you. The whole Universe represents a resource of knowledge and understanding and healing. East, West, Up, Down. Wherever. I believe in the use of botanicals especially when they have been proven to be safe and effective. Unfortunately, this is often not the case.
> I almost got the sense you were being hostile and bullying towards me. Not sure.
I am emoted because so much of what you write is misinformation. To suggest that:
> In my opinion, all psychiatric patients should do a 3 month trial of Cordyceps mushroom - the dose is 6000mg and up.
> But I would like to add to that - single or duo herbs are usually much less effective than 3-5 herbs.
>That's because unlike medications, these plants have multifaceted mechanisms and actions.
> I just think it makes sense to try a handful of herbal medicines before committing to a chemical medication.
Perhaps you would like to:
1. Revise your phraseology.
2. Provide evidence that your statements are true.
3. Do nothing.> I can help you with specific herb-herb questions if you have any curiosity on this one or that one or whatever.
I appreciate your offer. I will take you up on that from time to time.
Lyme Disease? Yes. Lyme Disease can cause psychiatric symptoms, including suicide. I dont understand why anyone would question why this spirochete could not have these effects, especially since it was a spirochete (syphilis) that drove Al Capone mad.
> But if you want a good grasp of how the two different approaches to treating disease work, it will take some effort on your part.Right back atcha!
As Ive said before, I appreciate your enthusiasm.
- Scott
Posted by SLS on March 23, 2018, at 12:20:55
In reply to Re: insomnia on Nortrip! Help me block the NE SLS » SLS, posted by Porkpiehat on March 22, 2018, at 15:40:03
> Update:
>
> Day five of nortriptyline with Marplan and lamictal. I take it during the day and the addition of alpha and beta blockers at night has taken the sleep issue away.
>
> Unfortunately Im finding it hard to make conversation during the first part of the day, becoming socially apathetic, and have zero sex drive. 25 mgs currently. The agitation/anger and oversleeping from the trazodone is gone. Not having the anxiety and concentration problems that I had the week I was on nothing. Compulsive drives have retuned also.
>
> Not sure if this is the way to go :/What are you taking for sleep and at what dosages?
- Scott
Posted by porkpiehat on March 23, 2018, at 12:55:57
In reply to Re: insomnia on Nortrip! Help me block the NE SLS, posted by SLS on March 23, 2018, at 12:20:55
for sleep I take doxylamine 25 mg, ativan 1mg, 10mgs propranolol, and 2mg prazosin.
I have tried leaving off any one of the components I do not sleep. Sometimes I add 100 mgs gabapentin for improved sleep and mood, but it may contribute to the stupid feeling I have during the first part of the day.
On the trazodone I slept much more deeply but had trouble rising, and the aforementioned anxiety/agitation/anger, as well as the compulsive issues.
it did take care of the GI issues and my concentration/social confidence was addressed.
Posted by SLS on March 23, 2018, at 13:45:12
In reply to Re: insomnia on Nortrip! Help me block the NE SLS » SLS, posted by porkpiehat on March 23, 2018, at 12:55:57
> for sleep I take doxylamine 25 mg, ativan 1mg, 10mgs propranolol, and 2mg prazosin.
Gosh. I think this is a job for Ed_UK.
I would think that propranolol is a potential culprit for the mood/behavioral symptoms you experience in the morning. Not sure. You could remove it temporarily to see what happens. Alternatively, you could try increasing the doxylamine to determine if it is responsible for these symptoms. I know that everyone is different, but prazosin 20 mg/day does not affect my desire to socialize. In addition, prazosin does not help with sleep. However, it has a positive impact on depression. I divide prazosin in dosing 3 times a day.
What happens when you raise the Ativan to 2 mg h.s.?
> On the trazodone...
> ...it did take care of the GI issues and my concentration/social confidence was addressed.What other drugs have helped with these things?
Trazodone:
1. Weak SRI
2. Anticholinergic
Doxylamine:
1. Antihistamine
2. Anticholinergic
Paxil:
1. Strong SRI
2. AnticholinergicPaxil can help with IBS (anticholinergic) as well as depression and social anxiety (SRI).
- Scott
Posted by bleauberry on March 23, 2018, at 14:13:20
In reply to Re: insomnia on Nortrip! Help me block the NE SLS, posted by SLS on March 23, 2018, at 12:19:05
SLS you are treating me differently than you treat everybody else here. I don't think that is fair.
I am being bullied. Some of the questions and comments have a malicious attacking tone to them. I don't understand the hostility. I am ok with it though I don't understand it.
Pessimism and condescension are not helpful in psychiatry, if you ask me. Just my opinion.
After 20+ years of treatment resistant depression I was fortunate to run into two doctors and one nurse practitioner who knew how to undo the treatment resistant part of the equation. I say that is good. But you say not so fast. I don't get that. ??? Most people would be excited about that, I think?
Some of your questions have some genuine curiosity in them. But many of the other questions seem hostile. I don't get it. ???
I share what those M.D.s taught me. My goal is to see people get well. Really well. Not somewhat well. Really, really well. And fast. Three years is the longest it should take, if you ask me. Ok five years - add in 2 beginning years with psych meds, and then add on 3 years with other stuff. I say that because the doctors told me I was the toughest case they had seen, psychiatrically speaking. The toughest case they had seen was in remission in 3 years following their protocols and prescriptions. My case was worse than yours in terms of suicidality and hospitalization and failed ECT but 3 years did it.
Like you, I failed MAOIs and tricyclics and all sorts of exotic combos. Failed 12 bilateral ECT sessions that cost $28,000. But found remission on cheap generic meds and some herbs. My story is just one of millions. Remission is actually not that far away, when there is a comprehensive game plan that involves more than just psychiatric mono-therapy.
Decades-long fights to improve mood are not justified, if you ask me. That is just not acceptable to me. Healing shouldn't take that much time unless new ideas, new strategies, and success stories are purposely edited out. Then it gets a lot harder and longer and likely impossible at some point.
Most of what I have shared over the years has been met with hostility by SLS. I am ok with that. There are people here who have in the past, currently and in the future, experience genuine hope, genuine improvement of quality of life, from the things I bring here to share. People want answers and options. Especially when conventional wisdom is failing them.
Free will.
ALL options should be employed - Psychiatric meds, Western world meds, Eastern world twigs, leaves and buds. It does not involve re-inventing the wheel or winging it. Everything is spelled out in great detail, including substances, brands, doses, mechanisms, managing complications, making an accurate diagnosis, frequency, etc etc. I have fortunately, or unfortunately, depending how you look at it, 20 years, gathered mountains of experience and knowledge on all of those topics. It would be a crime for me not to help other people with what I know.
If sometime in your life you read either or both of the two books I suggested - both are cheap, easy to read, and full of stuff you can relate to - then I predict you and I will be more on the same page. It is not easy busting out of the psychiatric cocoon to invite other strategies on board. Been there, done that. Not easy. Great resistance. I was there. I get that.
I am just a messenger here. I speak the things my 2 doctors and 1 nurse spoke. I share what is in books with good track records. Many patients are sadly failed by establishment-like thinking by clinicians and conventional thinking by clinicians. The ones who do not operate inside echo chambers or conventional wisdom seem to get people well when other approaches fail.
Each of us is on a unique journey. Free will.
Posted by SLS on March 23, 2018, at 15:38:46
In reply to Re: insomnia on Nortrip! Help me block the NE SLS » SLS, posted by bleauberry on March 23, 2018, at 14:13:20
I will attempt to adjust my tone.
Perhaps you can, too?
I appreciate the journey that you have taken to seek healing. Apparently, we have both been exposed to medical literature and doctors' wealth of knowledge cumulatively. However, when you write things that I consider to be misinformation or misleading, I will call you out on it - as I think you should do with me. I try to keep an open mind. I have tried rotation diets, numerous supplements, and various herbs in the past. Even though I did not find healing in them, I don't discard them as therapeutic modalities for others. I do not consider my knowledge of these things sufficient to comment on them very often. Your knowledge of herbs is by far superior to mine. However, I would offer that you perhaps not generalize your conclusions to advise others.
"In my opinion, all psychiatric patients should do a 3 month trial of Cordyceps mushroom - the dose is 6000mg and up."
Can you expand on this?
- Scott
Posted by ed_uk2010 on March 23, 2018, at 16:38:04
In reply to Re: insomnia on Nortrip! Help me block the NE SLS » SLS, posted by bleauberry on March 23, 2018, at 14:13:20
Hi Blue,
Here's my take on it :)
>Pessimism and condescension are not helpful in psychiatry, if you ask me. Just my opinion.
That's something I strongly agree with. The right attitude is needed to get well. The treating physician should attempt to pass some of this positivity on to the patient. There is no possibility of getting someone to engage by acting in a condescending manner. I think this is one of the reasons for benefit when people see an alternative therapist ie. they feeling that they are being listened to and given choices in their treatment which they have control over. This can be very therapeutic, and is one advantage of herbal medicine.
>I was fortunate to run into two doctors and one nurse practitioner who knew how to undo the treatment resistant part of the equation. I say that is good. But you say not so fast. I don't get that. ???
I'd say that is really good. BUT, what I'd also say is that in conditions such as depression which are exceptionally variable (in potential cause, presentation, treatment response, course and outcome), it is very difficult to apply your own treatment response to other people, including when you have the incomplete picture created on a forum. So, I'd only say 'not so fast' in assuming that others respond the same way.
A program based on herbs and antibiotics is one possibility in mental health. And an interesting one. I have myself taken long courses of antibiotics for non-psychiatric reasons, as well as several herbs. My mental health was not affected. Depression is very individual, and although positivity is important, I also think it's important to present treatment ideas as exactly that - ideas, and not definitive general solutions.
>when there is a comprehensive game plan that involves more than just psychiatric mono-therapy.
Now this is something I find interesting. To me, suggesting Lyme and micro-organisms as being the major cause of mental illness isn't really comprehensive or holistic. Already, it is assuming one particular type of causation, rather than a range. Certainly, this may apply to you and some others, but that doesn't mean it applies to everyone.
You could for example say.... those suffering from chronic treatment-resistant depression should be considered for a course of antibiotics, minocycline, for example. I think that would be reasonable. It is one of the possibilities.
To me, the most important thing here is about maintaining an open mind when standard options fail. In conditions such as depression, chronic fatigue and other multi-factorial illnesses, I wouldn't want to apply one particular causation or general treatment regimen to everyone. That could lead to more problems eg. when antibiotics fail, what next.
Posted by SLS on March 29, 2018, at 21:23:54
In reply to Re: insomnia on Nortrip! Help me block the NE SLS » SLS, posted by porkpiehat on March 23, 2018, at 12:55:57
Porkpiehat:
How are you doing?
- Scott
Posted by porkpiehat on April 15, 2018, at 16:58:20
In reply to Re: insomnia on Nortrip! Help me block the NE SLS » porkpiehat, posted by SLS on March 29, 2018, at 21:23:54
> Porkpiehat:
>
> How are you doing?
>
>
> - ScottHey man. I don't get pbabble notifications in my mail so I drift away.
No simple answers there...
I gave up on nortriptyline after a week because of apathy. Sleep got better when I took both propranolol and prazosin before bed, but ultimately the apathy sucked and so did the return to marplan side effects (tiredness, gasiness)
I went back to small dose of trazodone, 1mg of ativan, and half a doxylamine tablet.
sex drive came back, but my compulsiveness is becoming worse. I've been drinking every single night again (alone) and staying up late either buying or shopping for boats and fishing gear or related projects. Between this and the amount of pills I'm taking, and smoking a pack a day, I'm getting concerned. I'm getting fat and eat what I want and completely lost any kind of vision for my future.
Did a trial of hyrdroxyzine at night again as it has 5ht2a inhibition like trazodone and nortriptyline....I found way less comulsiveness/obsession in the next days probably because it also antagonizes D2 and alpha receptors. No uncontrollable drive to drink, felt embarrassed over the ridiculous amount I'm spending and the lack of self control. The downside of the D2/alpha action is that sex and social drives dropped too.
Really trying to get back into dating/and friends so this isn't good. Sleep wasn't great either. So I stopped.
Last week back on the trazodone and ativan. bought a kayak and hundreds of dollars of accessories.
Some of this impulsiveness I remember having on lamictal and SSRI's, but the crazy acting out happens typically when I take dopaminergics (ritalin, adderal, even Abilify)
This has been my MO since starting MAOIs last April/May. I would have switched off earlier but switching from Parnate to Marplan really improved my mood. Still get a weird scared feeling at times.
I wonder if the MAOI's increase compulsiveness in others or it's just my response to dopamine...I'm sure there's a pyschological component...plus the chance that these might be bi-polar tendencies.
This weekend I'm back on hydroxyzine because I was up until 3:30 am Friday night modifying my kayak and drinking bourbon...despite needing to be up early.
I'm terrified of coming off Marplan it has helped in so many ways. I don't see other options, and the withdrawl sounds miserably. And I hate antipsychotic add-ons.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.