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Dr. Bob is Robert Hsiung, MD,
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Posted by beckett2 on April 8, 2018, at 17:51:47
In reply to Re: Why is alcohol the only thing that helps me? » beckett2, posted by linkadge on April 8, 2018, at 17:20:46
> >Would you consider lack of motivation an >expression of anhedonia?
>
> Absolutely.
>
> We do things that we enjoy doing. If we enjoy doing it, we want to repeat it. When we stop enjoying things (or everything) we stop doing things.
>
> Its a learned response.
>
> Lack of motivation (for me) has slowly crept up as I stopped enjoying doing the things I once did. If the action stops providing pleasure, we stop doing it.
>
> Linkadge
>
>
>
>Do you think MMJ might help you with that? Maybe it's something else you're seeking, too.
Posted by Prefect on April 9, 2018, at 11:55:47
In reply to Re: Why is alcohol the only thing that helps me? » linkadge, posted by beckett2 on April 8, 2018, at 17:51:47
My concern is that it's come to the point I have to drink a whole bottle of whiskey a day in order to function. The more I drink I have to consume more and more since the alcohol is likely desensitizing my GABA receptors and causes a rebound effect where I feel withdrawal and likely suffer from rebound glutamate excitotoxicity when I don't drink.
I need to find an alternative. I'm considering weening off using clonazepam, get off the zoloft, and start taking Fluvoxamine at nights and abilify in the morning to see of it helps.
Posted by bleauberry on April 9, 2018, at 13:14:20
In reply to Why is alcohol the only thing that helps me?, posted by Prefect on April 6, 2018, at 14:34:51
My first gut instinct guess is that alcohol is stimulating the release of dopamine which might be your weak link, and that the way it stimulates dopamine is different than any of the psych meds.
I experienced the exact same things you described and the medication that fixed it all like magic was the medication I thought would make it all much worse - Ritalin!
It could be that dopamine is the weak link. As the adrenal glands try to compensate for that, they pump out the best substitutes they have, which are adrenalin-like. And thus your symptoms. When dopamine is normalized, those symptoms go away.
Your story and mine are identical except for 2 things. Ritalin for me instead of alcohol. And a diagnosis of Lyme as well. Your symptoms are 100% consistent with an unsuspected, stealth, misdiagnosed or undiagnosed, tick born disease. Either Borellia or Bartonella - both are bacterias from ticks - present a symptom profile that looks exactly like what you described.
Alcohol likely makes your problems and your life worse in the long run. It is generally destructive to many people. I would try experimenting with other things that hit dopamine.
And consider going a step further than merely treating the symptoms - set your sites on figuring why it is all happening in the first place - there is a reason - and in my experience it is not often the mystery we think it is - not often the complicated unsolvable puzzle that we think it is.
imo
> I suffer from severe anxiety, inner tension, tremors, cognitive deficit, derealization, etc
>
> One double shot of whiskey gives me more relief than 1 mg of clonazepam. I am able to think, I become more motivated, relaxed, and my inner tension and tremors stop.
>
> What is the mechanism behind this? It can't just be GABA and NMDA antagonism otherwise clonazepam would work too. It's got to be something else alcohol does that I need to find a medication that can do the same, otherwise I'm on the path to alcoholism.
>
> And no, my symptoms are not from alcohol withdrawal, I had them for a year before I accidentally discovered alcohol practically makes me NORMAL for a few hours.
Posted by SLS on April 9, 2018, at 15:03:13
In reply to Re: Why is alcohol the only thing that helps me?, posted by Prefect on April 9, 2018, at 11:55:47
> My concern is that it's come to the point I have to drink a whole bottle of whiskey a day in order to function. The more I drink I have to consume more and more since the alcohol is likely desensitizing my GABA receptors and causes a rebound effect where I feel withdrawal and likely suffer from rebound glutamate excitotoxicity when I don't drink.
>
> I need to find an alternative. I'm considering weening off using clonazepam, get off the zoloft, and start taking Fluvoxamine at nights and abilify in the morning to see of it helps.Why are you discontinuing Zoloft and starting fluvoxamine?
Have you tried:
Lamictal
Trileptal
Tegretol
N-acetylcysteine (NAC)Lamictal might increase dopamine (secondary to glutamate release inhibition). Tileptal and Tegretol can reduce glutamate and exitotoxicity. Tegretol can be sedating, which might be good in your case. NAC modulates glutamatergic activity and can increase dopamine, but often takes several months to take effect. Perhaps reducing inflammation is involved. I really don't know. Andrew Nierenberg suggested combining Lamictal with NAC.
Some people do well on a combination of Abilify, Lamictal, and Wellbutrin for severe depression. If you react poorly to Wellbutrin because of anxiety, aggitation, or dysphoria, nortriptyline or a SRI might make a good substitute.
- Scott
Posted by linkadge on April 9, 2018, at 17:01:15
In reply to Re: Why is alcohol the only thing that helps me?, posted by Prefect on April 9, 2018, at 11:55:47
Have you tried other anticonvulsants / mood stabilizers.
Topomax? Lamotrigine? Pregabalin?
Linkadge
Posted by Phillipa on April 9, 2018, at 17:19:06
In reply to Re: Why is alcohol the only thing that helps me?, posted by Prefect on April 9, 2018, at 11:55:47
Chloral hydrate is what stopped me from drinking the 4-5 beers a night. It does sound like you are building up a huge tolerance to alcohol. Can you stop drinking? If not than see an addiction specialist. Inpatient with valium and slowly weaning down. Phillipa
Posted by beckett2 on April 9, 2018, at 18:33:27
In reply to Re: Why is alcohol the only thing that helps me?, posted by Prefect on April 9, 2018, at 11:55:47
Lyrica has been helpful. I took Xanax for many years, and I just needed something after I detoxed. It's a thought. The effect is pro social and allows me some relaxation and enjoyment. (Just can't drive for the day after a certain amount.) Life is tough on the inside for some of us :/
Posted by Prefect on April 9, 2018, at 19:49:36
In reply to Re: Why is alcohol the only thing that helps me? » Prefect, posted by SLS on April 9, 2018, at 15:03:13
I'm discontinuing zoloft because it's not not working. I've been on it for almost a year at 150mg per day and it's not helping. I've also read zoloft and lamictal are a toxic combination. I want to taper of and either try prozac with lamital or luvox with abilify.
Posted by Prefect on April 9, 2018, at 20:13:00
In reply to Re: Why is alcohol the only thing that helps me? » Prefect, posted by bleauberry on April 9, 2018, at 13:14:20
I'm not sure I understand this lyme angle. I've been suffering from various form of this for 20 years. My understanding is antibiotics onlt work for lyme in the first 6 months of infection. You're proposing I go on antibiotics for a possible lyme infection after 20 years? Would it even work now?!
Posted by Prefect on April 9, 2018, at 20:23:56
In reply to Re: Why is alcohol the only thing that helps me? » Prefect, posted by SLS on April 9, 2018, at 15:03:13
I should add when I started luvox 20 years ago I had more positive results from 25 mg per night than I'm getting from 150 mg of zoloft a day. I suspect the sigma 1 agonism of luvox might be my therapeutic answer rather than just more serotonin. Zoloft is in fact a sigma 1 antagonist.
Posted by SLS on April 9, 2018, at 21:04:57
In reply to Re: Why is alcohol the only thing that helps me? » SLS, posted by Prefect on April 9, 2018, at 19:49:36
> I'm discontinuing zoloft because it's not not working. I've been on it for almost a year at 150mg per day and it's not helping. I've also read zoloft and lamictal are a toxic combination.
I didn't know that. In what way are they toxic?
> I want to taper of and either try prozac with lamital or luvox with abilify.
Will you add Lamictal if you go with Abilify and Luvox? I should think that the three drugs would go together well. What do you think?
- Scott
Posted by Prefect on April 9, 2018, at 21:16:47
In reply to Re: Why is alcohol the only thing that helps me? » Prefect, posted by SLS on April 9, 2018, at 21:04:57
Aparently one severly interferences with clearance of the other:
https://www.ncbi.nlm.nih.gov/pubmed/9627209
But I've read positive literature about prozac/lamictal combo for depersonizaltion disorder.
Why do you feel lamictal would be a good add on to luvox+abilify?
Posted by SLS on April 9, 2018, at 22:43:48
In reply to Re: Why is alcohol the only thing that helps me? » SLS, posted by Prefect on April 9, 2018, at 21:16:47
> Aparently one severly interferences with clearance of the other:
>
> https://www.ncbi.nlm.nih.gov/pubmed/9627209
>
> But I've read positive literature about prozac/lamictal combo for depersonizaltion disorder.
>
> Why do you feel lamictal would be a good add on to luvox+abilify?I have seen Abilify + Lamictal work well for a woman with severe depression. These drugs are also critical for my feeling better (not remission yet). In my opinion, both drugs are pro-dopaminergic, albeit via different mechanisms. Abilify often acts to make SSRIs work better, so perhaps the three drugs together will help you. Lamictal is metabolized by glucuronidation, not by CYP450 enzymes, so I don't see any problems with pharmacokinetics. You might want to start Abilify at 2.0-5.0 mg/day. It is metabolized by CYP450 3A4 and 2D6. Luvox might increase blood levels of Abilify. I'm not sure. For me, 15 mg/day of Abilify is optimal, but I have bipolar depression. I had severe depersonalization and derealization earlier in the course of my illness. If depersonalization is a feature of your condition, you might need to titrate the Abilify upwards. There are reports of Abilify helping:
https://www.ncbi.nlm.nih.gov/pubmed/24992087
Keep bothering Linkadge. He knows his stuff and thinks outside the box. I'm sure he can help you.
- Scott
Posted by Prefect on April 10, 2018, at 11:07:07
In reply to Re: Why is alcohol the only thing that helps me?, posted by SLS on April 9, 2018, at 22:43:48
I'll be taking Luvox at night. Would I take Lamictal at nigh too? I suspect it's somewhat sedating.
Posted by Prefect on April 10, 2018, at 11:18:47
In reply to Re: Why is alcohol the only thing that helps me? » Prefect, posted by bleauberry on April 9, 2018, at 13:14:20
BTW I should mention I've tested positive for Bartonella not even through a specialized testing lab but a public health lab.
You mention Ritalin, would low dose abilify not rebalance dopamine levels as well? It's a D1 agonist.
Posted by Prefect on April 10, 2018, at 12:21:03
In reply to Re: Why is alcohol the only thing that helps me? » Prefect, posted by bleauberry on April 9, 2018, at 13:14:20
Also I have a lot of inner tension, tachycardia, and sensory agitation. Would Ritalin not make this worse, because it's also a norepinephrine reuptake inhibitor. I went on Fetzima last year for a weak and it turned me into a basketcase.
Posted by linkadge on April 10, 2018, at 16:50:42
In reply to Re: Why is alcohol the only thing that helps me? » bleauberry, posted by Prefect on April 9, 2018, at 20:13:00
There are a few new studies linking overuse of antibiotics to an increased risk of future heart disease.
Of course, if you need them, use them. The notion, however, that people should be on a steady stream of antibioticis is perhaps a bit unwise.
Linkadge
Posted by SLS on April 10, 2018, at 17:08:00
In reply to Re: Why is alcohol the only thing that helps me? » bleauberry, posted by Prefect on April 10, 2018, at 12:21:03
> Also I have a lot of inner tension, tachycardia, and sensory agitation. Would Ritalin not make this worse, because it's also a norepinephrine reuptake inhibitor. I went on Fetzima last year for a weak and it turned me into a basketcase.
Fetzima sucks - except when it works :-). I just don't see any success stories, and I didn't like how milnacipran affects me.
Regarding Abilify, it is a D2/D3 partial agonist. It is thought to stabilize dopamine transmission. Abilify boosts transmission when there isn't enough (antidepressant) and dampens it when there is too much (antipsychotic). That's a bit simplistic, I guess.
Regarding Lamictal, you might find it a bit stimulating at first. Not like Ritalin, though. It is likely to be rather pleasant and feels like an antidepressant. This phenomenon can occur at 50 mg/day. If so, it will probaby fade in between dosage increases. For me, 200 mg/day helps quite a bit, but I need 300 mg/day to get the most improvement from Lamictal.
- Scott
Posted by Prefect on April 10, 2018, at 23:46:12
In reply to Re: Why is alcohol the only thing that helps me? » Prefect, posted by SLS on April 10, 2018, at 17:08:00
So my doctor refuses to give me more cloanzepam to ween off the alcohol. She presecribed me clonodine instead. We'll see how that works.
Posted by SLS on April 11, 2018, at 5:55:20
In reply to Re: Why is alcohol the only thing that helps me?, posted by Prefect on April 10, 2018, at 23:46:12
> So my doctor refuses to give me more cloanzepam to ween off the alcohol. She presecribed me clonodine instead. We'll see how that works.
Clonodine can be depressogenic - even in otherwise healthy people. If you get this reaction, you might opt for something else. Do you know if guanfacine is ever used? Both drugs are NE alpha-2a agonists.
Carbamazepine (Tegretol) and oxcarbazepine (Trileptal), both of which are anticonvulsants, are used to ease alcohol withdrawal. Perhaps you can research this.
https://www.ncbi.nlm.nih.gov/pubmed/?term=(carbamazepine+OR+oxcarbazepine)+alcohol+withdrawal
Important side effects:
Carbamazepine: Sedating; agranulocytosis
Oxcarbazepine: Hyponatremia
- Scott
Posted by baseball55 on April 11, 2018, at 18:52:26
In reply to Re: Why is alcohol the only thing that helps me? » Prefect, posted by SLS on April 11, 2018, at 5:55:20
Generally you shouldn't mix benzos and alcohol. This is how many people end up, accidentally or on purpose, killing themselves. Especially not with the quantity of alcohol you've been drinking.
Posted by rjlockhart37 on April 12, 2018, at 23:37:32
In reply to Why is alcohol the only thing that helps me?, posted by Prefect on April 6, 2018, at 14:34:51
whiskey is usally 80 proof alcohol, it bumps dopamine up, but also doing GABA, which is why you get punch of euphoria
benzos ... clonazepam, do not work on dopamine, mainly alprazolam is the one that touches dopamine
Posted by rjlockhart37 on April 12, 2018, at 23:48:48
In reply to Re: Why is alcohol the only thing that helps me?, posted by rjlockhart37 on April 12, 2018, at 23:37:32
when i was being ripped off alprazolam - alcohol - it did help with anxiety, and it helped withdrawls, f*ck those doctors they were worse in letting suffer, i've found other resorted treatments too
Posted by bleauberry on April 13, 2018, at 9:01:30
In reply to Re: Why is alcohol the only thing that helps me? » bleauberry, posted by Prefect on April 9, 2018, at 20:13:00
I understand your surprise and curiosity. It happened to me too after 20+ of psychiatric meds, a dozen psychiatrists, multiple diagnosis and all of them bad, failed ECT, failed backpacks full of prescriptions, total cost wasted estimated in the $120,000 range.
Then a Nurse Practitioner one day said that she has seen Lyme disease patients mistaken as psychiatric and she wondered if that had happened with me.
That was the beginning of a 3 year journey to REMISSION! After all that, remission was possible? Absolutely. You just have to hit the right target.
It is my opinion that most of us here a babble, and most psych patients in general, we are hitting the wrong targets. We are attempting to use psychiatric meds as long-term disease cures. They don't cure any diseases. They are excellent for acute manifestations and short term goals.
There are a ton of myths about Lyme. And antibiotics. I don't know where you got the '6 month' thing but that is one of the myths, one of many, many, many. There is a fair consensus that if you treat Lyme in the early stages - like perhaps within the first 6 months - then you can cure it, but that later Lyme is harder to treat. That is true. Not a myth. The deeper the bacteria dig into cartilage, done marrow, brain tissue, glands, the harder it is to reach them with the immune system or antibiotics.
But late Lyme can be cured. It is just harder. And when remission is reached, it can relapse requiring another round of treatment. Catching it early is definitely a better way to go.
But that often doesn't happen. Many people aren't even aware they had exposure to a tick. Nymph ticks are so small you might not even see it - smaller than a freckle. Half the time a bullseye rash does not happen. Half the time the lab test is wrong - the reason I was sick for 20+ years, including a stay in the psych ward.
If a doctor tests you and says, "I am happy to inform you that your test came back negative and it appears you don't have Lyme" - that is the same thing as sentencing an innocent prisoner to a lifetime in a dungeon with ever-increasing torture with time.
Both of my M.D.s and one N.P. are experts on Lyme. They all told me the same thing - that for every 1 person correctly diagnosed, there are an estimated 9 wrongly diagnosed - they got labelled as Fibromyalgia, Depression, Bipolar, Chronic Fatigue, Anxiety, and sometimes even Lupus and MS. They said nearly every new patient comes to them on psychiatric meds and poorly managed by previous doctors. And that when treatment is done, the psychiatric meds are either at much lower doses or eliminated completely.
In the lyme world, psychiatric meds are useful for short-term assistance. Sometimes they are needed permanently depending on longterm brain damage. For example in my case I know there has been some sort of long term impact in the dopamine system and Ritalin overcomes that. Nothing else could do that for me.
I did not experience any pscyhatric relief from antiobiotics until 1 year in. Remission didn't happen until year 3. The whole time I was on 2-4 antibiotics at a time, rotating every couple of months. There are reasons for that but I don't want to get into all that here.
You asked how would antibiotics work for 20+ years of suffering? Good question! My case is only one of millions and shows that it does work, can work. But how it works is more complicated.
In a nutshell - a stealth unsuspected infection - such as Borellia, Bartonella, Babesia, Mycoplasma (all from ticks and sometimes from cats, mosquitoes, flies, mice) - is going to produce toxins - poop, pee, enzymes, dead body parts, etc - in addition to the systemic inflammation damage to the body, and all of that debris floating around.
THAT stuff is what is jamming up our mood center in the brain. Get rid of that stuff. Antibiotics cause that to happen. When the population levels of pathogenic creatures are brought down to low levels (I think eradication is impossible) you no longer have symptoms. No more debris in the brain. Minimal anyway. Co-exist.
So longterm antibiotics work by two hypothesis:
1. Stop the source of the debris hitting the brain, the debris that is squashing out good mood chemicals or contaminating them....
2.Re-setting the immune system. My first LLMD had his own theory that antibiotics work by allowing the immune system to rest for some time. During that rest it can recover and reset. The immune system is intricately tied to mood. As anyone has noticed whenever they catch a flu or virus...It all is quite profound the first time you hear of this. I get that. Been there done that.
> I'm not sure I understand this lyme angle. I've been suffering from various form of this for 20 years. My understanding is antibiotics onlt work for lyme in the first 6 months of infection. You're proposing I go on antibiotics for a possible lyme infection after 20 years? Would it even work now?!
Posted by bleauberry on April 13, 2018, at 9:15:02
In reply to Re: Why is alcohol the only thing that helps me? » bleauberry, posted by Prefect on April 10, 2018, at 11:18:47
Bartonella! Wow. Ok. Of all the various pathogenic creatures from ticks, Bartonella is the one with the most profound psychiatric presentation, in my opinion. And it is not as easy to treat as the others.
I am on antibiotics right now for Bartonella, and Lyme in general, but with focus on Bartonella. Relapse. This relapse is different for me - mostly trembling and stage fright but not deep depression. A combination that really turned the corner for me, twice, concerning Bartonella, has been Doxycycline plus Rifampin. Rifampin is generally a turberculosis med. But it happens to have good efficacy against Bartonella.
When it comes to dopamine agonists, antagonists, stimulants, whatever, my experience has shown me that armchair quarterbacking is not usually real helpful. It can help steer us in a certain direction but not useful for the actual drug choice.
Would Ritalin be more helpful or would Ability be more helpful? Dunno. Only a personal trial would answer that question. That said, my doctor said she prescribes Ritalin more frequently than any other medication because it helps so many more people with so many more symptoms than any other med on the market. I don't think anyone will ever say that about Ability. ???
Armchair quarterbacking did lead me to Prozac+Zyprexa+Modafinil which was a good combination that kept me functional and fairly well, but not remission, for several years. Studies at PubMed led me directly to that combo. It worked good for a while. But a personal trial was the only way to find out. Eventually lyme symptoms were able to overwhelm the meds and they pooped.
My doc said Ritalin might help me because I flunked the ADHD questionnaire badly. But because of armchair quarterbacking, I was afraid to start it - anxiety was already an issue - I couldn't fathom the idea of adding a stimulant on top of anxiety! But my armchair quarterbacking was completely wrong - Ritalin turned out to be the best anti-anxiety med I ever tried! Totally relaxed, totally focused, and lots of energy for multitasking. The exact opposite of what I thought would happen.
> BTW I should mention I've tested positive for Bartonella not even through a specialized testing lab but a public health lab.
>
> You mention Ritalin, would low dose abilify not rebalance dopamine levels as well? It's a D1 agonist.
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