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Re: Marplan and insomnia (or something)

Posted by Scott L. Schofield on December 27, 1999, at 16:26:34

In reply to Re: Marplan and insomnia (or something), posted by Phillip Marx on December 27, 1999, at 0:08:44

I would not presume to diagnose you, but there are a few facts you may want to take note of.
I know the missionary position can be appealing at times.

> > That ambien will be as useless to you as it is now to me if you keep using it consistently for long due to tolerance increase up to virtual immunity (futility point).

Perhaps this is true of Ambien, but it is not true of all the benzodiazepines in all individuals. A combination of Halcion and Ativan did a real good job for me over the course of three years while taking Parnate or Nardil in combination with Norpramin. There was no decrease in efficacy once the dosages were titrated and later tweaked.

> > Uh, no. Some people develop tolerance to Ambien (probably behavioral tolerance, as occurs with alcohol), but that isn't the rule. For example, I used it every day for a year or more without needing to increase the dose. Your experience doesn't generalize.

> I know my experiences donít generalize, thatís why my first step into this forum was to ask if there were any atypicals like me around, since all other types of atypicals were begging for clues for help. I am philísanthropic enough to try to offer help to all those here medically stalled like I was for so long. How else could I respond to reading all this? I have a long history of trying to help people more than is good for me, I keep getting called co-dependent. I used to be reluctant to admit how much my own happiness depended on helping others, que sera. Trying to rescue everyone and everything on a sinking ship is not wise when the ship isnít really sinking. I probably shouldnít get my mission mixed up with my missionary inclinations again here or Iíll wear out again. Your experience expectations donít generalize well, which doesnít bode well for future depression avoidance. You are at least going to use up your endurance and get exhaustion tolerant (wouldnít that be interpreted (read) like depression, mental rather than physical) if you learn to settle for the short sleeps you get with Ambien. Your daily work output will decline and decay to the level you can recover nightly. Is your work output depressed? I couldnít work much on Ambien, and Iím the worst workaholic Iíve ever met, sort of. Maybe you are retired and donít need much sleep for your days.

> > BTW I wonder if perhaps your memory problems may be due to chronic sleep deprivation as well as overuse of high-dose benzodiazepines; your loss of motivation might be caused by partial remission from mania. (Why do you feel such a need to insist that you are not manic? Mania is defined by observed symptoms, which I think you know you have.)

One of the most effective treatments for severe mania is to combine a neuroleptic with a benzodiazepine. I imagine clonazepam would be the best choice for this. There are reasonable grounds for Elizabethís ponderings.

> Sleep deprivation hurt more than my memory, it hurt everything ever listed as effect from affect.

Sleep deprivation can also precipitate mania as well as being a symptom of it.

> I probably shouldnít get my mission mixed up with my missionary inclinations again here or Iíll wear out again.

> Iím the worst workaholic Iíve ever met, sort of.

Not to be a hard-on, but I think Elizabeth may be right. The previous passage you wrote resembles very closely some of the psychodymamics I experienced during a manic state. Whereas you seem to think of your "mission" as being an effort to help the mentally ill, my mission was to save the world by ridding it of the devil. I was a courageous sole to take on the devil single-handedly, considering that the rest of the world had demonstrated its impotency in that pursuit. I don't know - I guess it was pretty grandiose, but there was no chance in Hell that I was going to be able to recognize it at that time.

> Medicinal related memory problems were only significant for me on Ativan in therapeutic doses. Ativan is one of the anesthesiologistís choices to keep us from waking up and remembering surgery. Even Halcion can cause memory dysfunction, even amnesia, but I canít remember any??? Halcion is what made President Bush throw up on the Japanese ambassadors and what caused Sally Fieldís boyfriend in that bootlegger movie series look like he had AIDs

I did not experience any memory problems while taking Halcion, nor did I suffer a significant hangover or memory deficit the next day while taking Ativan. Of course the reaction profile will differ between individuals.

Halcion is not on the top of most doctorsí lists of hypnotics. It is extremely potent and has a very short half-life (3-5 hrs). It has been blamed for episodes of severe amnesia, a side-effect that I believe motivated Upjohn to cut the recommended dosages by half and produce lower-dose pills. I canít help but to wonder if the use of Halcion alone as a hypnotic might actually produce a mini benzo-withdrawal once the blood levels have dropped precipitously. Perhaps this was the reason why President Bush found it necessary to bring-up certain issues.

> My lo-pro call is manic-like but not manic-exact, conceding mania-standard too easily will put everyone back on a malevolent treadmill I donít think I should have been run on the first time. Suspicions of mania-standard cost me an extra couple of years of recovery. Mania-like, fine, lithium just wasted a lot (years) of my time. Mania-standard treatments failed which indicates non-mania-standard. Iím different in some ways, thanks, and Iím different in some other ways, sorry. Mania as cause/source and mania as result require different treatments. Lack of sleep is not always preceded by or indicative of mania-standard, if you have enough endurance you can sure test positive for increasing exhibited panic. If you split the mania definition right, you get more appropriate treatment, otherwise it will cost years by honest people who will never know they were wrong, even if you die. What you may be referring to as loss of motivation is really deferred motivation as I learned I had to put everything on hold until, if ever, promises of recovery ever came true. It would take years to complete all the projects I have preserved for such a time. Iím still reluctant to commit to much from the trauma of so much helpless powerlessness, I know how fast it overtook me completely against my will without any cooperation with convenient timing, there was no putting it off with a reschedule-please notice. My motivations are easiest to sustain for short, easy-to-complete quickly projects to this day still from sedative conditioning. I donít understand how loss of motivation can be caused by partial remission from mania, unless they were manic-only motivated projects, which I donít think any of mine are. The tree that kept filling my house downwind with its dirt I took down. Manic? I have to fix the garage fascia board it destroyed on the way down. Manic? I have to get the garden in the back yard replanted and the above-ground pool removed. Manic? Iíll have to mull over the rest. Iím willing to purge anything not belonging.

Recently, there has been a bit of a revision in the conceptualization of affective illness. Terms like "affective-spectrum" and "soft-affective illness" as well as ďsoft-bipolarĒ have been used to help place people for whom the classical ďhardĒ standards do not apply well. The motivation for such a ďliberalizationĒ of diagnostic criteria and the inclusion of quasi-affective presentations is to try to get more people better. What other motivation could there be? I think the missions of our researchers and clinicians seem philanthropic enough to forgive them for any of their mistakes.

My sincerest wishes for the attainment of your mental health.

- Scott




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