Posted by Elizabeth on May 17, 2001, at 13:32:06
In reply to Re: Ultram, selegiline » Elizabeth, posted by shelliR on May 16, 2001, at 22:28:02
> Hi Elizabeth.
'Ay.
> Creative approaches to TRD here means adding stimulents with MAOIs and combining lots of meds, but nothing like Dr. Bodkin.
IOW, it doesn't really mean "creative," just "not entirely orthodox." Creativity should involve some originality, don't you think? Anyway, that's probably the situation in most parts of the U.S.
> He didn't really have a good referral down here either. My last trials were all with nardil with atypical antipsychotics--all of which made me feel strange. To tell you the truth, I don't believe that they have been out long enough for anyone to say that they are truely safe for long term use.
Me neither, but they're definitely *safer* than the old APs. (It's been 10 yrs since Clozaril was approved in the U.S.)
How do you mean when you say they make you feel "strange?" I just got zonked on all the neuroleptics I tried (in teeny doses, too). Except for Moban; that was peculiar and difficult to describe.
> My pdoc has had one case of TD with an atypical and one case with an SSRI, both resolved within four months.
TD? Or acute dystonia? (How long had the pts been on the meds, if you know?) TD actually does resolve a lot of the time -- because it *can* be permanent, a myth has evolved that it *must* be.
> My doctor in the hospital has also had one case with an atypical and he doesn't have a very large patient population. So I'm sort of relieved that they did nothing for me. I actually feel safer taking hydrocodone. Really!
I agree that hydrocodone/APAP is safer, as long as you don't get into dose ranges where Tylenol toxicity becomes an issue.
Respiratory depression is the main risk of opioids (aside from addiction!), and that is one of the first things you become tolerant to. It's possible to continue increasing the dose indefinitely without ever reaching toxic levels because tolerance to respiratory
(Street heroin isn't reliable enough for addicts to do this, however. I think they tend to "overshoot" (ha ha) when the purity is unpredictable.) However, it is possible to get to a sort of "saturation" dose where you are completely tolerant and taking more does not produce any additional effect. (Kind of like the ceiling effect of buprenorphine, but at a much higher (ha ha, another pun) level.) I've never met anybody who made it that far, but that was the original idea behind MMT -- to get people on such a high dose of methadone that they were chained to the clinic and that no conceivable amount of heroin would have any effect. Most people on MMT today are nowhere near saturation levels -- they are typically able to stabilise themselves on much lower doses. Methadone, taken as maintenance treatment, basically has no effect on mood as long as you're on a stable dose (although those guys must be *so* constipated -- *that's* a side effect that you never grow tolerant to).> I picked my present pdoc because he's been around for years and years and I had the feeling he wouldn't be freaked out by my low dose of hydrocodone. I was right, but he's not of much help either.
Yeah. That he knows you and is able to trust you is a big advantage. Building up trust is really important in a pdoc-pt relationship in any situation, but especially in one like yours.
> My last pdoc is best known for trd, but she was really critical about any opiate use (threatened to terminate with me) and also didn't understand my refusal to take lamictal because of a quick large weight gain.
That's one advantage of female pdocs -- they seem (IME) to be more sympathetic to the serious difficulties associated with weight gain (socially as well as medically).
You shouldn't have to be on the defensive all the time with your doctor. If you felt that way, and if he made threats to terminate (which I think is just as manipulative and obnoxious as a patient making suicide threats solely to get attention), I think you were right to find somebody else. I'm only sorry you spent so much of your time and money on a pdoc who wasn't a good match for you. I hope you feel you at least got some benefit out of the time you were seeing him.
> > Somerset...? (Where's that?)
>
> Woops--Somerville. (although there is a town called somerset in MA)Ahh! I lived there for a while. Crappy place. :-} My friends and I called it the "grad student ghetto."
> > Going off MAOIs is hard, yup -- on top of the worst withdrawal syndrome of all the classic ADs, there's that damned "washout period."
>
> I had no withdrawal symptoms going of of Nardil. (I've done it twice, in less than a week). Maybe it's because my dose has never been higher than 45 mg a day.Lucky you, for whatever reason! I never had problems with SSRIs or Effexor, myself, but getting off of Nardil and Parnate sucked. I've never had so much trouble d/c-ing anything, even controlled drugs like benzos, stimulants, and Ambien.
> I am crazy busy (too busy) with my business now to do any drug trials. Drug trials have always been really hard for me and sometimes have landed me in the hospital.
Yes, that's a particular risk when a MAOI is involved, because of the washout (even if you don't get w/d symptoms). It sounds like you'll just need to wait for a window of opportunity if you want to switch.
> So far I'm still so low on the hydrocodone that I'm not worried. (After three years I really haven't increased). But because it is so short term I am able to observe how really really depressed I am without it (unlike when the nardil was working well).
Yes, that's how buprenorphine is for me: when it wears off, it's painfully obvious. Not like ADs that work indirectly through compensatory mechanisms (like the monoamine reuptake and metabolism inhibitors).
> So I go through these brief periods of real fear about my depression.
Me too. :-(
> If I do try selegiline, I will have to plan a few weeks off from responsibility. I hate responsibility, but I also know that meeting deadlines and having people come over a lot (I work from home) gets me out of bed during hard times. I don't want to disappoint anyone and I don't want to fail at something I'm really good at.
I know just how you feel. Depression is bad enough without adding demoralisation ("behavioural despair" to rat doctors) on top of it.
> I just ordered codeiene with paracetamol--(Is that the same thing as tylenal?). I'm not particularly worried about combinations, since I still have never taken more than 7.5 mg a day, and usually less.
"Ordered?" I don't want to know what you mean by that. Paracetamol is the European name for APAP (Tylenol), yup. How much codeine is in the pills?
> If you try selegiline again, I'd be really interested in hearing how it goes.
It's not too likely, but I'll be sure to let you know.
> I might be willing to take a few weeks off in August to try it. It's actually easier to go into the hospital for me to do drug trials because when you run a home business, your phone rings day and night and even though I turn the ringer off on my business line, some customers will call on my personal line, and I won't know and I'll answer.
I've heard too many stories from people who have that problem! When I need a business phone number, I'm going to be sure to keep my personal number private and unlisted.
> And it's is hard to say I'm out of town and then answer the phone!
Doh!
best,
-elizabeth
poster:Elizabeth
thread:61760
URL: http://www.dr-bob.org/babble/20010515/msgs/63351.html