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hand holding » Lorraine

Posted by Elizabeth on July 15, 2001, at 14:42:39

In reply to Re: I'll hold your hand if you'll hold mine » Elizabeth, posted by Lorraine on July 14, 2001, at 22:30:43

> > Hee hee. Do you know what the active (?) ingredients in "Stablium" are?
> Garum Armoricum, a fish and salt preparation discovered by the ancient Celts as a food supplement to improve resilience to physical and emotional stress.

What's your understanding of the mechanism of action? (By "active ingredients" I really meant the chemical(s), not the name of the plant, BTW.) I looked it up in a few places; it sounds interesting.

> An eight week, double blind, placebo controlled study showed Stabilium® 200- to be effective in reducing the discomfort experienced by college students before and during examinations.

Oh yeah, I could definitely use that. < g > I used to be pretty laid-back about tests (like, I took a nap during the SAT), but these days they stress me out a lot.

> It was also effective in another double blind, placebo controlled study, concerning cognitive function, memory and fatigue in adults.*

I always wonder exactly what it is that those research types are talking about when they refer to "cognitive function."

> > BTW, the skin picking is possibly a symptom of OCD (or subclinical OCD-spectrum syndrome). Stimulants could be expected to make it worse.
> Some do; some don't. Dexidrine did; thyroid T3 did; selegiline does. But I don't think Adderal does.

Adderall seems to be smoother than Dexedrine in a lot of ways (I don't know about Dexedrine Spansules, the slow-release formulation).

Although I don't generally have skin-picking problems, I developed one (temporary, thankfully) when I tried adding Cylert to Nardil (MAOIs can be expected to potentiate psychomotor stimulants). I got very twitchy and kept scratching or picking at my skin. The pdoc at the medical centre at my school said it was probably "just anxiety." (I later talked to my pdoc, who confirmed that people who take too many amphetamines often have problems of that sort.)

[Re activating and sedating side fx]
> The problem is that I am sensitive to overactivation and underactivation.

Some people are just sensitive to side effects in general. I'm like that about temperature (I don't tolerate heat or cold very well).

Anxiety with ADD or lethargy can be very hard to treat because anxious people tend to get jittery (to put it mildly) on stimulants (and, often, antidepressants -- my guess is that Serzone, Remeron, or Nardil would probably be the best one for this type of patient). It sucks because a lot of anxious people have problems with fatigue, lethargy, low energy, etc.

And on the other hand, benzodiazepines can make ADD symptoms and fatigue worse. I've never had a problem with being overly sedated by benzos, personally. I'm just hard to sedate, I guess < g >. Although just 10 mg of Mellaril did the job rather neatly.

> > I sort of have that problem with buprenorphine, too: the effective dose causes psychomotor agitation (although that smooths out after a while, and benzos help with it too).
> This sounds familiar.

Non-cardioselective beta blockers (like propranolol/Inderal) also help, BTW (although I think benzos do a more thorough job). It's pretty weird how I get jittery on opioids. It's not limited to buprenorphine, although it is worse with bup. than it is with pure full agonists (morphine, codeine, hydrocodone, fentanyl, etc.). I've encountered people who weren't so zonked on them, but never anyone who got actively wired the way I do.

> > It's because of the atypical-like symptoms. My guess could be wrong: I knew one woman who seemed to have pretty clear-cut atypical depression but who responded well to nortriptyline (for panic, depression, and alcoholism, with low-dose Xanax).
> I'm sorry, what do you mean atypical-like symptoms.

Well, the picture you provided was suggestive of atypical depression, although it didn't include the obvious "reversed vegetative symptoms" (hypersomnia and hyperphagia). Lethargy is a common feature in atypical depression. In particular, the "walking through mud" feeling sounds a bit like what is often described as "leaden paralysis" (yes, this is a real clinical term!). I also think that crying spells and social withdrawal tend to be more common in atypical depression than other types. Panic disorder (or panic-like anxiety symptoms, such as hyperventilating) is definitely more associated with atypical depression than with other types. "Hibernating" is a very common word people with atypical depression use to describe their condition.

Anyway, MAOIs aren't just for atypical depression (and what you described, though suggestive, isn't the textbook picture of atypical depression by any means): they've been touted as being effective for it because tricyclics (which, for a long time, were the main alternative) are so ineffective. TCAs work great for "classic" depression (melancholia) but aren't much help for other types (which really are far more common, IMO).

> > About the MAOIs: Parnate might be better for you than Nardil because Nardil has a high rate of weight gain. Some people are overstimulated on Parnate, but since this isn't generally a problem for you, I think it's a minor concern.
> What about Nardil with a stimulant?

That's a thought, although I think weight gain is still quite likely (stimulants don't work as appetite suppressants in the long term -- people generally develop tolerance to that effect very quickly). There's always the risk of paroxysmal hypertension from the combination. I don't consider this a major issue because I can check my blood pressure if I need to, and it's always reversible. (Also, I'm a young, average weight woman, and my cardiovascular health is fine. I'd be more concerned for someone with preexisting hypertension.)

OTOH, no AD beats Nardil for anxiety, and some people don't gain weight on it so it might be worth a try.

[re side effect sensitivity]
> Ain't that a b****. I suspect your right though. Still wish I hadn't opened that particular pandora's box.

Huh. In what sense is it a Pandora's box?

> > >I just don't want to get your hopes up about desipramine.
> Yeah, me too I guess.

Well, optimism is often helpful when taking on something like this. But it's good to know what to be optimistic about. < g >

> How is Desipramine working for you now?

I just got up to 150 mg today. No side effects except a little dry mouth. Too soon to know if it's working, although I do seem to have a little more energy.

[re choosing which med to try]
> I don't know, it feels pretty roulettish to me. No one knows how these drugs work. No one knows the mechanism of depression. No one know why one drug is more likely to work for a person than another (with few exceptions--like now i know SSRI's don't work, but TCAs--wont know till I try them, MAOs--wont know till I try them.

I disagree about the last part. Although it's not a certainty, you can make predictions about who will respond to what based on observed symptoms. You're right, though, we're venturing into largely uncharted territory when we start messing with our brains. (A little bit exciting, perhaps, but scary and frustrating too.)

And I know how you feel about finding a pdoc -- there aren't that many who can formulate a plan for how to attempt to deal with TRD, are willing to try weird stuff if necessary, and are good listeners. If you find one, hang on. < g >

> I'm near UCLA, which would be an obvious choice, but I don't want to pick a random name out of the hat and then find out that I'm stuck with someone who has a frame of mind that prevents them from listening and learning themselves.

That's a big problem with pdocs, yeah. A suggestion: try talking to the receptionist at the mood disorders clinic and ask her about the personalities of the doctors there. She (it's usually a she) might not know, but it's worth trying.

Also, LA is a big metro area. If there's a branch of the National Depressive and Manic Depressive Association ( nearby (and I'm guessing there is), start going to support groups and asking around about various pdocs.

> Sometimes, I wish I was stupid so I'd be oblivious to all this, but then when I slip into depression I literally feel my IQ going down and I feel stupid, but I KNOW that I am stupid so it doesn't work out that well if you know what I mean. < vbg > or < vbc > (very big cry).

Dude, you're *not* stupid. Although I don't have an opinion about how smart you are, I can tell that you're insightful, which is a good sign.

> Wasn't it the Pretenders who said "stop all you sobbing on me". Sorry--long rant.

No apologies necessary.




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