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Re: Handholding Elizabeth

Posted by Lorraine on July 27, 2001, at 11:19:35

In reply to Re: Handholding Lorraine, posted by Elizabeth on July 26, 2001, at 22:59:22

[re: can still be touched]

> I think that, relatively speaking, that's a good sign. To me it indicates a reactive mood, and the possibility that you have the potential to be cheered up temporarily.

And so I was last night by my wonderful husband. Stahl talks about the "end-stage" of depressive illness as one where the lows are so low but the ability to "feel" generally has been severely blunted. That scared the putty out of me. At least now I can see the rose, smell it and delight in it.

> > > Interesting about panic and hypothyroidism. All my TSH tests have been pretty normal, and T3/4 augmentation is something I've never tried.

It might be worth a try. Also, the notion of "estrogen dominance" causing panic symptoms is interesting. Apparently, estrogen dominance is not just a problem associated with menopause, but can be a woman's normal state throughout her lifetime. Another avenue to explore.

> > > Buprenorphine seems to make my periods irregular. I've been wondering about the mechanism there.

Isn't that odd? When I had endometriosis and would have great pain on starting my period, I was given a drug that is now sold over the counter (maybe it's advil?). Anyway, the trick was to catch the very wisp of the beginning of my period and take the pill at that time. If I was successful, then my period would start and I would not be in pain. But if I missed the very very beginning, what happened was my period would be delayed. I explained this to my doctor, who dismissed it out of hand. Point is there was something operating there that might be similar to your situation.

> > > You know, any effective antidepressant has the potential to trigger mania. When I started taking buprenorphine, it seemed to cause activation, psychomotor agitation, etc., rather than the calming effect that opioids seem to have on a lot of people.

Really? I have adverse reactions to drugs at times, like getting wired from decongestants. But is agitation and activation considered mania? I once (for a couple of days in the weeks just before the last stock market crash), had incredibly racing thoughts, could hardly contain my excitement and so forth, but was still able to sleep. From my reading of the DSM categories, that would not qualify as mania--although I was euphoric and felt a bit invincible.

> > > We work with the information we have, and count on the research folks to accumulate more information. I don't think that we should feel we have to wait for more research to be done before we can be comfortable treating mood & anxiety disorders.

Absolutely. We just need to recognize the limitations. Sort of like when I read a fairly compelling article on Darwinism and viral evolution which proposed that many of our chronic illness may ultimately be linked to viral conditions where the viruses have adapted so that they are much more difficult to detect. They started with the ulcer situation--where they first said diet and environment were the underlying causes and ultimately determined that it was a bacteria that was responsible for the condition--and moved on to heart disease, diabetes, depression and OCD. All speculative at this point, but it does sort of blow the lid off of current thinking. And I wouldn't be surprised... But does that change how we need to approach treating these conditions now? Probably not. (except maybe Amantadine should be tried as a low odds possibility).

> > > Only partially. I think that lately, research has focussed mainly on biology, and the empirical-descriptive school of thought has become passe'. This is unfortunate in a way, because despite technological and scientific advances, psychiatrists still mainly have to go on the clinical presentation.

The problem is that we have an entire conceptual framework that is premised on presentation rather than on physiology. I think the old system just has to be gutted. I think it gets in the way of determining what works and doesn't work because we test drugs on "depressed" people. Well, if the category "depressed" is not meaningful--that is if in fact very different physiological processes are occurring in different people with depression--then we are barking up the wrong tree. It may be that the med that is tested as effective in reducing symptoms by 50% in 51% of the subjects is actually 85% effective in 90% of the subjects with a specified physiology and that is the direction we need to be heading in in terms of research. So to the extent that the old paradigm henders rather than helps progress, it should be rethought and possibly abandoned. That doctors have been taught an incorrect frame of reference just makes the process of transition that much harder. It's like a legacy computer system at an old corporation--much easier to throw the whole thing out than to try to change it bit by bit.
> > > Well, we decided to go with parnate. My guy is an odd duck--he bases everything pretty much on your QEEG. So when I say, Nardil is associated with weight gain and sexual dysfunction, he says "I've never had anyone with your QEEG gain weight or have sexual dsyfunction on Nardil".

> > >That is so wacky!

Yeah, I agree it sounds wacky. If I really believed that there was another paradigm that offered a better result I would be concerned. But as it stands now, I don't think that the treatment I am receiving suffers. I am after all progressing on to MAOs just when you would think that I would. And, he would be quick to point out, that at least his approach is rooted in physiology--there is some measure of physical activity that is used to determine treatment. Just so you know he's not completely out there--what he does is run a QEEG and then perform a covariance analysis of your data against a data base of 8000 other people in terms of what meds were effective for them. He then prescribes based on that. His believes that my QEEG indicates that a combination of stimulants (he includes MAOs here) and anticonvulsants should work.

> > >There's a doctor here who's known for similar approaches (using EEGs and functional imaging to treat depression, mania, fibromyalgia, CFS, etc., and believing that these conditions are very often caused by seizure disorders). Some people seem to respect him quite a bit, while others think he's loopy. I'm not sure what to think (although I have met him and he does seem like a bit of a flake).

It's really too early in any of these approaches to determine whether they will ultimately prove to be worthwhile.

> > > It's not clear how Nardil would affect that. I think it could be related to serotonin and happens at the level of the hypothalamus. The effects of Nardil on insulin sensitivity probably play a role.

Complicated stuff. But if it is "insulin sensitivity" or "insensitivity?", then low carb should help.

> > > Ask the pharmacist if it's okay to cut Parnate pills in half.

Very good question. I will do that.

> > > I think that I remember reading that Tegretal has a very high rate of success with depressed people who have temporal lobe epilepsy. Another option, anyway.
> Consider Trileptal (oxcarbazepine), Tegretol's newer, gentler cousin.

Thanx again. Good suggestion.

> > > That's great to hear. I hope you can continue going; support groups can be of help in a number of ways.

Actually, I think it was your suggestion that I look into DMDA. I think it may be useful as well.





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