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Re: I was gone but now I'm back Lorraine

Posted by Elizabeth on August 17, 2001, at 3:24:22

In reply to Re: I was gone but now I'm back, posted by Lorraine on August 16, 2001, at 23:25:22

> I was in North Carolina for a couple of days with my daughter.

Hey, I lived in NC (Winston-Salem) for 8 years. Where were you (what part of NC, that is)?

> I can't really say how I'm doing exactly. It's not completely clear to me.

That's understandable. Sometimes it can take time for moods and such to cement.

> For one thing, I am pretty much done with hyperventilating.

The Parnate might be responsible; it sounds like you're growing tolerant to the initial stimulant-like effects, which is probably a good thing.

I don't know anything about estrogen dominance so I can hardly form an opinion there. < g >

> Correct and the last one I attended impressed upon me the importance of the participants in the group on its value (little value in that last one).

That's often said of 12-step groups, certainly: "find a meeting you like."

> ... I suspect it's like a lot of the non-med models, it works for some of the people some of the time.

I think it just isn't that effective in severe depression, personally. When I've been off meds, I haven't been able to get a thing out of CBT; and when I've been on medication that was working, CBT was irrelevant. Anxiety disorders (except possibly generalised social phobia) are another story.

> I have no idea about the strength of the claim that thoughts are responsible for emotions or emotions are responsible for thoughts.

I think the distinction between the two is more blurred than a lot of simplistic theories make it appear.

> How can we possibly know any of this? We are only an N of 1, but it's the 1 that matters most to us:-) I think the "experiments" using control groups with this or other talk therapy are just not useful. It either works for the individual or not.

Yes, exactly! Psychologists want to be "scientific" (a phenomenon that's been known as "physics envy"), but their "experiments" are usually pretty bogus.

> >I did learn some tricks that have helped a lot with the panic attacks.
> Do those techniques still work for you? Just curious. I've done the breathing stuff and it works for about 15 minutes.

I seldom have panic attacks anymore (although desipramine by itself doesn't seem to work as well as Parnate did). But yes, those techniques still help.

> What i mean is that I believe that there is sometimes just a mental component, sometimes just a physical component and sometimes both.

Ahh. I think I've said before that I don't find the mental-physical distinction to be meaningful. Also, I don't think it's necessarily true that endogenous depression will only respond to somatic treatments or that reactive depression will only respond to talk therapy.

> I find I can be stoic about certain side effects, like dry mouth, constipation, mild naseau and so forth, but am intolerant of others--like dramatic weight gain or sexual dysfunction.

That's true, different people have different priorities. Personally, if I find something that works, I make a serious effort to deal with the side effects.

> 40 lbs and sexual dysfunction--and marital difficulties associated therewith :-)

An effect of the tricyclic and also buprenorphine that I've been noticing is, err, dryness. I've been thinking of asking my pdoc for a cholinergic drug such as Aricept to combat this side effect.

> I agree. But it's actually not so bad. I have the file from my previous pdoc who notes my moods and life events during our visits and then I also was on Effexor for a long time (more than a year)--so we'll see.

Ahh so it's really not 100% retrospective; it's based on chart review. That's good.

> I have a fairly good memory of how bad things were or weren't

Me too, but remembering *when* sometimes eludes me! (Even on a monthly basis, as you're doing.) The only times I can reliably remember when I was feeling a certain month are when some significant, memorable event happened in that month.

> I'll let you know the results.

Cool! It will be interesting, I'm sure.

> I meant that some people are more internally driven while others are more dependent on others for their sense of self. You seemed to fall in the former camp--which is lucky if you were an odd duck of sorts.

Heh. Yes, I'm a bit of a loner, but I do have the usual basic human need for companionship.

> > > >I take Klonopin for RBD, and it works great.
> What's RBD?

REM sleep behaviour disorder. (Physically acting out dreams while asleep. Can cause injury to self or partner.)

> Ok--more unusual stuff my pdoc said: He says that hypertensive epiosodes (not hypertension)

Umm. You mean, not the chronic hypertension that folks with cardiovascular disease often seem to have?

> is not common among people who are down-regulated, but are instead more common among people who are up-regulated (over-stimulated).

(Interesting use of the expressions "down-" and "up-regulated.") That's a possibility. I don't feel that I was especially stimulated or sedated by Parnate, except at first when it was rather activating. But it makes sense that if a stimulant mechanism were involved (presumably catecholaminergic, based on Parnate's chemical similarity to amphetamine), people who were more sensitive to that effect (i.e., who feel more stimulated on Parnate) would be more likely to have some other stimulant-like side effects. Basically, my take on the Parnate spontaneous hypertensive episodes is that Parnate probably has stimulant-like actions in addition to MAO inhibition (e.g., promoting catecholamine release), and that the stimulant actions (notably, pressor effects of dopamine) are potentiated by the MAO inhibition.

> He also says to try small amounts of the forbidden food at home with the antidote handy to see how I'll do with them.

That's a good plan.

> I'm fine with cheddar and jack cheeses so far.

Jack is probably okay; I'd avoid cheddar.

> How's your desipramine going, elizabeth? Are you augmenting with anything new?

My pdoc just got back from his vacation, and I'll be seeing him on Tuesday. So I'm still on the same stuff. The desipramine isn't working as well as it was at the high dose (300 mg/day), but I'm still noticing some benefit. My hope is that it will just take longer to work at the lower dose. Otherwise I'm just taking buprenorphine and occasionally Klonopin.





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