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

Posted by Lorraine on August 17, 2001, at 11:45:53

In reply to Re: I was gone but now I'm back Lorraine, posted by Elizabeth on August 17, 2001, at 3:24:22


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

Ocean Isle to visit my cousins who were vacationing at the beach

> > 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.

Plus, this sedating component to Parnate might be serotonin related? Now I think my reaction is my bodies response to Parnate--ie growing or shrinking neurotransmittors--I'll have to wait it out and see where I land. I may need to add a stimulant to it.

> > > > 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.

My take is that that severe depression is so physical that monkeying with mind sets and mental gymnastics won't put a dent in it without some med support. If you have developed coping patterns for dealing with childhood abuse that are maladaptive and trigger shame spirals, you pretty much have to get in there and clean that stuff out because they cause deep mood dips (that's a technical term< g >) that are barely tolerable when you are normal and completely intolerable when you are depressed.

> > > 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.

It's blurred, but, for me at least, still useful in terms of determining how to tackle difficulties. Maybe it's backed into--is this something that changing my thinking or approach could help? Sometimes yes, sometimes no. When you have severe depression, swatting at it with meditation or exercise just seems pointless to me. But these things can make a difference when the depression is marginal (maybe the meds achieve response but not remission and this stuff makes the difference).

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

I don't know how much psychologists want to be scientific as opposed to how much they want to achieve respectability in a scientific community that doesn't value things that can't be measured or that don't fit the experimental design model in vogue today. My undergrad major was experimental psychology and I took a boat load of statistics classes and experimental design classes. It is very helpful for picking apart studies, but I find that I am still skeptical even of studies that fit the parameters of "good" scientific design. Maybe this is because so many of them show things that are false. For instance, the weight gain and sexual dysfunction side effects of the SSRIs are much higher than the studies would lead you to suspect. Now maybe this is the length of time of the study or the methodology of determining side effects (self report as opposed to asking), but it is easy to get misled by a study that is flawed in certain respects but presented in a nicely tied experimental design package. In a way, it goes back to the N of 1 and doctors saying "no, that side effect is not attributable to this med". The fact is they don't know and rather than coming clean with just how limited our knowledge is and deal with the amount of ambiguity out there, many doctors pretend (this isn't a conspiracy, the pretense gives the doctors comfort) a higher level of confidence than is warranted. In short, I think that the god of scientific methodology is a false god.

> > > 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.

Were the techniques to control self talk, like "this is just a panic attack. I'm not going to die" and breathing or something more?

> > >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.

Well, yeah. This is what makes it all so difficult because of the interactive nature of mind/brain stuff. But if you recognize this inherent limitation, I think the dichotomy can be useful (ie it's not wholly true, but then neither is it wholly false--it's just a useful "way of looking" at some of the issues).

> > > 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.

I can see that you do. If my previous pdoc had been more open minded, I might have added a stimulant to the Effexor and stayed on it.

> > > 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.

Dryness is a constant companion of those who lack estrogen, like me. I use some of the better lubricants, although right now I'm using something called "wicked" (this may be an off lable use :-) I'm also doing that thing for arousal that someone posted here (a certain thigh creme with argenon mixed in)--it works, but is a bit messy.

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

Yeah, Much better than relying on my memory alone.

> > > 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 have just found that it is so difficult to tell what is impacting what without a mood journal (daily--prospective). For instance, that supplement that I told you stopped my nail biting may not be what was affecting me because I'm still taking that supplement but I'm back to biting my cuticles. My pdoc thinks it was the Adderal that was affecting that activity. He said that he has had tricc??? (hair pullers) stop pulling hair on Adderal, surprised the putty out of him. So see a daily mood chart will have this info on it so that even if my "mind set" tells me it's the supplement that is supposed to calm nerves, the record is there for me to review later.

> > 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?

no, I'm talking about the "cheese" reaction to MAOs.

> > 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.")

Yeah, I know. It's a pretty simplistic way of looking at things (although simple does not mean wrong). The brain wave people (EEG Spectrum) looked at it this way also and used the same language.

> > >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.

You point (re stimulant actions of Parnate being associated with hypertensive episode) is a good one. My pdoc wasn't talking about Parnate though--he meant all MAOs and would expect the same reactions on Nardil for someone who was down regulated. Maybe this is related to being a slow or fast metabolizer as well. He means that your system may be over or under stimulated to begin with and that this is associated with how you react to the dietary restrictions of MAOs.

> > > I'm fine with cheddar and jack cheeses so far.
> Jack is probably okay; I'd avoid cheddar.

The cheddar was mild--not significantly aged.

> > > 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.

How many weeks are you on the desipramine now? Your patience is great and may well pay off. Let's hope.





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