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

Posted by Elizabeth on August 17, 2001, at 14:29:54

In reply to Re: I was gone but now I'm back Elizabeth, posted by Lorraine on August 17, 2001, at 11:45:53

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

I'm not sure exactly where that is, but W-S is nowhere near any beach.

> Plus, this sedating component to Parnate might be serotonin related?

It's hard to say. Messing with serotonin does throw your sleep biorhythms all out of whack. There are other (non-serotonergically mediated) effects that can contribute to drowsiness too (such as orthostatic hypotension).

> I may need to add a stimulant to it.

Careful with that, ok?

> 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.

That sounds about right, yup. I really wanted to believe that CBT would be "the answer," too, so it wasn't like I didn't give it my best shot.

> 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 understand, and this makes sense to me. I think that depression (without any deep childhood issues) can cause secondary problems such as demoralisation (just as panic disorder can lead to agoraphobia). Those secondary problems may resolve once the depression is treated, but if they don't, I think that talk therapy may be in order.

> 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.

That's pretty much what I meant. And I think that eliminating subjective experience from consideration in psychology is a mistake. (Reminds me of extremist behaviourism, a la B.F. Skinner.)

> 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.

I think this is an example of the effects that corporate pressure can have on research: if the funding's coming from the drug company, you want to get results that the drug company will like so they'll keep giving you money. So in situations where you have discretion, you [the researcher, that is] throw away data points that don't fit the curve, nudge the stats in the direction you want them to go, etc.

> 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?

That wasn't really a technique so much as a simple result of having someone point out to me that I was having panic attacks. I did some research on panic disorder, and it made me feel much more at ease, so that the panics were easier to cope with. The "techniques" I was referring to were things like diaphragmatic breathing and meditation.

> 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).

A model, you mean. Yes, that might be more accurate than to consider it the literal truth.

> > 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.

Well, there are a limited number of things that work, so... Buprenorphine has been a big challenge; it's much more intense (in terms of its effects, both desired and unwanted) than classic ADs were.

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

So many people on this board could tell stories that begin, "If my previous pdoc had been more open minded..."

> Dryness is a constant companion of those who lack estrogen, like me.

Good point; I don't think estrogen supplementation is a good idea for me, though.

> I use some of the better lubricants, although right now I'm using something called "wicked" (this may be an off lable use :-)

Off label? Uh. What's it labelled for?

> 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.


> I have just found that it is so difficult to tell what is impacting what without a mood journal (daily--prospective).

I think that's true; they are useful. Unfortunately, when I first start taking something, I tend to be too depressed to be in any shape to keep a mood journal!

> 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.

Same thing happened to me with lithium: I started taking it and a week later I was feeling much more alive and interested in things, so I assumed it was the lithium. In retrospect I think it was just a random fluctuation.

> 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.

That does seem like a symptom that could be exacerbated by stimulants, yes. (It's trichotillomania, BTW.)

> 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.

I think that putting it in writing also has the potential to be an outlet for your thoughts about the treatment, so that you don't get preoccupied with it outside the journal.

> > 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.

The phrase I was confused about was "hypertensive episodes (not hypertension)." When you said "hypertension," did you mean sustained hypertension (as in CV disease)? If not, what did you mean?

> You point (re stimulant actions of Parnate being associated with hypertensive episode) is a good one.

I think of it as the Parnate interacting with itself: it has two different effects that interact. (The stimulant effect has never been confirmed, but there's a lot of suggestive evidence.)

> 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.

I think Parnate and Nardil are not at all interchangeable. A person can be very tired on one and activated on the other.

> 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 could see that. What does it mean for people like me who tend to be slowed-down and tired but also have a hyperactive startle response?

> > Jack is probably okay; I'd avoid cheddar.
> The cheddar was mild--not significantly aged.

OK, if you have that level of information about it, that's probably fine to use your judgment.

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

I sure am (hoping).

I started taking DMI on 2 July at 25 mg/day. I got to 100 mg/day (low-end effective dose) on 12 July. So it's been a good while.





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