Posted by KaraS on July 18, 2004, at 15:47:54
In reply to Re: Zeugma, ADD diagnosis, posted by zeugma on July 18, 2004, at 7:08:00
Z,
My responses are spread out throughout this whole message.
> > > hi Kara,
> > >
> > > Yes I feel much worse after sleeping a lot. The optimum for me moodwise is to sleep about 5 hours hours. Unfortunately I seem to require a time to repay the 'sleep debt,' and then I have this comatose sleep that is unpleasant. but if I don't do this (for example on weekends when I work all week) I start to feel myself 'running down' inside. In fact, on Fridays I always feel this, and the mood- and energy-elevating effect of little sleep turns to acute dysphoria.
> > >
> > > I didn't experience any tachycardia on nortriptyline. I suspect I am relatively immune to this effect since it seems to be mediated through blockade of the muscarinic receptor, and I have reason to think that overactivity of this receptor helped cause my history of depression. depression has many causes, of course; that's why the TCA's are generally so effective, they are 'dirty' drugs, which can be a virtue.
> > >
> > > The least anti-muscarinic TCA is desipramine, which is similar to Paxil in potency in this regard; did you ever experience this effect on Paxil, if you tried it? If nortriptlyine energized you, then you would definitely be energized by desipramine. Of course, the tachycardia could be an indirect result of NE stimulation. Did you ever take Wellbutrin (forgive me if you told me already) and if so what effect did it have?
> > >
> > > I think you said you were on Effexor now? Is that energizing at all?
> > >
> > > If you are having the cycle of insomnia/oversleeping, I wonder if it's because you have a reversed circadian cycle. I don't have one now, but at the price of diminished energy: my energy naturally seems to peak around 4 am. 100 mg of nortriptyline is helping with energy a little, and the Provigil may be having a small effect too. Are you thinking of trying Ritalin again? I'm actually thinking of taking a 'drug holiday' from nortrip for a night, and taking a little Ritalin LA and seeing if I can get any work done on my grad school thesis. I wrote a chapter in January on an all-nighter but that had me feeling awful for a week!
> > >
> > >
> > > z
> > >
> >
> >
> > Hi Z,
> > I have also tried desipramine. Same effect on me as nortriptyline. In my mind they are the same drug. (BTW, how does anti-muscarinic differ from anticholinergic?)
>
> That backs up what my pdoc told me, that desipramine and nortriptyline are virtually interchangeable in terms of clinical effect. Except that nortriptyline is less sedating. Except for some. Of course...
>
Actually, I think you have that backwards. It's the desipramine that is the less sedating. Nortriptyline is often used by many to help with sleep while desipramine never helps anyone sleep. (Judging from your depth of knowledge, I'm guessing that you probably mistyped.)
> There are several kinds of cholinergic receptors, which are stimulated by the neurotransmitter acetylcholine, just like make different serotonergetic receptors can be stimulated by serotonin. The cholinergic receptors that I know of are the muscarinic and the nicotinic. Nicotinic receptors, as the name suggests, are stimulated by nicotine and blocked by Wellbutrin (hence its efficacy in stopping smoking). Nortriptyline probably blocks this receptor too, since it works just as well for this purpose as WB.
Thank you for explaining that to me. I find it fascinating that nortriptyline will also work for quiting smoking (as only someone who has tried many medications could find such a bit of info like that fascinating). Too bad all of the people forking over so much money for Wellbutrin don't know that.
> Muscarinic receptors are associated with the memory deficits of Alzheimer's disease, and anti-muscarinic potency is why the TCA's are called (misleadingly) 'dumb drugs.' They can cause memory problems, constipation, and tachycardia. I would argue however that a subset of depressed people have overactivity of these receptors, which causes early entry into REM sleep (see thread on Provigil) and which was taken as a diagnostic marker of endogeneous depression in the 60's. So the anti-muscarinic potency of these drugs is therapeutic, for some at least.
>
Very interesting. I didn't realize that they could measure entry into REM sleep back in the 60's (or that they even knew what REM sleep was back then).
> > I did have either tachycardia or irregular heart rate (I thought it was the latter, my pdoc insisted it was the former) from Celexa, believe it or not. That was a HORRIBLE medication.
> >
> > I tried Wellbutrin in small amount. It didn't give me tachycardia but I had a strange allergic effect. I felt like I couldn't breathe. I thought it could perhaps have been due to excipients in the pill but recently I remembered that I also tried the extended relief capsule with the same result.
> >
> > Provigil made my limbs feel like cement. Also very strange but a known side effect for some people.
> >
> > Effexor was rather neutral for me. I took the XR form because I experienced what I felt was an irregular heartbeat on the regular pills. I could take the XR in the morning or at night and it wouldn't make much of a difference. Unfortunately the antidepressant effect was limited but i had virtually no side effects. No pain, no gain I guess.
> >
> > Paxil did absolutely nothing for me except give me a hard time getting off of it.
> >
> > Zoloft did nothing for me. Also couldn't even tell I was taking anything. Amazing sexual response when I was going off of it. Like nothing I could even begin to describe - the ultimate aphrodesiac. (Hmmm, maybe I should go on and off of it more often...)
> >
> > I just took 5 mg. of selegiline to wake up my brain. I had just slept a lot and needed something desperately. It has helped a bit. I'm going to try 10 mg. sometime soon. Have you tried selegiline at all?
>
> No, never tried selegiline. Only SSRI's (nausea and panic attacks), Wellbutrin (weird autonomic disturbances, I became very light-sensitive and uncoordinated and was literally walking into walls), various stimulants (calming response, cognitive benefit, but rapid weight loss, which was why i finally returned to TCA's, besides being somewhat effective for ADHD and very effective for depression they stimulate the appetite- I know most people are looking for the opposite effect but when I get depressed (which is always, off meds) I can't eat and slowly waste away. The stims caused me to quickly waste away). >
Well I certainly did go on and on about my experiences with different meds. Sorry about that. It was late and I was rambling.
Regarding your meds reactions:
And I thought my Wellbutrin experience was strange! How awful for you. And you got panic attacks from the SSRIs' - even Paxil? The stimulants always relaxed you, even at higher doses? Is that because of your ADD? (I'm wondering if I increase the Ritalin and it still puts me to sleep, whether that is a good indicator that I have ADD?)My depression has varied over the years. I have at times had more major depression and at other times more atypical type. When it's atypical (as now) I don't have to worry about eating but more often than not I have major depression and if I'm not on any medication I can't sleep or eat at all either. I would not be here if it weren't for these meds. I know that for me there is a strong genetic predisposition. I've been battling depression my entire adult life but I don't really understand why my type of depression changes so much. Makes it hard to find one biochemical reason/malfunction to explain it (as you believe yours is related to nicotinic receptors.)
> > I've mentioned my experience with Ritalin in a few other posts, but I don't remember if I've said anything to you about it. I tried 5 mg. of generic methylphenidate and it made me so sleepy. Did you react like that to a small dose of it? Does that reaction seem like it might give more creedence to the argument that I have ADD? Or is it completely unrelated? I'll have to try the 10 mg. when I get up enough nerve and see what happens. I have yet to try anything that has a truly profound effect upon my focus or concentration (but when I find that, get antidepressant relief and normalize my sleep, I may actually be able to get a good job!!)
> >
> > Have you decided whether to forego sleep for a night, take Ritalin and work on your thesis?
> >
> > -Kara
>
> No, I was so wiped out by working in the morning, then picking up the Ritalin, then going for the long run, that I went right to sleep.
>
> z
>
>By the way, what field are you in? I'd ask what your thesis is about but I don't know that you'd want to give that kind of info away on a board like this. I'm curious, though, if your field is related at all to what we've been discussing.
Take care,
K
poster:KaraS
thread:364549
URL: http://www.dr-bob.org/babble/20040714/msgs/367421.html