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Re: 2nd Q on paradoxical stim. response - z, anybody? zeugma

Posted by KaraS on August 31, 2004, at 23:42:45

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS, posted by zeugma on August 31, 2004, at 6:45:35

> > > That's interesting about coffee. I'm sure glad it works that way!! I've read some posts by people who drink green tea or take green tea extract (not decaf versions) and they say that they think so much more clearly than when they drink coffee and without the jitteriness of coffee. Have you read any of those posts or tried green tea? I think the last poster said that he or she takes 3 bags in a cup of hot water. Yucko on the taste but it sure sounded like it worked well for him or her.>>
> > >
> > >
> > > I tried green tea as a result of those posts. I was actually going through a lot of anxiety at the time, and the idea was to have something 'stimulating yet calming.' The green tea was OK but could not replace coffee on the one hand, or display marked anxiolytic effects on the other. When I was younger, I used to drink 20 cups of black tea a night (I was totally nocturnal, and would sit and write on an old manual typewriter). Then I went back to college and discovered that if I had a cup of coffee during EVERY class, I wouldn't fall asleep or drift off. It worked for a while but then the narcolepsy or whatever it was got worse, after I graduated from college and tried to work a number of jobs. Constantly fired because I simply never felt 'awake' no matter how much coffee i drank (and i drank huge amounts).
> >
> > That "constantly fired" must have been very hard on you. I was able to hold down jobs even though I was depressed and exhausted (also a total night owl and the 8-5 is very tough on me) until the last few years. I was let go from my last job because of being slow. It was devastating for me - particluarly considering my rejection sensitivity. And, if I hadn't left my previous job to move out west, I would eventually have lost that one too if I hadn't found adequate anti-d help (and ADD help?) soon. It's so frustrating when it's out of your control. (But I'm sure I don't need to tell you that.)
> >
> It was very frustrating. It took a long time to find a job that was undemanding enough for me to keep. I was always getting the comment that I looked sick and sleepless, even if I had slept 12 hours the night (or day! my sleep schedule was completely chaotic) before. I still was getting the comment that I looked like I never slept last year, at the first full-time job that I've ever been able to keep. The ironic thing was that before trying stimulants, but on AD's, I was sleeping regularly, usually getting exactly eight hours of sleep. It bothered me that people still said that even though I was finally sleeping well! Obviously, I still suffered from profound exhaustion and the sleep I get is not really restorative, so I am always operating at a profound energy deficit. Stimulants help with the daytime energy, but then I can't sleep as well at night... well, it's a matter of balancing s/e with therapeutic effects.

It definitely sounds like you've had your share of stuff to deal with. Were you so exhausted because you had worn yourself out so during college by not sleeping much? Have you read anything about adrenal fatigue? It's more of a holistic concept. Most mainstream doctors don't recognize anything between normal and full-fledged Addison's disease, but the holistic ones do see a stage where the adrenals are weak and failing, yet not completely dead. I have recently come to the conclusion that condition pertains to me. I have gone without adequate sleep for a long time for a number of reasons. People are always commenting on how I'm always yawning. I've been trying to take things (meds and supplements) that are supposed to be stimulating, yet they make me more tired. As you know, I've been trying to figure out why. One of the possibilities has to do with adrenal fatigue. I think I've been trying to whip a sick or injured horse. If that's the case, then stimulants would be a short-term fix but would make me worse off in the long-run. So my next step is trying to get healthy physically so that I can properly treat my depression. So, the next anti-d I try will be something that has a good chance of being more neutral along the stimulation-sedation spectrum.

> And I am highly 'rejection sensitive' as well. Getting fired was no fun, besides the practical issues of having no money. The shocking thing is that provigil is actually helping with this. It's why I want to give it a trial up to 200 mg despite the side effects (and you're right, it's a moving target).

I wonder why that would be. Isn't rejection sensitivity tied more to serotonin?

> > > Why doesn't Cymbalta have the side effect profile of being stimulating when it prevents the reuptake of NE? Does it have to do with the location of the reuptake?>>
> > >
> > > This is something that is very important, but little seems to be known about it. Lilly marketed Strattera with the claim that Strat blocked NE reuptake in the prefrontal cortex while TCA's blocked it in the brainstem. Strattera did have a maked subjective difference from nortriptyline in that it made me feel totally 'clear', which was an improvement over how I felt without it. It did work on some symptoms of ADHD, and also on the narcolepsy or whatever, but eventually did produce the fatigue that most noticed when they started the drug. I think that's because it has extra pharmacological properties than advertised. It could be that Cymbalta does too, but time will tell.
> >
> > Maybe someday they will come up with a cleaner Strattera - like Lexapro vs. Celexa. Do you know if they're working on it?
> Strattera is actually an isomer of atomoxetine. Lilly had about 20 years to play around with the molecule before releasing it. For clean, pure NE reuptake inhibition, I think desipramine is still the best option, in the U.S. at least. I probably asked you this before, but did that give you tachycardia also? >

Yes, the first time that I took desipramine, my heart felt like it was going to explode. I was certain I was having a heart attack. I don't remember if you have tried it but I'm guessing that you have. What was your experience with it?

> > > BTW, you've often mentioned your text books and you know so much about this stuff. Are you in medical school now?>>
> > >
> > > No, I'm spending most of my time trying to figure out my brain on my own, which does seem to have some therapeutic effect, in that it allows me to connect the effects a medication has on me with some property of the drug, and I know by now (in my mid-thirties) that I don't do well with things I don't understand. I'm in philosophy, and I've been in grad school for ages now, mostly because finishing anything produces dysphoria so i have little incentive to get my degree (Linkadge had a post about the role of D1 receptors in completion, and the stims I am taking are actually helping with this).

I do get some satisfaction from finishing things but I rarely get to that point because of the lack of motivation to begin with. It does help to understand the situation. I feel that the more I learn about things the more I have a chance of getting it "fixed". OTOH, I find it also makes me quite mad that things aren't functioning the way they should. The knowledge can be a double-edged sword I guess.

> > I saw that post by Linkadge. It was really fascinating to me.
> What I've been thinking about, ever since reading that textbook I was quoting from, is how motivation and reward can be dissociated. When I saw Linkadge's post it explained something that had always puzzled me- how I could be motivated, and not anhedonic, but still feel unable to derive any satisfaction from accomplishing anything. The systems have been completely dissociated in my case. It's why I always felt better when I let my mind fog over, although that conflicted with my goals and ruined my self-image. I think Provigil can help me with this, if I can get past its side effects.

I hope the Provigil can help you with that too. Too bad about the side effects. Wish it were cleaner for you.

> > I think it's truly amazing how much you've been able to teach yourself about psychotropic meds. I thought I knew a lot until I came here. (Nonetheless, I'm glad I found this site. It's been such a comfort to finally connect with others who have my issues or similar ones.) Are there any books or text books that you could recommend that could help me learn more about all of this?
> >
> A really good book is David Healy's "The Antidepressant Era". he's got a new one called "Let Them Eat Prozac" that is about the SSRI-suicide link. The first one is out in paperback. It's a brilliant study of how the concept 'antidepressant' has evolved.
> And he has really good taste in poetry (check out to epigraphs to any of his books :)).

Thanks! I've added it to my list.

> > > I'm currently taking 100 mg Provigil. I would like to take more, but need to get the s/e ironed out (still wary of insomnia, and Provigil seems to reverse nortriptyline-induced analgesia, bringing back the abdominal pain that miraculously disappeared when i started nortrip).
> >
> > How frustrating about the abdominal pain coming back. It seems we're always trying to hit a moving target.
> yes, the target moves more the older we get. I can put up with side effects- I'm just worried all these drugs are destroying my intestines or something. If I go back to the gastroenterologist I know what he'll tell me. That I'm on too many meds :) I would like to be on the minimum possible, but I don't see how else I can control my symptoms.

You gotta do whacha you gotta do - otherwise you woudn't be functioning. Unfortunately your gastroenterologist is only concerned with your stomach.

> > > How soon do you think you'll be starting Cymbalta?
> >
> > I've just recently decided to move it up on my list of things to try. The 2 things that I was planning on trying soon (not together) were SJW and selegiline. For several reasons, they're both off of the list now - though i have to look into one more thing about SJW which could put it back on the list. If not, then I'll probaby call my doctor (who I haven't seen in quite a while) and make an appointment to get Cymbalta. I also want to see what a few of the others' experiences are with it first as I'm quite strapped financially right now and that would be a large expense. It would be taken as a gamble though if I thought it could get me functional again fairly soon.
> That would definitely be worth it! The preliminary reports, from people here trying it, are encouraging. maybe you could get free meds from one of the programs that offer this? I know someone who gets Lexapro for free, although I think Cymbalta is going to prove far superior to Lexapro in terms of actually getting people better. what is it about SJW that you're investigating?

The preliminary reports on Cymbalta are that people seem to be tolerating it well overall. The jury is still out on its efficacy.

My hedging on SJW relates to a post I read on the alternative board that said SJW may lower estrogen levels (which I definitely don't want to happen). So I'll look into that more. I think SJW is too serotonergic for me anyway. I was just thinking of it as a sort of stop-gap measure for now.





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