Posted by zeugma on September 14, 2004, at 18:45:40
In reply to Re: where are the diagnostic tests?!! » zeugma, posted by SLS on September 14, 2004, at 17:53:25
> Hi Z.
Hi Scott.
> Quitkin has been resting on the laurels of his work by repeating it over and over.That is the fate of many academics, I'm afraid. Are there any researchers you are aware of who are especially worth looking at?
>
> > in any case understanding the individual's unique circuitry would appear to be a staggering task,
>
> Maybe not so much. I don't know. I think it is a question of choosing the right biological probes or drugs to challenge the system with, and then seeing which areas of the brain, if any, light up in a PET scan or fMRI. It would be more empirical than deductive. This might be further improved perhaps by having the subject perform certain tasks while being exposed to the probe to better resolve regional or circuit activities.I agree that empiricism would be the way to go. These procedures have been extensively used in ADHD research, which have confirmed that methylphenidate and other stimulants improve specific performances on tasks, and that there is a differential response to methylphenidate in ADHD individuals as opposed to neurocognitive normals. there are some abstracts I've looked at that contrast AD classes in this way, but the (to me) interesting stuff, such as the observation that differential performance on tasks that required activation of hemisphere-specific abilities responded preferentially to TCA's and that the reverse was true of MAOI's, was done long ago, as evidenced by the drugs used in the studies. Most of what I've seen of more recent studies contrast the damaging effects of muscarinic antagonism on memory with the lack of such effects by newer AD's, which is hardly a surprise...
it appears also that progress in identfying genotypes for ADHD has been a lot more extensive than such work for depression. This is surprising in that adult ADHD is a more recent addition to the DSM than MDD.
> > I'm also feeling a little frustrated that nortriptyline appears to be the only psychotropic that doesn't damage my circuitry somewhere,
>
> Damage in what way? How can you tell?Strattera precipitated an anhedonic depression. provigil gave me headaches, GI disturbances, and eyelid twitches, which continue on Ritalin. Clonazepam precipitates hypnagogic hallucinations if I allow myself to fall asleep under its influence. Buspirone caused profound muscle weakness when I attempted, following my pdoc's instructions, to raise the dosage to the level where some efficacy in social phobia has been reported (I suppose he was trying at all costs to avoid prescribing me a benzo). Fluoxetine and other SSRI's produced nausea and worsened insomnia, which did not resolve after eight weeks in the case of fluoxetine (the others, which felt similar, produced much shorter trials as my tolerance for sleeplessness has declined over the years). I have never tried Effexor or an MAOI. Nortriptyline just feels 'right' to me. I can't explain it.
>
> > although it does not treat all my symptoms and so is acquiring quite a stable of fellow passengers in my bloodstream.
>
> What are your thoughts about trying Cymbalta? I can't think of any reason why you couldn't combine it with nortriptyline.
>
> The symptoms I am specifically concerned about are fatigue and ADHD related. Provigil helped both but was not clean at all and my pdoc did not like the sound of the s/e I reported to him. I have increased the methylphenidate to 20 mg and again, it is certainly working for the targeted symptoms, but also makes me feel that my CNS is under an unnatural stress. i suppose I'll either get used to it or drop it like I did the Provigil.by the way, what are your thoughts on therapy? I hold out hope for it because medications have their limits, and i don't feel like my CNS can handle more of them at the moment. The way I am thinking currently is that my medication regimen is forcing adaptations, and that one adaptation I am trying to make involves therapy. I.e. the degree i open up to her. The stims definitely make me more awake, and it's a lot easier to talk to a therapist when more of your brain would light up on a PET scan.
-z
>
> - Scott
>
poster:zeugma
thread:390599
URL: http://www.dr-bob.org/babble/20040909/msgs/390769.html