![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 43. This is the beginning of the thread.
Posted by Dr. Bob on September 15, 2003, at 20:12:59
In reply to Re: Non-stimulant, Non-tricyclic for ADHD? » DSCH, posted by Francesco on September 15, 2003, at 9:10:05
> Thank you for your kind reply. Yeah, it seems something like ODD.
> "having NE reuptake inhibition and then antagonizing some of the NE receptors" ... Why does Anafranil has both properties ?
> Could you explain to me what is the half-life of the meds ? For ex. Imipramine 19 hrs, (8-20 hrs).
> Why three numbers ?
> Does it mean that if I take Imipramine after 20 hours there won't be any trace of the med in my body ? (Clomipramine 19-37 hrs)
> mumble mumble ... does it mean that I could take Imipramine only when I need it for daily use ? Interesting issue ... since here Tofranil is considered the best TCA for ADHD ... It's less serotoniergic and more NEergic ... seems interesting : ) (I'll ask about Clonidine ... I think Guanfacine is a med of the same class)
>
> P.S. I red before posting your new post ... I usually stayed on it for ten-eleven months then stop it on summer than re-take it. And I did this for 5-6 years. Maybe some anxiety can taper off in the long term but the social avoidance usually lasts ... Besides the "ODD problem" I don't enjoy very much staying with people when I'm on it ... I easily get bored and want to go back home and reading my books ... Furthermore and unluckly sexual disinterest and weight gain doesn't taper off : ) (I know, it would be the same for Tofranil : /)
Posted by DSCH on September 19, 2003, at 22:19:13
In reply to Re: Non-stimulant, Non-TCA for ADHD? « Francesco, posted by Dr. Bob on September 15, 2003, at 20:12:59
> > Thank you for your kind reply. Yeah, it seems something like ODD.
> > "having NE reuptake inhibition and then antagonizing some of the NE receptors" ... Why does Anafranil has both properties ?Beats me. :-)
> > Could you explain to me what is the half-life of the meds ? For ex. Imipramine 19 hrs, (8-20 hrs).
> > Why three numbers ?Low, medium, high numbers correspond to fast, average, and slow metabolizing of the compound by individuals
> > Does it mean that if I take Imipramine after 20 hours there won't be any trace of the med in my body ? (Clomipramine 19-37 hrs)
No... at that point serum level of the drug would be at one half maximum from a single dose.
> > mumble mumble ... does it mean that I could take Imipramine only when I need it for daily use ? Interesting issue ... since here Tofranil is considered the best TCA for ADHD ... It's less serotoniergic and more NEergic ... seems interesting : ) (I'll ask about Clonidine ... I think Guanfacine is a med of the same class)
> >
> > P.S. I red before posting your new post ... I usually stayed on it for ten-eleven months then stop it on summer than re-take it. And I did this for 5-6 years. Maybe some anxiety can taper off in the long term but the social avoidance usually lasts ... Besides the "ODD problem" I don't enjoy very much staying with people when I'm on it ... I easily get bored and want to go back home and reading my books ... Furthermore and unluckly sexual disinterest and weight gain doesn't taper off : ) (I know, it would be the same for Tofranil : /)
>Keep the slective NE-RIs in mind too.
What's been going with you lately? Update? :-)
Posted by Francesco on September 20, 2003, at 20:12:58
In reply to Francesco? » Dr. Bob, posted by DSCH on September 19, 2003, at 22:19:13
Thanks for your explainations : ) You would deserve an ad-honorem degree in psychiatry (and kindness) ;-) By the way, why do they use HALF-life ? If half-life is x the time for being free of the med is 2x ? (it seems a school-problem ;-)
In these days my mood is quite good. Anafranil is helping somehow, I'm thinking about future and my mind isn't SO overwhelmed about inessential thoughts ... Of course the "meds-induced SP" occurred again ... in the last week I didn't see any friend and I feel very shy if I have to buy a newspaper or make a phone-call (misteries of brain ...) I'm experiencing some anhedonia but it's nothing compared to the SSRI's one ... My brain is impaired and I think that paradoxically is what helps my adhd. My mind is slower so I can control a bit better my impulses. I don't think this is a sharp solution to my problem but so far it has been the best.
Apart from Reboxetine are there other selective NE-RI ? I'm curious about Reboxetine but I've red many posts talking about impotence (not just sexual dysfunctions ...). Anyway my problem is not only find a med that could work but also find a psychiatrist that would prescribe it. My understanding of the US situation is that you can get what you want if you just ask : ) Consider yourselves lucky !
My alternatives for the future are:
1. Try Parmodalin (Parnate + a low dose of an antipsychotic). I've read somewhere that MAOIs can be useful for ADHD & they're also useful for social phobia so this would address all my problems. I know Amen didn't mention MAOIs but ... my simplicistic understanding of the issue is that MAOIs are useful for everything because they affect serotonin, NE and dopamine too. Another simplicistic way of considering my problem is:I have low dopamine (since I have ADHD)
Serotoninergic meds makes me Social Phobic
Serotoninergic meds can cause dopamine depletion
Low dopamine is related to Social Phobia
Maybe dopamine depletion cause my induced SP
Maybe a dopaminergic can help ! : )2. (sorry for this very long post but I don't see people so I need talking ;-)
Ask for a less serotoninergic TCA like Desipramine. Anafranil is the worst for what concerns side-effects so I can't see the reason why I'm on it. (I said I get a bit aggressive when I'm on IT ... could it mean TOO MUCH serotonin ? ... I know, introverted and aggressive at the same time is an awful combination : )
3. I have an appointment with the only italian psychiatrist who knows something about adult ADHD. I asked him by e-mail about Ritalin and he was very very vague ... I must be stupid because I insisted (it sounded like: "gimme ritalin !!!"). I don't know if he will allow me to try it (I doubt it after the paranoid mails I sent him) but if he allows me I think I'll try ... I know about addiction, tolerance and so on but I want to know how what kind of effects it has on me. I don't want to miss the (remote) chance of feeling normal for the first time in my life : ) Anyway I must be very cautios because he cannot *prescribe* Ritalin since it's not on the market. The only stimulant on the italian market is Provigil. I would ask about it to this doc.
4. Searching the web and begin purchasing Dexedrine and so on in Hawaii Islands at unbelievable prices. This is the last (and least) option.
I wrote a LOT !
Bye bye and let me know about you : )
Posted by DSCH on September 21, 2003, at 14:12:03
In reply to Francesco ! » DSCH, posted by Francesco on September 20, 2003, at 20:12:58
> Thanks for your explainations : ) You would deserve an ad-honorem degree in psychiatry (and kindness) ;-) By the way, why do they use HALF-life ? If half-life is x the time for being free of the med is 2x ? (it seems a school-problem ;-)
Thanks for the compliment.
Re:Half life... I think it's an exponential decay in concentration though metabolism rather than linear, much like the decay of radioisotopes.
> In these days my mood is quite good. Anafranil is helping somehow, I'm thinking about future and my mind isn't SO overwhelmed about inessential thoughts ... Of course the "meds-induced SP" occurred again ... in the last week I didn't see any friend and I feel very shy if I have to buy a newspaper or make a phone-call (misteries of brain ...) I'm experiencing some anhedonia but it's nothing compared to the SSRI's one... My brain is impaired and I think that paradoxically is what helps my adhd. My mind is slower so I can control a bit better my impulses. I don't think this is a sharp solution to my problem but so far it has been the best.
I have the thought the "SP-like" effect is due to a conscious wish on your part to dodge potential conflicts arising from your "ODD-like" symptoms that arise when you deal with people. Sound close to the mark?
There was a time when I was still taking pemoline along with DLPA and B-complex that I noticed the speed of my cognition was outpacing my ability to regulate it and my short term memory. I become very physically active and with a feeling of great well-being but really scatterbrained... ADHD? I think that was from having the pemoline exciting too much dopaminergic activity relative to noradrenergic (focus) and acetylcholnergic (memory).
Everything comes down to how you can nudge your system into a proper operating balance. There's a Nobel out there for whoever comes up with the broader, non-linear model that takes into account ALL the neurotransmitters and brain factors and their localized functioning and interconnections. Definately a problem worth the human and computational effort.
> Apart from Reboxetine are there other selective NE-RI ? I'm curious about Reboxetine but I've red many posts talking about impotence (not just sexual dysfunctions ...). Anyway my problem is not only find a med that could work but also find a psychiatrist that would prescribe it. My understanding of the US situation is that you can get what you want if you just ask : ) Consider yourselves lucky !
That's not really the case here. Ask about something by name (especially the stimulants) and you run the risk of being seen as the "seeker"-type here too.
> My alternatives for the future are:
> 1. Try Parmodalin (Parnate + a low dose of an antipsychotic). I've read somewhere that MAOIs can be useful for ADHD & they're also useful for social phobia so this would address all my problems. I know Amen didn't mention MAOIs but ... my simplicistic understanding of the issue is that MAOIs are useful for everything because they affect serotonin, NE and dopamine too. Another simplicistic way of considering my problem is:
>
> I have low dopamine (since I have ADHD)
> Serotoninergic meds makes me Social Phobic
> Serotoninergic meds can cause dopamine depletion
> Low dopamine is related to Social Phobia
> Maybe dopamine depletion cause my induced SP
> Maybe a dopaminergic can help ! : )Then again, maybe you have TOO MUCH dopamine (off meds) like I did. All activity with not enough focus and short term memory to reign it in. :-)
The best ADHD meds all effect norepinepherine. I don't believe the seperate effects have been well separated out yet.
There is atomoxetine as well as reboxetine for selective NE-RI. Atomoxetine only recently got accepted here in the US and is sold under the name Strattera. It's being marketed towards ADHD, which I think strengthens the case that even the hyperactive-side of ADD is quite wrapped up with noradrenergic activity moreso than dopaminergic.
I am skeptical about hyperactivity being related to too little dopamine. I think I had too little dopamine going, but it resulted in lethargy and anhedonia. Anyway, that's just my own subjective experience without nanobot monitors relying hard chemical data from the other side of my BBB. ;-)
I remember posting a while back that a RIMA might help you out. Humoryl should still be available in France at least. MAO-B, IIRC, would retard dopamine and norepinpherine break down more than it would serotonin. There is also low dose selegiline.
Amino acid supplements would be worth a shot too. I would try both L-phenylalanine and L-tyrosine (the precursors to dopamine and norepinepherine) plus vitmains and minerals as long as you aren't on a RIMA or MAOI. With a RIMA or MAOI, I would have a professional advise on amino supplementation (tyramine crisis!).
> 2. (sorry for this very long post but I don't see people so I need talking ;-)
>
> Ask for a less serotoninergic TCA like Desipramine. Anafranil is the worst for what concerns side-effects so I can't see the reason why I'm on it. (I said I get a bit aggressive when I'm on IT ... could it mean TOO MUCH serotonin ? ... I know, introverted and aggressive at the same time is an awful combination : )That you are able to write longer and more coherent and spelling/grammitically correct posts is a good sign! ;-)
If you can get a TC which targets norepinepherine more and serotonin less than does Anafranil then switching to it would probably help you. I'm not so well versed on how the TCs differ from each other. There is a good reference work in a library just a block from my house, so I will post again soon once I check on it.
> 3. I have an appointment with the only italian psychiatrist who knows something about adult ADHD. I asked him by e-mail about Ritalin and he was very very vague ... I must be stupid because I insisted (it sounded like: "gimme ritalin !!!"). I don't know if he will allow me to try it (I doubt it after the paranoid mails I sent him) but if he allows me I think I'll try ... I know about addiction, tolerance and so on but I want to know how what kind of effects it has on me. I don't want to miss the (remote) chance of feeling normal for the first time in my life : ) Anyway I must be very cautios because he cannot *prescribe* Ritalin since it's not on the market. The only stimulant on the italian market is Provigil. I would ask about it to this doc.
>
> 4. Searching the web and begin purchasing Dexedrine and so on in Hawaii Islands at unbelievable prices. This is the last (and least) option.
>
> I wrote a LOT !
> Bye bye and let me know about you : )My own idea would be to contact this ADHD-expert pdoc again, apologize, and mention to him that while you are on Anafranil your ability to communicate open-mindedly in a two-way fashion gets clouded (don't mention ODD by name). I would NOT mention specific "candidate" drugs by name with him for a while (unless you are talking about your history on/off meds). FIRST give him some space to organize your symptom profiles and then prescribe what HE thinks is the first, best choice for you. I doubt any pdoc likes the idea of being second-guessed by their own patient and all the sources the patient has access too. Let him do his job for a while with as little interference as possible, but remember you still have the right (and the responsibility as well!) to determine whether his advice is being helpful or not. Leave the psychopharmocological disscussions on the board for the time being. ;-)
I need to attend to business now. I'll post more soon.
Posted by francesco on September 21, 2003, at 15:14:29
In reply to Re: Francesco ! » Francesco , posted by DSCH on September 21, 2003, at 14:12:03
Since I don't know how to cut & paste with Dr. Bob's posts I have to use my short-term memory to answer ;-) Yes, my social phobia is partly dued to the will to avoid ODD-like offences to people. But there is something more ... I experience physical disconfort when I'm with people, I'm nervous if I'm touched, I'm shy even if I have to call a friend ... I mean ... If I were not on meds it would be SP.
For what concerns dopamine ... I don't know ... Maybe you're right and it's a NE problem (who knows ?) ... Anyway I'm not THAT extroverted when I'm not on meds ... but I can enjoy have conversation or relating with others ... I was enthusiastic by this because I stayed soo much time on Anafranil that I finished to believe I was an antisocial ... maybe I exaggerated my being extroverted but I was proud of it ! : )
Yes, I can think more clearly and speak more clearly (not only in English ... I can see the difference in Italian too). I had excellent results at university with the help of Anafranil (but I didn't go to lessons because I didn't want to relate with others !)
You're right, I made a mess with the psychiatrist ... I told him what HE had to do ... not a great idea ... he didn't returned me the last mail I wrote him but I still have an appointment ... I must remember what you said, it's very preciuos ... I have to give him the chance of playing the doctor's part ;-)
About moclobomide (everytime I spell it I sweat) ... my last p-doc suggested it ... but it's not available anymore in Italy (yeah, you should be right in France there should be Umoril). I don't think they will let me try selegyline (I'm sweating again) because "officially" is for Parkinson's disease.
Of course if I'd like I could order it by net but I'm going to avoid this expensive and complex procedure until I have "legal" alternatives ...
It's not dued to a wish of being a good citizen but rather to the fear of self-medicating without someone else's support. Just a psychological issue : )
I read on a link you posted (very very useful) the differences between the different TCAs. Some of them (like desipramine) are less SE-oriented and more NE-oriented. Secondary amines seem to have less side-effects and I can tolerate Anafranil (which is a tertiary amine) so I think they should be ok.
Tryciclics are the only one meds I can rely on because I'm quite sure I can find a p-doc who would prescribe another TCA if I am on Anafranil (at least, I hope so).I'll keep you informed : )
(what a sweat !)
Posted by DSCH on September 21, 2003, at 16:28:29
In reply to Francesco » DSCH, posted by francesco on September 21, 2003, at 15:14:29
Source:
Perrine, Daniel M.
"The Chemistry of Mind-Altering Drugs: History, Pharmacology, and Cultural Context"
American Chemical Society, 1996, p. 235-7.Amitriptyline (tertiary amine TC)
_Weight Gain: High
_Sedation: High
_Anticholinergic: High
_Hypotension: High
_Cardiotoxicity: HighClomipramine (tertiary amine TC)
_Weight Gain: Medium
_Sedation: Medium
_Anticholinergic: High
_Hypotension: Medium
_Cardiotoxicity: HighMaprotiline (secondary amine TC)
_Weight Gain: Medium
_Sedation: Medium
_Anticholinergic: Medium
_Hypotension: Medium
_Cardiotoxicity: MediumDoxepin (tertiary amine TC)
_Weight Gain: Medium
_Sedation: High
_Anticholinergic: Medium
_Hypotension: High
_Cardiotoxicity: MediumImipramine (tertiary amine TC)
_Weight Gain: Medium
_Sedation: Medium
_Anticholinergic: Medium
_Hypotension: Medium
_Cardiotoxicity: High
Amoxapine (secondary amine TC)
_Weight Gain: Medium
_Sedation: Low
_Anticholinergic: Low
_Hypotension: Medium
_Cardiotoxicity: MediumDesipramine (secondary amine TC)
_Weight Gain: Medium
_Sedation: Low
_Anticholinergic: Low
_Hypotension: Low
_Cardiotoxicity: MediumNortriptyline (secondary amine TC)
_Weight Gain: Medium
_Sedation: Low
_Anticholinergic: Low
_Hypotension: Low
_Cardiotoxicity: Medium-------------------------------------------------
OK... now for Dr. Preskorn
http://www.preskorn.com/columns/9803.htmlTable 3 in particular!
-------------------------------------------------
Francesco:
Desipramine might be better for you than clomipramine. It inhibits reuptake of norepinepherine much more specifically than does imipramine. It also does not antagonize NE-alpha-1 and NE-alpha-2 receptors.
Posted by DSCH on September 21, 2003, at 20:51:55
In reply to Francesco » DSCH, posted by francesco on September 21, 2003, at 15:14:29
Nortriptyline appears as though it may be similar in action profile to desipramine, and it is one of "+++" meds from this post of yours (an Italian opinion on ADHD meds). Too bad Preskorn did not write about it.
http://www.dr-bob.org/babble/20030912/msgs/260031.html
Desipramine got a "++".
I think your idea that the secondary amine TCs would be the best options to try next has merit. TCs are accepted as ADHD meds in Italy moreso than the pstims and you appear from your posts to be physically tolerating clomipramine well (and it's one of the worst offenders among TCs for those side-effects!). A TC which is not as psychoactively "dirty" as clomipramine might be the answer for addressing the ADHD without inducing these "ODD/SP" symptoms.
Posted by DSCH on September 21, 2003, at 21:14:24
In reply to Perrine's Tricyclic Chart and a Preskorn Article, posted by DSCH on September 21, 2003, at 16:28:29
A YMMV comment from Perine himself regarding the chart... (p. 235)
"Table 5.2 summarizes the relative incidence of side effects with these drugs; the drugs are listed from top to bottom from roughly the most side-effect-prone to the least. Nonetheless, in practice a great degree of idiosyncratic interaction occurs; and one individual may respond better to a drug at the top of the list than to one at the bottom. (Ref. 48)"
Posted by DSCH on September 23, 2003, at 15:44:50
In reply to Francesco » DSCH, posted by francesco on September 21, 2003, at 15:14:29
Just "bumping" to keep this thread current so we can keep our back-and-forth in one place for a change!
Posted by francesco on September 23, 2003, at 17:13:13
In reply to Re: Francesco, posted by DSCH on September 23, 2003, at 15:44:50
I'm not sure if I understood what you wrote in the last post : ) Anyway, thanks for the suggestion, I'll keep you informed ! : )
Posted by DSCH on September 23, 2003, at 19:15:12
In reply to Re: Francesco » DSCH, posted by francesco on September 23, 2003, at 17:13:13
> I'm not sure if I understood what you wrote in the last post : ) Anyway, thanks for the suggestion, I'll keep you informed ! : )
Since the main PB forum entered a new period, this thread dissapeared from the main page. I meerly made that post to bring it "back" so you wouldn't have to hunt for it or start a fresh one.
Just to let you know about me: keeping my carbohydrate intake low, taking vitamins and minerals, walking roughly seven miles a day, and drinking protein powder in water (rich in phenylalanine and tyrosine) 3-4 times a day has been keeping me pretty level and focused lately.
I get drowsy if I eat carbs in combination with protein and/or drink alcohol (doesn't take much).
I am no longer drinking licorice root tea. The dark patches under my eyes have gone away. I also tend to wake up from 5-7 AM without an alarm going off unless I stayed up really late. That is a big change from before.
Posted by Francesco on September 24, 2003, at 12:07:26
In reply to Re: Francesco » francesco, posted by DSCH on September 23, 2003, at 19:15:12
I'm glad you're doing fine with your diet and exercises. I would like to have the patience to make experiments with alternative solutions as you do. I was quite skeptical before but it seems they changed your life. I'm doing fine too with my little Anafranil pill. Today I forced myself to go to university to test my SP level. It was not that bad but it was not that easy. I hope that desipramine will be better from this point of view or I'll have to find another solution for the long term. I can be at home for the rest of my life but I don't think it's sane. Anyway, so far so good : )
my hidden dream was to try MAOIs to be sure not to have SP-like-side effects. Tepiaca in another post said in his country (Mexico) exists something like Parmodalin (Parnate + an old antipsychotic) and that he tried and devoleped some kind of TD-like-syntomps. So, my hidden dream is not a dream anymore : (
I would like to ask something about you but it would be social-babbling and we would be redirected ;-)
Bye
Posted by Dr. Bob on September 24, 2003, at 22:29:25
In reply to Re: Francesco » DSCH, posted by Francesco on September 24, 2003, at 12:07:26
> I would like to ask something about you but it would be social-babbling and we would be redirected ;-)
You could always ask over at Psycho-Social-Babble and post a link to it here...
Bob
Posted by Francesco on September 26, 2003, at 11:29:10
In reply to Re: Francesco » francesco, posted by DSCH on September 23, 2003, at 19:15:12
The Adhd p-doc answered my mail. He said that if I get nervous with antidepressants this *can* mean I'm bipolar II. I asked him about desipramine but he said that even if it has less side-effects than Imipramine, Imipramine is first choice for Adhd. He'll probably let me try Imipramine and if I get nervous with it add a mood stabilizer. I guess this means I will get twice fat & twice impotent. I can't question his eventual diagnosis but I'm quite suspect ... it would be far easier for him to say I'm bipolar II because he shouldn't have to justify the treatment *without* stimulants. anyway, sorry for the spelling mistakes but today I missed my Anafranil pill ;-)
Posted by DSCH on September 26, 2003, at 12:56:49
In reply to news : ) » DSCH, posted by Francesco on September 26, 2003, at 11:29:10
Why is it that my inner cynic is not surprised at what he said?
Paraphrase of the notional thought process:
"Imipramine is MY first choice as an ADHD med. Therefore if you do not respond well to it, you are probably BP2."*shakes head*
I really hope this is a misconception of mine and that our "best" medical minds are much more flexible and scientific than this! :-p
Are any ideas for your bio-ethics PhD thesis dissertation being sparked by this experience of yours? ;-)
Here's a key word for the literature search: "pharmacologic dissection" ;-)
Posted by DSCH on September 26, 2003, at 13:04:09
In reply to news : ) » DSCH, posted by Francesco on September 26, 2003, at 11:29:10
For what it's worth imipramine may be a step upwards as it tends to be less anticholinergic than clomipramine according to Perrine.
I wonder what he would have to say if he had followed our discourse from when it began back when I warned you about MAOIs? ;-)
Posted by DSCH on September 26, 2003, at 13:43:40
In reply to Re: Francesco » DSCH, posted by Francesco on September 24, 2003, at 12:07:26
> I would like to ask something about you but it would be social-babbling and we would be redirected ;-)
Yes?
http://www.dr-bob.org/babble/social/20030913/msgs/263522.html
Posted by Dr. Bob on September 26, 2003, at 18:54:45
In reply to Social babble self-redirect ;-) » Francesco , posted by DSCH on September 26, 2003, at 13:43:40
Posted by DSCH on September 27, 2003, at 0:34:50
In reply to Re: Francesco » DSCH, posted by Francesco on September 24, 2003, at 12:07:26
> my hidden dream was to try MAOIs to be sure not to have SP-like-side effects. Tepiaca in another post said in his country (Mexico) exists something like Parmodalin (Parnate + an old antipsychotic) and that he tried and devoleped some kind of TD-like-syntomps. So, my hidden dream is not a dream anymore : (
What is the "old antipsychotic" that gets mixed in with the Parnate in Parmodalin?
TD = tardive dyskinesia?
Posted by francesco on September 27, 2003, at 8:33:36
In reply to Re: news : ) » Francesco , posted by DSCH on September 26, 2003, at 12:56:49
>Why is it that my inner cynic is not surprised >at what he said?
My inner cynic wasn't susprised too but my inner optimistic (very inner ;-) was a bit surprised. He wrote (not me, him)in an article that Stimulants are first line treatment for Adhd. What's happened after ? Does he have mood swings ?
;-)>Paraphrase of the notional thought process:
>"Imipramine is MY first choice as an ADHD med. >Therefore if you do not respond well to it, you >are probably BP2."another possibile paraphrase:
"You suggest desipramine but I'm the doctor and you're just a patient. Therefore I suggest imipramine otherwise which is my role in the society ?" ;-)>I really hope this is a misconception of mine >and that our "best" medical minds are much more >flexible and scientific than this! :-p
I think there is no misconception : ) Doctors are human being too and their self-esteem is usually incredibily high. This oftens leads to several incredibile biases. I told the doctor before I was not obsessed, I just daydreamed all day long.
"Psichiatry is not interested in daydreaming"
He must have been ill when they explained Adhd at university ! "I drink more when I'm on meds"
"No way, they give meds to alcoholics" ... I sent him an article that linked SSRIs and increased-compulsive-alcohol consumption. Of course he never answered. "I got more depressed when I took Prozac" "No way, Prozac is an antidepressant" ... but "increased depression" is one of the listed side-effects, and so on ... The summary of all this can be: all negative effects you get from meds is auto-suggestion while all positive effects is dued to meds ... Very scientific !>Are any ideas for your bio-ethics PhD thesis >dissertation being sparked by this experience of >yours? ;-)
I would like to write a thesis about "ethics & meds" but I am a bit too much involved in it. There are SO many things that should be said : )
Posted by francesco on September 27, 2003, at 9:03:47
In reply to Re: news : ) » Francesco , posted by DSCH on September 26, 2003, at 13:04:09
>For what it's worth imipramine may be a step >upwards as it tends to be less anticholinergic >than clomipramine according to Perrine.
I agree. I will insist on desipramine but if he doesn't allow me to try it I will try imipramine. Sooner or later in my life I will have to try stimulants to know how they work & if they work.
Trials & errors procedure is far for more scientific in my opinion than put up a diagnosis in twenty minutes (or by mail !). If he's in doubt between ADHD & -bipolar rapid cycles- I think that he should allow me to try stimulants for few days and see what happens. Then if I get manic I'm bipolar II otherwise I'm ADHD. I know this is not a sharp procedure but which is the alternative ? I'm going to tell tell him also that I tried cocaine twice or thrice in my life and I didn't get euphoric at all. My main reaction to cocaine was wondering insistently why so many people spend so much money for it : )
>I wonder what he would have to say if he had >followed our discourse from when it began back >when I warned you about MAOIs? ;-)Psychiatrists are not used to follow discourses : ) There are so many things I would like to write in my PHD thesis ... first of all:
why do side-effects of antidepressants resemble so much to diagnostic cryteria for depression ?Imagine a person who eats very much and compulsively, who usually sleeps 12 hours a day, who's not interested in sex anyomore even if he was before, who's always tired and speaks and acts very slowly. Is he depressed ? No, he's taking Anafranil ... ;-)
Sorry for my harangue (find this on a dictionary) but I skipped Anafranil again to be able to go out this evening : )
Posted by francesco on September 27, 2003, at 9:38:34
In reply to Parmodalin? » Francesco , posted by DSCH on September 27, 2003, at 0:34:50
The antipsychotic in Parmodalin is Trifluoperazine (brand name Stelazine). In a capsule of Parmodalin there is 10mg of Parnate and 1mg of Trifluoperazine. At this low doses Trifluoperazine acts like an anxiolytic ... but there are still a couple of points that makes me think.
1. Tardive Diskynesia it doesn't seem to be related with dosage (correct me if I'm wrong). if Parmodalin works great for me I could take it for years. I don't know if 25-40% of chances of having my life ruined is worth the eventual benefits of Parmodalin.
2. I would have to bear also the side-effects of Trifluoperazine. For ex. Parnate is supposed not to have sexual side-effects but antipsychotics of course have. I red a couple of italian's posts (on italian sites) complaining about impotence on Parmodalin. (does Italian government has something against meds that *don't* have sexual side-effects ? are they a price dued if you're a bit strange ? chemical castration for bad genes genes' owners ? sorry, today I'm in a preacher mood ;-)
3. Parnate should affect positively dopamine, and this effect should be counteracted by Trifluoperazine (to some extent, don't know which). So one of the reasons to try it (avoid anedhonia-apathia given by meds) should be not a good reason ...
Any input ? : )
Posted by DSCH on September 28, 2003, at 9:12:46
In reply to Re: Parmodalin? » DSCH, posted by francesco on September 27, 2003, at 9:38:34
> The antipsychotic in Parmodalin is Trifluoperazine (brand name Stelazine). In a capsule of Parmodalin there is 10mg of Parnate and 1mg of Trifluoperazine. At this low doses Trifluoperazine acts like an anxiolytic ... but there are still a couple of points that makes me think.
>
> 1. Tardive Diskynesia it doesn't seem to be related with dosage (correct me if I'm wrong). if Parmodalin works great for me I could take it for years. I don't know if 25-40% of chances of having my life ruined is worth the eventual benefits of Parmodalin.As if that is not enough there is also Neuroleptic Malignant Syndrome (NMS).
http://www.rxlist.com/cgi/generic3/trifluo_wcp.htm
> 2. I would have to bear also the side-effects of Trifluoperazine. For ex. Parnate is supposed not to have sexual side-effects but antipsychotics of course have. I red a couple of italian's posts (on italian sites) complaining about impotence on Parmodalin. (does Italian government has something against meds that *don't* have sexual side-effects ? are they a price dued if you're a bit strange ? chemical castration for bad genes genes' owners ? sorry, today I'm in a preacher mood ;-)Perhaps it is the belief that, of all people, Italians should not have their sexual interests or ability increased as they are "high" enough as it is! ;-) (just joking)
Concern over sexual side effects by the professionals and the pharmaceutical industry was slow to get going here I believe (the old attitude: "be thankful that you aren't mentally ill anymore rather than complaining about your sex life"). But with the trend going towards more sophisticated medications with fewer side effects anyway, momentum has finally built up here. The industry realizes now, in this "post-Prozac" era, that a psychoactive drug that doesn't have sexual side effects is more likely to be a money-generating "hit"; and money is why they are ultimately in the business anyway (as a capitalist myself, I don't mean that badly). :-)
> 3. Parnate should affect positively dopamine, and this effect should be counteracted by Trifluoperazine (to some extent, don't know which). So one of the reasons to try it (avoid anedhonia-apathia given by meds) should be not a good reason ...
>
> Any input ? : )
>I think this line of reasoning is logically flawed; just because you have some SP symptoms *ON* Anafranil does not mean you should take an anti-SP drug. Your underlying condition is (probably) ADHD rather than SP so treat the ADHD unless your intent is to base a cocktail around Anafranil (and I don't see a good way of going about that either).
My philosophy would be: see what you can find in a replacement that keeps the good aspects of Anafranil (improved focus and overall mental function) while dropping the bad ones (this collection of symptoms borrowing from OCD, ODD, and SP). I think exhausting the possibilities of the "cleaner" tricyclics given your treatment history and the difficulties surrounding stimulants in your country is the best route forward. After that would come Reboxetine and then, if you can get it, Strattera. I would leave Ritalin as the final option at this point (but that's just my thinking anyway). I'm not wise/exeperienced enough to suggest a good way to make this happen with conservative pdocs who don't want sophisticated input from their patients regarding their own treatment. The one thought that occured to me was going back to the one who prescribed Anafranil to you in the first place and maybe simply mentioning to him/her that you have read that desipramine and nortriptyline have the least frequent and severe side effects of all the tricyclics.
Going back to the BP2 issue, what were your conclusions from reading that article that discussed the similarities and differences between them?
Posted by DSCH on September 28, 2003, at 9:31:21
In reply to Re: news : ) 2 » DSCH, posted by francesco on September 27, 2003, at 9:03:47
> Psychiatrists are not used to follow discourses : ) There are so many things I would like to write in my PHD thesis ... first of all:
> why do side-effects of antidepressants resemble so much to diagnostic cryteria for depression ?Because depression is not monolithic and linear but a collection of syndromes and non-linear. And treating an indivdual's own idiosyncratic form of depression with the wrong antidepressant only makes things worse.
Psychiatry is the only branch of medicine left that usually does not undertake imaging and chemical diagnostics (beyond the obligatory thyroid check the GP probably already did). So they resort to trial and error (my catchphrase: the "drug roulette wheel").
Being doctors, they are sensitive to accusations of iatrogenic problems, so it is understandable they attempt to shrug these off while accepting the up side when it comes. That's human nature.
Posted by francesco on September 28, 2003, at 11:45:23
In reply to Re: Parmodalin? » francesco, posted by DSCH on September 28, 2003, at 9:12:46
You seem to be right. I'm not social phobic so why treat social phobia ? the only reason was that in the last year I tried something like 4 different meds. With the possible exception of Paxil every med made me feel "weird" and this gives me problems in the social area. Maybe I'm not social phobic but I have some SP traits that worsen under meds ... I really don't know. Anyway I can't be sure that Imiprammine will give me the same kind of problem. The doc seems oriented to let me try first Imiprammine and only after an eventual failure Desipramine. I thought Desipramine was good also because is used in "ritired depressions", so I think it should be pro-social.
Anyway, he knows about the existence of adult-Adhd and this is quite good. The previous doc gave me Anafranil because he thought I had an OCD problem ... so he wouldn't give me other tryciclics because Anafranil is the best for OCD.
I can bear not to be sexual for a period. But I don't think I can stand it for life. So, if I have this kind of problem sooner or later I'll finish to quit the med (to re-start it after a vacation).I don't care about having sex here and now but I'm looking for a treatment that could be useful in the long term. My condition without meds is not unbearable, so I'm quite demanding ... I want to be sure that it's worth.
Another issue is that my body doesn't seem to be capable anymore to tolerate meds. The last two times I took Anafranil I got ill (got a bad fever) and I usually don't get ill. But I don't want to complain too much. In this thread there are people who suffer from Major Depression or worse while I can choose if taking meds or not. So I suppose I can't complain too much. Somehow I managed to make a lot of things despite the disturb ... (I'm trying to convince myself ;-)
about Bipolar II ... I have never been hypomaniac for days ... the only time was when I quit Anafranil cold turkey ... but I red it can happen
so maybe I could be bipolar rapid cycling. I can't remember exactly the points in the article just that I recognize myself far more in the Adhd profile. anyway I have problems in concentration (organization, etc.) if I'm depressed, high, or medium ... this doc seems to be an expert also in bipolar II ... therefore I hope he'll be able to understand my problems and give me a proper treatment ... Imiprammine is anyway a step forward
I'm a bit deluse about Parmodalin because I thougt despite the evidences that Maois could be the key. They are known to make people high even if they're not depressed (I have never been happy under meds) and parnate seems to be very similar to anphetamine in ist chemical structure. I'll ask about it to this new p-doc. The Parmodalin mix is a crime and it makes no sense.
I'm attracted by stimulants because I have the sensation that they affect your personality less than antidepressants. I have this feeling that they are in some way "saner" and more natural. and you can skip a dose and be yourself if you want. but the prices on the net are crazy and I wouldn't like to explain to police that I'm affected by Adhd ;-)
Thank you for the support. It really means a lot for me. Ok, today I had my anafranil pill so I can go to watch a movie now ;-) bye !
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