![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 114. Go back in thread:
Posted by franco neuro on April 6, 2005, at 13:06:21
In reply to Re: Anyone TIRED on Wellbutrin XL?, posted by Steen on April 5, 2005, at 22:05:53
Hi, and thanks for the well wishes,
> Did you have the side effects of being nervous, anxious and agitated?
The fancy doctor in NYC that I'm seeing gives all of his new patients psych tests. My main psychological issues (which are secondary but no doubt related to my physical problems of chronic pain and fatigue) came up as anxiety and dysthymia (chronic low grade depression). So I was concerned about this very issue. But, I have had zero increase in nervousness or anxiety. Whatever tiny bit of agitation I've had I think is mostly due to my trying to fight through the fatigue and stay awake.
> I'm worried because of other posts that I have read (I am not even sure it was on this website) about people having such long-lasting horrible effects. I wondered if they had significant problems prior to taking Wellbutrin and that's why the stories were so bad.
Take everything you read on these psych websites with a large grain of salt. I hope my previous post/tirade about my experience with Elavil didn't scare you. Our problems and experiences are unique. My problem with Elavil was that I took it for too long and went to too high a dose and stopped it too quickly. On the other hand I had absolutely no problem stopping SSRI's. (Maybe because they weren't doing anything except killing my libido!) I think negative drug reactions tend to be over-represented on sites like this. After all, anyone who has found a medication/s that resolved their "issues" probably would be out living their life and not spending so much of their free time posting here. At least that's what I would be doing. :-)
> I'll start tomorrow and we'll see. I'll check in.
Good Luck!!! I may go to twice a day tomorrow...
Posted by steen on April 6, 2005, at 13:38:41
In reply to Re: Anyone TIRED on Wellbutrin XL? » Steen, posted by franco neuro on April 6, 2005, at 13:06:21
franco neuro,
Thank you. I did take my first dose this morning and I'm OK. I feel a little nervous, which is new for me, but not bad so far. I have a problem with taking decongestants because they do this to me, but it's not bad and I can stand it if the results are good.
Your story about the Elavil didn't scare me. I had read on some other site about Wellbutrin that someone was put in the hospital for hallucinations and another was ...., well you know, it was on and on. I was just concerned about the side effects being that severe. I do think you're right, though, about the types of problems discussed and why.
I purposely decided to take this first week of this when I was off work. I didn't want to experience a lot of problems while working. I work part time and make my own schedule, so it was easy to do it this way.
Anyway, so far so good. Of course, it's just the first day!!
I appreciate your answer and hope you find something for your pain.
steen
Posted by KaraS on April 7, 2005, at 3:12:47
In reply to Re: Read this before answering my previous post » KaraS, posted by franco neuro on April 5, 2005, at 22:16:14
> Hi Franco,
>
> I was beginning to worry that everyone abandoned this thread. :-) The fatigue seemed to lesson yesterday but reappeared with a vengeance today. I had been taking 1/4 grain of Dr. Braverman's thyroid formula, but I stopped a couple of days ago. I decided to take it this morning and am wondering if that contributed to the fatigue, because I called his office today and they told me my thyroid antibodies came back high. So maybe the thyroid hormone is causing an immune reaction. I doubt it. I think it's the dopamine paradox and/or the double edged sword that is norepinephrine. I'll keep taking it for a while and see what happens.
I have the antibodies also. I read that they are in response to a protein in the thyroid gland and not to the thyroxin itself. (I wouldn't put money on it though.)
> I know the feeling. I'm always afraid that I'll do more harm to my already messed up brain/body. But what I'm more afraid of is never feeling healthy again and having the rest of my life pass me by like the last few years have. Having said that, the AP's will probably be my medications of last resort.
Same here but particularly with the APs. I don't think there's any long-term data on low dosage usage of them for depression. Have you considered MAOIs at all?
> Here's what it says in Stephen M. Stahl's "Essential Psychopharmacology: The Prescriber's Guide", amisulpride:
> -Is possibly a dopamine stabilizer and dopamine agonist.
> -Theoretically blocks presynaptic DA 2 receptors at low doses.
> -Theoretically blocks postsynaptic DA 2 receptors at high doses.
> -May be a partial agonist at DA 2 receptors, which would theoretically reduce DA output when DA concentrations are high and increase output when DA concentrations are low.
> -Blocks DA 3 receptor, which may contribute to it's clinical action.
> -Unlike other atypical AP's, amisulpride does not have potent actions at serotonin receptors.I did know that it behaves differently at lower dosages so I guess that would mean it's a dopamine stabilizer. That's good info. Thanks.
> > I've also heard that it can have some less than desirable side effects.
>
> Amen. Any drug that blocks DA can have some scary side effects.
I've also heard it affects prolactin levels.
> > I also didn't know that about hydergine. I have always thought of it in terms of Ach only. Have you tried it?
>
> You might be thinking of Galantamine, which is a cholinesterase inhibitor.
No, I was thinking about hydergine. I just didn't know enough about it.
> The million dollar question?
> > Dr. Goldstein doesn't address that, does he?
>
> As a matter of fact, I started flipping through the nearly 500 pages of "Tuning the Brain" and managed to find this tasty tidbit...[] are my additions...
>
> "I am being drawn to the conclusion that fatigue is, at least in part, related to NAc [nucleus accumbens] DA release, or the insufficiency thereof. PFC [prefrontal cortex], even mPFC [medial prefrontal cortex] , hypoactivity is common in neurosomatic disorders."
>
> He continues...
>
> "If the mPFC DA is insufficient, there will be hyperglutamatergic input to presynaptic D2 autoreceptors [BINGO!] on mesoaccumbens DA neurons, which is the apparent situation in neurosomatic disorders."
>
> I new it had to do with the EAA's glutamate and/or NMDA. As a matter of fact this is pretty much the thrust of his whole theory. Earlier in the book he says...
>
> "The ultimate goal increasingly appears to be (for most patients) to reduce the sensitivity of the NMDA receptor, one of the primary receptors for the excititory amino acid (EAA) glutamate."
>
> Also,
>
> "...it would make sense to decrease glutamate neurotransmission in a patient who has a disorder of synaptic gating, those who do poorly in high-stimulus environments, such as malls, and those who are overly sensitive to many sensory inputs as is frequently seen in CFS, FMS, IBS, multiple chemical sensitivities (MCS), PMS, and too many other 'esses' than I care to mention."
>
> Oh man do car exhaust and chemical smells kill me. I can smell someone spraying perfume on half a block away! Everyone's always telling me "what are you talking about I don't smell anything." And sure enough someone will come around the corner with a perfume bottle in their hand.
>
> This is turning into the mother of all posts. But that guy in Florida did get back to me and seems pretty real. I believe he may have consulted Dr. Goldstein on the phone but never saw him in person. He said he was lucky to have an alternative type doctor who, although she wasn't too keen on meds., was willing to help him out. As far as Dr. Braverman goes, he did give me the Wellbutrin but I'm not sure he's the guy to try out Goldstein's protocol with. You have to understand it's hard to see the guy in person. You're lucky to get a minute with him. My freind gave him "Tuning the Brain" a few months ago and now he acts like he doesn't remember it. And on his radio show a few weeks back he was virtually quoting from it. It's the ego thing again. But we'll see. If you read my post on the other thread below you'll see my argument as to why a paradoxical response to a stimulant almost has to be due to the autoreceptor. (I'm still waiting patiently for someone to respond to it. Any input will help.) Of course I'm no scientist and Dr. Goldstein does mention a possible problem with the DA transporter (but only in passing). But I doubt I'll ever boost my DA without first using a glutamate/NMDA antagonist. I should pummel my postsynaptic receptors with a stimulant just to make sure they're not just really downregulated. But I doubt this is the case. Ok I'll end this post now before I pass out...You're too funny. What NMDA antagonist do you have in mind? Have you tried memantine? Emme is currently using it in low dose (alone I believe) and has had some success as an antidepressant.
K
Posted by franco neuro on April 7, 2005, at 10:30:35
In reply to Re: Read this before answering my previous post » franco neuro, posted by KaraS on April 7, 2005, at 3:12:47
Hi Kara,
Well, it's day nine and it's still kicking my butt. I wasn't as tired yesterday but as the evening progressed I got more and more wiped out. It's got to be the norepinephrine. According to Goldstein, NE is itself an NMDA antagonist. Which is probably why the Wellbutrin is helping me with pain. I'm certainly not getting any dopamine boost.
> I have the antibodies also. I read that they are in response to a protein in the thyroid gland and not to the thyroxin itself. (I wouldn't put money on it though.)
Hmm...I'll have to talk to Braverman about this. Are you on any thyroid med?
> Same here but particularly with the APs. I don't think there's any long-term data on low dosage usage of them for depression. Have you considered MAOIs at all?
I have considered MAOI's, but I'd like to work the NMDA/glutamate angle first.
> I've also heard it affects prolactin levels.
Yes since dopamine and prolactin have an inverse relationship, any drug that antagonizes dopamine could raise prolactin.
> No, I was thinking about hydergine. I just didn't know enough about it.
Are you sure you weren't thinking of huperzine? :-)
> What NMDA antagonist do you have in mind? Have you tried memantine? Emme is currently using it in low dose (alone I believe) and has had some success as an antidepressant.
That's the question. I need either a direct NMDA-receptor antagonist or a drug that suppresses glutamate to keep it from stimulating the NMDA-receptor and apparantly dopamine autoreceptors. I haven't tried memantine yet. It's a direct NMDA antagonist, as is amantadine. It can be purchased from an overseas pharmacy, although it's quite expensive. The only one I've tried was Neurontin about 8 years ago. I only took a small dose for a short time but it did help. I should have stayed on it and pushed it up but I had no clue back then. Neurontin is an antagonist at the NMDA glycine receptor. It also should antagonize glutamate to a degree. I'm sure you're aware that it's Dr. Goldstein's #1 oral medication. By the way guaifenesin is also a mild antagonist at the NMDA glycine receptor. I have some and am going to give it another try at Goldstein's recommended dose of 1200mg twice per day.
Than there's Lamictal. It suppresses glutamate output. That's the one that's helping my friend big time. But I'm not sure if it's because he's bi-polar. And Lamictal is a major bi-polar med. But it has ended virtually all of his physical symptoms. It took a few months to kick in and he's up to 400mg but he loves it.
Ketamine is his #1 overall med but he uses it in IV or nose or eye drops, etc. I'm not going to find a doc who'll do that. But it also can be taken in pill form. It's one of those abused drugs so they might be reluctant to prescibe it. His other biggee is IV lidocaine. I might have a doctor who would do that. But it's really not practical.
There's Baclofen which is a GABA B agonist. It's supposed to be really good for multiple chemical sensitivity. Pretty much all of the anti-epilepsy meds block glutamate to some degree.
Also, Goldstein says that histamine may stimulate the NMDA receptor. Which is probably why antihistamines often help with diffuse pain. I've recently discovered this with Benedryl.
I need to get moving with this but without any dopamine it's tough to make a decision and get going. By the way the guy in Florida found relief with a combination of Baclofen, Mirapex, Chlorzoxazon, and Guaifenesin.
It's a vicious circle. NMDA/glutamate over-excitibility decrease dopamine, decreased DA causes NMDA/glutamate to become more excited, which decreases DA more, which...etc.,etc.,etc. Have to break the downward spiral.
Posted by KaraS on April 9, 2005, at 0:13:37
In reply to Re: Read this before answering my previous post » KaraS, posted by franco neuro on April 7, 2005, at 10:30:35
Hi Franco,
>
> Well, it's day nine and it's still kicking my butt. I wasn't as tired yesterday but as the evening progressed I got more and more wiped out. It's got to be the norepinephrine. According to Goldstein, NE is itself an NMDA antagonist. Which is probably why the Wellbutrin is helping me with pain. I'm certainly not getting any dopamine boost.
Sorry to hear that the Wellbutrin is still tiring you out. How long do you plan to trial it? (I wonder if rEEG could have predicted that response. I'm so sick of trying things that don't work out as I'm sure you are too.)
> Hmm...I'll have to talk to Braverman about this. Are you on any thyroid med?
Yes, I have been taking thryoid medication for a few years now. How about you?
> Yes since dopamine and prolactin have an inverse relationship, any drug that antagonizes dopamine could raise prolactin.
I didn't know that either. So you think that amisulpride is probably not any worse in this respect than any other antipsychotic?
> Are you sure you weren't thinking of huperzine? :-)
Nope. I was thinking of hydergine. I just knew it was a "smart drug" so I associated it with Ach. (but thanks for trying to save me :-))
> That's the question. I need either a direct NMDA-receptor antagonist or a drug that suppresses glutamate to keep it from stimulating the NMDA-receptor and apparantly dopamine autoreceptors. I haven't tried memantine yet. It's a direct NMDA antagonist, as is amantadine. It can be purchased from an overseas pharmacy, although it's quite expensive. The only one I've tried was Neurontin about 8 years ago. I only took a small dose for a short time but it did help. I should have stayed on it and pushed it up but I had no clue back then. Neurontin is an antagonist at the NMDA glycine receptor. It also should antagonize glutamate to a degree. I'm sure you're aware that it's Dr. Goldstein's #1 oral medication. By the way guaifenesin is also a mild antagonist at the NMDA glycine receptor. I have some and am going to give it another try at Goldstein's recommended dose of 1200mg twice per day.This may seem like a dumb question, but if you suppress glutamate do you run the risk of increasing anxiety (because glutamate eventually becomes GABA)? Also, if you keep glutamate from stimulating dopamine autoreceptors, does that then lead to downregulation or a decrease in the number of those DA autoreceptors? Guaifenesin is the stuff in cough syrups that is supposed to loosen mucous, right? You can get that in pills? Is it over the counter? I'm very curious as to how that will work for you. Have you thought about acamprosate at all?
> Than there's Lamictal. It suppresses glutamate output. That's the one that's helping my friend big time. But I'm not sure if it's because he's bi-polar. And Lamictal is a major bi-polar med. But it has ended virtually all of his physical symptoms. It took a few months to kick in and he's up to 400mg but he loves it.
Yikes! 400 mg. is a lot of Lamictal, isn't it? I don't remember if your friend is taking anything else besides Lamictal. Have you been diagnosed as bipolar? My doctor thinks I might have a soft bipoloar condition because I haven't responded fully to antidepressants and I have periods of more anxiety/agitation.
> I need to get moving with this but without any dopamine it's tough to make a decision and get going. By the way the guy in Florida found relief with a combination of Baclofen, Mirapex, Chlorzoxazon, and Guaifenesin.Wow. That's quite a cocktail. Has he been on Mirapex for long or is this a new addition? It seems like all of the people on this board who have tried it, developed a great deal of fatigue on it after a while (though not initially).
I hear you about the need to get moving on this. Likewise I can't seem to make treatment decisions either. I also find that I can't concentrate enough to do further research. The small amount of doxepin I'm taking may be adding to the mental fog. I'm really impressed that you're able to study all of this so intensely and comprehend it.
My sister has offered to pay for me to get the rEEG analysis done. I don't know whether to take her up on it. I don't want to waste the money. (I'd also like to be able to pay her back someday but don't know if that will be possible.) Down deep I don't think that anything is really going to help. I'm also afraid that if the scans suggest my best treatment meds, that they would be something that I can't tolerate for some reason. (That would be heartbreaking.) My last concern is the way that success may be defined according to this system. Perhaps an SSRI that lifts mood a lot but doesn't help (or even decreases) motivation would be considered success. I have a friend who was happy as can be on antidepressants but he couldn't get up off of the couch to save his life! Is that "success"?
> It's a vicious circle. NMDA/glutamate over-excitibility decrease dopamine, decreased DA causes NMDA/glutamate to become more excited, which decreases DA more, which...etc.,etc.,etc. Have to break the downward spiral.
How do you know for sure that this pertains to your case? Do you take any supplements like NAC or reduced glutathione to help combat this neurotoxicity?K
Posted by franco neuro on April 9, 2005, at 11:35:19
In reply to Re: Read this before answering my previous post » franco neuro, posted by KaraS on April 9, 2005, at 0:13:37
Hello there,
> Sorry to hear that the Wellbutrin is still tiring you out. How long do you plan to trial it? (I wonder if rEEG could have predicted that response. I'm so sick of trying things that don't work out as I'm sure you are too.)
Thanks. Actually, I didn't take it this morning. I wanted to give it another week or so but it was too fatiquing. Not sure if the fEEG or Brain Mapping would predict something like that.
>Yes, I have been taking thryoid medication for a few years now. How about you?
I had been taking Braverman's "Pathroid", which is his T3/T4 formula, for about a month but I stopped the last few days on Wellbutrin. Will start again tomorrow morning.
> I didn't know that either. So you think that amisulpride is probably not any worse in this respect than any other antipsychotic?
I think it may be somewhat better. But that's only my humble opinion.
> Nope. I was thinking of hydergine. I just knew it was a "smart drug" so I associated it with Ach. (but thanks for trying to save me :-))
Sure you weren't thinking of arganine? :-)
> This may seem like a dumb question, but if you suppress glutamate do you run the risk of increasing anxiety (because glutamate eventually becomes GABA)?
I don't know. But according to Dr. Braverman's Brain Mapping I'm high in GABA. (Which should also suggest I'm high in glutamate.) You would think being high in GABA would suppress anxiety but it hasn't. It may be because a hyperglutamatergic state trumps GABA's calming effects by it's overstimulation of the NMDA receptor. Too much glutamate initially may cause too much dopamine release in stressfull situations which converts too quickly to NE than epinephrine. This is what over time causes the DA deficit. Glutamate actually does cause DA secretion, but I think it's being chronically elevated is what overstimulates the DA auoreceptors ultimately causing a decrease in dopamine release.
> Also, if you keep glutamate from stimulating dopamine autoreceptors, does that then lead to downregulation or a decrease in the number of those DA autoreceptors?
I think Dr. Goldstein is implying that without glutamate overstimulating the autoreceptors, the synapse will return to a more normal state of affairs. I.e. you would be able to secrete a "proper" amount of DA without the overexcited autoreceptor prematurely shutting down it's release from the presynaptic neuron.> Guaifenesin is the stuff in cough syrups that is supposed to loosen mucous, right? You can get that in pills? Is it over the counter? I'm very curious as to how that will work for you. Have you thought about acamprosate at all?
Yep. It's been used by that Dr. St. Amand for a while but he didn't know how it worked. Dr. Goldstein explains that it antagonizes the NMDA glycine receptor which is why it's helping some CFS FMS patients. It is over the counter. I bought it last year online after reading St. Amands book. I bought it but never bought his theory so I didn't take it. I will try it now.
> Have you thought about acamprosate at all?
No. But it's funny you mentioned it. My friend on the Lamictal is looking for the final ten or twenty percent improvement. So Dr. Braverman suggested Campral.
"Campral (acamprosate) has in vitro affinity for GABA type A and GABA type B receptors, so it's been assumed that the therapeutic effects of acamprosate are due to actions on GABA receptors. However, acamprosate does not share most of the other effects of GABA receptor modifying drugs, such as antianxiety, hypnotic, or muscle relaxant activity. It is therefore possible, perhaps likely, that the effects are mediated some other way. Acamprosate is structurally related to l-glutamic acid (l-gutamate), which is an excitatory neurotransmitter. It's been proposed that acamprosate decreases the effects of the naturally-occurring excitatory neurotransmitter glutamate in the body. Since chronic alcohol consumption disrupts this system, and the changes last many months after alcohol ingestion is stopped, it's possible that acamprosate somehow restores the glutamate system towards normal. It's thought, no matter how it acts, that Campral decreases the pleasant "high" associated with alcohol consumption, and thus decrease the frequency of relapse during abstinence."Sounds like an interesting med. I don't get that nice relaxed feeling after a couple of beers that I used to get. I just feel irritated. However, on the rare occasion when I have 7 or 8 drinks. Like my cousin's wedding a few months ago. I notice that while I have a hard time sleeping and wake up a little woozey, my body also feels better the next day and I'm very horny! I'm still trying to figure out what this means. The alcohol is obviously relieving something in my brain. I found some absracts that say at higher amounts alocohol is indeed a glutamate/NMDA antagonist. And the withdrawal effects that alcoholics have may be due to the increased glutamate/NMDA activity when the alcohol is stopped. Interesting huh?
> Yikes! 400 mg. is a lot of Lamictal, isn't it?
Not really. It is the top of the range, but if you tolerate it well enough at that dose you can cautiously go higher. Even to 600mg or more. My fiend and Dr. Braverman are considering this right now.
> Have you been diagnosed as bipolar? My doctor thinks I might have a soft bipoloar condition because I haven't responded fully to antidepressants and I have periods of more anxiety/agitation.
I was wondering about this, but was almost certain I'm not bipolar. As a matter of fact I wish I were. I haven't had anything approaching hypomania in 20 years. Dr. Barverman gives Millon psychological tests as part of his initial battery of tests. It measures all kinds of psychological problems. I scored over 100 on anxiety and dysthymia (my 2 highest scores) and 0, i repeat, 0, for bipolar. Also zero or near zero for two other bipolar markers. I also came up high for somataform disorder (reflecting physical issues) and compulsiveness. Basically, I think it was spot on. If you do turn up being somewhat bipolar it's all the more reason to try Lamictal.
> Wow. That's quite a cocktail. Has he been on Mirapex for long or is this a new addition? It seems like all of the people on this board who have tried it, developed a great deal of fatigue on it after a while (though not initially).
I need to get more info. as to what order he added them, but I'm pretty sure he took the entire cocktail for about 2 years before he started tapering. He actually gave me his phone number and said I could call him to discuss it if I wanted. As far as I know he's not selling anything and seems quite sincere. I think he's so happy he got well that he wants to help out if he can. I will call him at some point soon, but I don't want to start hounding him and scare him away. :-)
It's hard to get moving. Believe me I've spent so much money on this wild goose chase I don't even want to think about it. I'm not even woking right now. The company that I worked for for 10 years was bought by a competitor and put out of business last year. I'm living off of my savings. I really need to start working again but I'm worried that if I end up trapped in a stressful situation again it'll surely kill me. I'm so stress averse right now. I think that definitely reflect a state of low chatecholamines. I'm not sure if Dr. Goldstein's theory is my problem, but his description of the typical neurosomatic patient fits me perfectly. The genetic predisposition, the childhood stress, the broken right arm at 6 and 14 causing chronic pain (irritating the brain), etc. And how neurosomatic patients are almost incapable of becoming addicted to drugs. Which was backed up on my Millon test. How the SSRI's haven't helped.
But the fact that I did have a couple of almost "normal" days after stopping the Zoloft proved to me that I can feel good agian. And that it is all related to brain chemistry. I'm sure I'll never feel 20 again, but I'll take a healthy 39. We really have no choice but to keep on trying.
Posted by KaraS on April 10, 2005, at 19:45:57
In reply to Re: Read this before answering my previous post » KaraS, posted by franco neuro on April 9, 2005, at 11:35:19
Hello there,
> Thanks. Actually, I didn't take it this morning. I wanted to give it another week or so but it was too fatiquing. Not sure if the fEEG or Brain Mapping would predict something like that.
So you're done with the Wellbutrin completely? How about the CES? Are you usuing that more regularly? I like the idea of it being able to hit so many different neurotransmitters at once without horrible side effects. I really hope that works well.
> I had been taking Braverman's "Pathroid", which is his T3/T4 formula, for about a month but I stopped the last few days on Wellbutrin. Will start again tomorrow morning.
Yes, that's right. You mentioned that previously. What is so unique about his "Pathroid" formula? What is the percentage of T4 to T3?
> > I didn't know that either. So you think that amisulpride is probably not any worse in this respect than any other antipsychotic?
>
> I think it may be somewhat better. But that's only my humble opinion.I had written amisulpride off of my list because someone had posted about the prolactin levels. I really shouldn't have. If I cross off too many things because of some side effects that I don't even know will be a problem for me, then I'm left with very few options. If I get over my fear of APs, then I might also try Abilify. Lately I've read a couple of posts from people having really good results from very low dose of this. My pdoc likes it and was more than willing to prescribe it for me. Wish I weren't such a chicken sh*t!
Have you considered Abilify? Is that only on your list if you need to move beyond the NMDA antagonists?
> > Nope. I was thinking of hydergine. I just knew it was a "smart drug" so I associated it with Ach. (but thanks for trying to save me :-))
>
> Sure you weren't thinking of arganine? :-)Yes, that's it! Arganine. (NOT!)
> > This may seem like a dumb question, but if you suppress glutamate do you run the risk of increasing anxiety (because glutamate eventually becomes GABA)?
>
> I don't know. But according to Dr. Braverman's Brain Mapping I'm high in GABA. (Which should also suggest I'm high in glutamate.) You would think being high in GABA would suppress anxiety but it hasn't. It may be because a hyperglutamatergic state trumps GABA's calming effects by it's overstimulation of the NMDA receptor. Too much glutamate initially may cause too much dopamine release in stressfull situations which converts too quickly to NE than epinephrine. This is what over time causes the DA deficit. Glutamate actually does cause DA secretion, but I think it's being chronically elevated is what overstimulates the DA auoreceptors ultimately causing a decrease in dopamine release.Ok, sounds feasible I think.
> > Also, if you keep glutamate from stimulating dopamine autoreceptors, does that then lead to downregulation or a decrease in the number of those DA autoreceptors?
>
> I think Dr. Goldstein is implying that without glutamate overstimulating the autoreceptors, the synapse will return to a more normal state of affairs. I.e. you would be able to secrete a "proper" amount of DA without the overexcited autoreceptor prematurely shutting down it's release from the presynaptic neuron.I was under the impression that hypersensitive autoreceptors meant that the number of autoreceptors stays the same and they just start overresponding to DA in the synapse. Others here corrected me and said that hypersensitive actually meant that the autoreceptors were too dense - that more of them are created and that's what causes the overresponsiveness. So when you downregulate them, you're actually decreasing the number of autoreceptors.
> > Guaifenesin is the stuff in cough syrups that is supposed to loosen mucous, right? You can get that in pills? Is it over the counter? I'm very curious as to how that will work for you. Have you thought about acamprosate at all?
>
> Yep. It's been used by that Dr. St. Amand for a while but he didn't know how it worked. Dr. Goldstein explains that it antagonizes the NMDA glycine receptor which is why it's helping some CFS FMS patients. It is over the counter. I bought it last year online after reading St. Amands book. I bought it but never bought his theory so I didn't take it. I will try it now.Since I also have CFS I will be very interested to see how the guaifenisen works for you.
> > Have you thought about acamprosate at all?
>
> No. But it's funny you mentioned it. My friend on the Lamictal is looking for the final ten or twenty percent improvement. So Dr. Braverman suggested Campral.
> "Campral (acamprosate) has in vitro affinity for GABA type A and GABA type B receptors, so it's been assumed that the therapeutic effects of acamprosate are due to actions on GABA receptors. However, acamprosate does not share most of the other effects of GABA receptor modifying drugs, such as antianxiety, hypnotic, or muscle relaxant activity. It is therefore possible, perhaps likely, that the effects are mediated some other way. Acamprosate is structurally related to l-glutamic acid (l-gutamate), which is an excitatory neurotransmitter. It's been proposed that acamprosate decreases the effects of the naturally-occurring excitatory neurotransmitter glutamate in the body. Since chronic alcohol consumption disrupts this system, and the changes last many months after alcohol ingestion is stopped, it's possible that acamprosate somehow restores the glutamate system towards normal. It's thought, no matter how it acts, that Campral decreases the pleasant "high" associated with alcohol consumption, and thus decrease the frequency of relapse during abstinence."I will be interested to hear how your friend fares on Campral. Sounds like even if you don't get to see Braverman much while he's off trying to become a star, he does at least come up with some good suggestions.
> Sounds like an interesting med. I don't get that nice relaxed feeling after a couple of beers that I used to get. I just feel irritated. However, on the rare occasion when I have 7 or 8 drinks. Like my cousin's wedding a few months ago. I notice that while I have a hard time sleeping and wake up a little woozey, my body also feels better the next day and I'm very horny! I'm still trying to figure out what this means. The alcohol is obviously relieving something in my brain. I found some absracts that say at higher amounts alocohol is indeed a glutamate/NMDA antagonist. And the withdrawal effects that alcoholics have may be due to the increased glutamate/NMDA activity when the alcohol is stopped. Interesting huh?Yeah. Your reaction to alcohol adds to your theory.
> Not really. It is the top of the range, but if you tolerate it well enough at that dose you can cautiously go higher. Even to 600mg or more. My fiend and Dr. Braverman are considering this right now.
I don't know that much about Lamictal doses - only what I've seen people post here that they take. If your friend isn't 100% yet, then it makes sense to try increasing the Lamictal or augmenting with something else. BTW, does this friend of yours also use the CES device or any other supplements from Dr. B or does he credit his improvement solely to Lamictal?
> > Have you been diagnosed as bipolar? My doctor thinks I might have a soft bipoloar condition because I haven't responded fully to antidepressants and I have periods of more anxiety/agitation.
>
> I was wondering about this, but was almost certain I'm not bipolar. As a matter of fact I wish I were. I haven't had anything approaching hypomania in 20 years. Dr. Barverman gives Millon psychological tests as part of his initial battery of tests. It measures all kinds of psychological problems. I scored over 100 on anxiety and dysthymia (my 2 highest scores) and 0, i repeat, 0, for bipolar. Also zero or near zero for two other bipolar markers. I also came up high for somataform disorder (reflecting physical issues) and compulsiveness. Basically, I think it was spot on. If you do turn up being somewhat bipolar it's all the more reason to try Lamictal.I wonder what my tests would show. I assume that the rEEG would show if there were some bipolarity. At least it would show if I would respond well to Lamictal which would then in itself imply bipolarity. It's nothing I ever considered about myself until recently but it's worth checking out.
> > Wow. That's quite a cocktail. Has he been on Mirapex for long or is this a new addition? It seems like all of the people on this board who have tried it, developed a great deal of fatigue on it after a while (though not initially).
>
> I need to get more info. as to what order he added them, but I'm pretty sure he took the entire cocktail for about 2 years before he started tapering. He actually gave me his phone number and said I could call him to discuss it if I wanted. As far as I know he's not selling anything and seems quite sincere. I think he's so happy he got well that he wants to help out if he can. I will call him at some point soon, but I don't want to start hounding him and scare him away. :-)
Sounds like a nice guy who wants to help others in the same way that he's been helped. Now he saw a doctor who utilized Goldstein's protocols, correct? That's how he came up with that cocktail? (Just want to make sure I'm keeping my facts straight here.)
> It's hard to get moving. Believe me I've spent so much money on this wild goose chase I don't even want to think about it. I'm not even woking right now. The company that I worked for for 10 years was bought by a competitor and put out of business last year. I'm living off of my savings. I really need to start working again but I'm worried that if I end up trapped in a stressful situation again it'll surely kill me. I'm so stress averse right now. I think that definitely reflect a state of low chatecholamines. I'm not sure if Dr. Goldstein's theory is my problem, but his description of the typical neurosomatic patient fits me perfectly. The genetic predisposition, the childhood stress, the broken right arm at 6 and 14 causing chronic pain (irritating the brain), etc. And how neurosomatic patients are almost incapable of becoming addicted to drugs. Which was backed up on my Millon test. How the SSRI's haven't helped.I can totally relate. I'm out of work and was traumatized at a couple of recent jobs. That along with my predisposition to anxiety and depression really put me in a bad state. I'm literally terrified to go back to the workplace. I've been living off of my savings as well. It's not a situation. The only good thing now is that I'm taking a small amount of doxepin which has the anxiety completely under control. A few weeks ago I couldn't eat or sleep because of stress. Just taking a shower was a Herculean feat. Now I'm still quite depressed but I can handle stress and function day to day. So I guess I'm part of the way there. It sure would be nice to get rid of the depression, think clearly and have energy/motivation. It seems to far fetched to even hope for such a cure at this point. Fortunately I come here often and read about others who have had those kinds of drastic improvements. I think that as long as we keep trying to understand, we'll eventually figure it all out and find appropriate solutions.
> But the fact that I did have a couple of almost "normal" days after stopping the Zoloft proved to me that I can feel good agian. And that it is all related to brain chemistry. I'm sure I'll never feel 20 again, but I'll take a healthy 39. We really have no choice but to keep on trying.It really is related to brain chemistry and possibly other things going on in the body physiologically. It will be worth all of the searching when we find something(s) that work for us. Just imagine feeling joy in living again, jumping out of bed in the morning because we can't wait to face the new day! It can happen.
K
Posted by islandangel on April 10, 2005, at 19:52:43
In reply to Re: Read this before answering my previous post » franco neuro, posted by KaraS on April 10, 2005, at 19:45:57
Hi: I originally posted about being tired on Wellbutrin XL 150mg. I have my first prescription of SR now. My doc prescribed 150mg once a day. I took it this morning and so far so good. I'll know tonight if I am wiped out by 7:00pm. But so far, I don't feel that way. Does anyone know-- if I can split the SR pills? I thought I'd take half at breakfast and half at noon. I don't want to mess up the time release if there is any. I haven't gone to 300mg just because at that level I got very angry and aggressive when I went up to 300mg on the XL.
I appreciate everyone on this thread! :)
Posted by franco neuro on April 11, 2005, at 10:29:12
In reply to Re: Read this before answering my previous post » franco neuro, posted by KaraS on April 10, 2005, at 19:45:57
Hi Kara,
> So you're done with the Wellbutrin completely? How about the CES?
Yes I stopped the Wellbutrin. I think it might be worth trying again, but I need to get the "fight or flight" DA-NE-E reaction under control first. I do you the CES occasionally and find it somewhat relaxing. They say the more you use it the better.
> What is so unique about his "Pathroid" formula? What is the percentage of T4 to T3?
I'm not sure what the percentages are. He had it written on the prescription. I think it was 2:1 t4 to t3. I'll find out. I'm only taking 1/4 grain.
> Have you considered Abilify? Is that only on your list if you need to move beyond the NMDA antagonists?
I'll try anything at this point.
> I was under the impression that hypersensitive autoreceptors meant that the number of autoreceptors stays the same and they just start overresponding to DA in the synapse. Others here corrected me and said that hypersensitive actually meant that the autoreceptors were too dense - that more of them are created and that's what causes the overresponsiveness. So when you downregulate them, you're actually decreasing the number of autoreceptors.
I think both scenarios can occur. But as far as the autoreceptors go I think it has more to do with hypersensitivity of individual receptors. However, if the amount of neurotransmitter in the synapse is chronically low than the postsynaptic receptors often increase in number in an attempt to make up for the weak "signal". The opposite is also true. If you chronically excrete too much of a specific neurotransmitter the number of postsynaptic receptors may decrease. It's all part of the brain's attempt to maintain homeostasis. Of course for some of us with neurosomatic problems brain it seems the brain has forgotten where homeostasis is.
> Since I also have CFS I will be very interested to see how the guaifenisen works for you.
I've only just started taking it. Goldstein recommends 1200mg of time released twice per day. I don't have time released so I'm trying to spread it out 600mg 4 times per day.
> BTW, does this friend of yours also use the CES device or any other supplements from Dr. B or does he credit his improvement solely to Lamictal?
He uses the CES and likes it. It's funny but he used to be obsessed with health foods and supplements and since the Lamictal started working he doesn't worry about that stuff too much anymore.
> I will be interested to hear how your friend fares on Campral. Sounds like even if you don't get to see Braverman much while he's off trying to become a star, he does at least come up with some good suggestions.
I wish he'd come up with a few good ones for me. :-)
> I wonder what my tests would show. I assume that the rEEG would show if there were some bipolarity. At least it would show if I would respond well to Lamictal which would then in itself imply bipolarity. It's nothing I ever considered about myself until recently but it's worth checking out.
Do you see a pdoc? They should be able to give you the Millon test.
> Sounds like a nice guy who wants to help others in the same way that he's been helped. Now he saw a doctor who utilized Goldstein's protocols, correct? That's how he came up with that cocktail? (Just want to make sure I'm keeping my facts straight here.)
I think he just happened to be lucky enough to have been seeing a doc that was willing to try out Goldstein's protocol with him. He pretty much just started trying meds. Keeping the ones that helped and dropping the ones that didn't. It's best to start with Goldstein's heavy hitters. Neurontin, Lamictal, Baclofen, etc.
> I can totally relate. I'm out of work and was traumatized at a couple of recent jobs. That along with my predisposition to anxiety and depression really put me in a bad state. I'm literally terrified to go back to the workplace.
Boy do I know the feeling.
> The only good thing now is that I'm taking a small amount of doxepin which has the anxiety completely under control.
Glad to here it.
> I think that as long as we keep trying to understand, we'll eventually figure it all out and find appropriate solutions.
That's the plan.
> It really is related to brain chemistry and possibly other things going on in the body physiologically. It will be worth all of the searching when we find something(s) that work for us. Just imagine feeling joy in living again, jumping out of bed in the morning because we can't wait to face the new day! It can happen.
From your keyboard to God's ears.
You know Dr. Goldstein's most effective treatments are IV ketamine and IV lidocaine. I'd really like to give them a try. I may have found a doc who may use them. A friend of my sister's (who is having all kinds of strange physical problems) just went to see him. He's a fairly well know CFS doc in this area. I went to his website and he mentions IV ketamine and also baclofen as possible treatmens, so he's obviously aware of Goldstein's work. I may have to give him a call. I've also started taking a lot of fish oil/borage oil/flax oil to combat the inflamation in my body. Also, TMG and plenty of B vitamins to help lower my homocysteine level. Homocysteine, as I've recently found out, is glutamate/NMDA agonist. There's a lot of fixing to do.
Posted by KaraS on April 13, 2005, at 21:24:07
In reply to Re: Read this before answering my previous post » KaraS, posted by franco neuro on April 11, 2005, at 10:29:12
> Hi Franco,
> Yes I stopped the Wellbutrin. I think it might be worth trying again, but I need to get the "fight or flight" DA-NE-E reaction under control first. I do you the CES occasionally and find it somewhat relaxing. They say the more you use it the better
And not just for relaxation, right? It's also supposed to help with depression I thought.
> I'm not sure what the percentages are. He had it written on the prescription. I think it was 2:1 t4 to t3. I'll find out. I'm only taking 1/4 grain.
So to begin with he had you on Wellbutrin, "Pathroid" and the CES device. Does he have any other plans for you? Have you told him or called his office to say that you've gone off of the Wellbutrin or are you not planning on seeing him anymore?
> I think both scenarios can occur. But as far as the autoreceptors go I think it has more to do with hypersensitivity of individual receptors. However, if the amount of neurotransmitter in the synapse is chronically low than the postsynaptic receptors often increase in number in an attempt to make up for the weak "signal". The opposite is also true. If you chronically excrete too much of a specific neurotransmitter the number of postsynaptic receptors may decrease. It's all part of the brain's attempt to maintain homeostasis. Of course for some of us with neurosomatic problems brain it seems the brain has forgotten where homeostasis is.
...or perhaps for some of us homeostasis is not a healthy place to be. (Since my problems encompass my entire adulthood, I think I'm in this group.)
> I've only just started taking it. Goldstein recommends 1200mg of time released twice per day. I don't have time released so I'm trying to spread it out 600mg 4 times per day.
Any reaction yet on the guaifenisen or is it too early to tell?> He uses the CES and likes it. It's funny but he used to be obsessed with health foods and supplements and since the Lamictal started working he doesn't worry about that stuff too much anymore.
Not so funny. If you feel good then where's the need?
> Do you see a pdoc? They should be able to give you the Millon test.I had been seeing one but couldn't afford it anymore. Recently I did some intake at a free clinic but I've yet to see a doctor. I don't have high hopes though. I imagine he or she will just try to throw the latest SSRI at me or perhaps Cymbalta if I'm lucky.
What is the Millon test? Is it a written questionnaire? Does it take into account the newer definitions of bipolarity that many pdocs are using these days?
> I think he just happened to be lucky enough to have been seeing a doc that was willing to try out Goldstein's protocol with him. He pretty much just started trying meds. Keeping the ones that helped and dropping the ones that didn't. It's best to start with Goldstein's heavy hitters. Neurontin, Lamictal, Baclofen, etc.Definitely need to get a hold of that book!
> > It really is related to brain chemistry and possibly other things going on in the body physiologically. It will be worth all of the searching when we find something(s) that work for us. Just imagine feeling joy in living again, jumping out of bed in the morning because we can't wait to face the new day! It can happen.
>
> From your keyboard to God's ears.:-)
> You know Dr. Goldstein's most effective treatments are IV ketamine and IV lidocaine. I'd really like to give them a try. I may have found a doc who may use them. A friend of my sister's (who is having all kinds of strange physical problems) just went to see him. He's a fairly well know CFS doc in this area. I went to his website and he mentions IV ketamine and also baclofen as possible treatmens, so he's obviously aware of Goldstein's work. I may have to give him a call. I've also started taking a lot of fish oil/borage oil/flax oil to combat the inflamation in my body. Also, TMG and plenty of B vitamins to help lower my homocysteine level. Homocysteine, as I've recently found out, is glutamate/NMDA agonist. There's a lot of fixing to do.I hear you. I'm going to increase my fish oil intake soon. TMG is on my list also. Homocysteine is bad in so many ways. I've been a bit lax with the B vitamins. I'd better start taking them more regularly again. The latest doctor sounds encouraging. Definitely keep me posted as I also have CFS and I think I'm not that far away from you. (I only get CFS attacks periodically these days - unlike when I first was diagnosed. These days I usually get an attack when I'm run down. Now I'm having one but this is the first in a while. But I imagine the treatments you're referring to will do more than just combat the outward physical symptoms of CFS.)
Talk to you later.
K
Posted by islandangel on April 13, 2005, at 22:23:07
In reply to Re: Read this before answering my previous post » franco neuro, posted by KaraS on April 13, 2005, at 21:24:07
Okay, So here's the update on being tired on Wellbutrin XL. I made the switch to SR earlier this past week,hoping the shorter release would help my extreme tiredness. So far, it seems to be working. I just take 150mg SR in the morning. I notice within an hour after I take it I begin to get sleepy but it doesn't last all day like it did with the XL. I get over that tiredness within a couple of hours. I'm still leaving out Elavil for Fibromyalgia/Fatigue at night because I am sleeping so well I don't really need it. I've also cut out carbohydrates and for some reason it really makes me feel better physically.
Hope you are all doing well!
Posted by franco neuro on April 14, 2005, at 11:42:10
In reply to Re: Read this before answering my previous post » franco neuro, posted by KaraS on April 13, 2005, at 21:24:07
Hi Kara,
I need to use the CES device more. I really bought it for the relaxation, but I guess over time it should help depression too. I'm not sure if the $300 could have been better spent at this point, but what the heck I thought I'd get it anyway.
> So to begin with he had you on Wellbutrin, "Pathroid" and the CES device. Does he have any other plans for you? Have you told him or called his office to say that you've gone off of the Wellbutrin or are you not planning on seeing him anymore?
Actually, the Wellbutrin and thyroid were my suggestions and he just agreed with them. He really hasn't had much to offer. I wish he did because I know he's smart. He made the right call with my friend. But I have to say he pretty much told my friend that he was bipolar and Lamictal is a big bipolar med. So I still don't know if it's the bipolar effect that's helping him or the Goldstein anti-glutamate chronic fatigue stuff. Maybe it's both.
I haven't called Braverman's office. I'm just stuck. I called Dr. Podell's office and the woman said she "wasn't aware" if he was using IV ketamine or IV lidocaine. Good answer. So now I'm back to where do I go from here. Should I call the psychopharmacologist pdoc that's in the yellow pages and is located nearby? Maybe I can persuade him to let me try some of Goldstein's oral meds. Maybe not. Braverman does give IV's in his office but I think they're just vitamin drips. Maybe I can persuade him to give me a ketamine or lidocaine IV. I did find a couple of websites about IV ketamine and how it's being used for chronic pain from RSD (regional sympathetic dystrophy). The only doc I could find is in Arizona. There is a RSD support group in Bloomfield so maybe I can call and ask them. This sucks.
> ...or perhaps for some of us homeostasis is not a healthy place to be. (Since my problems encompass my entire adulthood, I think I'm in this group.)
Me too. But I think somewhere deep down our brain knows where the correct homeostasis is but it just can't get to it.
> Any reaction yet on the guaifenisen or is it too early to tell?
Well I took 1200mg in one dose the other day and I must say my brain felt a little weird. Sort of muffled if that makes sense. I'm going to try an experiment 600mg guaifenesin + 300mg lipoic acid + 1 benedryl all at the same time. They are all NMDA antagonists. I want to see how my brain feels with that combo.
> What is the Millon test? Is it a written questionnaire? Does it take into account the newer definitions of bipolarity that many pdocs are using these days?
It's another psychiatric test. The one Dr. Braverman gives is like the SAT. It's about 175 questions. I'm not sure how up to date it is. The problem is it says my two main issues are anxiety and dysthymia which it says should be treated with serotonin and GABA agonists. But the Brain Mapping says my brain serotonin and GABA are already high and dopamine is low. The dysthymia definitely comes from the chronic physical discomfort. The anxiety I think is part of the whole hypervigilent neurosomatic symptom complex. I shouldn't be anxious with all the serotonin and GABA in my head. So why am I? Back to the NMDA/glutamate theory. Which Braverman's Brain Mapping doesn't check. I don't even know if it can be tested. I'm even thinking of trying Amerge which is a serotonin antagonist considering I felt really good for the couple of days after I stopped Zoloft. I'm going to read through "Tuning the Brain" yet again and make a concise list of the major meds and what they work on.Let me leave you with this cheery tidbit from "Tuning the Brain"...it concerns mice who were bred to have overactive NMDA receptors...
"Because the activity of the NMDA receptor is associated with memory and learning, these mice are smarter than normal ("wild-type") mice but are also more sensitive to pain caused by tissue injury and inflammation."
There you have it. The same thing that's causing us to be anxious, depressed, fatigued and in pain has also made us smarter than the average mouse! A cruel twist of fate indeed...
Posted by franco neuro on April 14, 2005, at 11:43:57
In reply to Re: Tired on Wellbutrin XL followup, posted by islandangel on April 13, 2005, at 22:23:07
Hi,
Glad to hear the SR is working better for you. Keep us posted...
Posted by DumbFox on April 14, 2005, at 12:55:15
In reply to Re: Tired on Wellbutrin XL followup, posted by islandangel on April 13, 2005, at 22:23:07
I began Wellbutrin XL 150mg 2 weeks ago, increasing to 300mg after the first 4 days. I have been extremely exhausted since the first dose. I was prescribed this for ADHD and it is making me worse! I can't focus on anything because I am literally nodding off constantly.
I'm glad to hear you are doing better on the SR version. I am speaking with my doctor's nurse this afternoon and am hoping for a stimulant to add. I have not noticed any improvement in depression or my ADHD symptoms since starting WB, just the extreme fatigue.
Does anyone have a theory on why the XL is making a few of us so tired?
Posted by steen on April 14, 2005, at 13:07:18
In reply to Re: I'm so tired on XL too., posted by DumbFox on April 14, 2005, at 12:55:15
I have been on Wellbutrin XL 150 mg qd for 8 days and I haven't felt more tired until the last two nights when I have woken up about 4 and find it hard to get back to sleep. BUT, I can stand that because I have felt a little more energy and my libido is coming back. I haven't had any side effects other than the insomnia and I'm hoping that will subside. So far, so good. The research that I did on Wellbutrin said that the fatigue was temporary, how temporary I don't know.
Good luck.
Posted by KaraS on April 15, 2005, at 16:05:58
In reply to Re: Read this before answering my previous post » KaraS, posted by franco neuro on April 14, 2005, at 11:42:10
> Hi Kara,
>
> I need to use the CES device more. I really bought it for the relaxation, but I guess over time it should help depression too. I'm not sure if the $300 could have been better spent at this point, but what the heck I thought I'd get it anyway.
Don't judge it until you've used it a lot over a significant period of time. You may be surprised at the results.
> Actually, the Wellbutrin and thyroid were my suggestions and he just agreed with them. He really hasn't had much to offer. I wish he did because I know he's smart. He made the right call with my friend. But I have to say he pretty much told my friend that he was bipolar and Lamictal is a big bipolar med. So I still don't know if it's the bipolar effect that's helping him or the Goldstein anti-glutamate chronic fatigue stuff. Maybe it's both.The Wellbutrin and thyroxin any pdoc could have agreed to. I would hope he had more up his sleeve than that for all of the testing and expense you've endured. Same with the Lamictal for your friend. I bet both are helping your friend along with the CES.
> I haven't called Braverman's office. I'm just stuck. I called Dr. Podell's office and the woman said she "wasn't aware" if he was using IV ketamine or IV lidocaine. Good answer. So now I'm back to where do I go from here. Should I call the psychopharmacologist pdoc that's in the yellow pages and is located nearby? Maybe I can persuade him to let me try some of Goldstein's oral meds. Maybe not. Braverman does give IV's in his office but I think they're just vitamin drips. Maybe I can persuade him to give me a ketamine or lidocaine IV. I did find a couple of websites about IV ketamine and how it's being used for chronic pain from RSD (regional sympathetic dystrophy). The only doc I could find is in Arizona. There is a RSD support group in Bloomfield so maybe I can call and ask them. This sucks.I don't blame you for not calling Braverman's office. I wonder if it would be worth it for you to have the rEEG done since you've already gotten the QEEG imaging but I can see that you're more interested in Goldstein's protocols at this point.
What are the lidocaine and ketamine used for? What are the rationales behind their usage? Too bad Dr. Goldstein doesn't have a list of doctors who follow his protocols. (I'm assuming that his book doesn't give this info and that he doesn't have a website with this info either.)
How did you find the doctor in Arizona? I made a mistake in my last post when saying that I reside near you. I think I was confusing you with Elroy or Chris O or someone else who lives in San Diego. Anway, I have a friend in Arizona that I visit occassionally so this might be a doctor for me to keep in mind for the future. (It wouldn't be Dr. Dharma, would it?)
> Well I took 1200mg in one dose the other day and I must say my brain felt a little weird. Sort of muffled if that makes sense. I'm going to try an experiment 600mg guaifenesin + 300mg lipoic acid + 1 benedryl all at the same time. They are all NMDA antagonists. I want to see how my brain feels with that combo.
Sounds interesting. How long will you try it out for? The long term effects may be quite different than the way you feel initially.
> It's another psychiatric test. The one Dr. Braverman gives is like the SAT. It's about 175 questions. I'm not sure how up to date it is. The problem is it says my two main issues are anxiety and dysthymia which it says should be treated with serotonin and GABA agonists. But the Brain Mapping says my brain serotonin and GABA are already high and dopamine is low. The dysthymia definitely comes from the chronic physical discomfort. The anxiety I think is part of the whole hypervigilent neurosomatic symptom complex. I shouldn't be anxious with all the serotonin and GABA in my head. So why am I? Back to the NMDA/glutamate theory. Which Braverman's Brain Mapping doesn't check. I don't even know if it can be tested. I'm even thinking of trying Amerge which is a serotonin antagonist considering I felt really good for the couple of days after I stopped Zoloft. I'm going to read through "Tuning the Brain" yet again and make a concise list of the major meds and what they work on.
Dr. B. should be the one answering that question. I wonder what he would say - assuming you got enough time with him to ask! I felt very sexually hypersensitive when I stopped Zoloft. Someone here suggested that it was because of dopamine surging back. I hadn't heard of Amerge. I'll have to check it out. Another med that came to my mind when reading your last paragraph is tianeptine. Have you considered that one? I've read some really good things about it and some very scary things about it.
> Let me leave you with this cheery tidbit from "Tuning the Brain"...it concerns mice who were bred to have overactive NMDA receptors...
>
> "Because the activity of the NMDA receptor is associated with memory and learning, these mice are smarter than normal ("wild-type") mice but are also more sensitive to pain caused by tissue injury and inflammation."
>
> There you have it. The same thing that's causing us to be anxious, depressed, fatigued and in pain has also made us smarter than the average mouse! A cruel twist of fate indeed...:-) That's comforting indeed. Next time I'm feeling overwhelmed I'll just think of those dumb mice...
K
Posted by franco neuro on April 18, 2005, at 14:51:32
In reply to Re: Read this before answering my previous post » franco neuro, posted by KaraS on April 15, 2005, at 16:05:58
Hi,
> What are the lidocaine and ketamine used for? What are the rationales behind their usage? Too bad Dr. Goldstein doesn't have a list of doctors who follow his protocols. (I'm assuming that his book doesn't give this info and that he doesn't have a website with this info either.)
The lidocaine and ketamine IV's are used as a test to see which oral meds you would most likely respond to. They can also be a treatment in and of themselves. Lidocaine predominantly suppresses glutamate release. Whereas ketamine is an NMDA receptor antagonist. If you find that the lidocaine relieves some or all of your symptoms than you should probably try a drug like Lamictal or Parafon Forte which suppress glutamate release. If, on the other hand, the ketamine helps more, than a drug like amantadine, memantine, etc. may be the place to start. Both ketamine and lidocaine are available in a pill form but they are not as effective and have potentially more side effects. The IV's also don't require weeks or months of taking before you feel an effect. You should know with the initial IV if it's going to help or not. It's all about saving time and not having to spend months or years popping meds haphazardly until you come up with a winning combo.
> How did you find the doctor in Arizona? I made a mistake in my last post when saying that I reside near you. I think I was confusing you with Elroy or Chris O or someone else who lives in San Diego. Anway, I have a friend in Arizona that I visit occassionally so this might be a doctor for me to keep in mind for the future. (It wouldn't be Dr. Dharma, would it?)
I just did a google search for "ketamine IV" and came across a site for RSD (regional sympathetic dystrophy). This Arizone doc is using an in patient 5 day course of ketamine. Not what I want or need. Here is the link:
http://www.rsdhope.org/ShowPage.asp?PAGE_ID=82
There's also a doc in Philadelphia doing the same thing. They are trying to claim it's a "new protocol" that they discovered. Of course Dr. Goldstein has been using IV ketamine and IV lidocaine for pain for years. God the egos in the medical profession are ridiculous. I've contacted a couple of RSD support groups in the area and am trying to get some more info. I think I can get the lidocaine IV as part of a vitamin IV from an alternative doc I have gone to before. I'd rather just get the lidocaine but what can you do. By the way I wish I lived in San Diego. It's supposed to be a nice place.
> I felt very sexually hypersensitive when I stopped Zoloft. Someone here suggested that it was because of dopamine surging back.
I believe that's it exactly. While some SSRI's may increase dopmine with chronic long term use they usually supress DA in the short term.
"SSRI's, acting through the 5-HT2C receptor, increase extracellular 5-HT which acts acutely on 5-HT1 receptors of several types in the VTA to inhibit DA secretion." "Tuning the Brain"
You know too much serotonin can be a problem. Particularly when it's high in comparison to DA. Most people, including most doctors, are completely unaware of this do to the glorification of the SSRI.> I hadn't heard of Amerge. I'll have to check it out. Another med that came to my mind when reading your last paragraph is tianeptine. Have you considered that one?
Amerge (naratriptan) is usually used to treat migraines. It blocks the 5-ht1b receptor which should lower serotonin levels. I'm going to try and stick with Goldstein's heavy hitters. At least initially. I just wish I could find a doc to help me with this. Darn it's frustrating!
Posted by KaraS on April 18, 2005, at 15:44:57
In reply to Re: Ketamine and Lidocaine IV's... » KaraS, posted by franco neuro on April 18, 2005, at 14:51:32
> Hi,
>
> The lidocaine and ketamine IV's are used as a test to see which oral meds you would most likely respond to. They can also be a treatment in and of themselves. Lidocaine predominantly suppresses glutamate release. Whereas ketamine is an NMDA receptor antagonist. If you find that the lidocaine relieves some or all of your symptoms than you should probably try a drug like Lamictal or Parafon Forte which suppress glutamate release. If, on the other hand, the ketamine helps more, than a drug like amantadine, memantine, etc. may be the place to start. Both ketamine and lidocaine are available in a pill form but they are not as effective and have potentially more side effects. The IV's also don't require weeks or months of taking before you feel an effect. You should know with the initial IV if it's going to help or not. It's all about saving time and not having to spend months or years popping meds haphazardly until you come up with a winning combo.Thanks for the explanation. I can see why you would want to have this done. Not only would you save time, but it seems that if you guess wrong on this, you could make yourself a lot worse.
> I just did a google search for "ketamine IV" and came across a site for RSD (regional sympathetic dystrophy). This Arizone doc is using an in patient 5 day course of ketamine. Not what I want or need. Here is the link:
>
> http://www.rsdhope.org/ShowPage.asp?PAGE_ID=82
>
> There's also a doc in Philadelphia doing the same thing. They are trying to claim it's a "new protocol" that they discovered. Of course Dr. Goldstein has been using IV ketamine and IV lidocaine for pain for years. God the egos in the medical profession are ridiculous. I've contacted a couple of RSD support groups in the area and am trying to get some more info. I think I can get the lidocaine IV as part of a vitamin IV from an alternative doc I have gone to before. I'd rather just get the lidocaine but what can you do. By the way I wish I lived in San Diego. It's supposed to be a nice place.Philadelphia is at least closer to you than San Diego. (I'm actually in LA but San Diego IS very nice.) I suppose if that doctor is willing to do what you're looking for, then it's worth it to put up with the ego issue. It's almost impossible to avoid unfortunately.
> > I felt very sexually hypersensitive when I stopped Zoloft. Someone here suggested that it was because of dopamine surging back.
>
> I believe that's it exactly. While some SSRI's may increase dopmine with chronic long term use they usually supress DA in the short term.I've never heard of SSRIs increasing DA in the long-term. I thought that they decreased it and that if anything, it got worse with time. If more DA were made available in time, then the SSRI apathy that so many people experience, would tend to go away eventually - which I've never heard of.
> "SSRI's, acting through the 5-HT2C receptor, increase extracellular 5-HT which acts acutely on 5-HT1 receptors of several types in the VTA to inhibit DA secretion." "Tuning the Brain"> You know too much serotonin can be a problem. Particularly when it's high in comparison to DA. Most people, including most doctors, are completely unaware of this do to the glorification of the SSRI.
Unfortunately most doctors never bother to do any research once out of medical school. They only know what the drug reps tell them and the drug reps sure don't tell them about SSRIs' potential effect on dopamine.
> > I hadn't heard of Amerge. I'll have to check it out. Another med that came to my mind when reading your last paragraph is tianeptine. Have you considered that one?
>
> Amerge (naratriptan) is usually used to treat migraines. It blocks the 5-ht1b receptor which should lower serotonin levels. I'm going to try and stick with Goldstein's heavy hitters. At least initially. I just wish I could find a doc to help me with this. Darn it's frustrating!I pretty sure that in my case, I'm low in serotonin as well dopamine so that wouldn't be a solution for me. I can imagine this is all very frustrating for you. It's hard to do so much research and start figuring out these things that are far ahead of where most of the medical community is at. I guess the only answer is to continue to persevere until you find a doctor who is willing and able to help you.
If you're at all still interested in rEEG, here is an interesting post by someone here on the Newbie Board:
http://www.dr-bob.org/babble/newbs/20041227/msgs/484207.html
I've asked him or her to repost that on the main board so I (and anyone else interested) could ask questions.
Take care.
Kara
Posted by franco neuro on April 22, 2005, at 14:00:27
In reply to Re: Ketamine and Lidocaine IV's... » franco neuro, posted by KaraS on April 18, 2005, at 15:44:57
Hi Kara,
> I've never heard of SSRIs increasing DA in the long-term. I thought that they decreased it and that if anything, it got worse with time. If more DA were made available in time, then the SSRI apathy that so many people experience, would tend to go away eventually - which I've never heard of.
I agree. Goldstein sites a couple of studies that show some SSRI's raising DA in some areas of the brain after long term use. But he also mentions contradictory studies and states that SSRI's have never helped anyone get over chronic fatigue. Which I believe is totally correct.
> Unfortunately most doctors never bother to do any research once out of medical school. They only know what the drug reps tell them and the drug reps sure don't tell them about SSRIs' potential effect on dopamine.
So true.
Right now I'm still searching for a doc who'll do the lidocaine IV and/or ketamine IV. I think the lidocaine will be easier to get. I also ordered some supplements that are supposed to raise dopamine. I've also been jogging lately. It's a double edged sword. I really need to get my cardiovascular system back in shape but vigorous excersise does deplete DA and NE. But I think right now the upside is greater than the downside. I'll try not to over do it. The saga continues...
Posted by KaraS on April 23, 2005, at 1:56:47
In reply to Re: Ketamine and Lidocaine IV's... » KaraS, posted by franco neuro on April 22, 2005, at 14:00:27
Hi Franco,
Keep me posted if you have any success with the supplements and/or if your are able to find a physician willing to follow Goldstein's protocol with you. I'm really very interested.
Kara
P.S. I think the jogging is a good idea too.
Posted by islandangel on April 24, 2005, at 15:22:22
In reply to Re: Ketamine and Lidocaine IV's... » franco neuro, posted by KaraS on April 23, 2005, at 1:56:47
Hi everyone, thought I would update you all. I've been about 2.5 weeks now after switching from XL to Wellbutrin SR. I still get the tiredness but it only lasts for a short while. I am still able to sleep at night without Elavil and I'm slowly but surely getting better about waking up early instead of dragging myself out of bed at 9am. I've also lost 10 pounds cutting out carbohydrates and sugar! I feel so much better with that little bit of weight off. From time to time I have racing thoughts during stressful days but at least I'm not a zombie like before. I've also been trying high dose 300mg CoQ10 for energy, it seems to be helping a little.
Take care all!
Posted by Declan on April 25, 2005, at 17:25:31
In reply to Re: Ketamine and Lidocaine IV's..., posted by islandangel on April 24, 2005, at 15:22:22
Hi
What dose of Ketamine? When I used it decades ago (non prescribed) it was pretty wild, and except in *tiny* doses its hard to imagine anyone thinking it helped them function better.
Declan
Posted by rfied on May 3, 2005, at 21:37:35
In reply to Re: Read this before answering my previous post » KaraS, posted by franco neuro on April 11, 2005, at 10:29:12
> Franco, Hi, what is your impression of Dr Bravermans office/approach, I'm thinking of taking my daughter there(mitral valve prolapse causing anxiety,depression) but SNRI not working. Is it all legit or just forcing u to buy his vitamin supplements, BEAM really show your neuro trans condition?? Is 1st appt like 5 hours total? any input would be appreciated before I blow $$$
Thanks, blessings
rfied
>
Posted by AMD on May 7, 2005, at 21:39:49
In reply to Re: Ketamine and Lidocaine IV's... » KaraS, posted by franco neuro on April 22, 2005, at 14:00:27
Thursday night I did my first ever recreational (or otherwise) dose of ketamine: I snorted a bump of ketamine powder from my hand. At the time I was high on cocaine, and had been drinking and smoking most of the night. I didn't notice any effects even a few hours after the bump.
I am taking 200 mg of Lamictal and 40 mg of Celexa for bipolar II disorder, and about 8 hours after the bump I took ~ 50 mg of Seroquel to help me sleep.
Now, a couple days after, still feeling blue from that night -- I suspect cocaine withdrawal -- I am wondering if that dose of ketamine in combination with my current psychotropic drug regimen may have caused permanent brain damage. Is this possible? If not from the K alone, then from mixing it with my medications and/or the other drugs I did that night?
amd
Posted by Declan on May 8, 2005, at 0:21:28
In reply to On the ketamine note ... » franco neuro, posted by AMD on May 7, 2005, at 21:39:49
No damage because no discernable effect. Ketamine has the *most* pronounced effects, as I guess you would know.
Declan
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.