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Dr. Bob is Robert Hsiung, MD,
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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
Posted by AMD on May 8, 2005, at 0:52:29
In reply to Re: On the ketamine note ..., posted by Declan on May 8, 2005, at 0:21:28
Is it that simple?
Here I am scrounging through the numerous articles on concentration, memory loss, and ketamine.
Well, I assume I took about 25-75 mg nasally. Not sure how high or low a dose this is considered.
amd
Posted by Declan on May 8, 2005, at 3:41:57
In reply to Re: On the ketamine note ... » Declan, posted by AMD on May 8, 2005, at 0:52:29
Yeah I think so. Years ago I used vet stuff, 25-100mg IM or God forbid IV. Weirder than anything else I tried. Flow into a wall and turn into plastic 1/2" thick, that sort of thing. Terrible stuff, IMO.
Declan
Posted by franco neuro on May 11, 2005, at 19:48:44
In reply to FRANCO Read this before answering my previous post, posted by rfied on May 3, 2005, at 21:37:35
> 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
>Hi,
Sorry it took so long to respond. I've been out of the loop for a couple of weeks. Also sorry to here that your daughter is having some problems. I'm reluctant to give anyone advice on whether they should see a particular doctor or take a particular medication. All I can do is pass on my experiences. I don't know what kind of insurance you have, but if your planning on paying out of pocket be prepared to dig deep. If you tell them you have no insurance and are financially strapped they will give a big discount. But it's still going to be expensive.
The first visit will last the better part of a day. I think I was there about six hours. After all the testing you get about a half an hour with Braverman. I think, in my case, the BEAM was pretty accurate. Also, the Millon psychological diagnostic test. I also had an EKG and an ultrasound of my heart. And had six vials of blood taken. This was all well and good. The problem is, after all was said and done, I'm still pretty much trying to cure myself. The guy is really hard to get any time with after the first visit.
Also, when I've gone back to discuss medication adjustments or switches they always try to get me to take another round of very expensive tests. I mean $200 for an 18 question 20 minute cognative function test. Come on. I'm not saying the guy isn't smart. He picked the right medication for a friend of mine and while it hasn't completely cured him it has given him his life back. But I think a lot of other doctors would have come up with the same very popular drug (Lamictal) for a lot less money. Maybe not.
As for me, my psychological issues are secondary to my chronic pain and chronic fatigue. I think I may have finally found the answer in the book "Tuning the Brain" by retired genius Dr. Jay A. Goldstein. The problem is I still need a doctor to help me with his medication protocol. I'm not sure for me that Dr. Braverman is the guy. I haven't given up on him yet though and plan on going back and getting him to work for some of the money I spent there. It's always a crap shoot. That's why I cringe at the thought of going to yet another doctor. I hope this has been some help to you. Good luck.
Posted by rfied on May 11, 2005, at 20:15:44
In reply to Re: FRANCO Read this before answering my previous post, posted by franco neuro on May 11, 2005, at 19:48:44
thanks, i called his office, they weren't that pleasant, he calls later abruptly just to pressure u to set up appt. I am also trying Dr Ronald Hoffman in NYC, famous nutritional Dr , his people a lot more compassionate, caring on phone, when i mentioned Braverman the one lady had a bad reaction, all the brain experts i have emailed dont believe Bravermans approach, only a theory no clinical peer review etc>
you may want to consider the Hoffman Center in NYC
Posted by Chairman_MAO on May 11, 2005, at 20:49:27
In reply to Re: On the ketamine note ... » Declan, posted by AMD on May 8, 2005, at 0:52:29
I would not be concerned about any untoward effects given that dosage and the drugs you are taking. Ketamine is really quite a safe drug. The problem is knowing that what you took _IS_ pharmaceutical ketamine and nothing else ...
Posted by Chairman_MAO on May 11, 2005, at 20:51:47
In reply to Re: FRANCO Read this before answering my previous post, posted by rfied on May 11, 2005, at 20:15:44
I am not saying it applies in this case, but sometimes there are "no peer reviews" of a given treatment because no one who is part of the orthodoxy wants to allow one to take place.
Example: Marijuana is schedule I because there is no medical use. --> we cannot do a marijuana trial for x disorder because it is schedule I --> marijuana has no medical use --> ad nauseum
Posted by franco neuro on May 12, 2005, at 14:25:31
In reply to Re: FRANCO Read this before answering my previous post, posted by rfied on May 11, 2005, at 20:15:44
Interesting. What exactly do they do at the Hoffman Center. I'm actually trying to find a doctor who uses Lidocaine and/or Ketamine IV's to treat chronic pain. I've done a lot of research on the mechanisms involved with chronic neuropathic pain and I think this will help me a lot. The only good thing is I think I can get Braverman to give me a Lidocaine IV. He does the whole intravenous vitamin thing and they often put lidocaine in the mix to prevent irritation to the arteries. I just want them to hold the vitamins and just give me the lidocaine. As long as they'll make money off of it I'm sure they'll do it. I really want to try the ketamine IV but they may not go for that one. I don't think they understand the pharmacokinetics.
Posted by franco neuro on May 12, 2005, at 14:52:10
In reply to Re: On the ketamine note ... » AMD, posted by Chairman_MAO on May 11, 2005, at 20:49:27
Exactly. Ketamine is indeed a safe and useful medication. The thing that pisses me off about recreational drug use is that inevitably some knucklehead eighteen year old will pop a fistful of whatever the "in" drug is at the moment and end up dead or brain fried. Then the media blows it out of proportion and the politicians start screaming about how this "dangerous" substance should be taken off the market. Then of course the DEA and FDA morons make it almost impossible for people who actually have medical problems to get what is otherwise a very effective medication because uninformed ball-less doctors become afraid to prescribe it! Ok...end of rant...
Posted by ed_uk on May 12, 2005, at 16:35:37
In reply to Re: On the ketamine note ..., posted by franco neuro on May 12, 2005, at 14:52:10
> The thing that pisses me off about recreational drug use is that inevitably some knucklehead eighteen year old will pop a fistful of whatever the "in" drug is at the moment and end up dead or brain fried. Then the media blows it out of proportion and the politicians start screaming about how this "dangerous" substance should be taken off the market. Then of course the DEA and FDA morons make it almost impossible for people who actually have medical problems to get what is otherwise a very effective medication because uninformed ball-less doctors become afraid to prescribe it! Ok...end of rant...
This particularly applies to opioids. There seems to be mass hysteria about opioids in the US!
Ed.
Posted by rfied on May 12, 2005, at 17:49:30
In reply to Re: FRANCO Read this before answering my previous post, posted by franco neuro on May 12, 2005, at 14:25:31
try his website... drhoffman.com, he has a radio show just like braverman, but only sees 4 new patients a day.slower pace. Cymbalta is anew SNRI that has proven pain relief effect
Posted by Chairman_MAO on May 13, 2005, at 9:18:46
In reply to Re: On the ketamine note ..., posted by franco neuro on May 12, 2005, at 14:52:10
Ketamine is actually one of the safest anesthetics known to man. It is used in cases of SEVERE CHILD BURN VICTIMS because it produces minimal respiratory depression and extraordinarily effective anesthesia.
Moreover, kids, for whatever reason, do not "trip" on it. Of course, the medical establishment simply views that as an arbitrary fact rather than examining the possibility that perhaps the brain and mind are less mechanistic than we'd like to think ...
Posted by franco neuro on May 13, 2005, at 10:18:59
In reply to Re: FRANCO Read this before answering my previous post, posted by rfied on May 12, 2005, at 17:49:30
I will give the website a look. Four patients per day is impressive. Not many doctors would do that. Unfortunately he probably charges Manhatten prices too. I may just go and see a local psychiatrist/psychopharmacolgist I found. Or may even just try to use a few of the doctors I've already seen to get a few medications and start trying to solve this on my own.
As far as cymbalta, I'd welcome the norepinephrine boost but I think the last thing I need is more serotonin. SSRI's have tended to make things worse. Wellbutrin helps with pain but knocks me out. I'm really interested in blocking the NMDA receptor. I think that's where the root of the problem lies. Ketamine does this. And if you respond to a ketamine IV than you know you need a med that blocks the NMDA receptor. Oral ketamine isn't as effective and has more ADR's. Memantine does this but isn't available in the U.S. Dextromethorphan also does this.
http://www.anesthesia-analgesia.org/cgi/content/abstract/99/6/1753
Posted by franco neuro on May 13, 2005, at 11:01:24
In reply to Re: On the ketamine note ... » franco neuro, posted by ed_uk on May 12, 2005, at 16:35:37
Yes. I was thinking of opioids in particular. But there are others. Ketamine, as ChairmanMAO has correctly pointed out, is an extremely effective (and safe) medication. Drugs that are abused are usually done so because they are effective medications. Nobody's out on the street "jonesing" for an SSRI. There is an alarming trend in this country of the goverment trying to protect us from ourselves. It sickens me. There have been a lot of overblown news reports lately of the "dangerous" drug dextromethorphan. Once again it's all because a few morons decided to drink 20 bottles of cough syrup to get a buzz.
Posted by franco neuro on May 13, 2005, at 11:24:17
In reply to Re: On the ketamine note ... » franco neuro, posted by Chairman_MAO on May 13, 2005, at 9:18:46
> Ketamine is actually one of the safest anesthetics known to man. It is used in cases of SEVERE CHILD BURN VICTIMS because it produces minimal respiratory depression and extraordinarily effective anesthesia.
Exactly. Not only is it an excellent anesthetic/analgesic, but a patient's response to a ketamine IV can be used to predict which oral medications will help them achieve pain relief. Here is an example:
http://www.anesthesia-analgesia.org/cgi/content/abstract/99/6/1753
I emailed the Dr. Cohen that's listed as one of the contributors to the study. He's down at Johns Hopkins in Baltimore. He actually got back to me and I'm thinking of taking a ride down to see him. IV lidocaine can be used in the same way. I keep getting back to him, but Dr. Jay Goldstein was doing this stuff 10 or 12 years ago. Of course like all pioneers he was ignored, if not belittled, by the dinosaur-like medical establishment. They have to wait ten years before they realize the guy was on to something. But, of course, they'll never give him any credit. My friend gave Dr. Braverman the book "Tuning the Brain" by Dr. Jay Goldstein. A month later he acted like he didn't remember it. Meanwhile on his radio show he was basically quoting form it. They're all egomaniacs.
Posted by ed_uk on May 13, 2005, at 11:30:32
In reply to Re: On the ketamine note ... » ed_uk, posted by franco neuro on May 13, 2005, at 11:01:24
Hi Franco,
What type of pain do you suffer from? I think you mentioned that you used to take amitriptyline but it was too sedating. Have you tried desipramine or nortriptyline?
Ed.
Posted by ed_uk on May 13, 2005, at 11:35:49
In reply to Re: On the ketamine note ..., posted by franco neuro on May 13, 2005, at 11:24:17
Desipramine, a TCA which acts as a relatively selective norepinephrine reuptake inhibitor, can be useful in neuropathic pain.............
Efficacy of desipramine in painful diabetic neuropathy: a placebo-controlled trial.
Max MB, Kishore-Kumar R, Schafer SC, Meister B, Gracely RH, Smoller B, Dubner R.
Neurobiology and Anesthesiology Branch, National Institute of Dental Research, National Institutes of Health, Bethesda, MD 20892.
Although amitriptyline relieves pain in many patients with painful diabetic neuropathy, side effects often preclude effective treatment. Desipramine has the least anticholinergic and sedative effects of the first generation tricyclic antidepressants. We compared a 6 week course of desipramine (mean dose, 201 mg/day) to active placebo in 20 patients with painful diabetic neuropathy in a double-blind crossover trial. Pain relief with desipramine was statistically significant in weeks 5 and 6. Eleven patients reported at least moderate relief with desipramine, compared to 2 with placebo. Pain relief tended to be greater in depressed patients, but relief was also observed in patients who did not show an antidepressant effect. We conclude that desipramine relieves pain in many patients with painful diabetic neuropathy, offering an alternative for patients unable to tolerate amitriptyline. Blockade of norepinephrine reuptake, an action shared by desipramine, amitriptyline, and other antidepressants proven effective in neuropathic pain, may mediate this analgesic effect.
Clin Pharmacol Ther. 1990 Mar;47(3):305-12. RDesipramine relieves postherpetic neuralgia.
Kishore-Kumar R, Max MB, Schafer SC, Gaughan AM, Smoller B, Gracely RH, Dubner R.
Neurobiology and Anesthesiology Branch, National Institute of Dental Research, National Institute of Health, Bethesda, MD 20892.
Desipramine has the least anticholinergic and sedative effects of the first generation tricyclic antidepressant agents, but its pain-relieving potential has received little study. Other antidepressant agents--notably amitriptyline--are known to ameliorate postherpetic neuralgia, but those agents are often toxic. In a randomized double-blind crossover design, we gave 26 postherpetic neuralgia patients 6 weeks of treatment with desipramine (mean dose, 167 mg/day) and placebo. Nineteen patients completed both treatments; 12 reported at least moderate relief with desipramine and two reported relief with placebo. Pain relief with desipramine was statistically significant from weeks 3 to 6. Psychiatric interview at entry into the study produced a diagnosis of depression for 4 patients; pain relief was similar in depressed and nondepressed patients and was statistically significant in the nondepressed group alone. We conclude that desipramine administration relieves postherpetic neuralgia and that pain relief is not mediated by mood elevation. Blockade of norepinephrine reuptake, an action shared by desipramine, amitriptyline, and other antidepressant agents that have relieved neuropathic pain, may be involved in relief of postherpetic neuralgia.
Posted by franco neuro on May 13, 2005, at 21:43:19
In reply to Re: On the ketamine note ... » franco neuro, posted by ed_uk on May 13, 2005, at 11:30:32
Hi Ed,
> What type of pain do you suffer from? I think you mentioned that you used to take amitriptyline but it was too sedating. Have you tried desipramine or nortriptyline?
I suffer from neuropathic pain. It's mostly on my left side. Nerve pain and weekness in my left leg and foot and visceral and pelvic pain. I wish I had taken desipramine instead of amitriptyline. It's a much "cleaner" med. All the time I was taking it I thought it was it's antihistamine action that was putting me to sleep. But I've come to realize it wasn't. I've tested various antihistamines and I don't find them sedating at all. They are somewhat analgesic as far as the visceral pain goes. I had to keep upping the dose of amitriptyline over the course of the three and a half years I was on it. I must have really been propping up my NE levels because when I stopped it I really went down hill fast. It was like the bottom dropped out. I felt like my muscles were melting away. It was pretty horrible. I still haven't recovered over two years later. Right now I'm trying to find the right cocktail. Neurontin has helped a lot with the peripheral pain. And the first day I took bupropion SR I felt a sense of relief all over the left side of my chest and torso. There was just a feeling like it was filling up this painful hollowness (if that makes any sense) on my left side. Ufortunately, it started to knock me out. I know there is a large NE componant to my problems. But I'm trying to pinpoint exactly which NE receptors. I'd like to give Clonidine a shot. It's stimulates the alpha-2 receptor and has some other interesting properties.
Posted by franco neuro on May 13, 2005, at 22:46:42
In reply to Desipramine in neuropathic pain » franco neuro, posted by ed_uk on May 13, 2005, at 11:35:49
Yes, I like the fact that it's not particularly anticholinergic. I want to dull the pain, not my intellect. I'm really trying to get at the heart of how this all happened. No one has explained it better that Jay Goldstein in "Tuning the Brain". I read that book and it was as though he was describing my life. Here are some excerpts:
"If an individual is temperamentally, developmentally, and/or environmentally predisposed to interpret too many stimuli as possibly threatening, then attentional resources, which require increased secretion of neurotransmitters norepinephrine (NE) and dopamine (DA) (among others), will be consumed locally at too rapid a rate, and the brain will develop a deficit in them sooner or later. Then, an overt neurosomatic disorder will occur."
"It has taken me twenty years of thinking to succinctly synthesize what is described here, i.e., improper selection of salience produces overuse of the 'attentional spotlight,' which raises signal-to-noise ratio by overly frequent secretion of dopamine and norepinephrine. At some time during a person's life, a neural network orchestrated by the prefrontal cortex may be unable to induce sufficient production of these transmitter substances. This inability may be sporadic or virtually constant, but the result will be neurosomatic symptoms."
"A postulate to which I shall continually refer in this book is that patients with neurosomatic disorders have overly learned and overly generalized associative responses and that the primary molecular basis of this memory dysfunction involves the NMDA receptor."
Me again. Basically, an oversensitized NMDA receptor for glutamate and/or an over secretion of glutamate causes the brain to be in a state of overexcitability or hypervigilance (i.e. overactive fight or flight response, increased startle response, anxiety, poor response to stress, perceiving non-threatening situations as threatening, etc., etc.) This state of perpetually being stressed out ultimately leads to a depletion of DA and NE.
"Inhibiting the NMDA receptor, the presynaptic release of glutamate, and facilitating NE and DA secretion should be effective ways of treating neurosomatic disorders."
That's it in a nutshell. The man is a genius. I love this book. He has a whole list of his favorite medications. But what he considered the best treatments and also the best tools for predicting which medications would work best for his patients, are IV ketamine (NMDA antagonist) and IV lidocaine (primarily suppresses glutamate release). Now all of this makes perfect sense to me. But I can't seem to find a doctor who knows his *ss from his elbow, let alone what the function of the NMDA receptor is!
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