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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 53. This is the beginning of the thread.
Posted by Prefect on April 6, 2018, at 14:34:51
I suffer from severe anxiety, inner tension, tremors, cognitive deficit, derealization, etc
One double shot of whiskey gives me more relief than 1 mg of clonazepam. I am able to think, I become more motivated, relaxed, and my inner tension and tremors stop.
What is the mechanism behind this? It can't just be GABA and NMDA antagonism otherwise clonazepam would work too. It's got to be something else alcohol does that I need to find a medication that can do the same, otherwise I'm on the path to alcoholism.
And no, my symptoms are not from alcohol withdrawal, I had them for a year before I accidentally discovered alcohol practically makes me NORMAL for a few hours.
Posted by linkadge on April 6, 2018, at 16:14:00
In reply to Why is alcohol the only thing that helps me?, posted by Prefect on April 6, 2018, at 14:34:51
Alcohol activates the reward pathways in the brain much more then benzodiazapines. In this way, the relaxing effect may feel more positive.
I have been using medical pot and notice something similar. I.e. its helping me much more than traditional anxiety / depression meds. Many anxiety / depression meds just make me feel dysphoric.
Linkadge
Posted by Phillipa on April 6, 2018, at 17:48:54
In reply to Why is alcohol the only thing that helps me?, posted by Prefect on April 6, 2018, at 14:34:51
Perfect when I used to drink 4-5 beers at night I always felt good. And I wasn't drunk just relaxed and always drank at bedtime. Benzos just aren't the same. But I quite drinking over 20 years ago. I got tricked by the doc when he gave me chloral hydrate. So now it's low dose benzos only but never feel relaxed? Phillipa
Posted by Christ_empowered on April 6, 2018, at 23:27:11
In reply to Re: Why is alcohol the only thing that helps me?, posted by linkadge on April 6, 2018, at 16:14:00
could you try a different benzodiazepine? my mood was better w/ ativan vs klonopin, personally. some people even report some antidepressant effects from xanax.
Posted by Prefect on April 7, 2018, at 12:11:54
In reply to Re: Why is alcohol the only thing that helps me?, posted by linkadge on April 6, 2018, at 16:14:00
I think you may be onto something about reward pathways. This is why I'm considering either low dose naltrexone to raise my opioid levels or low dose abilify to balance dopamine levels. What's your thoughts on this?
Posted by SLS on April 7, 2018, at 12:26:39
In reply to Re: Why is alcohol the only thing that helps me? » linkadge, posted by Prefect on April 7, 2018, at 12:11:54
> I think you may be onto something about reward pathways. This is why I'm considering either low dose naltrexone to raise my opioid levels or low dose abilify to balance dopamine levels. What's your thoughts on this?
Good thinking.
- Scott
Posted by linkadge on April 7, 2018, at 13:56:24
In reply to Re: Why is alcohol the only thing that helps me? » linkadge, posted by Prefect on April 7, 2018, at 12:11:54
>I think you may be onto something about reward >pathways. This is why I'm considering either low >dose naltrexone to raise my opioid levels or low >dose abilify to balance dopamine levels. What's >your thoughts on this?
Hmm. I like to use the 'feel good' test. If the drug makes you feel better, take it. Naltrexone or abilify may help (I have not taken either, so I have no sense of the feel).
I read one study in which the AD effect of ketamine was associated with a rapid activation of the reward pathways in the brain. It seemed to work in mice to quickly normalize activity in this region (in patients where there was underactivity).
I'm not advocating using any drug willy-nilly to feel good (as there can be pitfalls). I just know from my own case, that when I get really depressed I don't feel anything and don't want to do anything. SSRIs don't seem to help this (or even make it worse).
Linkadge
Posted by linkadge on April 7, 2018, at 13:59:25
In reply to Re: Why is alcohol the only thing that helps me? » Prefect, posted by SLS on April 7, 2018, at 12:26:39
Just to add, I am still experiencing a significant benefit from medical marijuana.
The dose I am taking does not get me high, and (seemingly) causes little impairment.
I have taken virtually every SSRI / SNRI, several TCAs, an MAOI, many benzodiazapines, anticonvulsants, antipsychotics and stimulants.
Linkadge
Posted by SLS on April 7, 2018, at 14:07:35
In reply to Re: Why is alcohol the only thing that helps me?, posted by linkadge on April 7, 2018, at 13:59:25
> Just to add, I am still experiencing a significant benefit from medical marijuana.
This is good news. I know it can be hard to be optimistic after so many failed drug trials. I hope you continue to feel better.
- Scott
Posted by linkadge on April 7, 2018, at 17:26:11
In reply to Re: Why is alcohol the only thing that helps me? » linkadge, posted by SLS on April 7, 2018, at 14:07:35
I stopped the venlafaxine cold turkey with no issues. I have been feeling better.
Linkadge
Posted by Lamdage22 on April 8, 2018, at 1:34:42
In reply to Re: Why is alcohol the only thing that helps me?, posted by linkadge on April 7, 2018, at 13:59:25
but you cant drive on medical marihuana right?
Posted by Lamdage22 on April 8, 2018, at 1:39:53
In reply to Re: Why is alcohol the only thing that helps me?, posted by Lamdage22 on April 8, 2018, at 1:34:42
for me thc and cbd is poison
Posted by beckett2 on April 8, 2018, at 1:58:49
In reply to Re: Why is alcohol the only thing that helps me? » Prefect, posted by linkadge on April 7, 2018, at 13:56:24
>
> I read one study in which the AD effect of ketamine was associated with a rapid activation of the reward pathways in the brain. It seemed to work in mice to quickly normalize activity in this region (in patients where there was underactivity).
>
> I'm not advocating using any drug willy-nilly to feel good (as there can be pitfalls). I just know from my own case, that when I get really depressed I don't feel anything and don't want to do anything. SSRIs don't seem to help this (or even make it worse).This is true, isn't it? I know this has been discussed-- the ssri's and the lot flatten feelings, but I just got the lightbulb moment. So a damn ssri won't treat exactly what I'd like it to treat. Quite ridiculous really. But what else to take?
I'm glad to hear about your success with CBD. And that you discontinued Effexor just like that.
Drat this whole illness.
>
> Linkadge
>
>
>
>
Posted by beckett2 on April 8, 2018, at 2:04:48
In reply to Why is alcohol the only thing that helps me?, posted by Prefect on April 6, 2018, at 14:34:51
> I suffer from severe anxiety, inner tension, tremors, cognitive deficit, derealization, etc
>
> One double shot of whiskey gives me more relief than 1 mg of clonazepam. I am able to think, I become more motivated, relaxed, and my inner tension and tremors stop.
>
> What is the mechanism behind this? It can't just be GABA and NMDA antagonism otherwise clonazepam would work too. It's got to be something else alcohol does that I need to find a medication that can do the same, otherwise I'm on the path to alcoholism.
>
> And no, my symptoms are not from alcohol withdrawal, I had them for a year before I accidentally discovered alcohol practically makes me NORMAL for a few hours.The various benzos are different in effect-- couldn't tell you why, but I've only liked two and the rest made me feel like rubbish. Clonazapam I did not like, and I'd rather a shot of whiskey that it.
I suppose if you don't overdo or feel worse later or in the long run, lots of people find whiskey works fine.
Posted by linkadge on April 8, 2018, at 12:07:17
In reply to Re: Why is alcohol the only thing that helps me?, posted by Lamdage22 on April 8, 2018, at 1:34:42
>but you cant drive on medical marihuana right?
My doctor told me I could drive, but just to wait a few hours. Marijuanna will be legalized in Canada soon. There is likely emerging legislation on what thresholds constitute impairment. You obviously cannot be impaired while driving.
Linkadge
Posted by linkadge on April 8, 2018, at 12:10:14
In reply to Re: Why is alcohol the only thing that helps me? » linkadge, posted by beckett2 on April 8, 2018, at 1:58:49
In theory, SSRIs are supposed to treat depression (a core symptom of which is anhedonia).
In practice, I don't know how well they work on that symptom.
There is some evidence too that SSRIs may work better in women (not conclusive, but emerging evidence).
The article I read suggested that women were 2x as likely to achieve remission on an SSRI then men.
Linkadge
Posted by beckett2 on April 8, 2018, at 15:52:05
In reply to Re: Why is alcohol the only thing that helps me? » beckett2, posted by linkadge on April 8, 2018, at 12:10:14
> In theory, SSRIs are supposed to treat depression (a core symptom of which is anhedonia).
>
> In practice, I don't know how well they work on that symptom.
>
> There is some evidence too that SSRIs may work better in women (not conclusive, but emerging evidence).
>
> The article I read suggested that women were 2x as likely to achieve remission on an SSRI then men.
>
> Linkadge
>
>Would you consider lack of motivation an expression of anhedonia?
Posted by linkadge on April 8, 2018, at 17:20:46
In reply to Re: Why is alcohol the only thing that helps me? » linkadge, posted by beckett2 on April 8, 2018, at 15:52:05
>Would you consider lack of motivation an >expression of anhedonia?
Absolutely.
We do things that we enjoy doing. If we enjoy doing it, we want to repeat it. When we stop enjoying things (or everything) we stop doing things.
Its a learned response.
Lack of motivation (for me) has slowly crept up as I stopped enjoying doing the things I once did. If the action stops providing pleasure, we stop doing it.
Linkadge
Posted by beckett2 on April 8, 2018, at 17:51:47
In reply to Re: Why is alcohol the only thing that helps me? » beckett2, posted by linkadge on April 8, 2018, at 17:20:46
> >Would you consider lack of motivation an >expression of anhedonia?
>
> Absolutely.
>
> We do things that we enjoy doing. If we enjoy doing it, we want to repeat it. When we stop enjoying things (or everything) we stop doing things.
>
> Its a learned response.
>
> Lack of motivation (for me) has slowly crept up as I stopped enjoying doing the things I once did. If the action stops providing pleasure, we stop doing it.
>
> Linkadge
>
>
>
>Do you think MMJ might help you with that? Maybe it's something else you're seeking, too.
Posted by Prefect on April 9, 2018, at 11:55:47
In reply to Re: Why is alcohol the only thing that helps me? » linkadge, posted by beckett2 on April 8, 2018, at 17:51:47
My concern is that it's come to the point I have to drink a whole bottle of whiskey a day in order to function. The more I drink I have to consume more and more since the alcohol is likely desensitizing my GABA receptors and causes a rebound effect where I feel withdrawal and likely suffer from rebound glutamate excitotoxicity when I don't drink.
I need to find an alternative. I'm considering weening off using clonazepam, get off the zoloft, and start taking Fluvoxamine at nights and abilify in the morning to see of it helps.
Posted by bleauberry on April 9, 2018, at 13:14:20
In reply to Why is alcohol the only thing that helps me?, posted by Prefect on April 6, 2018, at 14:34:51
My first gut instinct guess is that alcohol is stimulating the release of dopamine which might be your weak link, and that the way it stimulates dopamine is different than any of the psych meds.
I experienced the exact same things you described and the medication that fixed it all like magic was the medication I thought would make it all much worse - Ritalin!
It could be that dopamine is the weak link. As the adrenal glands try to compensate for that, they pump out the best substitutes they have, which are adrenalin-like. And thus your symptoms. When dopamine is normalized, those symptoms go away.
Your story and mine are identical except for 2 things. Ritalin for me instead of alcohol. And a diagnosis of Lyme as well. Your symptoms are 100% consistent with an unsuspected, stealth, misdiagnosed or undiagnosed, tick born disease. Either Borellia or Bartonella - both are bacterias from ticks - present a symptom profile that looks exactly like what you described.
Alcohol likely makes your problems and your life worse in the long run. It is generally destructive to many people. I would try experimenting with other things that hit dopamine.
And consider going a step further than merely treating the symptoms - set your sites on figuring why it is all happening in the first place - there is a reason - and in my experience it is not often the mystery we think it is - not often the complicated unsolvable puzzle that we think it is.
imo
> I suffer from severe anxiety, inner tension, tremors, cognitive deficit, derealization, etc
>
> One double shot of whiskey gives me more relief than 1 mg of clonazepam. I am able to think, I become more motivated, relaxed, and my inner tension and tremors stop.
>
> What is the mechanism behind this? It can't just be GABA and NMDA antagonism otherwise clonazepam would work too. It's got to be something else alcohol does that I need to find a medication that can do the same, otherwise I'm on the path to alcoholism.
>
> And no, my symptoms are not from alcohol withdrawal, I had them for a year before I accidentally discovered alcohol practically makes me NORMAL for a few hours.
Posted by SLS on April 9, 2018, at 15:03:13
In reply to Re: Why is alcohol the only thing that helps me?, posted by Prefect on April 9, 2018, at 11:55:47
> My concern is that it's come to the point I have to drink a whole bottle of whiskey a day in order to function. The more I drink I have to consume more and more since the alcohol is likely desensitizing my GABA receptors and causes a rebound effect where I feel withdrawal and likely suffer from rebound glutamate excitotoxicity when I don't drink.
>
> I need to find an alternative. I'm considering weening off using clonazepam, get off the zoloft, and start taking Fluvoxamine at nights and abilify in the morning to see of it helps.Why are you discontinuing Zoloft and starting fluvoxamine?
Have you tried:
Lamictal
Trileptal
Tegretol
N-acetylcysteine (NAC)Lamictal might increase dopamine (secondary to glutamate release inhibition). Tileptal and Tegretol can reduce glutamate and exitotoxicity. Tegretol can be sedating, which might be good in your case. NAC modulates glutamatergic activity and can increase dopamine, but often takes several months to take effect. Perhaps reducing inflammation is involved. I really don't know. Andrew Nierenberg suggested combining Lamictal with NAC.
Some people do well on a combination of Abilify, Lamictal, and Wellbutrin for severe depression. If you react poorly to Wellbutrin because of anxiety, aggitation, or dysphoria, nortriptyline or a SRI might make a good substitute.
- Scott
Posted by linkadge on April 9, 2018, at 17:01:15
In reply to Re: Why is alcohol the only thing that helps me?, posted by Prefect on April 9, 2018, at 11:55:47
Have you tried other anticonvulsants / mood stabilizers.
Topomax? Lamotrigine? Pregabalin?
Linkadge
Posted by Phillipa on April 9, 2018, at 17:19:06
In reply to Re: Why is alcohol the only thing that helps me?, posted by Prefect on April 9, 2018, at 11:55:47
Chloral hydrate is what stopped me from drinking the 4-5 beers a night. It does sound like you are building up a huge tolerance to alcohol. Can you stop drinking? If not than see an addiction specialist. Inpatient with valium and slowly weaning down. Phillipa
Posted by beckett2 on April 9, 2018, at 18:33:27
In reply to Re: Why is alcohol the only thing that helps me?, posted by Prefect on April 9, 2018, at 11:55:47
Lyrica has been helpful. I took Xanax for many years, and I just needed something after I detoxed. It's a thought. The effect is pro social and allows me some relaxation and enjoyment. (Just can't drive for the day after a certain amount.) Life is tough on the inside for some of us :/
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