![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by good4u on May 30, 2001, at 20:52:20
In desperation, I am trying to contact the best doctors in the country, be they neurologists, neuropsychiatrists, or psychiatrists, clinicians or researchers, to see if ANYONE has heard of a problem similar to mine or who MIGHT be able to offer some insight
I have had NO luck with accurate diagnosis of my problem nor, more importantly, relief of symptoms to date. ANY advice/insight you can offer is GREATLY appreciated, and I am willing to travel ANY distance for an appointment if something can be done to help.
There are two problems that won't seem to go away. They are:
1. There is a restless, “over-stimulated” feeling in the front
of my head. It feels as if my brain is receiving a great excess of electrical energy in
the area in my forehead, as if that part of my brain is never relaxed, or is always ON.
This feeling is accompanied by repetitive mental patterns,
patterns that I am compelled to draw in my mind. The
compulsion to draw these patterns and the speed in which I do
so, increase in severity as the restless, over-stimulated
feeling increases.2. I have a very spaced out, drugged up feeling-constantly. For some reason, the source seems to in the front of my head directly above and slightly behind my eyes.
This feeling has greatly impaired my ability to think,
plan, make associations, grasp what others are saying, and
recall from memory. Following are more explicit descriptions of these problems. I realize that it is probably difficult to understand such perceptive subtleties, so I will try to give as many examples as I can.
In reference to 1. above:
In 1996, upon a doctors recommendation, I began taking 20 mg.
of Paxil for depression. My depression rapidly lifted and felt
o.k. for 6-7 months. At this point, I began “drawing” these
“patterns” in my mind, and felt an excess of energy and
restlessness in the front of my head. I felt no restlessness
in my body nor did I physically have an unusually high energy
level.
As several months passed, this combination of symptoms increased
dramatically eventually reaching the point in which I had to
decrease my daily dose. Over the span of 6 weeks I slowly weaned
myself off the Paxil, however, decreasing the medication had
no effect on the severity of the symptoms. 2 days after
completely being off the medication, the “patterns” vanished as
did the over-stimulation-feeling in my head. My brain felt very
“relaxed.”
I liken the feeling at this point (when my brain felt “relaxed” finally) the to turning down a dimmer switch on a lamp that is
blindingly bright. The “dimmer switch” on the front part of my
brain had finally been turned down to the normal level. 1 month
later I began feeling the depression returning. Now seeing a
different doctor, I was put on 200 mgs. of Zoloft and 750 mgs.
of depakote. My depression again rapidly lifted and I felt o.k.
for 9-10 months when again I began making the patterns, and
feeling the over-stimulation and restlessness. Over the next
year-18 months, under my doctors instruction, I tried lowering
the dose of Zoloft, raising the dose of Depakote, and tried
several other medications and combinations. Nothing changed.
At this point I would have much rather suffered through the
depressive symptoms than the horrible side effects of the
medication. Several times I weaned myself slowly off the drugs
only to find that the side effects were now permanent. I have
been off all medication for 2 full months with no decrease
or change in these symptoms. **(I have noticed that when I have
caffeine, the patterns and “restlessness” (again, not “physical” restlessness) increase
for several hours).
In reference to 2. above:
Two days after discontinuing the Zoloft and 4 weeks after
discontinuing the Depakote, I began experiencing a weird
sensation in the front of my head. Hard to describe, the
sensation would last for about a second and would happen every
5-10 minutes. The feeling was a quick "flip-flop" (sorry, so
difficult to describe) in the front of my brain. It was a
whirling, spaced out feeling seemingly localized only in that small part
of my head. The more this happened, the more I would feel
“spaced out” and “drugged” in between these 1 second "flip-flop"
episodes. Now I am left with a constant “drugged up, spaced out”
feeling.. Although it feels like there is excessive energy in the one spot in my brain, the majority of the front of my brain feels dead to emotions and thoughts. It feeld as though it is numb. Seemingly with no antagonist, this feelings/perceptions vary in severity from moderate to extreme.Some questions I have are:
1) Could these symptoms be from medication withdrawal. (it feels very much like withdrawal).
2) What tests can be done? Won’t imaging tests/scanning using the latest EEG/MRI/SPECTRA be able to help?I am hoping someone in the world might be able to help me. As it stands right now, this condition has left me emotionally and cognitively vacuous. I am unable to “live in the moment.” My reaction time in conversation and in daily living is slow. I feel “disconnected” and “unsure-footed.” “Disoriented” is another word I would use to describe my state. There is “numbness” of thought and feeling in the front part of my brain.
I would so very much appreciate any help or guidance you can offer.
Sincerely, with greatest appreciation and hope,
J Witowsky
Posted by Cam W. on May 31, 2001, at 8:12:07
In reply to ATTN: CAM W., posted by good4u on May 30, 2001, at 20:52:20
JW - First I must qualify anything I say with: I am a pharmacist who works in community psychiatry. I am not trained in diagnosis (as matter of fact, I really suck). I can't tell a borderline personality disorder from a schizoaffective disorder from a psychotic depression; but if a doc tells me what they think a person has, I can make suggestions on what drugs may work (from past experience). Therefore, any advice I may give is tainted by this caveat. Also, I am Canadian, so I doubt I'd be able to help you find a doc. Out of curiosity, have you had an MRI &/or CAT scan to rule out any major organic problems?
As to your section 1; have you tried Risperdal™ (risperidone) or Zyprexa™ (olanzapine). These drugs do wonders for ruminations, with minimal adverse effects if you follow a strict diet and are maintained on a low dose. Don't let the moniker "atypical antipsychotic" fool you; paraphrasing the T.V. commercial, "They're not just for psychosis, anymore."
The "drawing of patterns", after having your depression resolve sounds like it could be a residual symptom of you depression. This might also be helped with a low dose atypical antipsychotic and dwelling (ruminating) on this symptom may have made it more prominent. The permanence of these symptoms now could mean that you have been able to bring these symptoms to the forefront of your consciousness, or are now more sensitive to this residual symptom of the depression, and it now overshadows some of the other depressive symptoms that can return with weaning from the antidepressants. OTOH it could be that the nature of your disorder has changed, and now the "picture drawing" has become a more prominent feature.
As for the spaced-out, drugged feeling, I'd hazard a guess that you are getting too much serotonin. Sometimes, people who take SSRIs, but don't have low serotonin, complain of a mental dulling or "fogged brain". OTOH, the ruminations of "picture drawing" could be causing some of the cognitive dulling, as the more time that you do spend worrying about your symptoms, takes away from your ability to focus on other things.
The "relaxed" brain features could mean that your symptoms partially went into remission Caffeine and other stimulants can increase ruminations without significant physical stimulation.
The "spaced out" side effects from coming off the Zoloft could be withdrawl side effects or they could be a further manifestation of your original complaint. The "flip-flop" could be a natural manifestation &/or progession of the ruminating disorder, and this could potentially be worsened by serotonin withdrawl symptoms.
As for tests to run, it would be wise to have a full medical to rule out organic causes for your symptoms, but I am now getting into areas where I have absolutely no expertise. I still think that an adequate trial of a low dose atypical would be in order if a normal physical work-up (including a full brain MRI) finds nothing abnormal.
Sorry I am not much help, but this really is beyone the scope of my expertise and all the above are just guesses (and not very informed ones at that) - Cam
Posted by grapebubblegum on May 31, 2001, at 8:46:15
In reply to Re: ATTN: CAM W. » good4u, posted by Cam W. on May 31, 2001, at 8:12:07
Sorry to bust into this thread and divert the topic a bit, but when I see you, I like to pick your brain. Now, I am very curious about the omnipresent drug, caffeine.
It is widely held that caffeine can worsen panic disorder blah blah blah. Paradoxically, my worst episodes of recurrent panic attacks happened when I was for some reason on a caffeine abstinence kick. My dad was considered bipolar, and he told me that he sometimes drank 8 cups of coffee per day.
I crave caffeine and feel that I need it so I don't have that "slow and foggy head" and so that I can handle stimulus without being very irritated by it.
My pdoc told me this about caffeine: contrary to popular belief, people don't take it because it makes them "hyper"; rather they like it because it causes a negative feedback loop in something or other neurotransmittor that I can't remember... noradrenaline? Nor something? Sorry, I'm sorely lacking in neurotransmittor knowledge.
She said that rather than exciting the brain, the desired effect people crave from caffeine is that it reduces diffuse activity that makes people unable to focus. Therefore, people can focus and concentrate better, as witnessed by the proven effect that people do better on cognitive tests after taking caffeine. So, to wrap up my point, I find it interesting that someone with anxiety problems (me, although I consider panic attacks different from anxiety) feels much better on a stimulant like caffeine. Also, my 5 year old son who supposedly has bipolar disorder just like my dad did, seemed to do better with a can of mountain dew every morning (I tried this before taking him to the doctor for real meds) and of course we have all heard that kids with "ADHD" can sometimes benefit from a little caffeine in the morning before trying the big guns of ritalin and adderal, etc.
I touched on a lot of topics but my basic question is: can you shed some light on what caffeine really does and how it does more than just "pep you up" as is the public perception? What was my doc trying to say about caffeine interfering with the uptake of some neurotransmittor in the back of the brain and thus producing a calming effect?
I hope we are not all frustrating you by asking you harder and harder questions; we just see you as our window into better understanding, and we accept that you don't know it ALL, so as always, thanks for your time and trouble.
Posted by Cam W. on May 31, 2001, at 10:03:36
In reply to You mentioned caffeine, Cam, posted by grapebubblegum on May 31, 2001, at 8:46:15
GBG - As I understand it, the theory behind any stimulant for increasing vigilance, is that our brains tend to work on several trains of thought at one time or skip between these thoughts, and stimulants stop this skipping. This allows one to focus on the project at hand, without the inevitable mind drift or daydreaming. This is thought to be done by increasing the amount of dopamine neurotransmission.
Stimlants can worsen panic because, in some ways, in certain areas of the brain, an increase in dopamine neurotransmission &/or an increase in dopamine receptor stimulation decreases serotonin neurotransmission &/or serotonin release from the neuronal axon terminals.
In the long run, this can be a heavy price to pay for increased vigilance because it can affect mood. While caffeine (or any stimulant) does increase vigilance, allowing you to focus on a task, it could possibly set one up for increased panic attacks (or perhaps increased risk of depression) in the future if the decrease in serotonin is sustained and if the body is unable to compensate for this decrease.
Take it from someone who use to drink a pot and a half of coffee before noon. I was an owly son of a bi...gun (even more so than now...really). Restricting my caffeine (only take 3 shots of espresso in my venti caramel macchiato, now - Greg, you've created a Starbuck's monster) has seemed to help, somewhat, in the mood department (I guess you could say that I went from a Professor Snape to a Professor McGonigal). Remember, caffeine, like all stimulants, can be abused.
This situation is different in someone with ADHD, who are thought to have decreased dopamine neurotransmission, where increases in dopamine, by stimulants, only try to bring the levels back to "normal". So, a U.S. Mountain Dew (our government is still trying to protect our children from the evils of extra stimulation, so we only have "The Taste of a New Generation" and "The Real Thing" to get off on) may not hurt your son and may even decrease his need for prescription stimulants (if taken regularily). I would let his doc know of the caffeine intake, as it is a drug. When I give sugar and caffeine to my six year old, I make sure I am leaving her with her mother. The little one can literally climb the walls.
I do not work with children very much in my profession, so my advice here is probably not to the level it should be. I hope that this gives you some of the information that you were looking for. - Cam
Posted by grapebubblegum on May 31, 2001, at 11:35:42
In reply to Re: You mentioned caffeine, Cam » grapebubblegum, posted by Cam W. on May 31, 2001, at 10:03:36
That was funny about leaving the child with her mother... Well, anyway, I told my son's pediatrician about the Mountain Dew and he was all for it because who wants to prescribe stimulants for a young child? But anyway, the caffeine only improved his mood and made him focus and concentrate better (i.e. sitting and playing quietly with a longer attention span and being able to speak rationally instead of having temper outbursts) but I discontinued that therapy when he was started on topamox and geodon. I suppose he would fit the "ADHD" profile but the doc and I have agreed not to address that yet, as he is not even in school yet.
Well, I understand the part about caffeine increasing anxiety and panic potential, but like I said, my worst times were when I was a caffeine monk and took none, which makes me question the possible etiology of my panic disorder. But, as you said, too much caffeine is not a good thing. I used to drink all I wanted all day long and found that I had a vicious temper. Now, like you, I have my own self-set limit. Two big mugs of three scoops of ground starbucks apiece. Stronger than most might like but that is my daily ration and I never go over it. If finished before noon or 2 pm it doesn't interfere with nighttime sleep. In fact, I have always slept like a rock.
Thanks for the neurology food for thought. I'll put it in my "to digest and understand later" folder. Is there a good book that I could read to start understanding neurotransmittors and pharmacology? I'm kind of stumbling around in the dark here and I'd like a good foundation that is not over my head.
Posted by Cam W. on May 31, 2001, at 12:02:31
In reply to Caffeine = visits with mom, ha ha ha, posted by grapebubblegum on May 31, 2001, at 11:35:42
GBG - There is an in depth psychopharmacology textbook online set up by The American College of Neuropsychopharmacology (ACNP) called "Psychopharmacology: The Fourth Generation of Progress". I downloaded and printed it off the day before I left my last job (approx. 1000 pages). It gave me a little smug satisfaction doing it, as I didn't have to wear out my home printer or pay for the paper. It does fill about 3 to 4 binders. You can read it online, as well at:
There are articles by some fairly heavy hitters in the psych game. It is rather intensive, but is a great reference, and is updated (not sure how often, though).
Another site on pharmacology, that is much easier to read is:
http://pharmacology.about.com/health/pharmacology/
I hope that these are of some help. - Cam
Posted by Marie B on May 31, 2001, at 13:18:44
In reply to Re: Psychopharmacology Text Online » grapebubblegum, posted by Cam W. on May 31, 2001, at 12:02:31
Dear Cam==
I see you are on this mesage board at the same time frame as I, and although I realize you are "just" a pharmacist, but I ask for your insight.
Please read my post on "EFFEXOR withdrawal and Pregnancy" which should be the next thread.
The withdrawal symptoms posted by good4u are similar to mine, such as the spaced-out, drugged feelings and feeling a 'spot' in a specific area of my brain Whereas good4u describes problems at the front of the brain, I feel it most in the back, at the bottom, above my neck.
What I am asking is simply {har har} how can we alleviate withdrawal?
And most important at present.. What about the fetus I am carrying??
Posted by grapebubblegum on May 31, 2001, at 14:31:05
In reply to Re: Psychopharmacology Text Online » Cam W., posted by Marie B on May 31, 2001, at 13:18:44
Cam, thanks, and maybe it will keep me from asking you another million questions although you've been patient with the first million.
I like your sense of humor; please see my post in another thread titled "my message board." I hope that you and anyone else interested will stop by. That's where I talk about things OTHER than psychopharmacology.
Posted by Jane D on May 31, 2001, at 15:04:07
In reply to Re: Psychopharmacology Text Online- thanks, posted by grapebubblegum on May 31, 2001, at 14:31:05
You might also like Essential Psychopharmacology by Stephen M. Stahl. It's a book I learned about here and found very helpful. I think it probably can take someone from knowing nothing to being able to understand some of the research papers (or at least think they do). I'm also just old enough to find printed books easier to absorb than online material. The illustrations are fantastic and very funny. The one downside is its cost - about $60 (US).
Posted by grapebubblegum on May 31, 2001, at 20:24:31
In reply to Re: Another Psychopharmacology Text - not online » grapebubblegum, posted by Jane D on May 31, 2001, at 15:04:07
Thanks, Jane. I also like to sit down and read a book rather than stare at a computer for too long.
I'll put it in my "when I can afford it" online list at Amazon.com.
This is the end of the 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.