![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 29 to 53 of 72. Go back in thread:
Posted by AMenz on June 5, 2001, at 11:19:40
In reply to Re: Codeine for Depression Treatment » AMenz, posted by Elizabeth on June 4, 2001, at 16:35:06
Codeine is supposed to be addictive. I'm already unable to get off a 1mg benzo daily.
When you say an opioid is it a synthetic or a natural derivative of opium. Better yet since I do not have a science background-what is an opioid agonist, as opposed to an opiate?
What is the action of codeine that it relieves depression and is the effect palliative like, eg. like benzos which wear off quickly and have to be readministered as oppossed to SSRI which and lithium which build up in the bloodstream slowly and take several days to wear off.
I'm almost embarassed to write to you because you seem extremely knowledgeable. What is your background, if I may ask?
> At what dosage and, since you say it's a temporary, for how many days is it safe to take this.
>
> How safe do you want?
>
> There seems to be a wide range of variability in the rates at which different people develop tolerance.
>
> BTW: there is no evidence or reason to suppose that opioid agonists are "cover-ups" that don't address the "root cause" of depression. (This is an argument commonly made by proponents of "talk" therapies in criticising the use of any drug at all, incidentally.)
>
> -elizabeth
Posted by paulk on June 5, 2001, at 12:05:48
In reply to Re: Codeine for Depression Treatment-Elizabeth, posted by AMenz on June 5, 2001, at 11:19:40
>Codeine is supposed to be addictive. I'm already unable to get off a 1mg benzo daily.
I’m not a doctor, but just a life long paient. That being said: Why are you trying to get off? The best way to get off is to switch to a long half-life Benzo like Clonazepam and to taper down – sometimes by as little as ¼ of the dose per week. ( one week at 1mg - next at .75 next at .5 next at .4 next at .3, .2,.1 )
Be aware that you may not be addicted to the benzo at all. What you might be experiencing is the reemergence of symptoms that the benzo is helping you with. That is not addiction. If this is the case you need to ask yourself why you are stopping. I could see switching to Effexor of some other med to deal with anxiety – but if they don’t work for you why not use what works? Some doctors are overly anti benzos – they have seen patients that abused benzos – most mental patents don’t abuse these drugs – and if you are on 1 mg – it sure doesn’t sound like you are.
You want to use the lowest dose that controls your symptoms – that can be quite low for some of us (I take .25mg of Clonazepam). Larger than necessary doses seem to effect memory and learning..
I don’t like the idea of using a benzo “as needed” except in the case of bipolar depression. Most of the time, anxiety can be treated with a regular low dose – going up and down can CAUSE anxiety.
Clonazepam BTW is probably one of the best to use – it has a long half-life and some seritnergic effect as well. Xanex (Alprazolam) has some anti-depressant action but has too short of a half-life to be practical for most (it would be interesting if they came out with a slow release version of it.).
Good luck to you
Posted by Glenn Fagelson on June 5, 2001, at 21:05:36
In reply to opioid antidepressants case series (as promised) » paulk, posted by Elizabeth on May 29, 2001, at 19:48:02
> As promised, here's the case series I referred to in my previous post. Interestingly, the primary author is the same Dr. Stoll who has become known for his work on omega-3 fatty acids for mood disorders.
>
>
> Am J Psychiatry 156(12):2017, December 1999
> ©1999 American Psychiatric Association
>
> Treatment Augmentation With Opiates in Severe and Refractory Major Depression
> Andrew L. Stoll, MD, and Stephanie Rueter, BA
> Belmont, Mass.
>
> To the Editor:
>
> Substantial evidence supports the antidepressant efficacy of opiates (1). This report summarizes our open-label experience using the µ-opiate agonists oxycodone or oxymorphone in patients with highly refractory and chronic major depression.
>
> Mr. A was a 44-year-old man with severe and chronic depression. Numerous trials of antidepressants produced only limited benefit. Mr. A also had an extensive history of opiate abuse, and he noted that the only times he ever felt normal and not depressed was during opiate use. Because of the refractory nature of his depressive symptoms and his apparent self-medication with opiates, Mr. A was given a trial of oxycodone under strict supervision. After 18 months of oxycodone treatment (10 mg/day), Mr. A remained in his longest remission from depression without the emergence of opiate tolerance or abuse.
>
> Ms. B was a 45-year-old woman with bipolar disorder and opiate abuse (in remission for 2 years). A trial with standard mood stabilizers had failed, and she had experienced mania with several standard antidepressant drugs. As with Mr. A, Ms. B reported feeling well only when taking opiates, particularly oxymorphone. Oxymorphone (8 mg/day) was thus cautiously added to ongoing lamotrigine therapy (as a mood stabilizer), and she remained well for a minimum of 20 months without drug tolerance or abuse.
>
> Mr. C was a 43-year-old man with chronic major depression that was unresponsive to numerous antidepressants with and without augmentation. Detailed questioning revealed that he once experienced marked antidepressant effects from opiates that he received after a dental procedure. There was no history of opiate abuse, and a cautious trial of oxycodone was initiated. Mr. C experienced a dramatic and gratifying antidepressant response from oxycodone (10 mg t.i.d. for 9 months) without opiate tolerance or abuse.
>
> This report describes three patients with chronic and refractory major depression who were treated with the µ-opiate agonists oxycodone or oxymorphone. All three patients experienced a sustained moderate to marked antidepressant effect from the opiates. The patients described a reduction in psychic pain and distress, much as they would describe the analgesic effects of opiates in treating nocioceptive pain.
>
> Two of the three patients described in this report were previous abusers of opiates. Although the clinical use of opiates in patients with a history of opiate addiction is usually contraindicated, in these cases there was a strong indication that they were self-medicating their mood disorders (2) with illicit opiates. None of the patients abused the opiates, developed tolerance, or started using other, illicit substances.
>
> We used oxycodone in three additional patients without histories of opiate abuse. In two of these three patients, oxycodone produced a similar sustained antidepressant effect. Two of these patients experienced mild-to-moderate constipation, and one experienced daytime drowsiness from the opiates. Opiates should be considered a reasonable option in carefully selected patients who are desperately ill with major depression that is refractory to standard therapies.
>
> REFERENCES
>
> 1. Bodkin JA, Zornberg GL, Lukas SE, Cole JO: Buprenorphine treatment of refractory depression. J Clin Psychopharmacol 1994; 15:49-57.
>
> 2. Khantzian EJ: Self-regulation and self-medication factors in alcoholism and the addictions: similarities and differences. Recent Dev Alcohol 1990; 8:255-271.I do not know about the rest of you, but
Vicodin absolutely ruins my sex drive. It does,
however, have a wonderful anti-depressant effect
with me. I take Vicodin as needed for headaches,
injuries, and sometimes just to reduce the effect
of severe depression. I have been using the
Vocodin for almost 3 years now; I have been very
careful with it because I realize how addicting
it could become. I have in no way become addicted
to Vicodin, but I know that the relief that I get
from it has great potential for abuse. So again,
I am very, very careful with it.
Glenn
Posted by petter on June 6, 2001, at 1:16:24
In reply to Re: Codeine for Depression Treatment-It's true, posted by froggy on June 5, 2001, at 5:49:19
> I never really thought about it before but when I was in a bad car accident I had to take 500mg's codine every 4-6 hours and I felt great! I never got too down being in a wheel chair and so much pain.
> Recentley I just started taking vicodin again because I am not completely out of pain. I do like the effects when mixed with an AD.
> Unfortunatley here the doctors think that codine was developed by Satan and to take one is to become a drug addict. I feel like one when tring to find a doctor that will give me a script.
> It is sad what they reduce a person too.H1!
Whatch up for codeine. It can cause treathment resistent depression I have seen this many times in the hospital were I use to work. Tolerans can also occur.
Take care//Petter
Posted by shelliR on June 6, 2001, at 19:32:41
In reply to Re: Codeine for Depression Treatment » Pacha, posted by Elizabeth on June 1, 2001, at 16:18:18
Elizabeth,
Do you know if the same amount of hydrocodone (which has synthetic codeine, right?) and codeine at the same strength have equal effects. Is codeine phosphate the same as codeine? I tried codeine phosphate 8mg , paracetamol 500mg (actually took
1/2 pill as I do with hydrocodone but I'm not sure if it has the same antidepressant effects. I'm having a really awful day (depression -wise). Maybe I took it less than an hour ago, so that's why I am not yet feeling the antidepressant effects, or maybe synthetic codeine has a different feeling than codeine.Thanks, Shelli
Posted by Elizabeth on June 6, 2001, at 20:54:19
In reply to Re: Codeine for Depression Treatment-Elizabeth, posted by AMenz on June 5, 2001, at 11:19:40
> Codeine is supposed to be addictive. I'm already unable to get off a 1mg benzo daily.
In what sense do you have trouble getting off the benzo (Xanax? Klonopin?)? Like, do you feel an urge for it, like you would feel an urge for food after not eating for a while? Do you suffer from rebound anxiety or insomnia or other withdrawal symptoms? (This happens with some antidepressants, like Effexor, Paxil, and Parnate, too, but people who suffer withdrawal symptoms are not considered "addicted" solely by virtue of the withdrawal symptoms. Addiction is understood in terms of craving for a substance.)
> When you say an opioid is it a synthetic or a natural derivative of opium. Better yet since I do not have a science background-what is an opioid agonist, as opposed to an opiate?
"Opioid" or "opioid agonist" refers to a drug that activates opioid receptors; "opioid antagonists" are drugs that block opioid receptors, preventing them from being activated. This is a way of describing a group of drugs based on their effects.
"Opiate" is sometimes used to refer to all opioid agonists, although technically it refers to opium constituents (codeine and morphine, as well as an inactive chemical called thebaine) and chemically close drugs that are derived from them (like hydrocodone, hydromorphone, oxycodone, etc.). This is a way of classifying drugs based on their origin (the opium poppy), or similarity to naturally-occuring chemicals that come from a particular origin.
> What is the action of codeine that it relieves depression and is the effect palliative like, eg. like benzos which wear off quickly and have to be readministered as oppossed to SSRI which and lithium which build up in the bloodstream slowly and take several days to wear off.
The time it takes to reach steady-state levels is not the reason that SSRIs, for example, take a few weeks to work (lithium usually works within a week or two if it's going to work). It has to do with their chronic, rather than direct, effects. Chronic use of opioids or benzodiazepines can cause tolerance to some of their effects (just as you can become tolerant to some of the side effects of antidepressants after using them for a while).
> I'm almost embarassed to write to you because you seem extremely knowledgeable. What is your background, if I may ask?
I don't like to talk about personal stuff on the internet. I'm not a doctor or anything. Please don't be afraid. :-) (Not that you should be afraid of doctors, either. Usually, anyway.)
-elizabeth
Posted by Elizabeth on June 6, 2001, at 21:03:10
In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by shelliR on June 6, 2001, at 19:32:41
> Do you know if the same amount of hydrocodone (which has synthetic codeine, right?) and codeine at the same strength have equal effects.
No ("equipotent" is the word for that). The lowest strength of hydrocodone available in a single pill is 5 mg; the lowest amount of codeine is 15 mg (I think). Codeine is generally weaker than hydrocodone, meaning that hydrocodone is capable of producing greater effects, as well as being more potent (which is just a matter of the effective dose).
> Is codeine phosphate the same as codeine?
It's the salt of codeine that is used clinically. (Some drugs are available as different salts: e.g., lithium carbonate vs. lithium citrate.) Codeine would be the "free base," just as crack is the free base of cocaine hydrochloride.
> 1/2 pill as I do with hydrocodone but I'm not sure if it has the same antidepressant effects.
That's not much codeine, certainly not equivalent to the same dose of hydrocodone.
Don't self-medicate, if you can avoid it. It's a risky thing to do.
-elizabeth
Posted by shelliR on June 6, 2001, at 22:04:45
In reply to Re: Codeine for Depression Treatment » shelliR, posted by Elizabeth on June 6, 2001, at 21:03:10
> Don't self-medicate, if you can avoid it. It's a risky thing to do.
>
> -elizabethThanks for the information, Elizabeth. Actually I have no choice but to self-medicate. My pdoc says it's okay to take the hydorcodone but he won't prescribe it. My gyn will give me enough for 10 days for pms symptoms, but that's it. And I don't believe that I will find a pdoc who will prescribe hyrodocodone for depression (even Dr. bodkin won't anymore).
I am planning to ask my pdoc about Buprenorphine, which I may have a better chance of getting from a doctor. I think I am self-prescribing, rather than self-medicating, in a sense. My pdoc is informed about what I am taking so I'm sure he will warn me if there is any danger involved. But because opiates are so often addictive drugs, doctors other than pain management doctors have to be really careful. I think I mentioned before that my gyn told me that doctors are very carefully monitored for these drugs and she said it is the most common way that doctors get warnings and lose their licenses.
When I was a very young adult and severely depressed (pre-prozac) my pdoc gave me tricyclics and I couldn't take them. They completely disoriented me. I ended up in the hospital (Sheppard-Pratt, supposed to be a good hospital) and again they gave me tricyclics, and again I couldn't adjust. Neither my pdoc or the pdocs in the hospital even suggested a MAOI.
Right after my hospital stay, absolutely on a fluke, I happened to catch Nathan Kline on PBS, and bought his little paperback book (From Sad to Glad). I asked my pdoc why she hadn't put me on one of them and she sort of hemmed and hawed and said, "oh, yes, that was going to be my next suggestion." Like right, thanks. So basically at the age of 22 I felt that I saved my own life because I just happened to have been lucky. And I have never ever put my life totally in the hands of any doctor, without doing my own research. It's much easier now, but there were times I spent entire days at the library at NIH.
I had a pdoc for ten years who is considered the best in the city with treatment resistent depression. She would not even read any of the McLean studies on opiates. Over and over I heard definitively that codeine is not an anti-depressant. So although my preference would be collaboration with a pdoc, I'll take my chances with supervised self-medication.
Shelli
Posted by Elizabeth on June 7, 2001, at 1:47:06
In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by shelliR on June 6, 2001, at 22:04:45
> Thanks for the information, Elizabeth. Actually I have no choice but to self-medicate. My pdoc says it's okay to take the hydorcodone but he won't prescribe it. My gyn will give me enough for 10 days for pms symptoms, but that's it. And I don't believe that I will find a pdoc who will prescribe hyrodocodone for depression (even Dr. bodkin won't anymore).
I know of a few doctors who've used opioids with success. It might help if you pitched Ultram to them -- there's been a bit of work with it for depression, social phobia, and OCD. Anyway, as long as a doctor knows you're taking it and what dose you're taking, that's fine. Just don't start self-adjusting your dose or whatever.
> I am planning to ask my pdoc about Buprenorphine, which I may have a better chance of getting from a doctor.
Not from a pdoc. Buprenorphine makes them squeamish because it only comes in the injectible solution and even if you aren't injecting it, you need to use a syringe to take it.
> I think I am self-prescribing, rather than self-medicating, in a sense.
Hence, taking the wrong dose of codeine.
> But because opiates are so often addictive drugs, doctors other than pain management doctors have to be really careful.
Pain management doctors too.
> I think I mentioned before that my gyn told me that doctors are very carefully monitored for these drugs and she said it is the most common way that doctors get warnings and lose their licenses.
I know. It's terrible.
> When I was a very young adult and severely depressed (pre-prozac) my pdoc gave me tricyclics and I couldn't take them. They completely disoriented me. I ended up in the hospital (Sheppard-Pratt, supposed to be a good hospital) and again they gave me tricyclics, and again I couldn't adjust. Neither my pdoc or the pdocs in the hospital even suggested a MAOI.
Wow. I didn't like the side effects of TCAs either, but they were nothing compared to opioids.
> Right after my hospital stay, absolutely on a fluke, I happened to catch Nathan Kline on PBS, and bought his little paperback book (From Sad to Glad).
Careful, you're dating yourself. ;-)
> I asked my pdoc why she hadn't put me on one of them and she sort of hemmed and hawed and said, "oh, yes, that was going to be my next suggestion." Like right, thanks. So basically at the age of 22 I felt that I saved my own life because I just happened to have been lucky. And I have never ever put my life totally in the hands of any doctor, without doing my own research. It's much easier now, but there were times I spent entire days at the library at NIH.
I know how you feel. Due to bad past experiences, I have a certain distrust of pdocs (well, more a "trust but verify" mentality) that makes it hard for me to work with them. I always come in with a list of things I want to do, they always want to hear lots of history and stuff. I should just make a writeup.
> I had a pdoc for ten years who is considered the best in the city with treatment resistent depression. She would not even read any of the McLean studies on opiates.
She wouldn't even *read* them? What kind of doctor is that?
> Over and over I heard definitively that codeine is not an anti-depressant. So although my preference would be collaboration with a pdoc, I'll take my chances with supervised self-medication.
Codeine is a crappy opiate, not the one I would choose if I felt a full agonist were appropriate. How did you come to be switched to that from the hydro?
-elizabeth
Posted by shelliR on June 7, 2001, at 11:43:54
In reply to Re: Codeine for Depression Treatment » shelliR, posted by Elizabeth on June 7, 2001, at 1:47:06
> I know of a few doctors who've used opioids with success. It might help if you pitched Ultram to them -- there's been a bit of work with it for depression, social phobia, and OCD. Anyway, as long as a doctor knows you're taking it and what dose you're taking, that's fine. Just don't start self-adjusting your dose or whatever.Can't take ultram unless I discontinue the nardil, seems like.
>
> Not from a pdoc. Buprenorphine makes them squeamish because it only comes in the injectible solution and even if you aren't injecting it, you need to use a syringe to take it.I am waiting to hear about a consultation at Johns Hopkins, since they have also done that small study on buprenorphine. I want to make sure opiates are a possibility or I don't think it's worth going for the consultation.
>
> > I think I am self-prescribing, rather than self-medicating, in a sense.
>
> Hence, taking the wrong dose of codeine.Well, I can take as much as I need to of codeine; it is easy to get over the internet, so I thought I try it.
> > But because opiates are so often addictive drugs, doctors other than pain management doctors have to be really careful.
>
> Pain management doctors too.I have a call in to a pain management dr. in Virginia who works narcotic protocol programs for pain. I talked to his nurse and am waiting to hear if he would accept me for depression. The other thing is how expensive he is, but since my needs are different, the nurse said he may also not charge me his usual. I am feeling pretty desperate, I talked to my pdoc this morning and he feels he can't help me and I need to find someone else. That in itself is not a great loss, but it is scary to be in the position that only someone both creative and with the willingness to take a risk can treat me. I have relied on nardil for so many years, it is so strange to be in this position.
>
> Wow. I didn't like the side effects of TCAs either, but they were nothing compared to opioids.
I'm talking about such severe disorientation that I couldn't hardly even dress myself. I've had no disorientation with hydrocodone.
> Careful, you're dating yourself. ;-)That's okay. I'm much smarter than I was twenty years ago and have a triving, creative business.
And I am very very afraid of losing that business if I can't control my depression. This last week has been really bad until I take hydrocodone and I don't have enough to take 1/2 pill twice a day, so I have been only taking it once.> I know how you feel. Due to bad past experiences, I have a certain distrust of pdocs (well, more a "trust but verify" mentality) that makes it hard for me to work with them. I always come in with a list of things I want to do, they always want to hear lots of history and stuff. I should just make a writeup.
I have a certain, I think healthy, mistrust of any doctor. A doctor is a person, not a god. I am really good at what I do, but I make mistakes sometimes. I don't exempt doctors from the same possibility. I do tend to find pdocs a bit more arrogant than other doctors. And I do come in with everything typed up--all past medications and results, so that I don't have to spend the whole session answering questions.
>
> > I had a pdoc for ten years who is considered the best in the city with treatment resistent depression. She would not even read any of the McLean studies on opiates.
> She wouldn't even *read* them? What kind of doctor is that?A doctor that you leave after ten years.
>
> > Over and over I heard definitively that codeine is not an anti-depressant. So although my preference would be collaboration with a pdoc, I'll take my chances with supervised self-medication.
>
> Codeine is a crappy opiate, not the one I would choose if I felt a full agonist were appropriate. How did you come to be switched to that from the hydro?I haven't switched; I am trying to build in safety valves since it is such a battle to get enough hydrocodone. I wanted to see if the other would work BEFORE I ran out of hydrocodone. So far I have access to only 10 pills per month.
I can get more hydrocodone with a consultation on the internet, but I would really like a real pdoc to work with me and support my treatment.
>Shelli
Posted by Elizabeth on June 8, 2001, at 14:35:56
In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by shelliR on June 7, 2001, at 11:43:54
> Can't take ultram unless I discontinue the nardil, seems like.
That's true. Ultram is a mild risk, IMO, with SRI type drugs (SSRIs, Effexor, Serzone, etc.) but a serious one with MAOIs.
I'm trying Ultram right now. I think it is well suited to chronic pain (and psychiatric disorders) but is not a great choice for acute pain (or PRN use for other conditions). It takes about 3 hours to work. It has at least one long-acting metabolite (desmethyltramadol). Taking regular scheduled doses over time should result in steady-state plasma levels of desmethyltramadol, leading to a smoother effect than you'll get with typical short-acting opioids (including buprenorphine).
I've found that tramadol doesn't work well for me (even after 3 hours) in the dose range that is supposed to be safe. One might be able to use higher doses by adding an anticonvulsant. I don't know for sure that it would work well even if I went outside the accepted dose range, though.
> I am waiting to hear about a consultation at Johns Hopkins, since they have also done that small study on buprenorphine. I want to make sure opiates are a possibility or I don't think it's worth going for the consultation.
Johns Hopkins...I'm curious, where do you live? (I'm originally from the DC area, is why I ask.)
I'm planning on setting up an appointment for a consultation at Columbia. We can compare notes. < g >
> Well, I can take as much as I need to of codeine; it is easy to get over the internet, so I thought I try it.
Shhh! :-) It's true that it's possible to get a lot of medications (even some that are federal Schedule III, IV, or V controlled substances) on the net, but I expect the government to start cracking down on this. I would not count on the net as a long term source of codeine or other opioids, especially. If you start becoming pharmacologically dependent on it and then are suddenly unable to get it, you could have a very hard time (as many an addict has learned the hard way).
> I have a call in to a pain management dr. in Virginia who works narcotic protocol programs for pain.
That's cool. Some of them are reasonable and understand that tolerance doesn't mean you're abusing the drug; it's just a natural result of taking opioids. Others want to push you into "pain management" which means using non-opioid drugs like NSAIDs and nonpharmacological stuff like acupuncuture (this has become a mainstream thing now), physical therapy, TENS, cognitive-behavioural therapy, etc. -- even if it's ineffective or inadequately effective (as these therapies often are). I felt fortunate to get any medication (Relafen (NSAID), baclofen, and finally Soma after the other two failed!) when I went to a pain clinic at an academic medical centre.
> I talked to his nurse and am waiting to hear if he would accept me for depression.
Good luck...let me know what happens.
People who have pain syndromes as well as depression are most likely to be treated with opioids. I've thought about going to a pain doctor too (chronic back pain which exacerbates my insomnia).
> The other thing is how expensive he is, but since my needs are different, the nurse said he may also not charge me his usual.
Some doctors have a few places in their schedules reserved for people who can't pay the usual charge. One time I was in a partial program (day treatment) and it came out that one of the people in the program was there for free. A lot of the other people were pretty angry when they found out about it because that program was not something that private insurance would usually cover and they don't take Medicaid (as a result, the people in the program were pretty much all young white people from upper- or upper-middle class families).
> I am feeling pretty desperate, I talked to my pdoc this morning and he feels he can't help me and I need to find someone else. That in itself is not a great loss, but it is scary to be in the position that only someone both creative and with the willingness to take a risk can treat me.
I know *exactly* what you mean. I've been in that position too.
Do you want to talk over email? We seem to have a lot of the same situations and problems. I'd like the chance to talk to someone who understands what I'm going through. You know? Anyway, if you'd like to talk, I can post an address where you can reach me.
> I'm talking about such severe disorientation that I couldn't hardly even dress myself. I've had no disorientation with hydrocodone.
Which TCAs did you try? The side effects that caused me to stop TCAs without an adequate trial are similar to the opioid side effects that bother me so much (constipation, dry mouth, etc.), only milder, which is why I'm thinking of trying a TCA again.
> > Careful, you're dating yourself. ;-)
>
> That's okay. I'm much smarter than I was twenty years ago and have a triving, creative business.I'd like to think that most people get smarter as they age (although sometimes this doesn't seem to be true). It sounds like you've got a pretty good thing going -- nice (and encouraging) to hear.
> And I am very very afraid of losing that business if I can't control my depression.A legitimate fear. I'm sure you've suffered losses before as a result of depression. I know I have (which doesn't exactly help make the depression go away).
> I have a certain, I think healthy, mistrust of any doctor. A doctor is a person, not a god.
Right. But a lot of them -- especially "old school" types, but also some younger doctors who I think are trying to emulate their teachers -- think they are, at the least, superior human beings. They're the ones with the education, but they should be able to provide a convincing reason for anything they want you to do (or refuse to do for you).
> I am really good at what I do, but I make mistakes sometimes. I don't exempt doctors from the same possibility. I do tend to find pdocs a bit more arrogant than other doctors.
They work with patients who are more vulnerable and helpless-seeming than the average medical patient. Also, psychiatry is sort of ghettoised by the rest of the medical profession -- psychiatrists aren't seen as "real doctors" by a lot of other doctors. So they sometimes try to compensate for that by being more arrogant. (IMHO)
> And I do come in with everything typed up--all past medications and results, so that I don't have to spend the whole session answering questions.
I need to write up a history, too. My records are terribly confusing, and pdocs I've seen in the past often like to minimise what they put on paper (because of confidentiality concerns -- they do document things that really need to be documented for legal reasons, but they try to avoid having a lot of incriminating records for insurance companies to peruse).
> > She wouldn't even *read* them? What kind of doctor is that?
>
> A doctor that you leave after ten years.What I'm wondering, I guess, is how you stayed with her for so long.
> I haven't switched; I am trying to build in safety valves since it is such a battle to get enough hydrocodone. I wanted to see if the other would work BEFORE I ran out of hydrocodone. So far I have access to only 10 pills per month.
Ouch. 10 doses (or even 20) would not be enough for me to get by on. (Buprenorphine is really a 3x/day med, and hydrocodone and codeine are, if anything, shorter-acting.)
> I can get more hydrocodone with a consultation on the internet, but I would really like a real pdoc to work with me and support my treatment.
In the best of all possible worlds....
-elizabeth
Posted by shelliR on June 8, 2001, at 22:42:05
In reply to Re: Codeine; early report on Ultram trial; stuff » shelliR, posted by Elizabeth on June 8, 2001, at 14:35:56
Hi Elizabeth--I didn't realize that you were doing an ultram trial. Doesn't sound like a good start. What precipiated the change from Buprenorphine?
Here's my update:
First of all I talked to Dr. B from McLean . It is nice that researchers answer their own phones! Nice for me anyway. Poor guy, this is my fourth phone call to him, but I am very appreciative and offered to send him a fee, (rejected offer!). I was thinking of going into the hospital to get off Nardi and start selegiline, and my potential doctor from the hospital called Dr. B also because he had never used selegiline with anyone.Okay: his advice. "Try selegiline" and he gave me the name of the researcher at NIMH who did a large study on it with geriatric patients . I talked to that researcher today (a dr. sunderland) and he told me that there was no difference in side effects, including anxiety, between the placebo group and medicated group. Because I told him I had "heard" on the interernet that it can make you shakey. He said that was not his experience in the study, but I think we at PB may be a different breed.
So back to Dr. B. My therapist was saying that she thought the hydrocodone was making me worse and I said I thought the lack of effectiveness of nardil was the reason for very nearly falling apart off and on for the last year and a half. Then I come home and I have an e-mail from a mostly former babbler who (very respectfully) asked the same question. So that prompted my call to Dr. B at 5:30 pm yesterday. I was so happy he answered and wasn't angry that I called again. He felt it was not the hydrocodone, that it was the ineffectivenss of nardil for me now and made several suggestions. I also asked him if he felt that buprenorphine would be better for me, and he said as long as I wasn't increasing the hydro, he wouldn't bother.
Then today my usual doctor at the hospital got me in touch with another attending doctor at the hospital on a unit I won't go on (the regular adult unit--too big, too scary, too lonely for me) and he actually suggested that I go on oxycoton (sp?) (I think it was that, not oxycodone) because it would be longer lasting. I was stunned that a doctor was suggesting this to me. He wants me to go into the hospital and I can go to the unit I feel safe on (dissociative disorders unit) and he will be my doctor. And I called the head doctor of that unit, who I have known for years and I told her that he might want to prescribe an opiate for me. She didn't blink, and acknowledged that for some people it is effective. I was so overwhelmed with gratitute that two doctors in one hour didn't tell me that I was going to become an addict and that opiates are NOT ANTIDEPRESSANTS that I actually started to cry!
So I am (I think) going to go into the hospitial Sunday evening and try to work out a drug regiment with the doctor I talked to today. The only problem is that I've talked to him before and he doesn't listen well to me. He's not big on selegiline and suggested that I try sonata also, even though I've already tried a very small dose of ridilin, and all stimulents do not feel right for me. So I'm a bit nervous, because I would like to stick to the selegiline plan. (He's a real cocktail guy, and cocktail docs don't like MAOIs because it gives them less choices). But my therapist is threatening to terminate with me unless I find a pdoc who supports my use of hydro and supervises me, and I wasn't at all feeling optimistic I would be able to do that until I talked to him.
Talked to the people at Johns Hopkins, was not impressed that they had anything differerent to offer me, and since I don't have a pdoc at the moment, they couldn't see me anyway for a consultation.
I stayed with my pdoc for ten years because I was doing pretty well most of the time, she was always available for me, and was willing to mix meds that other docs wouldn't at the time, e.g., nardil and serzone together. We then had a lot "debates" about the hydro and I felt like at the end she just started throwing meds at me--all the atyp antipsy which I hated. When I wouldn't try zeprexa because of weight gain, she said I didn't really want to get well, and that was the end.
And I agree--I don't think this internet thing is going to last. I think it's actually really crazy.
So I will go into the hospital on Sunday. I've been there five times through the years before, it's a great staff and a small unit, it's not scary to me, but it's not a mood disorder unit. So it's good to have the other doctor involved. I'm hoping no more than a week, usually when I go in it's for about 5 days, but I'm not sure because of this medication thing. I'll have a laptop, but I don't know if there will be a phone to hook it up to. You can bring in your cell phone, but otherwise there are just payphones, unless the staff lets me use one of their lines. Actually, there is jack in the smoking room, but I don't think I could stand to go in there for even five minutes with that air.
I can email you-- if you create and post a temporary e-mail address from yahoo or hotmail then I can send you my real one. But that would I think be if we wanted to exchange personal info--like exactly where I live in the d.c. area, what my work is, etc., and same for you. For regular med stuff I think it's better to keep it on the board, people don't have to read it, but it might catch the eye of someone who has had similar experiences that we wouldn't otherwise find out about if our posts were off the board.
Shelli
Posted by Elizabeth on June 8, 2001, at 23:09:20
In reply to Update: very very very very very long » Elizabeth, posted by shelliR on June 8, 2001, at 22:42:05
> I didn't realize that you were doing an ultram trial. Doesn't sound like a good start. What precipiated the change from Buprenorphine?
Side effects, awkward route of administration, difficulty getting a script, difficulty obtaining it even once I've got the script....
The nice thing about these drugs is that a trial lasts at most a few days, not a month or more.
> First of all I talked to Dr. B from McLean.
Isn't he great? Too bad he's not taking new patients.
> Okay: his advice. "Try selegiline" and he gave me the name of the researcher at NIMH who did a large study on it with geriatric patients. I talked to that researcher today (a dr. sunderland) and he told me that there was no difference in side effects, including anxiety, between the placebo group and medicated group.
Excellent. Dose advise?
> Because I told him I had "heard" on the interernet that it can make you shakey. He said that was not his experience in the study, but I think we at PB may be a different breed.
It's possible. I definitely got jitters on it, but it generally seems to be well tolerated.
> ... So that prompted my call to Dr. B at 5:30 pm yesterday. I was so happy he answered and wasn't angry that I called again. He felt it was not the hydrocodone, that it was the ineffectivenss of nardil for me now and made several suggestions.
He's seen Nardil poop-out many times. (Two of them involving me.)
> I also asked him if he felt that buprenorphine would be better for me, and he said as long as I wasn't increasing the hydro, he wouldn't bother.
Buprenorphine is a pain to get and a pain to use, as I mentioned above.
> Then today my usual doctor at the hospital got me in touch with another attending doctor at the hospital on a unit I won't go on (the regular adult unit--too big, too scary, too lonely for me) and he actually suggested that I go on oxycoton (sp?) (I think it was that, not oxycodone) because it would be longer lasting.
OxyContin. Sustained-release oxycodone. Not a bad idea at all. An alternative would be MS Contin (slow-release morphine) or Kadian (an even longer-lasting morphine). These are all long-acting (Kadian is supposed to be once daily). A down side is that the federal government is putting pressure on the maker of OxyContin to cut back the amount they make -- a move which will have a serious impact on people's ability to get it. Someday there's going to be a huge backlash against the War on Drugs -- people will just become too fed up with their rights being taken away one by one.
> I was stunned that a doctor was suggesting this to me. He wants me to go into the hospital and I can go to the unit I feel safe on (dissociative disorders unit) and he will be my doctor.
Dude! That's cool. (Why the dissociative disorders unit?) I think it's great that you're receiving so much acceptance from doctors.
> So I am (I think) going to go into the hospitial Sunday evening and try to work out a drug regiment with the doctor I talked to today. The only problem is that I've talked to him before and he doesn't listen well to me. He's not big on selegiline and suggested that I try sonata also, even though I've already tried a very small dose of ridilin, and all stimulents do not feel right for me.
Sonata? I think you're mixing that up with another musical-sounding drug, Concerta. < g >
What do the stimulants do to you? I had weird and variable blood pressure reactions (including orthostatic hypotension) to most of them, but that was in combination with Parnate. The one time I tried one (Cylert) by itself, it seemed to be somewhat helpful at a very tiny dose.
> So I'm a bit nervous, because I would like to stick to the selegiline plan. (He's a real cocktail guy, and cocktail docs don't like MAOIs because it gives them less choices).
"Cocktail guy." I know the type: they want to pile a bunch of drugs on you rather than use just one that works. (The reverse type is problematic also because they think any regimen, no matter how helpful and necessary each component is, needs to be "simplified.")
> But my therapist is threatening to terminate with me unless I find a pdoc who supports my use of hydro and supervises me, and I wasn't at all feeling optimistic I would be able to do that until I talked to him.
Therapists shouldn't make threats like that. It's downright abusive. IMHO.
> Talked to the people at Johns Hopkins, was not impressed that they had anything differerent to offer me, and since I don't have a pdoc at the moment, they couldn't see me anyway for a consultation.
They can't see you for a consult if you don't have a pdoc? That's a little weird.
> I stayed with my pdoc for ten years because I was doing pretty well most of the time, she was always available for me, and was willing to mix meds that other docs wouldn't at the time, e.g., nardil and serzone together.
Nardil and Serzone -- there's a weird one indeed. What happened?
> We then had a lot "debates" about the hydro and I felt like at the end she just started throwing meds at me--all the atyp antipsy which I hated.
Yeah, those are pretty much only worthwhile for psychosis, *some* cases of bipolar, and occasionally for absolutely intractible insomnia.
> When I wouldn't try zeprexa because of weight gain, she said I didn't really want to get well, and that was the end.
I think you mentioned that. I had a really nice pdoc once who had a good attitude about the weight gain thing (she took it seriously as a side effect).
> And I agree--I don't think this internet thing is going to last. I think it's actually really crazy.
It's out of control, no doubt about that. On the other hand, the can of worms has been opened -- people who've gotten used to being able to be their own doctors won't take kindly to having that taken away. Still, does anyone dare to speak out against the government on the subject of drugs? I mean, even doctors are afraid of them.
> I'm hoping no more than a week, usually when I go in it's for about 5 days, but I'm not sure because of this medication thing.
5 days...standard insurance time. :-}
> I'll have a laptop, but I don't know if there will be a phone to hook it up to. You can bring in your cell phone, but otherwise there are just payphones, unless the staff lets me use one of their lines.
Maybe we can set something up so I can call to check in? I'd like to know you're doing okay. The hospital can be hard even under the best of circumstances.
> Actually, there is jack in the smoking room, but I don't think I could stand to go in there for even five minutes with that air.
There's a smoking room without a window or ventilation???
> I can email you-- if you create and post a temporary e-mail address from yahoo or hotmail then I can send you my real one.
That was my idea also. Try cybersquid_400@yahoo.com. Send me the phone # for the unit you'll be on, if possible (and if you feel comfortable doing so).
> But that would I think be if we wanted to exchange personal info--like exactly where I live in the d.c. area, what my work is, etc., and same for you.
Well, my thoughts are that I'd like to talk to you in more detail, but I don't like revealing personal info on the board here (for obvious reasons).
Whatever you decide, I do hope you'll write. You seem like a good sort.
Best of wishes,
-elizabeth
Posted by shelliR on June 9, 2001, at 0:47:29
In reply to Re: Update: very very very very very long » shelliR, posted by Elizabeth on June 8, 2001, at 23:09:20
> > First of all I talked to Dr. B from McLean.
> > Okay: his advice. "Try selegiline"> Excellent. Dose advise?
forgot to ask, but the last time he said to go up very very high. I'll have to ask the doctor from the hospital who talked to him.
>
>
> OxyContin. Sustained-release oxycodone. Not a bad idea at all. An alternative would be MS Contin (slow-release morphine) or Kadian (an even longer-lasting morphine). These are all long-acting (Kadian is supposed to be once daily). A down side is that the federal government is putting pressure on the maker of OxyContin to cut back the amount they make -- a move which will have a serious impact on people's ability to get it. Someday there's going to be a huge backlash against the War on Drugs -- people will just become too fed up with their rights being taken away one by one.Kids are getting oxycontin on the streets and crushing them, thus getting the effect of several doses worth at one time. It's very popular in high schools now, and there's been some deaths.
>
> > I was stunned that a doctor was suggesting this to me. He wants me to go into the hospital and I can go to the unit I feel safe on (dissociative disorders unit) and he will be my doctor.
>
> Dude! That's cool. (Why the dissociative disorders unit?) I think it's great that you're receiving so much acceptance from doctors.
I'm due. I've gone through the whole last year with absolutely no acceptance. And I have a dissociative disorder, DDNOS, so that's why the dissociative disorders unit. Actually I think it's called The center for Abuse and Recovery now, and not everyone is diagnosed as dissociative, although most are. It's a very structured program, probably a lot like the one at McLean--maybe not as good, although it used to be.and suggested that I try sonata also, even though I've already tried a very small dose of ridilin, and all stimulents do not feel right for me.
>
> Sonata? I think you're mixing that up with another musical-sounding drug, Concerta. < g >
< gg >, you're totally right!
> What do the stimulants do to you? I had weird and variable blood pressure reactions (including orthostatic hypotension) to most of them, but that was in combination with Parnate. The one time I tried one (Cylert) by itself, it seemed to be somewhat helpful at a very tiny dose.They make my body pulsate and shakey and I sort of feel like it's too hard to stay in my body., but nowhere else to go.
>
> > So I'm a bit nervous, because I would like to stick to the selegiline plan. (He's a real cocktail guy, and cocktail docs don't like MAOIs because it gives them less choices).
>
> "Cocktail guy." I know the type: they want to pile a bunch of drugs on you rather than use just one that works. (The reverse type is problematic also because they think any regimen, no matter how helpful and necessary each component is, needs to be "simplified.")Right on target with the cocktail guy. He gives you a pie chart diagram-- serotonin, norepinephrine and dopamine- He's really into it. He wrote an article in for the health section of the Washington Post called the three tenors: http://groups.yahoo.com/group/a_new_voice/message/722
>
> > But my therapist is threatening to terminate with me unless I find a pdoc who supports my use of hydro and supervises me, and I wasn't at all feeling optimistic I would be able to do that until I talked to him.
> Therapists shouldn't make threats like that. It's downright abusive. IMHO.Yes, we have a lot of disagreements, a few very bitter, but the truth is she is the therapist who has helped me the most so far. She has seen me lose so much ground in the last year and she is convinced it is the hydro, as was my pdoc. From her point of view, "she is worried", and thus the threat. But I agree, it’s not right. But I also know she is not trying to be abusive; she is doing what she thinks is right.
> the people at Johns Hopkins, was not impressed that they had anything differerent to offer me, and since I don't have a pdoc at the moment, they couldn't see me anyway for a consultation.
They can't see you for a consult if you don't have a pdoc? That's a little weird.Well, they get mostly people I assume whose doctors send them for evaluations and then get back to them to change med protocols. With me there would be no one to talk to (except me, of course). They don’t do any treatment.
>
Nardil and Serzone -- there's a weird one indeed. What happened?My blood pressure fell to low. It was sort of fun. I was very floatly and felt very light, but not grounded enough.
>
>
It's out of control, no doubt about that. On the other hand, the can of worms has been opened -- people who've gotten used to being able to be their own doctors won't take kindly to having that taken away. Still, does anyone dare to speak out against the government on the subject of drugs? I mean, even doctors are afraid of them.I don’t understand why they’re not monitored for prescribing narcotics like all other doctors. They send you the medication., rather than the prescription. I wonder if there is no paper trail.
>
> > I'm hoping no more than a week, usually when I go in it's for about 5 days, but I'm not sure because of this medication thing.
>
ÿ 5 days...standard insurance time. :-}Actually, ten days is about standard there, but I get worried about my business so try to leave fast. The problem is that even if you go in voluntarily, they decide when to let you out. Also last time it was not a good experience for me. I felt overstimulated and thought it was best to leave. I came in as the fifth patient and in three days it went up to 12 (full census). So it was very chaotic, although the patients were a good, sane group.
> Maybe we can set something up so I can call to check in? I'd like to know you're doing okay. The hospital can be hard even under the best of circumstances.
I don’t like to get a lot of calls when I’m there because the phones are in a group room and it's very unprivate. I have a cell phone but I only call out from it, don't leave it turned on. I’m really fine when I’m there. Last time a couple of friends came, but usually I don't even want visitors. I bring my own sheets and blanket and my own food! I’ll try to e-mail you if possible.
>
>
>There's a smoking room without a window or ventilation???
There is ventilation, but when ten people are smoking is a tiny room, it’s not much help. And I am super sensitive to smoke; I hate it.>
> ...... You seem like a good sort.
That sounds very English to me!Shelli
>
Posted by Elizabeth on June 9, 2001, at 22:25:02
In reply to Re: Update: very very very very very long » Elizabeth, posted by shelliR on June 9, 2001, at 0:47:29
> Kids are getting oxycontin on the streets and crushing them, thus getting the effect of several doses worth at one time. It's very popular in high schools now, and there's been some deaths.
You can't inject sustained-release drugs safely, but OxyContin came in up to 160 mg strengths (until the govt put pressure on the drug company to pull them from the market). This is like 32 Percocets -- enough to kill a person with no tolerance, easily.
> I'm due. I've gone through the whole last year with absolutely no acceptance. And I have a dissociative disorder, DDNOS, so that's why the dissociative disorders unit.
What sort of DDNOS? "NOS" disorders could be a lot of different things. Sometimes they're unofficially recognised disorders, sometimes they're subclinical variations on clinically recognised disorders.
> Actually I think it's called The center for Abuse and Recovery now, and not everyone is diagnosed as dissociative, although most are.
PTSD, BPD, and dissociative disorders tend to get grouped together. Women's programs tend to focus on these issues (which is why I avoid them). McLean has both a Women's Partial Program (South Belknap, the house featured in _Girl, Interrupted_) and a Dissociative Disorders/Trauma inpatient program (Proctor 2). (I was in the Mood and Anxiety Disorders Program.)
> They make my body pulsate and shakey and I sort of feel like it's too hard to stay in my body., but nowhere else to go.
Huh. I had panic-like reactions on some of them, also blood pressure problems. But if I tried them now, without the Parnate, they might work.
> Right on target with the cocktail guy. He gives you a pie chart diagram-- serotonin, norepinephrine and dopamine- He's really into it. He wrote an article in for the health section of the Washington Post called the three tenors: http://groups.yahoo.com/group/a_new_voice/message/722
Ugh! That's so oversimplified. It also leaves out other systems, like the cholinergic and endogenous opioid systems.
> > Therapists shouldn't make threats like that. It's downright abusive. IMHO.
>
> Yes, we have a lot of disagreements, a few very bitter, but the truth is she is the therapist who has helped me the most so far. She has seen me lose so much ground in the last year and she is convinced it is the hydro, as was my pdoc.I dunno...sometimes, nonmedical therapists like to blame the meds (or the client!) for their ineffectiveness.
> From her point of view, "she is worried", and thus the threat. But I agree, it’s not right. But I also know she is not trying to be abusive; she is doing what she thinks is right.
Is there a way you could tell her that you think it's wrong to make threats to clients like that, without upsetting her? She's probably hurt other people that way too.
> Well, they get mostly people I assume whose doctors send them for evaluations and then get back to them to change med protocols.
Yeah, that's how I encountered Dr. Bodkin -- my pdoc knew him from residency.
> With me there would be no one to talk to (except me, of course). They don’t do any treatment.
The purpose would be to make a treatment plan (preferably in writing).
> My blood pressure fell to low. It was sort of fun. I was very floatly and felt very light, but not grounded enough.
That's what happened to me on Parnate + some of the stimulants, only I didn't feel good. I felt dizzy and my vision would go black when I stood up.
> I don’t understand why they’re not monitored for prescribing narcotics like all other doctors. They send you the medication., rather than the prescription. I wonder if there is no paper trail.
I don't know the details of online pharmacy/consultant businesses. I gather they tend to go out of business pretty fast if they prescribe controlled substances with a minimal (or no) consult, though.
> Actually, ten days is about standard there, but I get worried about my business so try to leave fast.
It's not the hospital that determines the standard amount of time; it's the insurance. My insurance approves 5 days at a time, then decides whether to approve more.
> The problem is that even if you go in voluntarily, they decide when to let you out.
Yes! That's called "conditional voluntary" admission in Massachusetts. It's not really voluntary at all -- if you try to leave, they can threaten to have you committed. I've never been in that situation, but my guess is that judges are more likely to side with the doctor than with the patient.
> Also last time it was not a good experience for me.
You're not alone. A lot of people have bad hospital experiences, especially those who like to have a say in their own treatment (hospital staff who don't know you seem to assume that you're just another ignorant patient).
I understand about not wanting phone calls in the hospital. But I would like to hear from you over email. It'd be nice to chat a little bit, at least now and after you get out.
> > ...... You seem like a good sort.
>
> That sounds very English to me!In fact, I picked it up ("a good sort") from an English ex-boyfriend. :-)
-elizabeth
Posted by Lorraine on June 9, 2001, at 23:09:37
In reply to Re: Update: very very very very very long » shelliR, posted by Elizabeth on June 9, 2001, at 22:25:02
Shelli, Elizabeth:
Elizabeth: I just wanted to say how much I enjoy your posts. Sooo thought out and intelligent, yet compassionate. Really great to see your posts.Shelli: Just my 2 cents, Selegiline makes me a bit edgy and I think heightens my anxiety. (My dose of Selegiline is 10mg/ day. I've decreased it to 5mg/day when I get too aggitated. I'm very sensitive to meds generally.) I am very reluctant to give it up though because I find it's cognitive effects (really helps me think and focus) unparalleled. It has not had an antidepressant effect, the Neurontin has provided that. I also take it with Adderral. I am not home free on this combo. I adjust doses every other day or so trying to get it right. And then the anxiety piece remains to be solved. As I mentioned in another post to you, I am trying Neurofeedback. We will see if it is worthwhile or hogwash. I did run into another patient leaving with me the other day and he said "isn't is great! I came in with depression and panic attacks and I haven't felt this good in 24 years." Well, needless to say, that gave me hope. But, who knows with this sort of stuff. Anyway, I feel like so much of this med thing is roll of the dice. 96 combos to try that might work, what are the odds that we choose the right one, at the right dose, and give it enough time? Especially if you are treatment resistant--are actually, in my case, just get so many side effects and have fairly high standards on what side effects are acceptable. Weight and sexual dysfunction don't work for me as side effects, I'm sorry. It's a pretty big chunk of life to be asked to give up, and I believe that it is pretty easy for doctors who are not depressed to press for results that diminish the quality of life substantially. (It actually makes me hopping mad.)
Posted by Elizabeth on June 10, 2001, at 9:39:42
In reply to Re: Update: very very very very very long, posted by Lorraine on June 9, 2001, at 23:09:37
> Elizabeth: I just wanted to say how much I enjoy your posts. Sooo thought out and intelligent, yet compassionate. Really great to see your posts.
Thank you. I appreciate being appreciated. :-)
> Shelli: Just my 2 cents, Selegiline makes me a bit edgy and I think heightens my anxiety.
Yeah, that was what it did to me too (but I was taking 40 mg/day). A lot of people find it helpful for cognitive problems, as you describe.
You might look at some of the older drugs if the newer ones tend to cause weight gain and sex problems. Sexual dysfunction seems to be an almost-universal side effect of the SSRIs, in particular.
-elizabeth
Posted by Lorraine on June 10, 2001, at 10:55:51
In reply to stuff » Lorraine , posted by Elizabeth on June 10, 2001, at 9:39:42
> You might look at some of the older drugs if the newer ones tend to cause weight gain and sex problems. Sexual dysfunction seems to be an almost-universal side effect of the SSRIs, in particular.
Yeah, I have given up on the SSRIs, only had a partial response and a lot of side effects. Me and my pdoc are trying stimulants and mood stabilizers. Of the mood stabilizers, neurontin seems to be the one that works best for me. Dexidrine made me too edgy and now Adderral is being tried. I am still on the Selegiline--I just lower the dose and add an amphetamine. The Adderral makes me active, but funny thing, does not tend to make me productive. After this, I think there is still Provigil (sp?) and Celerta (sp?) and possibly Desoxyn (sp?) to try in the stimulant class. And I may go back and try Moclobemide again adding Neurontin to it this time. Next stop, I figure is Desipramine (sp) and Parnate. Are these last two the "older" drugs you have in mind? From what I have read, these two seem to have the lowest side effect profile.
Thanx
>
> -elizabeth
Posted by Elizabeth on June 10, 2001, at 20:41:30
In reply to Re: stuff, posted by Lorraine on June 10, 2001, at 10:55:51
> Yeah, I have given up on the SSRIs, only had a partial response and a lot of side effects.
Hmm, is that better or worse than no response and no side effects? :-)
> After this, I think there is still Provigil
(modafinil)
> Celerta (sp?)
Concerta? (a new sustained-release formulation of methylphenidate)
> and possibly Desoxyn (sp?)
methamphetamine
(good luck)> And I may go back and try Moclobemide again adding Neurontin to it this time.
Moclobemide? Jeez. I assume you're not in the USA. If you are, it's a waste of your energy (IMHO).
> Next stop, I figure is Desipramine (sp) and Parnate. Are these last two the "older" drugs you have in mind? From what I have read, these two seem to have the lowest side effect profile.
Desipramine is a tricyclic. Parnate (tranylcypromine) is a monoamine oxidase inhibitor. They're both old. They're among the more side-effect-free drugs in their respective classes.
-elizabeth
Posted by Maraschino on June 11, 2001, at 19:17:30
In reply to Re: Codeine for Depression Treatment-Elizabeth, posted by AMenz on June 5, 2001, at 11:19:40
> Codeine is supposed to be addictive. I'm already unable to get off a 1mg benzo daily.
>
> When you say an opioid is it a synthetic or a natural derivative of opium. Better yet since I do not have a science background-what is an opioid agonist, as opposed to an opiate?
>
> What is the action of codeine that it relieves depression and is the effect palliative like, eg. like benzos which wear off quickly and have to be readministered as oppossed to SSRI which and lithium which build up in the bloodstream slowly and take several days to wear off.
>
> I'm almost embarassed to write to you because you seem extremely knowledgeable. What is your background, if I may ask?
>
> > At what dosage and, since you say it's a temporary, for how many days is it safe to take this.
> >
> > How safe do you want?
> >
> > There seems to be a wide range of variability in the rates at which different people develop tolerance.
> >
> > BTW: there is no evidence or reason to suppose that opioid agonists are "cover-ups" that don't address the "root cause" of depression. (This is an argument commonly made by proponents of "talk" therapies in criticising the use of any drug at all, incidentally.)
> >
> > -elizabethIf this the same Elizabeth (Shapere) who posted on Usenet for many years, she is indeed an expert on psychopharmacology and the like. For even more of her, you can check out http://groups.google.com for Elizabeth Shapere.
Hope this helps..
Maraschino
Posted by Lorraine on June 11, 2001, at 21:32:01
In reply to Re: stuff » Lorraine , posted by Elizabeth on June 10, 2001, at 20:41:30
> > Yeah, I have given up on the SSRIs, only had a partial response and a lot of side effects.
>
> Hmm, is that better or worse than no response and no side effects? :-)I believe it's worse because you stay on the horse too long following a blind alley.
> > Celerta (sp?)
>
> Concerta? (a new sustained-release formulation of methylphenidate)No, it's Cylert (pemoline). Say have you heard anything about a time release Adderral?
>
> > and possibly Desoxyn (sp?)
>
> methamphetamine
> (good luck)Actually, it's my pdoc that suggested it. So I can get the prescription. The question is whether I want to try it or not. In my past (long ago far away--like 30 years ago), I abused drugs. But I was never addicted and I don't think I have an addictive personality generally. The question is whether it would be a good drug to try. I think I've read about energy depletion or something like that with it.
>
> > And I may go back and try Moclobemide again adding Neurontin to it this time.
>
> Moclobemide? Jeez. I assume you're not in the USA. If you are, it's a waste of your energy (IMHO).I am in the USA. My pdoc writes a prescription that is then filled by a Canadian pharmacy and mailed to me. I did this before and it's not too bad. It's not covered by insurance, but Moclobemide is cheap so who cares?
Right now all of these pharmaceutical experiments are on hold while I try Neurofeedback to see if I can stabilize some subthrehold seizure-like activity that is probably causing my physical anxiety. It would be great to have a non-drug solution to at least part of the problem. The depression might remain though. I am using EEGSpectrum for this. Susan Othmer has treated 3000 patients with various ailments and I'm sure various results. Her own son had epilepsy so she was very motivated to employ Neurofeedback with him. I don't have epilepsy, but I suspect the approach is the same--train the person to narrow the volitility and variation range of alpha, beta and theta brain waves. My pdoc is a neurologist. His reading of my QEEG confirms the reading at EEGSpectrum--namely that I have a lot of spiking activity, one or two out of range spikes every 14 seconds. Those spikes destabilize me, impacting my memory, my autonomic functions (physical anxiety)and generally wreak havoc in the brain. EEGSpectrum believes that this is why I am treatment resistent. Of course, my pdoc is trying, without success so far, to treat the problem with anti-convulsants. We really do not know a lot about the brain right now. Anyway, I'm hopeful about the feedback treatment, but also know that it is experimental and may turn out to be another blind alley for me. Of course, I expect the placebo effect to at least perk things up for a little while. I'll keep you posted on progress.
Posted by Elizabeth on June 12, 2001, at 1:31:37
In reply to Re: Codeine for Depression Treatment-Elizabeth » AMenz, posted by Maraschino on June 11, 2001, at 19:17:30
> If this the same Elizabeth (Shapere) who posted on Usenet for many years, she is indeed an expert on psychopharmacology and the like. For even more of her, you can check out http://groups.google.com for Elizabeth Shapere.
"Maraschino," huh? Well, thanks for the vote of confidence. :-) It's nice to be appreciated, although I would hardly call myself an expert. (How about "informed consumer?")
But I don't use my full name on Usenet. Much of what has been posted on Usenet about me (*especially* those posts that include my full name) is rather...libelous. A deranged individual ("flight of the phoenix," "alexplore," and many others) who gives mental illness a bad name has taken a dislike to me and some random people who I don't even know (and an ex-boyfriend...sad story). He believes I'm conspiring with these people. (It's not clear what I'm conspiring to do with these people I don't know and the ex who I don't even talk to.)
I haven't posted much to Usenet recently. "Alexplore" has succeeded in scaring me away, I guess. Anyway, I don't have time to sift through all the flames these days.
Thanks for this virtual place, Dr. Bob.
-elizabeth
P.S. Hey, Maraschino, should I be suspicious that you spelled my name right? And can I ask about the derivation of your alias?
Posted by Elizabeth on June 12, 2001, at 2:09:35
In reply to Re: stuff » Elizabeth, posted by Lorraine on June 11, 2001, at 21:32:01
> > > Yeah, I have given up on the SSRIs, only had a partial response and a lot of side effects.
> >
> > Hmm, is that better or worse than no response and no side effects? :-)
>
> I believe it's worse because you stay on the horse too long following a blind alley.Hmm. How about a partial response and no side effects (except very minor ones)? (Parnate)
> No, it's Cylert (pemoline).
Cylert! I took a small dose for a while in college, and it was surprisingly helpful. I feel like I should revisit it. It's very long-acting, and smoother than other psychostimulants. Its pharmacologic mechanism of action is unclear. It actually helped me get (and keep) my sleep-wake cycle back in sync with the rest of the world, because I would take it every morning and feel more alert, and then start to get tired in the evening as it wore off.
> Say have you heard anything about a time release Adderral?
Controlled release Adderall? That would be quite a task, and probably not worth the money and effort.
> > methamphetamine
> > (good luck)
>
> Actually, it's my pdoc that suggested it. So I can get the prescription.That's impressive. Pdocs hate to write for that one. I would expect it to be safer and more tolerable than dextroamphetamine, because it has a more favourable ratio of central to peripheral effects.
> The question is whether I want to try it or not. In my past (long ago far away--like 30 years ago), I abused drugs. But I was never addicted and I don't think I have an addictive personality generally.
Hmm. How do you define "abused?" (Believe it or not, the American Psychiatric Association has attempted to come up with a rigorous definition, although most psychiatrists seem to ignore that definition when they label patients "substance abusers.")
> The question is whether it would be a good drug to try. I think I've read about energy depletion or something like that with it.
Well, I don't know if the sustained-release formulation ("Gradumets") is still made. You might get a lot of highs and lows in energy as one dose wears off and then another starts to work. It's a pretty short-acting drug (I'm not a big fan of those; I want to be able to go about my business and not have to worry about my medication wearing off every few hours).
> > Moclobemide? Jeez. I assume you're not in the USA. If you are, it's a waste of your energy (IMHO).
>
> I am in the USA. My pdoc writes a prescription that is then filled by a Canadian pharmacy and mailed to me.Huh. My impression was that the by-the-book way to do this involved a lot of red tape and hassle, so I never considered it an option (especially since I didn't even respond completely to the irreversible nonselective MAOIs). If it's just a matter of finding an amenable Canadian pharmacist, though, it might well be worth it. How much does it cost? (I'm pretty sure my insurance won't cover prescriptions that are filled outside the USA, especially for drugs that aren't even approved here.)
> Right now all of these pharmaceutical experiments are on hold while I try Neurofeedback to see if I can stabilize some subthrehold seizure-like activity that is probably causing my physical anxiety.
That's interesting. I have had several EEGs that showed no or little sign of anything being wrong in that department, but I had a SPECT scan which suggested...umm, it's not clear what it suggested, but it was definitely weird.
I hope your experiment does some good. I would like to hear about it. (As with all things, I'm curious how (or if) it works.)
> I don't have epilepsy, but I suspect the approach is the same--train the person to narrow the volitility and variation range of alpha, beta and theta brain waves.
Those refer to different combinations of amplitude and frequency: for example, theta rhythm refers to low-amplitude (voltage) and moderately high-frequency (fast) waves.
> My pdoc is a neurologist. His reading of my QEEG confirms the reading at EEGSpectrum--namely that I have a lot of spiking activity, one or two out of range spikes every 14 seconds. Those spikes destabilize me, impacting my memory, my autonomic functions (physical anxiety)and generally wreak havoc in the brain. EEGSpectrum believes that this is why I am treatment resistent.
Yeah, I got the same line about my SPECT. < g > I did get my medical records -- finally -- and plan to call up a neurologist I know to see if he can determine the clinical relevance, if any, of the abnormal SPECT scan.
> Of course, my pdoc is trying, without success so far, to treat the problem with anti-convulsants.
Isn't a lot of that due to intolerance of side effects? Which ones have you tried so far?
> We really do not know a lot about the brain right now.
Yeah. I'd sure like to know a few things about mine, in particular. < g >
Again, good luck with the neurofeedback.
-elizabeth
Posted by Maraschino on June 14, 2001, at 14:26:08
In reply to Elizabeth speaks » Maraschino, posted by Elizabeth on June 12, 2001, at 1:31:37
> > If this the same Elizabeth (Shapere) who posted on Usenet for many years, she is indeed an expert on psychopharmacology and the like. For even more of her, you can check out http://groups.google.com for Elizabeth Shapere.
>
> "Maraschino," huh? Well, thanks for the vote of confidence. :-) It's nice to be appreciated, although I would hardly call myself an expert. (How about "informed consumer?")Infromed consumer sounds good, and you really do seem very informed.
>
> But I don't use my full name on Usenet. Much of what has been posted on Usenet about me (*especially* those posts that include my full name) is rather...libelous. A deranged individual ("flight of the phoenix," "alexplore," and many others) who gives mental illness a bad name has taken a dislike to me and some random people who I don't even know (and an ex-boyfriend...sad story). He believes I'm conspiring with these people. (It's not clear what I'm conspiring to do with these people I don't know and the ex who I don't even talk to.)I wasn't aware of that, but after looking at it it a shame. Didn't you use to post theough, from aol - using Shapere? Sorry, if I'm mistaken.
>
> I haven't posted much to Usenet recently. "Alexplore" has succeeded in scaring me away, I guess. Anyway, I don't have time to sift through all the flames these days.
>
> Thanks for this virtual place, Dr. Bob.I thank him too, because there is much better info ans support here than in uUsenet groups.
>
> -elizabeth
>
> P.S. Hey, Maraschino, should I be suspicious that you spelled my name right? And can I ask about the derivation of your alias?Maraschino is just a nick.. that's all.
And thanks for your greatinfo here and on Usenet too. You give lots of different kinds of advice on depression.Maraschino
p.s sorry for the delay.. I'm not on the computer that much/
Posted by Elizabeth on June 14, 2001, at 15:19:44
In reply to Re: Elizabeth speaks, posted by Maraschino on June 14, 2001, at 14:26:08
> Infromed consumer sounds good, and you really do seem very informed.
Thank you. I try.
> I wasn't aware of that, but after looking at it it a shame. Didn't you use to post theough, from aol - using Shapere? Sorry, if I'm mistaken.
Yeah, much to my embarrassment, I did once have an AOL account. < g >
> > Thanks for this virtual place, Dr. Bob.
>
> I thank him too, because there is much better info ans support here than in uUsenet groups.There is. Thanks to people like "alexplore," a lot of the knowledgeable and supportive posters have abandoned Usenet. Moderated forums, such as this one, have proven more resilient than those that allow anyone to post anything.
> And thanks for your greatinfo here and on Usenet too. You give lots of different kinds of advice on depression.
Well, you're quite welcome. And thank *you* for taking the time to thank me. :-)
-elizabeth
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