![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 28. This is the beginning of the thread.
Posted by Onestone on December 18, 2008, at 11:45:44
Hi, everybody, second post here.
Background: I'm male, middle aged, and a lifelong sufferer from anhedonia (aka as constant misery), with associated lethargy. My external circumstances are pretty much ideal (apart from having no work at the moment), and I do things which ought to be fun.
The only pleasurable time (as contrasted with "not too bad") I've had in the last twenty years was listening to the radio in a taxi being taken home from a casualty department just after my knee had been smashed up. No, you're not supposed to make a joke out of that. ;-) I'm trying to find out what drugs they gave me that evening.
I've tried quite a few drugs in the distant past, including citalopram, paroxetine, some "modern" MAOI, and recently edronax.
I've also done several years of psychotherapy, which sorted out quite a bit of the secondary damage, uncovering some serious childhood abuse. But I'm feeling as miserable as ever.
The edronax, a noradrenaline reuptake inhibitor, was really scary. It left me feeling like the victim in a horror film, wondering what was about to happen, scared of the people around me. I came off it about a month ago. It's also left me with a lasting degradation of concentration (which wasn't brilliant to start with). Will this come back?
The only drug which has ever worked (i.e. with benefits exceding drawbacks) has been St. John's wort. I live somewhere where you can get quality SJW reliably. When I first tried it, its effect was immediate (after ~2 days), despite my cynicism at the time. However its effect is too weak - it transforms me from 90% dysfunctional to 80% dysfunctional.
The psycho who prescribed the edronax broke off all contact with me abruptly when I (politely) asked him about dopamine drugs, leaving me bewildered and angry. I'm not intending to pay his bills.
I was at a different psycho this morning. When I asked her about dopamine drugs, she said she'd gen up on them, but asked me if I'd be prepared to give another "standard" drug a go? I said OK, and she's prescribed me venlafaxine.
Here we go again - Why on earth did I say yes? Yet another useless drug which will "sort of" make me feel "a bit better", with horrible side effects. Why is venlafaxine, a serotonin/noradrenaline reuptake inhibitor, going to do any good at all when several SSRIs and one NoRI have been useless or alarmingly useless? Or is there some reasonable chance this stuff might work?
Am I on the right track in thinking I need a dopamine drug? Why are psychos so scared of and reluctant to prescribe these drugs?
I'm so much closer now to putting plan B into effect than when I formulated it, and this would certainly end the misery, but I don't want to. I'm still hoping to get something out of life. If anybody can say anything to cheer me up a bit, something to help me get through the Christmas period, I'd be very greatful.
Thanks!
Posted by SLS on December 18, 2008, at 12:05:51
In reply to How high are the chances venlafaxine might work?, posted by Onestone on December 18, 2008, at 11:45:44
My impression from the medical literature:
Rate of 50% response = 70%
Rate of full remission = 35%This compares favorably to other antidepressants and represents an improvement over the SSRIs. Adding a drug like Wellbutrin or Remeron will increase these odds.
- Scott
Posted by Phillipa on December 18, 2008, at 12:06:55
In reply to How high are the chances venlafaxine might work?, posted by Onestone on December 18, 2008, at 11:45:44
Bad time of year for so many of us. I would try and focus that this might be the med and that a lot of posters have had excellent results on it when other meds have failed. Good luck to you. Phillipa
Posted by Fivefires on December 18, 2008, at 14:08:00
In reply to Re: How high are the chances venlafaxine might work?, posted by SLS on December 18, 2008, at 12:05:51
In my years in 'my head illness' I've found there is something about Effexor and/or Effexor-XR (Although there's a diff' I think between the regular and the extended release.) that's better than the other ADs. My pdoc wants to add a bit of Seroquel ... DANG IT ALL ... EVERYONE'S TAKIN' SEROQUEL!??? It's my life ... well, it was anyway (?), and I fear antipsychotics, altho' I've tried Wellbutrin and recall feeling BLAH, but never Remeron. I'm such a nervous wreck most of my medication is anti-anxiety, but this creates such social difficulties, therein comes depression. Shake head. Why is pdoc anti Remeron and pro Seroquel? Inpatient a bit and signed out AMA, but a lot of patients were on Seroquel and saying ... in a 'stoned sort of manner' YEAH GET SEROQUEL IT'S REALLY GOOD STUFF YEAH ...
Alien husbands have taken my children hostage for Christmas, New Years ... jeez I need somethin'!
too often gone, sorry; thinking of all,
5f
Posted by desolationrower on December 18, 2008, at 14:34:03
In reply to Re: How high are the chances venlafaxine might work?, posted by Fivefires on December 18, 2008, at 14:08:00
Wow, yes i think remeron would be a much better choice, and doesn't cost as much...alpha2 antagonism is the main antiD effect of quetiapine i think, both are sleepy bye bye meds...why would one prescribe quetiapine? because antipsychotics make the doctor feel cool and innovative...
-d/r
Posted by Sigismund on December 18, 2008, at 15:05:16
In reply to How high are the chances venlafaxine might work?, posted by Onestone on December 18, 2008, at 11:45:44
Parnate or bupe might suit you better.
Posted by linkadge on December 18, 2008, at 16:06:53
In reply to Re: How high are the chances venlafaxine might work? » Fivefires, posted by desolationrower on December 18, 2008, at 14:34:03
A metabolite of seroquel is a potent norepinephreine reuptake inhibitor and 5-ht1a agonist. I think this metabolite would be a useful psychiatric medication.
Linkadge
Posted by desolationrower on December 18, 2008, at 16:07:45
In reply to Re: How high are the chances venlafaxine might work? » Onestone, posted by Sigismund on December 18, 2008, at 15:05:16
> Parnate or bupe might suit you better.
Yeah, i'd suggest going with the venlafaxine since you already started, and so you don't have to worry about hypertensive crisis or washout over holidays. If no remission, add mirtazapine. If that combo doesn't work, i'd say its time to stop messing around and take a real MAOI. st johns wort is too promiscous to really know what you should try based on that response.
Hey, holidays coming up, and vlfx+mtzpn or Parnate is probably going to significantly improve stuff.
-d/r
Posted by dapper on December 18, 2008, at 17:38:28
In reply to How high are the chances venlafaxine might work?, posted by Onestone on December 18, 2008, at 11:45:44
Effexor to this day has been the most effective drug for lifting me out of my hole. I was in remission for a couple years until it pooped out. But it did work for me when I needed something to work, and fast. Allowed me to accomplish some big goals, and think clearly to make good rational decisions. It's effects are strong, and you need to give it a couple weeks to adjust. Coming off of it is very difficult too, if and when you need to. But judging on where you are at right now, it may be what you need to put you back on your feet. I too do not respond well to SSRI's. Good luck to you.
Posted by Racer on December 18, 2008, at 17:54:34
In reply to How high are the chances venlafaxine might work?, posted by Onestone on December 18, 2008, at 11:45:44
Different drugs with the same mechanism of action work differently for different people -- ie: SSRIs -- so I've come to think that the drug itself is more important than the mechanism of action per se. Also, there's the rational relationship between the various neurotransmitters, which sometimes gets overlooked -- raising one may not be the answer, normalizing the ratio might be.
Venlafaxine is a good drug for a lot of people, and many very good psychopharmacologists look on it as being more reliable and often faster acting than many of the other antidepressants out there. And it does work, and work well, for many people, so I wouldn't focus all that much on other drugs which did not work for you.
As for dopamine, it's not solely about how much dopamine you've got floating around -- it's also about where it is, how sensitive the receptors are, etc. Too much dopamine can often lead to downregulation of the DA receptors, it can lead to catecholamine depletion -- which would leave you miserable AND without sufficient neurochemicals to treat the resulting depression -- etc.
Also, keep in mind that dopamine is a precursor of norepinephrine, as well as being a neurotransmitter in its own right. You may find that a medication which affects NE also boosts your pleasure in life, whether or not that's solely based on its dopaminergic effects.
Posted by softheprairie on December 19, 2008, at 6:29:21
In reply to How high are the chances venlafaxine might work?, posted by Onestone on December 18, 2008, at 11:45:44
Venlafaxine/Effexor could give you partial relief, and in a while you may be able to talk the doctor into adding a stimulamt to augment it, which would be very reasonable for someone who has tried several first- and second-line meds to no avail. I was on Effexor plus Concerta for a few years.
Even if venlafaxine doesn't work out, it sounds like it would be evidence/show good faith on your part to the new doctor that you are willing to work with her, and she may be willing to try one of your suggestions next.
(I had no discontinuation trouble tapering off of Effexor, by the way, so you don't necessarily need to worry about that time.)
Posted by Onestone on December 19, 2008, at 15:29:34
In reply to Re: How high are the chances venlafaxine might work?, posted by Fivefires on December 18, 2008, at 14:08:00
Hi, thanks for the reply. I wonder what it would be like if we could swap our troubles for a day. Everything here is just greyness, greyness, greyness. They even started making most cars grey a few years back.
Posted by Onestone on December 19, 2008, at 15:42:16
In reply to Re: How high are the chances venlafaxine might work?, posted by desolationrower on December 18, 2008, at 16:07:45
> > Parnate or bupe might suit you better.
Maybe. They look like they've got scary side effects.
> Yeah, i'd suggest going with the venlafaxine since you already started, and so you don't have to worry about hypertensive crisis or washout over holidays. If no remission, add mirtazapine. If that combo doesn't work, i'd say its time to stop messing around and take a real MAOI. st johns wort is too promiscous to really know what you should try based on that response.
Well, I'm not starting till I get back after a week with the family. The psycho agreed with this. Far better when I'm 10 minutes walk away from the doctor.
I don't get to choose what drugs to take (beyond take it or leave it), since they're all tightly controlled where I live. Except SJW which is "herbal", therefore "harmless" (hah!).
> Hey, holidays coming up, and vlfx+mtzpn or Parnate is probably going to significantly improve stuff.
Oh deity! At least there's nobody in our Yuletide gathering who's going to be energetically cheerful.
> -d/r
Posted by Onestone on December 19, 2008, at 16:47:25
In reply to Re: How high are the chances venlafaxine might work?, posted by softheprairie on December 19, 2008, at 6:29:21
> Venlafaxine/Effexor could give you partial relief, and in a while you may be able to talk the doctor into adding a stimulamt to augment it, which would be very reasonable for someone who has tried several first- and second-line meds to no avail. I was on Effexor plus Concerta for a few years.
May I ask why? What did you need it for?
> Even if venlafaxine doesn't work out, it sounds like it would be evidence/show good faith on your part to the new doctor that you are willing to work with her, and she may be willing to try one of your suggestions next.
:-) Indeed! All medications where I live are tightly controlled, except for "harmless" (yes, I know) stuff like St. John's Wort. The psychiatrist must have spent ~20 minutes with me yesterday, and she gave me very good vibes. I get the impression she's amenable to charm, too.
However, I just don't believe the venlafaxine will work. Why should it, nothing else has? The worst that could happen is it leaves me feeling "a bit better" or "not _that_ bad" and I delude myself that things are going to be OK, and I end up no better off in a year's time, with yet another year of life lost. I've not got all that many left.
Actually, one thing did work, and quite spectacularly, namely the painkiller I got when I injured my knee. This morning I managed to speak to the guardian of records at the casualty department that treated me, but they didn't have any specific record of what they gave me (if anything). She said that they routinely use(d) tramadol as a pain killer. Tramadol is an opioid (wikipedia).
> (I had no discontinuation trouble tapering off of Effexor, by the way, so you don't necessarily need to worry about that time.)
If I have to cope with that, I will, somehow. A few years back, I had three crowns fitted on my teeth without an anaesthetic, because I was scared of the side effects.
Posted by softheprairie on December 19, 2008, at 23:41:29
In reply to Re: How high are the chances venlafaxine might wor » softheprairie, posted by Onestone on December 19, 2008, at 16:47:25
> > Venlafaxine/Effexor could give you partial relief, and in a while you may be able to talk the doctor into adding a stimulamt to augment it, which would be very reasonable for someone who has tried several first- and second-line meds to no avail. I was on Effexor plus Concerta for a few years.
>
> May I ask why? What did you need it for?
>(I'm in the US, by the way. I guess I had assumed you were also, which I know is foolish, so I don't know the prescribing culture in your area.)
Well, I'm a bit unclear myself in my memory of the timeline that answers your question.
My first psych meds were just for depression, starting my first year of college (tho' I had been depressed even before that, but didn't seek medical attention for it specifically until college). It started pretty conventionally, with just one SSRI, then a switch to a different SSRI, then broadening out to other pharma classes and combining more than one med at a time. I got through college with a lot of difficulty, two years later than the ones I started with, as I left school for a while and had some incompletes, and was part-time when I returned. My OCD wasn't diagnosed at the time, or maybe just with a notation of "has obsessive traits." I am also very overweight and have had complaints of fatigue for many years, and was diagnosed w/ sleep apnea during college, and despite C-PAP complaince, I still have severe fatigue.
Slowness on exams and perfectionism were becoming increasing problems in school.
Anyways, I was able to get into a law school in my state that allowed me to go at less than the full # of hours at a time, because I knew I didn't have the energy to carry a full load. Then, in law school my depression and OCD got worse, and I went to new psych providers in my new town. There was some disagreement on if I actually have ADD or not, tho definitely not the hyperactive variety. I had some psych testing that officially said I had some attention problems, but didn't qualify as ADD. But, I was miserable at law school with depression and OCD. I complained about my terrible time concentrating, and asked about adding ADD medication to my depression treatment, if I recall correctly, and the nurse practioner who was my prescriber allowed it. I'm not sure if she marked it down as being for ADD or depression primarily. Then, that office moved, and my prescriber got a different job, and I switched to a new Dr., this one an MD that does med management and talk therapy both. I had declining functioning and left school with one incomplete in a writing class, and not such good grades in the ones that were mostly based on a final exam, because I was too slow in writing the test and didn't finish in time. It was supposed to be a leave of absence, but I didn't finish the incomplete writing class, and it turned into an F and I didn't try to go back, since I couldn't really say what I had changed about myself to be able to keep up if they let me back.
I was last in school in 2001. I had over five years of working full-time after that, but there was a new supervisor at my place of employment who was giving me bad job reviews for slowness, and I was doing my best, but couldn't please her. I ended up resigning rather than get fired. That was in early 2007. I haven't been employed since; I am on disability.
I have had my current psychiatrist since 2001. Somewhere in there he changed my first-listed/most prominent diagnosis from depresion to OCD. He now has my diagnoses in this order: OCD; major depressive disorder; and attention deficit disorder (I know the latest DSM puts the H in there with the ADD even if one isn't hyperactive, but my dr. used the old term, I guess). Some of my stimulant Rx's had the notation "for ADD," while I remember at least one saying "for depression, attention." At least with the most recent pdoc I have seen since 2001, I was honest in saying I was interested in stimulants not just for ADD, but for depression and energy. I'm not sure if it's legal for the DOCTOR to say stim. Rx is for energy or weight-loss in my locality, or just really looked down upon, but I do know it's allowed legally here to be used off-label for depression. There's a lot more to the story, having to do w/ stims being discouraged when the problem is OCD, with the general psych opinion being that stims promote obsessiveness, and whether to tread my depression or OCD first, but I sense I've writen a bunch already.
Posted by Racer on December 20, 2008, at 19:30:16
In reply to Re: How high are the chances venlafaxine might wor » softheprairie, posted by Onestone on December 19, 2008, at 16:47:25
> >
> However, I just don't believe the venlafaxine will work. Why should it, nothing else has?This sounds a lot like a self-fulfilling prophecy. Venlafaxine is a great drug for a lot of people -- even people who have had no luck with other medications.
Even the SSRIs are not all the same -- Lexapro left me far more depressed AND nearly catatonic, Paxil left me lethargic, Prozac on starting had me twitching out of my skin, and Zoloft was pretty benign and partially effective. All have the same mechanism of action, but very, very different subjective effects on the one human being typing this. It's the same within every class of meds, at least for me: Adderall increased my depression, Dexedrine was fine, etc.
Just because the medications you've tried so far have not been effective, it does not mean that the others will be equally ineffective. And even if they are not perfect, maybe you'll get enough relief that you can make some changes in your life that help augment and sustain the effects.
As for using opioids to boost dopamine, while you very likely would feel better for a time, that doesn't mean it's a good answer. For one thing, the concerns regarding tolerance are valid. Becoming addicted to an opioid, ON TOP OF your existing depression, would truly add a whole new level of misery to your life. That alone would lead me to urge you to consider other alternatives first.
Another thing to remember is that dopamine is far, far more than "the feel-good" neurochemical. Dopamine is associated with the positive symptoms of schizophrenia, for example, and it's necessary for movement -- thus Parkinson's when the dopamine producing cells start to die off.
The most valuable lesson I learned in biopsych classes is this: I do not know far more than I do know, and that sentence would be echoed by most of the researchers out there. There are no simple equations in finding the right medication. "I feel no pleasure, therefore I should boost the activity of dopamine" is a very nice idea. It's unlikely to translate into effective pharmacotherapy, though...
I wish you the best, and hope you find that venlafaxine is effective when you do try it.
Posted by SLS on December 20, 2008, at 20:53:21
In reply to Re: How high are the chances venlafaxine might wor, posted by Racer on December 20, 2008, at 19:30:16
With depression, it is difficult to be certain that a drug will work. Just as important, it is not a certainty that a treatment will not work.
I will say this, though. If your depression is biological, you will likely still respond favorably to the right treatment regardless of how convinced you are that you won't. So, if it doesn't matter what you think, you might as well stay neutral to the idea that the treatment will work.
The above paragraph represents an oversimplification of the dynamics between the biological and the psychological. My advice to you is to try to remove as much "depressive pressure" as you can so as to allow the brain every chance to respond to treatment.
Depressive pressure (psychosocial stress) can trigger a depression in a biologically vulnerable individual. If not resolved, it can also lead to relapses and prevent once effective drugs from working again. The message here is that some people need to attend to the biological and psychological both.
- Scott
Posted by Onestone on December 21, 2008, at 2:30:55
In reply to Re: How high are the chances venlafaxine might wor, posted by Racer on December 20, 2008, at 19:30:16
> > However, I just don't believe the venlafaxine will work. Why should it, nothing else has?
> This sounds a lot like a self-fulfilling prophecy. Venlafaxine is a great drug for a lot of people -- even people who have had no luck with other medications.
:-) Actually, my question wasn't just rhetorical. Why should I expect this new drug, venlafaxine work? These drugs aren't just curing drugs, they're also diagnostic tools. Aren't they? I'm kind of frustrated that no psychiatrist seems to reason "your reaction to drug A was this, drug B was this, ..... your symptoms are K, L, M, N, O, ...., so that suggests to me we need to .....". I had a ghastly reaction to edronax. Was that because my Noradrenaline level really doesn't need raising? Instead, all these doctors just seem to prescribe the drugs in a set order (or their favourite order, or a random order) until one works, or the patient gives up.
> Even the SSRIs are not all the same -- Lexapro left me far more depressed AND nearly catatonic, Paxil left me lethargic, Prozac on starting had me twitching out of my skin, and Zoloft was pretty benign and partially effective. All have the same mechanism of action, but very, very different subjective effects on the one human being typing this. It's the same within every class of meds, at least for me: Adderall increased my depression, Dexedrine was fine, etc.
> Just because the medications you've tried so far have not been effective, it does not mean that the others will be equally ineffective. And even if they are not perfect, maybe you'll get enough relief that you can make some changes in your life that help augment and sustain the effects.
There's surely _some_ science here, isn't there? St. John's wort _has_ worked for me. What should this tell a psychiatrist? Its effect is too mild, though.
> As for using opioids to boost dopamine, while you very likely would feel better for a time, that doesn't mean it's a good answer. For one thing, the concerns regarding tolerance are valid. Becoming addicted to an opioid, ON TOP OF your existing depression, would truly add a whole new level of misery to your life. That alone would lead me to urge you to consider other alternatives first.
I realise all this. The alternatives aren't safe either - my little experiment with edronax has left me intellectually worse off. But maybe occasional use of an opioid might be warranted, in emergencies which don't involved a twisted knee. Maybe once a week, once a month, or once a year? The question is also a way to poke psychiatrists in the ribs. ;-)
> Another thing to remember is that dopamine is far, far more than "the feel-good" neurochemical. Dopamine is associated with the positive symptoms of schizophrenia, for example, and it's necessary for movement -- thus Parkinson's when the dopamine producing cells start to die off.
Why are docs so reluctant to try it, as third or fourth drug in their random list? That's also a genuine question, not a rhetorical one.
> The most valuable lesson I learned in biopsych classes is this: I do not know far more than I do know, and that sentence would be echoed by most of the researchers out there. There are no simple equations in finding the right medication. "I feel no pleasure, therefore I should boost the activity of dopamine" is a very nice idea. It's unlikely to translate into effective pharmacotherapy, though...
> I wish you the best, and hope you find that venlafaxine is effective when you do try it.
Thanks! I was just as cynical ~10 years ago when I first tried SJW, but it started working within three days.
Posted by softheprairie on December 21, 2008, at 3:26:38
In reply to Re: How high are the chances venlafaxine might wor » Racer, posted by Onestone on December 21, 2008, at 2:30:55
> :-) Actually, my question wasn't just rhetorical. Why should I expect this new drug, venlafaxine work? These drugs aren't just curing drugs, they're also diagnostic tools. Aren't they? I'm kind of frustrated that no psychiatrist seems to reason "your reaction to drug A was this, drug B was this, ..... your symptoms are K, L, M, N, O, ...., so that suggests to me we need to .....". I had a ghastly reaction to edronax. Was that because my Noradrenaline level really doesn't need raising? Instead, all these doctors just seem to prescribe the drugs in a set order (or their favourite order, or a random order) until one works, or the patient gives up.
>
> >> >
> There's surely _some_ science here, isn't there? St. John's wort _has_ worked for me. What should this tell a psychiatrist? Its effect is too mild, though.
>
I think the SJW being a little helpful could be a sign that you could benefit from a prescription MAO inhibitor. Knowledgeable posters, is this correct? That SJW is, or is similar to, a mild MOAI?
Posted by raisinb on December 21, 2008, at 11:48:32
In reply to Re: How high are the chances venlafaxine might wor, posted by softheprairie on December 21, 2008, at 3:26:38
Yes, St. John's Wort is an MAOI.
Posted by desolationrower on December 21, 2008, at 14:32:02
In reply to Re: How high are the chances venlafaxine might wor » softheprairie, posted by raisinb on December 21, 2008, at 11:48:32
I don't think SJW has enough MAO inhibition for it to be relevant or noticable. Lots of things cause slight MAOI inhibition, including this coffee i'm drinking.
Did you try high-dose SJW? Or run into problems (side effects, cost)? I think the dosages on some herbal treatments are far too low for people with severe illness.
The general reason docs and researchers are scared of doapmine is that it is the chemical most associated with addiction. No doc wants to get their patient hooked on something.
As for side effects, i've not taken buprenorphine, but Parnate has been very mild for side effects, at least after the first few weeks. Much less than ssris i was on.
-d/r
Posted by glennb on December 22, 2008, at 11:29:32
In reply to How high are the chances venlafaxine might work?, posted by Onestone on December 18, 2008, at 11:45:44
To answer your question, they do not know why venlaxafine might work for you given that drugs a, b, c, did not. As far as I know, all these drugs work slightly differently and the fact that any one might work for a given person may actually be a side effect of the medication rather than the intended effect. This is intensely frustrating for people like us and I totally empathize with your frustration. I recently trialed venlaxafine and had no response to it. That doesn't mean you won't. I'm now trialing Cymbalta and had the same initial reaction you did when the next doctor suggested it. When done with this trial, I will have been on every SSRI/SNRI except lexapro. But it kind of behooves us to jump through the hoops and try all this garbarge looking for what works for us. So again, to answer your question 'why will this work' nobody really knows and the more honest doctors will tell you that. Your last paragraph sounds like you are having suicidal thoughts. PLEASE seek immediate help if you are. Also, please understand you are not entirely alone in your suffering. Good luck with the trial. If it doesn't work out move on to the next thing. By the way, it makes sense that tramadol would make you feel better. I use oxycodone to ease my pain, opiates work, they are as the other poster mentioned dangerous. You don't want an opiate addiction on top of refractory depression.
Posted by Fivefires on December 23, 2008, at 14:11:43
In reply to Re: How high are the chances venlafaxine might work? » Onestone, posted by Sigismund on December 18, 2008, at 15:05:16
Tks D, S, but, bupe? What is this?
Tried Nardil and living alone couldn't hold out; stopped in 2wks. I posted had begun to feel a bit of my 'old well-operating self' return.
In the midst of med thread, see friends here, so may I say here DB, the holidays are completely overwhelming and i'm in tears at all expected of me by fam and so little understood, and I too can't help but expect a lot from self; so many yrs I could keep up w/ the best of 'em.
I very much dislike greeting loved ones w/ a phony smile and the words .. Merry Christmas!, but to you all who do understand, I am so thankful as you are the best gift of all.
And: I may not get to any other threads for a couple days. :(
wishing u all the best, 5f
Posted by Phillipa on December 23, 2008, at 20:09:55
In reply to Re: How high are the chances venlafaxine might work?, posted by Fivefires on December 23, 2008, at 14:11:43
So your're out of bed and taking part in Christmas? Phillipa
Posted by Fivefires on December 27, 2008, at 14:54:00
In reply to Re: How high are the chances venlafaxine might work? » Fivefires, posted by Phillipa on December 23, 2008, at 20:09:55
> So your're out of bed and taking part in Christmas?>
I get up to do things and then leave them half done and go back to bed. It doesn't look like my house. No Christmas here. I'm losing my mind I guess.
Phillipa
miss you, 5f
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