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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 218 to 242 of 317. Go back in thread:
Posted by ed_uk2010 on March 11, 2012, at 13:39:44
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by SLS on March 11, 2012, at 7:48:16
Gosh Scott, that abstract is a bit beyond me!
> Hi Ed.
>
> I found this. I believe it lends evidence to my pet theory that the neural hyperactivity of the sgACC seen in depression is reduced by prazosin via NE alpha-1b receptor blockade.
>
>
> http://www.ncbi.nlm.nih.gov/pubmed/18704022
>
>
> CNS Spectr. 2008 Aug;13(8):663-81.
> The subgenual anterior cingulate cortex in mood disorders.
> Drevets WC, Savitz J, Trimble M.
> Source
>
> Section on Neuroimaging in Mood and Anxiety Disorders, Molecular Imaging Branch, National Institute of Mental Health, Bethesda, MD, USA. drevetsw@mail.nih.gov
> Abstract
>
> The anterior cingulate cortex (ACC) ventral to the genu of the corpus callosum has been implicated in the modulation of emotional behavior on the basis of neuroimaging studies in humans and lesion analyses in experimental animals. In a combined positron emission tomography/magnetic resonance imaging study of mood disorders, we demonstrated that the mean gray matter volume of this "subgenual" ACC (sgACC) cortex is abnormally reduced in subjects with major depressive disorder (MDD) and bipolar disorder, irrespective of mood state. Neuropathological assessments of sgACC tissue acquired postmortem from subjects with MDD or bipolar disorder confirmed the decrement in gray matter volume, and revealed that this abnormality was associated with a reduction in glia, with no equivalent loss of neurons. In positron emission tomography studies, the metabolic activity was elevated in this region in the depressed relative to the remitted phases of the same MDD subjects, and effective antidepressant treatment was associated with a reduction in sgACC activity. Other laboratories replicated and extended these findings, and the clinical importance of this treatment effect was underscored by a study showing that deep brain stimulation of the sgACC ameliorates depressive symptoms in treatment-resistant MDD. This article discusses the functional significance of these findings within the context of the preclinical literature that implicates the putative homologue of this region in the regulation of emotional behavior and stress response. In experimental animals, this region participates in an extended "visceromotor network" of structures that modulates autonomic/neuroendocrine responses and neurotransmitter transmission during the neural processing of reward, fear, and stress. These data thus hold important implications for the development of neural models of depression that can account for the abnormal motivational, neuroendocrine, autonomic, and emotional manifestations evident in human mood disorders.
>
> PMID:
> 18704022
> [PubMed - indexed for MEDLINE]
> PMCID:
> PMC2729429
>
> Free PMC Article
Posted by SLS on March 11, 2012, at 15:15:49
In reply to Re: Adding Parnate and prazosin., posted by ed_uk2010 on March 11, 2012, at 13:39:44
> Gosh Scott, that abstract is a bit beyond me!
Now that I can read more that two consecutive sentences at a time, these things are easier for me to understand and process. I even read an entire article in a Scientific American magazine last week. I haven't been able to do this since my remission in 1987, when I read my first and only book cover-to-cover. Ordinarily, I would have to rely on skimming to get through an abstract like this. Even children's books have been beyond me such that I could not read whole paragraphs. When she was a young child, my niece once asked me to read one of her books to her aloud. I couldn't do it. For most of my life, I have not had access to the written word. I think this has been my greatest loss.
- Scott
> > Hi Ed.
> >
> > I found this. I believe it lends evidence to my pet theory that the neural hyperactivity of the sgACC seen in depression is reduced by prazosin via NE alpha-1b receptor blockade.
> >
> >
> > http://www.ncbi.nlm.nih.gov/pubmed/18704022
> >
> >
> > CNS Spectr. 2008 Aug;13(8):663-81.
> > The subgenual anterior cingulate cortex in mood disorders.
> > Drevets WC, Savitz J, Trimble M.
> > Source
> >
> > Section on Neuroimaging in Mood and Anxiety Disorders, Molecular Imaging Branch, National Institute of Mental Health, Bethesda, MD, USA. drevetsw@mail.nih.gov
> > Abstract
> >
> > The anterior cingulate cortex (ACC) ventral to the genu of the corpus callosum has been implicated in the modulation of emotional behavior on the basis of neuroimaging studies in humans and lesion analyses in experimental animals. In a combined positron emission tomography/magnetic resonance imaging study of mood disorders, we demonstrated that the mean gray matter volume of this "subgenual" ACC (sgACC) cortex is abnormally reduced in subjects with major depressive disorder (MDD) and bipolar disorder, irrespective of mood state. Neuropathological assessments of sgACC tissue acquired postmortem from subjects with MDD or bipolar disorder confirmed the decrement in gray matter volume, and revealed that this abnormality was associated with a reduction in glia, with no equivalent loss of neurons. In positron emission tomography studies, the metabolic activity was elevated in this region in the depressed relative to the remitted phases of the same MDD subjects, and effective antidepressant treatment was associated with a reduction in sgACC activity. Other laboratories replicated and extended these findings, and the clinical importance of this treatment effect was underscored by a study showing that deep brain stimulation of the sgACC ameliorates depressive symptoms in treatment-resistant MDD. This article discusses the functional significance of these findings within the context of the preclinical literature that implicates the putative homologue of this region in the regulation of emotional behavior and stress response. In experimental animals, this region participates in an extended "visceromotor network" of structures that modulates autonomic/neuroendocrine responses and neurotransmitter transmission during the neural processing of reward, fear, and stress. These data thus hold important implications for the development of neural models of depression that can account for the abnormal motivational, neuroendocrine, autonomic, and emotional manifestations evident in human mood disorders.
> >
> > PMID:
> > 18704022
> > [PubMed - indexed for MEDLINE]
> > PMCID:
> > PMC2729429
> >
> > Free PMC Article
>
>
Posted by europerep on March 11, 2012, at 16:38:08
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by SLS on March 11, 2012, at 15:15:49
> For most of my life, I have not had access to the written word. I think this has been my greatest loss.
I'm confused. You are posting scientific articles as well as your considerations on them all the time. Plus you are using a *very* extensive vocabulary, and not once have I seen you you use words incorrectly.
To me it never seems like you are particularly cognitively "challenged" - quite the opposite, actually.
Posted by SLS on March 11, 2012, at 17:57:27
In reply to Re: Adding Parnate and prazosin. » SLS, posted by europerep on March 11, 2012, at 16:38:08
> > For most of my life, I have not had access to the written word. I think this has been my greatest loss.
>
> I'm confused. You are posting scientific articles as well as your considerations on them all the time. Plus you are using a *very* extensive vocabulary, and not once have I seen you you use words incorrectly.
>
> To me it never seems like you are particularly cognitively "challenged" - quite the opposite, actually.Don't sweat it, man. It is not necessary that you understand. You seem quite challenged by me. Why is that?
- Scott
Posted by Phillipa on March 11, 2012, at 19:12:06
In reply to Re: Adding Parnate and prazosin. » europerep, posted by SLS on March 11, 2012, at 17:57:27
Scott I'm also confused as eurorep. As how would it be possible to post on a site like babble and offer advise on meds to others. Not doubting curious? Also didn't you attend computer work at the NIMH? Maybe I read it wrong do it all the time. Phillipa
Posted by SLS on March 11, 2012, at 19:28:07
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on March 11, 2012, at 19:12:06
> Scott I'm also confused as eurorep. As how would it be possible to post on a site like babble and offer advise on meds to others. Not doubting curious? Also didn't you attend computer work at the NIMH? Maybe I read it wrong do it all the time. Phillipa
I didn't say that I couldn't write.
For every paragraph that I struggle to read, I can easily write ten. My problem is not with getting the information out. It is with getting the information in.
I hope that helps to illuminate things.
I am not unintelligent. Neither am I a liar. Either way, I feel insulted for the posture assumed by Europerep. I felt that he challenged the veracity of my self-description rather than respectfully requesting more information from me.
- Scott
Posted by sigismund on March 11, 2012, at 20:16:53
In reply to Re: Adding Parnate and prazosin. » SLS, posted by europerep on March 11, 2012, at 16:38:08
>not once have I seen you you use words incorrectly.
Apart from being a little over keen on 'whom' :)
No really, the prazosin is going well for me.
I may be able to slowly reduce my benzo dose.
Posted by Phillipa on March 11, 2012, at 20:23:12
In reply to Re: Adding Parnate and prazosin. » Phillipa, posted by SLS on March 11, 2012, at 19:28:07
Scott I know you are definitely not unintelligent. Just the opposite. But it was something wanted to claify with you. Thanks Phillipa
Posted by papillon2 on March 11, 2012, at 21:01:09
In reply to Re: Adding Parnate and prazosin. » Phillipa, posted by SLS on March 11, 2012, at 19:28:07
> I didn't say that I couldn't write.
>
> For every paragraph that I struggle to read, I can easily write ten. My problem is not with getting the information out. It is with getting the information in.
>
> I hope that helps to illuminate things.I have found this personally illuminating. I have some cognitive deficits, I know it. I have not forgotten my prior abilities. But when I tell my psychiatrist she doesn't believe me nor appreciate my distress.
Her never having seen me sans-depression would be a factor, but maybe there's something similar going on.
Posted by SLS on March 12, 2012, at 0:05:37
In reply to Re: Adding Parnate and prazosin., posted by sigismund on March 11, 2012, at 20:16:53
> >not once have I seen you you use words incorrectly.
>
> Apart from being a little over keen on 'whom' :)
>
> No really, the prazosin is going well for me.
>
> I may be able to slowly reduce my benzo dose.
Excellent!!!Maybe I'll cut down on the "whom" thing. :-)
- Scott
Posted by SLS on March 12, 2012, at 0:42:36
In reply to Re: Adding Parnate and prazosin., posted by papillon2 on March 11, 2012, at 21:01:09
> > I didn't say that I couldn't write.
> > For every paragraph that I struggle to read, I can easily write ten. My problem is not with getting the information out. It is with getting the information in.
> >
> > I hope that helps to illuminate things.
> I have found this personally illuminating. I have some cognitive deficits, I know it. I have not forgotten my prior abilities. But when I tell my psychiatrist she doesn't believe me nor appreciate my distress.
>
> Her never having seen me sans-depression would be a factor, but maybe there's something similar going on.
Yes. The ability to speak well using big words despite depression is a blessing and a curse. Few people even realize that it takes practice and effort to accomplish this. At first, the doctors at the NIH were concerned that I might not be depressed enough to enter their research program. However, after observing me for a few weeks, they understood the dissonance between how I spoke and how I felt. At the study blind breaking, they revealed to me that I was one of the worst cases they had ever seen. I spent the better part of 9 months sitting in a chair, staring off into space. I didn't have the mental energy to focus my eyes on the TV. Later, a professor at New York University called my condition "horrendous". I cried because I felt vindicated. It was reassuring that someone finally understood the severity of my condition.I have never really described to the Psycho-Babble community in detail how I experience depression. It is only recently that I have done so. I think this has something to do with my feeling better and experiencing an awakening. My thoughts are now clearer and I am perhaps more motivated to write these things. The better I feel, the greater is my understanding of the severity of my suffering. At my present rate of progress, I expect that it will take another year to reach full remission. However, I should be able to go to work before that.
I pray that my emerging from depression doesn't follow the patterns of response seen in "Awakenings". I saw the movie. I did not read the book. I imagine the book was even more wrenching than the movie.
- Scott
Posted by sigismund on March 12, 2012, at 1:09:54
In reply to Re: Adding Parnate and prazosin., posted by papillon2 on March 11, 2012, at 21:01:09
> my psychiatrist she doesn't believe me
If you will forgive the generalisation, psychiatrists make a practice of not believing their patients.
I imagine they would believe their patients twice as often if they were paid half as much.
Posted by SLS on March 12, 2012, at 6:53:04
In reply to Re: Adding Parnate and prazosin., posted by sigismund on March 12, 2012, at 1:09:54
> > my psychiatrist she doesn't believe me
>
> If you will forgive the generalisation, psychiatrists make a practice of not believing their patients.
>
> I imagine they would believe their patients twice as often if they were paid half as much.LOL
- Scott
Posted by europerep on March 12, 2012, at 8:36:49
In reply to Re: Adding Parnate and prazosin. » europerep, posted by SLS on March 11, 2012, at 17:57:27
> Don't sweat it, man. It is not necessary that you understand. You seem quite challenged by me. Why is that?
Oh jeez... did I say that you don't seem depressed to me? No, and that is not by accident.
But if you want to know the truth then yes, I am not buying this "for most of my adult life I wasn't able to read" thing. To me, there appear to be too many logical flaws in this claim when held against both the content and the form of your posts on this forum.
Your reaction to my post strikes me. You usually don't lose your stoic calm even when insulted. Just my observation.
Posted by SLS on March 12, 2012, at 9:12:01
In reply to Re: Adding Parnate and prazosin. » SLS, posted by europerep on March 12, 2012, at 8:36:49
> > Don't sweat it, man. It is not necessary that you understand. You seem quite challenged by me. Why is that?
>
> Oh jeez... did I say that you don't seem depressed to me? No, and that is not by accident.
>
> But if you want to know the truth then yes, I am not buying this "for most of my adult life I wasn't able to read" thing. To me, there appear to be too many logical flaws in this claim when held against both the content and the form of your posts on this forum.
>
> Your reaction to my post strikes me. You usually don't lose your stoic calm even when insulted. Just my observation.
I'm not usually insulted here. Yet, you do it again.Of what importance to you is my medical condition? Why are you so compelled to comment on it without my solicitation? This isn't the first occasion that you have. You have been wrong both times.
Do you think that I'm a liar such that you "are not buying" my self-descriptions and historical accounts? If you don't think I'm a liar or an exaggerator, how do you account for my explanations? Lack of intelligence? A subconsious need to be the "worst"? What?
What is your best guess as to how long it took for me to compose this post? Did you even take this variable into consideration when you opined on my ability to write?
Like I said, don't sweat it. It is not necessary that you understand me. I do wish you would desist on commenting on my condition and treatment, though. I don't find your writings to be helpful or of a positive nature.
I don't mind if you answer my questions throughout this post. I actually prefer that you do. I really would like to know what you think drives me to presumably exaggerate my descriptions of my medical condition?
- Scott
Posted by europerep on March 12, 2012, at 11:23:43
In reply to Re: Adding Parnate and prazosin. » europerep, posted by SLS on March 12, 2012, at 9:12:01
> I'm not usually insulted here. Yet, you do it again.
Oh, it has happened at least a couple of times during the time I have been here. There was this EricFromNC or something like that guy about a year ago. But that's not even the point actually. If you consider that me voicing my thoughts on here is insulting then you are free to do so. After all, this is the internet, and people are free to talk just as they are free to be offended.
>Why are you so compelled to comment on it without my solicitation?Opening a thread on an internet board is solicitation to me. And I am only continuing to post here in this thread because you react in the way you did.
> If you don't think I'm a liar or an exaggerator, how do you account for my explanations?
Quite frankly, that is secondary to me. In the end, it is you who has to answer those questions for yourself. "Europerep is an idiot and has no idea what I'm talking about" is a possible answer, but it's far from being the only one.
> Did you even take this variable into consideration when you opined on my ability to write?
My comment was rather on your ability to comprehend complex texts of scientific nature. There's just no way (that I can think of) that a man who hasn't been able to read for his adult life is able to talk neuroscience with Ed and Link or develop "pet theories" about which type of depression could respond to what type of treatment.
> Like I said, don't sweat it.
I don't even know that that means.
> I don't find your writings to be helpful or of a positive nature.
Maybe others do? As it turns out, I'm not the only one who thinks what I said in my initial post.
Posted by SLS on March 12, 2012, at 19:08:52
In reply to Re: Adding Parnate and prazosin. » SLS, posted by europerep on March 12, 2012, at 11:23:43
> > I'm not usually insulted here. Yet, you do it again.
> Oh, it has happened at least a couple of times during the time I have been here. There was this EricFromNC or something like that guy about a year ago.
I guess he wasn't special.
> But that's not even the point actually.
If that is not the point, then why make it?
> If you consider that me voicing my thoughts on here is insulting then you are free to do so.
Thank you. Phew. For a minute there, I was going to beg you for your permission to be insulted by you.
> After all, this is the internet, and people are free to talk just as they are free to be offended.
I see. So, you really don't care how you impact the feelings and well-being of others?
> > Why are you so compelled to comment on it without my solicitation?
> Opening a thread on an internet board is solicitation to me.
I think you ought to more thoroughly study the definition of the word "solicitation". I did no such thing.
> And I am only continuing to post here in this thread because you react in the way you did.
Silly me. Would you like to have the last word?
As you say, "I am only continuing to post here in this thread because you react in the way you did."
> > If you don't think I'm a liar or an exaggerator, how do you account for my explanations?
> Quite frankly, that is secondary to me.
What, then, is primary to you?
> In the end, it is you who has to answer those questions for yourself.
Asked and answered. Thank you.
> "Europerep is an idiot and has no idea what I'm talking about"
When it comes to me, you wouldn't be the first.
> is a possible answer, but it's far from being the only one.
Name one more, just for the sake of demonstration. I might even let you have the last word.
> > Did you even take this variable into consideration when you opined on my ability to write?
> My comment was rather on your ability to comprehend complex texts of scientific nature.
Yup. I do. I already let out the secret of how I acccomplish this. But to find out, you will have to review the entire thread. :-)
> There's just no way (that I can think of) that a man who hasn't been able to read for his adult life is able to talk neuroscience with Ed and Link or develop "pet theories" about which type of depression could respond to what type of treatment.
Surprise! I can and I do.
So, then, I am a liar and an exaggerator.
There can be no other explanation. I obviously have a subconscious need to be the worst case of depression in the history of the world.
> > Like I said, don't sweat it.
> I don't even know that that means.
It means don't worry yourself about how I might feel about what you have written. Your insults don't affect my self-esteem one iota, but they do anger me. Am I allowed to voice anger in your idyllic Internet world?
> > I don't find your writings to be helpful or of a positive nature.
> Maybe others do? As it turns out, I'm not the only one who thinks what I said in my initial post.
Ah. I see. It is time to determine Scott's degree of depression by majority vote. You can't vote on the Truth, only on the way you choose to navigate it.
You might want to get to know your next target better before you pass judgment and execute your attack. You certainly didn't know me.
- Scott
Posted by JohnLA on March 12, 2012, at 23:20:38
In reply to Re: Adding Parnate and prazosin. » SLS, posted by europerep on March 12, 2012, at 11:23:43
europerep-
take a chill pill as we say in the US. i'm sure you have better things to do than to question scott about his depression, ability to write, etc.
silly discussion really. depression is so unique to each of us that to make blanket statements about what one can and cannot do while depressed makes absolute no sense.
how about this? i'm thinking english is not your first language and something is getting 'lost in translation' in your posts to scott? maybe i'm wrong on this.
regardless, let it go.
ps where is lou pilder when you need him?!
Posted by SLS on March 13, 2012, at 7:03:28
In reply to Adding Parnate and prazosin., posted by SLS on December 29, 2011, at 6:55:56
Anyway...
The last three days have been the best yet. The improvement is unmistakable, albeit gradual and uneven. I try to evaluate my condition in terms of weeks and months rather than days. That is not to say that I don't get frightened and frustrated when I experience a period of worsening. These valleys are not as deep as they had been, though. Along with the progression of higher and higher peaks, I conclude that the outcome of my treatment follows a trend towards further improvement.
Far out!
I am currently taking:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 6 mgIt appears that each drug contributes a therapeutic effect that is complementary to the others. Attempting to remove any one of these drugs results in relapse.
I think that some people might profit from making a list of those drugs from which they experienced a partial response, and then consider using them in developing a polypharmaceutical treatment. That's basically what I did. My choices were based upon clinical, empirical observation rather than theory. Pondering theories for why these drugs work for me is interesting, but retrospective.
As I have noted, I hand-picked the first 5 drugs on the list that I was taking. I gleaned only a minimal partial improvement, however. My doctor then proposed the brilliant idea to add prazosin. I would never have thought to do this myself. However, it is obvious that prazosin is not sufficient to operate monotherapeutically for me. As Ed_UK so insightfully noted, it seems that prazosin might be effective when combined with a noradrenergic drug. Of course, both Parnate and nortriptyline are noradrenergic. That is not to say that prazosin wouldn't augment serotonergic drugs just as well.
I do not use theory to exclude drugs from consideration. I do use it to include drugs for consideration.
I feel so relieved to think that my pain and frustration of depression might be coming to an end. <deep breath> Phew.
A few more prayers to the higher power wouldn't hurt.
- Scott
Posted by Beckett on March 13, 2012, at 7:38:11
In reply to Re: Adding Parnate and prazosin. » SLS, posted by SLS on March 13, 2012, at 7:03:28
>A few more prayers to the higher power wouldn't hurt.
You got 'em
Serendipity and a systematic approach
:-)
Posted by europerep on March 13, 2012, at 8:27:59
In reply to Re: Adding Parnate and prazosin. » europerep, posted by SLS on March 12, 2012, at 19:08:52
Look Scott, you seem to think that I don't like you or something. Or that I want to question whether you are really suffering from depression, or whether your suffering is legitimate. None of the above is true.
What it comes down to here is this: I see quite a few of logical flaws in the story that you tell about yourself. That doesn't mean that they are necessarily there, but they might be. Even if you don't want to consider these things, others here on the forum have a right to hear what people (such as me) think, just as they have the right to then dismiss my opinion.
If you go back to my initial post and read it from a neutral perspective, it is neither flaming nor insulting, and it's not even impolite. It is blunt and to the point, yes. If I should have wrapped my thoughts in more if's, maybe's, please's or possibly's, then how about this: welcome to the internet.
Your attempt to dissect my words and draw me into a lengthy discussion is pointless, especially since you at the same time reject everything I'm saying and yet pretend to want to hear more or to have me explain things. You are an intelligent person, all the info is there, and you can basically take it or leave it.
Posted by europerep on March 13, 2012, at 8:30:48
In reply to europerep, posted by JohnLA on March 12, 2012, at 23:20:38
> silly discussion really. depression is so unique to each of us that to make blanket statements about what one can and cannot do while depressed makes absolute no sense.
True, that would make no sense, but I haven't done that.
And there is nothing lost in translation here, at least as far as I can see. My thoughts on this subject are actually fairly simple.
Posted by ed_uk2010 on March 13, 2012, at 15:42:44
In reply to Re: Adding Parnate and prazosin. » SLS, posted by SLS on March 13, 2012, at 7:03:28
One thing I'm unsure about is how your prazosin dose was determined. Is 6mg the most you can tolerate without excessive hypotension? .....although I have no idea whether >6mg would be any more effective.
FWIW, I don't think anyone is trying to upset you on this thread, I think they are simply commenting on the eloquence of your posts, which is much greater than most people who have read many books!
Posted by SLS on March 13, 2012, at 17:07:52
In reply to Re: Adding Parnate and prazosin. » SLS, posted by ed_uk2010 on March 13, 2012, at 15:42:44
> One thing I'm unsure about is how your prazosin dose was determined.
Clinical titration. My starting dose was 3 mg. I actually felt better at this dosage, but I would lose the benefit towards the end of a dosing period. I take prazosin t.i.d. At 6 mg, things evened out. Who knows, I might have responded just as well to 4 or 5 mg. Since the prazosin was so tolerable, I felt that there was no harm in giving myself some headroom with the 6 mg dosage.
> Is 6mg the most you can tolerate without excessive hypotension?
No. I was able to tolerate more, but there was no additional benefit from going higher. I went to 9 mg.
Man, it feels good to feel good. Things are so much brighter and clearer.
- Scott
Posted by ed_uk2010 on March 15, 2012, at 18:13:13
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by SLS on March 13, 2012, at 17:07:52
Given prazosin's very short half-life, how do think you would fare on 1mg to 1.5mg four times a day?
Also, what is the role (if any) of other non-selective alpha blockers in psych disorders? I was thinking of doxazosin (Cardura) in particular. Doxazosin is much more widely used than prazosin as an antihypertensive due to its long duration of action and less precipitous initial fall in BP.
I am delighted at your recent progress, by the way :)
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