Psycho-Babble Medication Thread 27239

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Re: Bidding Goodbye to the Patch - Bob

Posted by Adam on March 17, 2000, at 15:11:14

In reply to Re: Bidding Goodbye to the Patch, posted by bob on March 16, 2000, at 20:18:32

> [sorry, but I read that thread subject as "Bidding Goodbye to Patch Adams" ;^]

Hah! :)
>
> Pardon me for being naive about your insurance plan, but how much coverage do you get for going out-of-network?

None, zero, zip, nada. My docs thought they would make an exception, since such exceptions can be made, but they wouldn't even consider it. A flat out and immediate no has been the answer.

They seem a bit draconian vs. my Doc's expectations. I wonder if Tuft's is in trouble. Another local HMO, Harvard Vangard, just tanked recently and is now being resucitated by the university which shares its name, and the State. Tufts had to pull entirely out of Northern New England, and as a result is getting sued by a big military contractor in Maine, Bath Iron Works. Chances are there are other suits too. The certainly pulled the plug on my psychotherapy last year rather abrubtly, and I think prematurely. If it wasn't for the selegiline trial, I might be in dire straits right now.
>
> Just mentioning it because for me, my insurance plan is so screwed on in-network coverage that my therapist quit from that plan, and it actually works out better for me AND my therapist for her to be out-of-network! Go figure.

No mystery there. Managed care can stink.
>
> cheers,
> bob

 

Re: Bidding Goodbye to the Patch - Noa

Posted by Adam on March 17, 2000, at 15:17:25

In reply to Re: Bidding Goodbye to the Patch, posted by Noa on March 17, 2000, at 10:24:04

> > Adam,
>
>
> I forgot about you being in the study, and that it would come to an end. I feel so awful for you, because you have been doing so incredibly well, it seems inhumane to take your patch away from you. I hope you can work things out with the new docs.

Well, I did know this would happen, and have known since the beginning. It is too bad they can't even sell it to me now, but it is reasonable that the transdermal selegiline system needs to be tested before it can be marketed. It has proven to be safe, and for some efficatious, so hopefully before long the patch will be available for purchase as an antidepressant. A couple years on the oral form doesn't bother me. I just want to be allowed to take it with coverage, since paying for it myself would really strain me financially.

 

Re: Adam, Chris- Seligiline - Andrew

Posted by Adam on March 17, 2000, at 15:33:42

In reply to Re: Adam, Chris- Seligiline, posted by AndrewB on March 17, 2000, at 13:25:35

> What are the deppressive symptoms that Seligiline helped you with? Did you have a diagnosis?

I guess I have Major Depressive Disorder, and that's about as good a diagnosis as I have ever gotten. It helps with depression, plain and simple. I also have an OCD-spectrum disorder that I think it has done little for except decrease my vulnerability to the emotional turmoil that OCD can cause. For the most part, I have dealt with my obsessive tendancies via psychotherapy, but it does kind of flare up at times. However, my main problem for the past few years has been depression. Weather I am typical, atypical or what I'm not really sure. I suspect I am atypical, but that's only because I resoponded to an MAOI, which is supposedly an ideal drug for "atypicals" (where TCAs seem to be more for the melancholic types), though that's not a hard-and-fast rule by any means. I read the DSM-IV and I think I'm half the depressive subtypes in there, and by the plurality of dx's I've received, so have some of the physicians. I prefer to chuck the whole subtype diagnosis thing and say "For Adam disease, selegiline works." That's the only really objective measure to put on me.

 

Adam

Posted by michael on March 17, 2000, at 18:27:27

In reply to Re: Bidding Goodbye to the Patch - Noa, posted by Adam on March 17, 2000, at 15:17:25

> > > Adam,
> >
> >
> > I forgot about you being in the study, and that it would come to an end. I feel so awful for you, because you have been doing so incredibly well, it seems inhumane to take your patch away from you. I hope you can work things out with the new docs.
>
> Well, I did know this would happen, and have known since the beginning. It is too bad they can't even sell it to me now, but it is reasonable that the transdermal selegiline system needs to be tested before it can be marketed. It has proven to be safe, and for some efficatious, so hopefully before long the patch will be available for purchase as an antidepressant. A couple years on the oral form doesn't bother me. I just want to be allowed to take it with coverage, since paying for it myself would really strain me financially.


Adam -

I've never tried this place out, but I'm going to pass it along nonetheless. I came acorss it earlier this week while I was doing some research on selegiline. Here's the address:

http://www.drugplace.com/BrandNameGenericDrugs.htm

I don't know if the prices are up to date, but it was listing 60 5mg tablets of selegiline for $14. (works out to approx $0.30ish per tablet - didn't check into shipping charges, etc.)

They do, however request a prescription, or offer to call you doctor if you give them the number.

If you don't have a script, the best I could find was roughly $0.85 per tablet. (in the UK)

Like I said, I don't know anything about them... I'm sure there's a few bucks tacked on for shipping... don't know if there's a minimum order... It's not free, but cheaper than I found elsewhere... Don't know if that's of any use to you... but there it is.

 

Re: Bidding Goodbye to the Patch

Posted by Judy on March 17, 2000, at 20:07:01

In reply to Bidding Goodbye to the Patch, posted by Adam on March 16, 2000, at 19:41:06

Adam -

How strange! I JUST this morning thought of your patch study and wondered what you would do next.

I have every confidence that oral Selegeline will work for you. While my several months taking it orally weren't as successful as your transdermal trial, it did work for my depression although it never quite touched my dysthymia. Interestingly, when I finally had to throw in the towel on Selegeline and start Parnate as a last resort, I took exactly two 20 mg Parnates and the next morning woke up in that wonderful hypomania that you experienced at the beginning of your Selegeline study. That's WAY too fast to expect Parnate to work, so I'm theorizing that the Selegeline was inhibiting a lot more MAO's than I thought, and the small amount of Parnate finally put me over the edge (even after a two-week washout).

I think your psychopharm is being truthful with you - not trying to ditch you. My doctor perscribed Selegeline for me but never felt comfortable about it. He wouldn't even hear of attempting to augment it with anything. He said it was just too new a drug, at high doses, with no track record to draw info from.

About the cost. The price was $260 per month when I was taking 60 mg per day (that's 12 pills a day of a drug meant to be given in 5 or 10 mg daily doses to Parkinsons patients!) Fortunately my Tufts insurance covered it without question (I'm still waiting for them to knock on my door wanting their money back!). My poor pharmacist at CVS was calling all over the country trying to round up six pharmacy bottles of 60 pills each for me each month.

Finally, I have my fingers crossed for you. I'm hoping Selegeline is the Adam Disease drug, whether taken orally or transdermally. And don't rule out the other MAOI's if you're in a pinch. I suspect you'd respond to one or all of them as well.

Judy

 

Subverting the system...

Posted by bob on March 18, 2000, at 8:34:15

In reply to Re: Bidding Goodbye to the Patch - Bob, posted by Adam on March 17, 2000, at 15:11:14

... but first, a joke:
> No mystery there. Managed care can stink.

These three famous doctors die in a tragic SUV crash late one Wednesday coming back from the 19th hole. Next thing they know, they're at the Pearly Gates so they figure, "Hey, we're doctors" and they start to stroll right in. That's when Saint Pete steps up and says, "Whoa, fellas!! Not so fast! Not EVERYBODY gets to go through -- what've you done to get you a ticket inside?"

The first doc steps up and says, "I invented the artifical hip. Now, thousands of people, especially seniors, who fall and break their hip can now regain their mobility instead of being confined to a wheelchair or, worse, a bed for the rest of their lives." Petey thinks it over a few seconds and says, "Yeah, yeah! I like that -- that's good enough for me", and he ushers the first doc through the Gates.

The second doc steps up and says, "Ah, that was nothing! I invented the artifical heart. Thousands of people each year rely on my invention when their own hearts fail, allowing them to live until an organ donor can be found and someone's heart can live on in a new body." Pete gives it a thought, and says "That's marvelous! Wonderful! You definitely belong in here" and leads doc#2 through the Pearly Gates.

Finally, doc 3 steps up. Saint Pete, all excited now, says, "Okay, so what's YOUR story?" Doc 3 says, "Well, I just was the CEO of the largest HMO in the whole WORLD. Just think about all the care that people received under my thoughtful and compassionate guidance of their HMO."

Pete stood there and rubbed his chin some, obviously lost in thought. Then, he says,"You know, doc, that is the most stupendous story I've heard yet. Truly remarkable. Fabulous...

... you can stay for three days."

As for being subversive:
I think we need the Law & Order DAs on our case here. We need to file some criminal case against these so-called-health-organizations for depraved indifference. Forget civil proceedings -- let's get some of the decision-makers' asses thrown in jail. More seriously, tho, maybe we should study and learn how the gay community fought (and continues to fight) to get drug trials to stop giving placebos once an anti-HIV med shows results, and how to get these meds fast-tracked through the FDA.

Point of subversion #2:
Maybe we need our own version of the Anarchist's Cookbook. A "make your own transdermal patch" recipe sounds like it would be quite welcome.

my two cents (the joke was for free)
bob

 

Re: Subverting the system...

Posted by Cindy W on March 18, 2000, at 19:42:39

In reply to Subverting the system..., posted by bob on March 18, 2000, at 8:34:15

> ... but first, a joke:
> > No mystery there. Managed care can stink.
>
> These three famous doctors die in a tragic SUV crash late one Wednesday coming back from the 19th hole. Next thing they know, they're at the Pearly Gates so they figure, "Hey, we're doctors" and they start to stroll right in. That's when Saint Pete steps up and says, "Whoa, fellas!! Not so fast! Not EVERYBODY gets to go through -- what've you done to get you a ticket inside?"
>
> The first doc steps up and says, "I invented the artifical hip. Now, thousands of people, especially seniors, who fall and break their hip can now regain their mobility instead of being confined to a wheelchair or, worse, a bed for the rest of their lives." Petey thinks it over a few seconds and says, "Yeah, yeah! I like that -- that's good enough for me", and he ushers the first doc through the Gates.
>
> The second doc steps up and says, "Ah, that was nothing! I invented the artifical heart. Thousands of people each year rely on my invention when their own hearts fail, allowing them to live until an organ donor can be found and someone's heart can live on in a new body." Pete gives it a thought, and says "That's marvelous! Wonderful! You definitely belong in here" and leads doc#2 through the Pearly Gates.
>
> Finally, doc 3 steps up. Saint Pete, all excited now, says, "Okay, so what's YOUR story?" Doc 3 says, "Well, I just was the CEO of the largest HMO in the whole WORLD. Just think about all the care that people received under my thoughtful and compassionate guidance of their HMO."
>
> Pete stood there and rubbed his chin some, obviously lost in thought. Then, he says,"You know, doc, that is the most stupendous story I've heard yet. Truly remarkable. Fabulous...
>
> ... you can stay for three days."
>
> As for being subversive:
> I think we need the Law & Order DAs on our case here. We need to file some criminal case against these so-called-health-organizations for depraved indifference. Forget civil proceedings -- let's get some of the decision-makers' asses thrown in jail. More seriously, tho, maybe we should study and learn how the gay community fought (and continues to fight) to get drug trials to stop giving placebos once an anti-HIV med shows results, and how to get these meds fast-tracked through the FDA.
>
> Point of subversion #2:
> Maybe we need our own version of the Anarchist's Cookbook. A "make your own transdermal patch" recipe sounds like it would be quite welcome.
>
> my two cents (the joke was for free)
> bob
Bob, loved the joke! Managed care certainly isn't for the benefit of the patient.

 

Re: Bidding Goodbye to the Patch

Posted by saint james on March 18, 2000, at 22:55:35

In reply to Bidding Goodbye to the Patch, posted by Adam on March 16, 2000, at 19:41:06

I would contact the manufacture directily to see if you can get the patch thru a needy med program.
Most manuf. give meds out to those who cannot get them for whatever reason.

james

 

Re: Bidding Goodbye to the Patch

Posted by Robin on March 19, 2000, at 11:51:45

In reply to Re: Bidding Goodbye to the Patch, posted by Judy on March 17, 2000, at 20:07:01

> Adam -
>
> How strange! I JUST this morning thought of your patch study and wondered what you would do next.
>
> I have every confidence that oral Selegeline will work for you. While my several months taking it orally weren't as successful as your transdermal trial, it did work for my depression although it never quite touched my dysthymia. Interestingly, when I finally had to throw in the towel on Selegeline and start Parnate as a last resort, I took exactly two 20 mg Parnates and the next morning woke up in that wonderful hypomania that you experienced at the beginning of your Selegeline study. That's WAY too fast to expect Parnate to work, so I'm theorizing that the Selegeline was inhibiting a lot more MAO's than I thought, and the small amount of Parnate finally put me over the edge (even after a two-week washout).
>
> I think your psychopharm is being truthful with you - not trying to ditch you. My doctor perscribed Selegeline for me but never felt comfortable about it. He wouldn't even hear of attempting to augment it with anything. He said it was just too new a drug, at high doses, with no track record to draw info from.
>
> About the cost. The price was $260 per month when I was taking 60 mg per day (that's 12 pills a day of a drug meant to be given in 5 or 10 mg daily doses to Parkinsons patients!) Fortunately my Tufts insurance covered it without question (I'm still waiting for them to knock on my door wanting their money back!). My poor pharmacist at CVS was calling all over the country trying to round up six pharmacy bottles of 60 pills each for me each month.
>
> Finally, I have my fingers crossed for you. I'm hoping Selegeline is the Adam Disease drug, whether taken orally or transdermally. And don't rule out the other MAOI's if you're in a pinch. I suspect you'd respond to one or all of them as well.
>
> Judy

They make a generic selegiline that is alot cheaper and I liked it better. Has anyone else tried the generic?

robin

 

Patchless...Re: Subverting the system...

Posted by Adam on March 27, 2000, at 22:55:36

In reply to Subverting the system..., posted by bob on March 18, 2000, at 8:34:15

>
> As for being subversive:
> I think we need the Law & Order DAs on our case here. We need to file some criminal case against these so-called-health-organizations for depraved indifference. Forget civil proceedings -- let's get some of the decision-makers' asses thrown in jail. More seriously, tho, maybe we should study and learn how the gay community fought (and continues to fight) to get drug trials to stop giving placebos once an anti-HIV med shows results, and how to get these meds fast-tracked through the FDA.
>
> Point of subversion #2:
> Maybe we need our own version of the Anarchist's Cookbook. A "make your own transdermal patch" recipe sounds like it would be quite welcome.
>
> my two cents (the joke was for free)
> bob

Hey hey,

Both good suggestions, bob. If I could figure out what that adhesive was they used to stick the little things to me (sort of a band-aid-cubed kind of attachment...rrrrrip), then I'd be in business.

As it turne out, all they had at the pharmacy I went to was the generic stuff, so I got that. 15mg/day turns out to be pretty cheap, and well within my budget even without coverage.

I'm also doing quite well emotionally. This is kind of nice, in a way, to not even deal with the insurance company, but the study docs at McLean can't see me forever for free, which I understand perfectly well.

I'm still a bit worried that 15mg/day isn't really sufficient (there's not much MAO-A inhibition at this dose), and that I'll slowly start to relapse, but for the present Dr. Bodkin seems to think I should give this dose a try and see how it goes. If I understand correctly, after being on a therapeutic dose of an MAOI, it can take some time after stopping the drug for MAO to return to normal levels, maybe a week to ten days. Since I'm on a dose that almost completely inhibits MAO-B, and partially inhibits MAO-A, it may slow the return of unaffected MAO-A, and that's why I'm still doing so well. No way to really know, I suppose.

But I guess I'll do what's been suggested and monitor myself closely. I'm certainly happy to not have to worry about diet yet. I ate four slices of pepperoni-sausage pizza and drank two Newcastle Brown Ales (from a bottle-I'm not too crazy) friday night with to tangible effect. I, unfortunately, left my sphygmomanometer at home, so I couldn't check to see if there was any intangible effects. I'll do that experiment soon.

Ciao for now, and thank you to all for your kind messages!

Adam

 

Re: Selegiline without the Patch

Posted by Adam on April 11, 2000, at 15:34:04

In reply to Patchless...Re: Subverting the system..., posted by Adam on March 27, 2000, at 22:55:36

Hey, folks,

I've been a busy boy.

Anyway, for those interested in selegiline administered both transdermally and orally...

I miss the patch! I'm doing OK, but taking selegiline orally vs. through my arm is indeed a different experience.

I started out on 15mg/day. For the life of me, I can't figure out why it was suggested I try this, since I've seen no evidence anywhere of antidepressant efficacy at that dose, but the head of the selegiline transdermal system (STS) study I was in thought I should give it a go. It didn't really work. After experiencing some subtle changes in mood that became less subtle, I suggested (insisted, rather) I up the dose, and have done so accordingly.

I'm up to 30mg/day now, which is still on the low end, though this dose may work. I've got big time jitters, though, and even dividing it up 15mg t.i.d., I feel like I'm crashing at around midnight or 1:00 AM, hard. And although I experience this change late at night, it's not easy to get to sleep unaided. One plus about not being in the study is I can augment and/or take hypnotics as appropriate. Benedryl for those times I just need to sleep works pretty well. I've noticed for jitters I can take a little lorazepam on occasion if it's really annoying, but then I feel spacey, so I try not too.

I'm hoping this wound-up feeling gets better with time. It's nothing at all like the "hypomanic" (not sure of the validity of that term for the state I was in) feeling I had when first getting the active drug transdermally. This is like the worst experience I ever had with coffee multiplied. It's hard to sit still, and my hands are all over myself. That was an annoying habit I had that I was told was connected to OCD: The tendancy to kind of pick at myself or bite my nails compulsively. I really do find myself rubbing at my scalp or face without even noticing it, biting nails or fingertips, etc. and then catching myself and feeling embarassed.

On the plus side, I'm feeling a bit better emotionally. I don't know if this is due to MAO inhibition or just plain stimulant high. But it's a step in the right direction.

Some thoughts I have had about augmentation have been:

Inositol: As many of you know, this has shown some efficacy for OCD in a very limited, double-blinded study done in Israel, though I think it had a good design (near perfect placebo, for one thing). Only trouble is, the dose assayed was 18g/day, which is kind of absurd. I may try to buy myo-inositol by the kg from Sigma. It's relatively cheap that way, and I know it's pure. They may not go for it, though. Even still, something I have to take by the shovel-full doesn't appeal to me entirely.

Risperidone: Not sure if anyone will go for this one. In some cases, this atypical antipsychotic has shown some promise for refractory OCD patients at low doses. It is theorized that in the low dose range it may help by blocking dopamine receptors, while higher doses it might exacerbate OCD symptoms by antagonizing 5-HT receptors. I'm thinking this might be a good choice if administered carefully, mostly to counteract some of selegiline's more troublesome (for me) properties: Mainly it's a big-time dopamine potentiator, with MAO-B and DA-reuptake inhibitory properties, as well as (weak) amphetamine metabolites. My main worries are (in no special order) A) My doctor will laugh at the mere suggestion B) Loss of some good antidepressant effects, and C) All the other crap that comes with taking antipsychotics.

Well, we'll see. It hasn't all been a barrel of laughs. But then again, it's a far cry from the suicidal nightmare of early 1999. I'm still grateful for that.

 

Re: Selegiline without the Patch

Posted by Arne on April 11, 2000, at 16:14:18

In reply to Re: Selegiline without the Patch, posted by Adam on April 11, 2000, at 15:34:04

How about snorting the selegiline to avoid first-pass metabolism? Could that work?

 

Re: Selegiline without the Patch

Posted by Adam on April 11, 2000, at 19:19:37

In reply to Re: Selegiline without the Patch, posted by Arne on April 11, 2000, at 16:14:18

Whoops. I meant 15mg b.i.d. above.

As for intranasal selegiline, that's a new one to me. I have a feeling
just crushing the tablets and snorting a few lines of deprenyl isn't a good
idea. Perhaps an optimal preparation of selegiline for nasal delivery
might work, but I have no real clue, and no access to such a prep. I've
seen someone here consider sublingual delivery. My only response to that
might be a worry that incidental ingestion would necessitate the same
precautions needed for straight oral delivery, and, well, those tablets
taste like ass.

> How about snorting the selegiline to avoid first-pass metabolism? Could that work?

 

Re: Selegiline without the Patch

Posted by Elizabeth on April 14, 2000, at 1:08:39

In reply to Re: Selegiline without the Patch, posted by Adam on April 11, 2000, at 15:34:04

Hi Adam. Your selegiline experience sounds familiar, in some ways (mostly the negative ones)....

> I started out on 15mg/day. For the life of me, I can't figure out why it was suggested I try this, since I've seen no evidence anywhere of antidepressant efficacy at that dose, but the head of the selegiline transdermal system (STS) study I was in thought I should give it a go. It didn't really work.

Not surprised...but as you've seen, going up too fast can cause massive jitters! (Then again, I thought I was increasing it slowly, and you seem to have too, but we still got the jitters.)

> I'm up to 30mg/day now, which is still on the low end, though this dose may work. I've got big time jitters, though, and even dividing it up 15mg t.i.d., I feel like I'm crashing at around midnight or 1:00 AM, hard. And although I experience this change late at night, it's not easy to get to sleep unaided.

Tried Ambien?

> This is like the worst experience I ever had with coffee multiplied. It's hard to sit still, and my hands are all over myself. That was an annoying habit I had that I was told was connected to OCD: The tendancy to kind of pick at myself or bite my nails compulsively. I really do find myself rubbing at my scalp or face without even noticing it, biting nails or fingertips, etc. and then catching myself and feeling embarassed.

I don't have OCD (that I know of), but I've found myself doing this too at various times. It actually is related to the amphetamine-like actions and/or metabolites of selegiline. (I first experienced it when I tried adding Cylert to Nardil. I asked my pdoc about it, he said that sometimes people who've ODed on stimulants do that.)

> On the plus side, I'm feeling a bit better emotionally. I don't know if this is due to MAO inhibition or just plain stimulant high. But it's a step in the right direction.

Cool -- hope it lasts! I don't think you should have trouble getting your doc to prescribe Risperdal if you want to try that - lots of people take it with an antidepressant. It might help with the insomnia as well as the jitters and skin picking.

 

Re: Selegiline without the Patch

Posted by Adam on April 14, 2000, at 16:22:56

In reply to Re: Selegiline without the Patch, posted by Elizabeth on April 14, 2000, at 1:08:39

> Hi Adam. Your selegiline experience sounds familiar, in some ways (mostly the negative ones)....
>
Yeah, I wondered when I started if things you and others described might happen to me too, but hoped that since I had had such a positive experience on transdermal selegiline I would tolerate the oral administration better than I have. Unfortunately, it's been kind of a pain.

> > I started out on 15mg/day. For the life of me, I can't figure out why it was suggested I try this...
>
> Not surprised...but as you've seen, going up too fast can cause massive jitters! (Then again, I thought I was increasing it slowly, and you seem to have too, but we still got the jitters.)
>
Well, the initial intent was to keep me on 15mg/day indefinitely, and then when I complained it wasn't working, I was immediately bumped up to 30mg, which I foolishly complied with. The result was pretty dramatic and uncomfortable. I should have known better.


> Tried Ambien?

No, but I may get some. Heard anything about Sonata?

>
> I don't have OCD (that I know of), but I've found myself doing this too at various times. It actually is related to the amphetamine-like actions and/or metabolites of selegiline. (I first experienced it when I tried adding Cylert to Nardil. I asked my pdoc about it, he said that sometimes people who've ODed on stimulants do that.)

Well, everybody's got OCD these days. Anyway, I was very interested to read you have experienced similar things. Perhaps it is just a stimulant effect. "Picking" was something I kind of trained myself not to do after a while. Would what I'm experiencing fall under "akathisia?" I find it interesting that neuroleptics, which block DA receptors, cause restlessness, while stimulants, which antagonize DA receptors somehow (among other things), cause restlessness. Does akathisia come only later, after DA signalling has readjusted to dysregulation by DA receptor antagonism? And, are these symptoms of stimulants in some way or another inducing a state of "chemical OCD"? That would be way bad for me, I think.

>I don't think you should have trouble getting your doc to prescribe Risperdal if you want to try that - lots of people take it with an antidepressant. It might help with the insomnia as well as the jitters and skin picking.

I think so too, given what I've read about it in "the literature". I just don't know what goes on in practice, which is why I was concerned. I've suggested things to pdocs in the past that I thought made perfect sense, got poo-pooed, and then later I'd read about clinical cases where doctors did exacly what I thought would work. It's frustrating.

Anyway, as much fun as playing with drugs in my head can be, I'm reluctant in some ways to keep adding things to counter this-or-that side effect only to expose myself to new risks of other side effects. You tried parnate after sel. and had (besides the cardiovascular problems, which I don't want to minimize), some success. From what I've read, parnate seems to be quite a stimulant also. Is is less so than selegiline? I'm giving serious thought to just switching.

Thank you in advance for any or all answers...

-Adam

 

Re: Selegiline without the Patch

Posted by Noa on April 15, 2000, at 11:57:04

In reply to Re: Selegiline without the Patch, posted by Adam on April 11, 2000, at 15:34:04

>my hands are all over myself. That was an annoying habit I had that I was told was connected to OCD: The tendancy to kind of pick at myself or bite my nails compulsively. I really do find myself rubbing at my scalp or face without even noticing it, biting nails or fingertips, etc. and then catching myself and feeling embarassed.


Adam, although I have had such tendencies my whole life, it is only within the past couple of years that my scalp and skin picking has really become a problem. Especially last year or so. Your post now makes me think maybe it is related to the high dose of Effexor XR that I am on. Or could it be the ritalin? Or even the Serzone?

I have been thinking about lowering the Effexor XR anyway, because it definitely causes the jittery feelings, like your description of too much coffee. It gives me resltess legs at night, making it very hard to go to sleep. The serzone calms it a bit, but not enough.

Where can I get more info on the relationship between meds and these compulsive/impulsive body-focused disorders?

Noa

PS--good luck with the selegeline.

 

Re: Selegiline without the Patch

Posted by Elizabeth on April 15, 2000, at 15:39:47

In reply to Re: Selegiline without the Patch, posted by Noa on April 15, 2000, at 11:57:04

> Adam, although I have had such tendencies my whole life, it is only within the past couple of years that my scalp and skin picking has really become a problem. Especially last year or so. Your post now makes me think maybe it is related to the high dose of Effexor XR that I am on. Or could it be the ritalin? Or even the Serzone?

My guess: Ritalin.

> I have been thinking about lowering the Effexor XR anyway, because it definitely causes the jittery feelings, like your description of too much coffee. It gives me resltess legs at night, making it very hard to go to sleep. The serzone calms it a bit, but not enough.

I think the standard tx for restless legs syndrome is Klonopin or l-dopa (the former seems like it'd be a good choice for you).

> Where can I get more info on the relationship between meds and these compulsive/impulsive body-focused disorders?

I actually got a lot of results just from looking up "skin picking" on Medline. You might start there.

 

Re: Selegiline without the Patch

Posted by Elizabeth on April 15, 2000, at 16:03:34

In reply to Re: Selegiline without the Patch, posted by Adam on April 14, 2000, at 16:22:56

> Well, the initial intent was to keep me on 15mg/day indefinitely, and then when I complained it wasn't working, I was immediately bumped up to 30mg, which I foolishly complied with. The result was pretty dramatic and uncomfortable. I should have known better.

How long did you take 15 for before upping it?

> > Tried Ambien?
>
> No, but I may get some. Heard anything about Sonata?

Too short-acting, but it might be okay for you if you don't have trouble staying asleep.

> Well, everybody's got OCD these days.

????? !!!

> Anyway, I was very interested to read you have experienced similar things. Perhaps it is just a stimulant effect.

I'm sure it's a stimulant effect.

> "Picking" was something I kind of trained myself not to do after a while. Would what I'm experiencing fall under "akathisia?"

I don't think so....

> I find it interesting that neuroleptics, which block DA receptors, cause restlessness, while stimulants, which antagonize DA receptors somehow (among other things), cause restlessness. Does akathisia come only later, after DA signalling has readjusted to dysregulation by DA receptor antagonism?

I don't know about akathisia, but some of the extrapyramidal effects of neuroleptics are supposedly caused by down-regulation, notably tardive dyskinesias & dystonias.

As for your question, I guess anxious people just can't win when it comes to meds!

> And, are these symptoms of stimulants in some way or another inducing a state of "chemical OCD"? That would be way bad for me, I think.

I think you'd be the one to answer that, since you know what OCD feels like. Does this feel the same?

> I think so too, given what I've read about it in "the literature". I just don't know what goes on in practice, which is why I was concerned. I've suggested things to pdocs in the past that I thought made perfect sense, got poo-pooed, and then later I'd read about clinical cases where doctors did exacly what I thought would work. It's frustrating.

I know, I know! Of course, you realize that reading somebody's "we tried this with this one patient and it worked!" letter to the editor does not mean something is accepted practice. But, FWIW, I do know lots of people who've taken Risperdal who have nonpsychotic depression or manic-depression.

> Anyway, as much fun as playing with drugs in my head can be, I'm reluctant in some ways to keep adding things to counter this-or-that side effect only to expose myself to new risks of other side effects. You tried parnate after sel. and had (besides the cardiovascular problems, which I don't want to minimize), some success.

Actually I originally tried Parnate before selegiline -- wanted to see if I could find something else that worked and was tolerable that wouldn't be as risky as Parnate.

> From what I've read, parnate seems to be quite a stimulant also.

Eh, I think it is. I do get the itchies on it (mysterious! my internist wants me to see a derm about it), and I think I've probably been doing the skin picking thing more as a result. (This thread could get really disgusting if we wanted it to, you know. :) Also, it seems to have improved my attention somewhat, and it's not a very good general anxiolytic although it prevents panic attacks. (There's my critique.)

> Is is less so than selegiline?

Apples & oranges.

> I'm giving serious thought to just switching.

It really is too bad you couldn't stay on the patch. I hope that it gets approved -- do you think that transdermal administration might make other drugs more tolerable too?

> Thank you in advance for any or all answers...

Not sure how helpful I was, but you're welcome.

 

Re: Amusing note to Adam re: Selegiline...

Posted by CarolAnn on April 15, 2000, at 16:04:19

In reply to Re: Selegiline without the Patch, posted by Adam on April 14, 2000, at 16:22:56

Did you know that selegiline is being marketed for use in DOGS with emotional problems? They're calling it Anipryl, and apparently sales are quite good. And, as with the argument between antidepressants and talk therapy, there are arguments about using drugs verses "training" dogs better! I guess, it's true, "it's a dog's life"! Or something like that. Take Care! CarolAnn

 

Re: Picky, picky

Posted by Adam on April 16, 2000, at 22:38:06

In reply to Re: Selegiline without the Patch, posted by Elizabeth on April 15, 2000, at 16:03:34

> How long did you take 15 for before upping it?

I took it for about a month. For the first couple of weeks, I thought things were going OK, and I was kind of psyched, but then I really started to notice, especially by the end of the third week, a worsening in mood. It was slow to come, but it's like by the middle of the third week I found myself feeling really withdrawn, pessimistic, uninterested in being with anyone but my girlfriend, etc.

When I took the extra 15mgs, I felt an improvement in mood in about two to three days. This seems to fast, but now, having taken 30 mg. for about 8 days, I feel pretty good. Maybe I should monitor myself with an online HAM-D or something.

> > No, but I may get some. Heard anything about Sonata?
>
> Too short-acting, but it might be okay for you if you don't have trouble staying asleep.

Hmm. Well, I'll give it a try, I think, before going to the Ambien.

> > Well, everybody's got OCD these days.
>
> ????? !!!

Sorry! This is a bit sarcastic, though the irony isn't directed at you. I read an article someplace a while ago that OCD diagnoses were on the rise, and that some suspected people without OCD were getting misdiagnoses with greater frequency.

>
> > I find it interesting that neuroleptics, which block DA receptors, cause restlessness, while stimulants, which antagonize DA receptors somehow (among other things), cause restlessness. Does akathisia come only later, after DA signalling has readjusted to dysregulation by DA receptor antagonism?
>
> I don't know about akathisia, but some of the extrapyramidal effects of neuroleptics are supposedly caused by down-regulation, notably tardive dyskinesias & dystonias.
>
> As for your question, I guess anxious people just can't win when it comes to meds!

Rats. Above, I meant to say stimulants "agonize" DA receptors (saying stimulants stimulate sounds kind of funny), the implication being the DA system might become desensitized somehow following increased DA, maybe in a similar fashion to somatodentritic autoreceptor-mediated downregulation of other neurotransmitter systems.


> I think you'd be the one to answer that, since you know what OCD feels like. Does this feel the same?

Kind of, yeah. There's other stuff, too, but I don't feel like going into it now.

>But, FWIW, I do know lots of people who've taken Risperdal who have nonpsychotic depression or manic-depression.

Did any of them mention side effects? I would think that Risperidal might be helpful to manic-depressives because of its effects not only on the dopamine but serotonin systems. I hope to take it, if I do, in doses that only effect the DA system. My concern is that, while the DA effects are a pain for anxiety, they're part of this great antidepressant response I get from selegiline.

Man, this sucks sometimes.

> Apples & oranges.

Gotcha.

> It really is too bad you couldn't stay on the patch.

I never realised how much nicer selegiline would be on the patch than off. I don't know if it will get approved or not, but it seems to me that it should. People are using the selegiline transdermal system (STS) for a number of indications now, and all reports show it's easier to take that way, for reasons you already know. My only fear is that if they can't show it's a gangbusters antidepressant for a significant number of people, even if they approve the STS, it will be for doses far smaller than what I need, and I would have to plaster myself with patches to get the right amount. This is probably a silly concern, but it nags at me all the same.

>Do you think that transdermal administration might make other drugs more tolerable too?

I think that so long as one does not have a bad skin reaction either to the drug or the adhesive, and diffusion throught the skin to the bloodstream is efficient, such an approach should help with many drugs. I actually asked about other MOAIs, and was told that Parnate was "too toxic" for this approach. I don't know why. Also, while Dr. Bodkin was taking some blood from me (after an RA totally impaled me, but failed to hit the vein), I asked him: "Why the heck can I get an MAO-A and B inhibitory dose of selegiline and still eat cheese? What's going on in the gut, anyway?" His answer was that no one really knows. He also pointed out that higher doses than what I was taking on the patch necessitated dietary restrictions. There is partial inhibition of MAO-A in the gut at 20mg/day (what I was taking), but not enough to fully potentiate the tyramine pressor response. I don't know if this would be true for other MAOIs.

But even if there's no benefit to the patient in the area of dietary restrictions, the tolerability issues avoided by STS delivery must be significant indeed. Other drugs, so long as first-pass metabolism rapidly degrades the parent compound and produces troublesome metabolites, should, I think, be as transformed by transdermal delivery as selegiline: lower dose needed to reach efficacious levels in the blood; fewer issues with short half-life, as it is lengthened, and also drug administration is spread out evenly over the day; fewer annoying side effects from metabolites, not only because first-pass metabolism is avoided, but also because actual dose is far smaller than is needed for oral delivery.

I wonder if you might even do well on transdermal selegiline. If what the literature says is true, I was getting an effective dose of the parent compound well in excess of the equivalent of a 100mg oral dose, and felt better than I do now on a 30mg oral dose. And, at least for me, the response was fast as hell. Hands down the most amazing thing I ever tried for mental health.

> Not sure how helpful I was, but you're welcome.

Quite helpful, as always.

Take it easy.

 

Re: Amusing note to Adam re: Selegiline...

Posted by Adam on April 16, 2000, at 22:41:08

In reply to Re: Amusing note to Adam re: Selegiline..., posted by CarolAnn on April 15, 2000, at 16:04:19

Yes, I've heard about this. Mutts get Prozac for doggie OCD, too. I guess drugs might be especially useful for dogs, as it must be kind of hard to do targeted behavioral therapy on the poor things, language barrier and all.

> Did you know that selegiline is being marketed for use in DOGS with emotional problems? They're calling it Anipryl, and apparently sales are quite good. And, as with the argument between antidepressants and talk therapy, there are arguments about using drugs verses "training" dogs better! I guess, it's true, "it's a dog's life"! Or something like that. Take Care! CarolAnn

 

Re: Thank goodness for Psychobabble

Posted by Noa on April 17, 2000, at 12:33:14

In reply to Re: Selegiline without the Patch, posted by Elizabeth on April 15, 2000, at 16:03:34

>(This thread could get really disgusting if we wanted it to, you know. :)


While I was searching for "skin picking" in medline, I came across a study that surveyed a sampling of American adults and found that most people pick their noses!!

:^j

 

Re: Thank goodness for Psychobabble

Posted by Adam on April 18, 2000, at 17:33:05

In reply to Re: Thank goodness for Psychobabble, posted by Noa on April 17, 2000, at 12:33:14

"You can pick your friends, and you can pick your nose,
but you can't pick your friend's nose."

I simply must wonder aloud who on Earth funds such studies.

Good for a laugh, though!


> >(This thread could get really disgusting if we wanted it to, you know. :)
>
>
> While I was searching for "skin picking" in medline, I came across a study that surveyed a sampling of American adults and found that most people pick their noses!!
>
> :^j

 

Re: Thank goodness for Psychobabble

Posted by bob on April 18, 2000, at 22:38:19

In reply to Re: Thank goodness for Psychobabble, posted by Adam on April 18, 2000, at 17:33:05

> "You can pick your friends, and you can pick your nose,
> but you can't pick your friend's nose."

I always have preferred:
"You can pick your friends and you can pick your nose,
but you can't wipe your friends on the side of the couch."

;^)
bob

 

Re: pick your friend's nose? not exactly, but...

Posted by CarolAnn on April 19, 2000, at 9:16:07

In reply to Re: Thank goodness for Psychobabble, posted by Adam on April 18, 2000, at 17:33:05

> "You can pick your friends, and you can pick your nose,
> but you can't pick your friend's nose."
>

BUT, when you have a best girlfriend and you are both entering a big party or special event, you WILL take turns tilting your heads back and doing "boogie checks"(just looking to see if there's anything "visible" your friend needs to take care of)! CarolAnn


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