![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 180 to 204 of 434. Go back in thread:
Posted by Elizabeth on August 7, 2001, at 8:31:56
In reply to Re: Update Lorainne, Elizabeth, et. al., posted by shelliR on August 6, 2001, at 20:35:14
> Tomorrow will be my first day on Parnate. I think I'll take 5mg in the morning and hope for the best.
I hope that works out for you. The sleep problems -- difficulty maintaining sleep at night and drowsiness in the afternoon -- seem to be pretty much universal with MAOIs, unfortunately.
> In the meantime, my pdoc gave me the okay to up my oxycontin (10mg bid to 10mg bid + 10mg prn).
Good! So you don't have to worry about what happens with your therapist.
> And he changed my klonopin to valium.
So Valium works for you for panic attacks? That's weird. How much do you take?
> I really haven't seen any brillance, just more openness to options.
That's better than brilliance, IMO.
> My therapist said on the phone over the weekend that I was exhibiting addictive behavior; I replied that
> I was exhibiting the behavior of someone horribly depressed who is trying to stay alive and *really* doesn't
> want to go into the hospital *again*.I really don't think your therapist is in a position to make value judgments like that.
> I asked my pdoc about a switch to buprenorphine instead of oxycontin because of the less addictive possibility, but
> he didn't think it was worth it. (See I was trying to show my non-addictive behavior. :-) )Jeez. I think he's probably right, although you might try switching to buprenorphine if the OxyContin loses its effect: I think you're less likely to become tolerant to buprenorphine. (I could be wrong about that, of course. I've never even taken oxycodone.)
> So I am still with my therapist (she didn't really believe he'd add more oxy as a prn), and we've agreed not to talk
> about medication.That's probably for the best. Your therapist isn't an MD, is she? (For a while I was in the odd position of seeing an MD therapist and another MD for meds.)
> ... I really wanted to work out attachment issues with her--not
> just switch therapists again and move the attachment to someone else like I always do. Then after attachment, work
> on intimate relationship issues.This stuff is very foreign to me. How does one "work on attachment issues?" (And what are attachment issues, anyway?)
What's your therapist's approach/school of thought, if you know?
> But I do feel a lack of respect for me eminating
> because of the codone/contin and have felt it before regarding several things I've done that she strongly disagrees with.Therapists aren't superhuman. They make judgments and have subjective opinions just like everybody else does.
> And I wondering, Elizabeth if you've gotten any information that is helpful to you re serum levels.
Uh. No, not really. I talked to the doctor who's covering for my pdoc; he said that he would expect a dose of 300 mg/day to result in a serum level of about 200-250 in a normal metaboliser.
> Have you felt anything different yet, since halving your dose? (i.e., not as well?)
Yes; it doesn't seem to be helping as much. I hope that I can find a level that isn't toxic but still works.
> Thanks for letting me write a book here; btw, haven't you guys ever heard of a library.
Your stories are more interesting than most books. :-)
Looking at later posts:
> What's the difference between cylert and concerta?
Cylert is pemoline -- a different drug altogether, not amphetamine-like. Concerta is just a new slow-release formulation of methylphenidate (i.e., Ritalin).
> > I've never tried getting medication from outside the U.S.
Is that because you'd have to pay out of pocket?
That, and the hassle. A lot of things. If it were something truly distinctive then I might consider it, but just for a different (and possibly less effective) formulation of a drug I can get here? Nah. I have thought about asking my pdoc if he'll show me how to give it to myself IM so that I don't have to do the whole lying down thing in the middle of the day.
-elizabeth
Posted by Elizabeth on August 7, 2001, at 8:35:08
In reply to Re: jumping in » Elizabeth, posted by Lorraine on August 6, 2001, at 12:10:22
I'm pretty sure that the headaches I was having when I was 14 were directly related to my depression. (I probably give the Prozac more credit than it deserves because although if it did anything for my depression it was very subtle, it did seem to do away with the headaches.)
-elizabeth
Posted by Lorraine on August 7, 2001, at 11:04:05
In reply to Re: Update Lorainne, Elizabeth, et. al., posted by shelliR on August 6, 2001, at 20:35:14
Hi Shelli, elizabeth, others:
I just wanted to say that when I address something in the heading to Shelli or elizabeth it is never meant to be exclusive--any and all readers, writers, thinker are welcome to join in.
> Tomorrow will be my first day on Parnate. I think I'll take 5mg in the morning and hope for the best.
That's how I started out too. Then day 2 5mg am and 5mg pm.
> In the meantime, my pdoc gave me the okay to up my oxycontin (10mg bid to 10mg bid + 10mg prn).
You may not need it, but I guess it's good for keeping your therapist at bay.
> And he changed my klonopin to valium.
> How can you give up a doctor like this who doesn't freak out about either valium or oxycontin, just doesn't
> return phone calls
Flexibility really counts, I think.> My therapist said on the phone over the weekend that I was exhibiting addictive behavior;
Shelli, do you have an addictive past?
> > >and we've agreed not to talk about medication.I wonder if you could do this generally with her. I mean what is she doing second guessing your meds anyway. We all "self-medicate" to the extent that we make do with what we have reducing doses, increasing doses--this is not considered a big deal normally
> > > but I really wanted to work out attachment issues with her--not just switch therapists again and move the attachment to someone else like I always do. Then after attachment, work on intimate relationship issues.
Shelli--do you have attachment issues with your therapist? Is she a surrogate parent in some way?
> > >I've already exposed all my shame with her, so I don't want to start over. (but if I've really worked out my shame issues with her why does it seem so scary to bring them up with someone else?)
Shame is a big, big, big, big ,big deal. I think. It takes a lot of faith in someone to work through shame issues with them. I'm not sure I could do that with someone who threatens to withdraw their approval of me. Also I'm wondering if working out attachment issues with someone who threatens to abandon you is best. Shelli, if you can't leave her now (and I understand how hard it is to do that and how hard it is to start with someone new) then maybe you should write her a letter about this stuff. Because it sounds like you guys have some things to work out here and it could be good for you to do this more immediate work on your relationship with her. (Shelli, I know I'm being pushy--so just take what you find useful and toss the rest. Judgmentalism is a huge issue with me. I'm allergic to it. :-)
> > >[re shame worked out] shelli--i had lot of shame issues that I worked out with my therapist and have disclosed to people who are very close to me (husband, friends). I don't think it would bother me to talk to a new therapist about them, but I haven't disclosed some to my mother (and I should just for healing) or my brother (might never be able to). Part of it is choosing people that it is safe to disclose things to. I don't think the "vulnerability" goes away--I think that it quits running you life though. Or, better way to look at it, loses its power slowly over time.
> > >[re why do I care what she thinks]
Huge issue for me Shelli--isn't this what "shame" is all about? I attended a Recovery Inc meeting last week where someone was talking about an encounter he had with his landlord and said "i realize i didn't have to let the bridge down". These guys have their own lingo--but the point was that there was the external world and the internal world and that we choose how much of the external world to allow in. Somehow this "bridge" concept clicked for me as an image. This make me think that Recovery inc might have something of value for you. You might check them out (they are everywhere).
> > > Hope you both (all --if there are any lurkers) are doing okay.
I'm doing well, actually. Yesterday, I took my second dose at 12:45 (instead of 1:30) and I exercised. I was able to sleep pretty well so that's encouraging.
> > > Thanks for letting me write a book here;
I'm glad you did. We share some issues.
btw, haven't you guys ever heard of a library. Lorriane, you could get The Magic Daugher from the library, *then* if you like it, buy it.
Yeah, I used to do that (it's actually great here, i can request books online and then pick them at my local library). The problem is that when I hibernate, I stop going out. So now that I am in an up-swing, I could start this again.
Lorraine
Posted by Lorraine on August 7, 2001, at 12:06:47
In reply to Re: jumping in Shelli » Lorraine, posted by shelliR on August 6, 2001, at 21:24:50
Shelli:
> > > I had that problem with nardil and sleep also. Afternoon sleepiness and horrible difficulty staying asleep at night. That never got any better for me so I had to stay on a relatively low dose of nardil. I am taking both atarax and klonopin hs, but that wasn't enough if I went above 45mg which is just a normal dose. So probably I will have to face that with parnate also.
> > > What is your pdoc suggesting, as far as the sleep problem?I haven't yet talked with my pdoc re sleeping issues. I would rather find a way of dealing with them without adding a sleeping pill to my packet of pills. Maybe a combination of good sleep hygiene, meditation (brain wave tapes that track the sleeping state), exercise, pill taking adjustment etc. What is atarax?
> > > because she thinks I'm going to end up a drug addict. She's been saying this for the past three years.Why does she believe this?
[re hospitals]
> > > Sometimes they've really helped me get through wash out periods and also times when the stress in my life was to great for me to handle and I had to I guess be "taken care of" in the sense that I didn't have to work, or explain why I wasn't working, or remember to eat, etc. Of course, a cruise might have also done the trick and I might have considered that if my insurance paid for cruises :-)Yes, I think hospitals are a tool to have in our case of tricks.
> > > > >I remain convinced that a possible *addiction* (habituation) to codone/contin is better than the other options.
> >
> > Yikes. (see that's how my therapist feels :-Yes, but I don't see your position as "bad" just lower on the list of alternatives than perhaps you have placed it. Jensen says the following: "since the opiates are a brain transmitte, they can fail like anyh other chemical systeim in the grain. Potentially abusable "reward center" chemicals are an integral part of the brain's circuitry". He also notes the opiates works partically by locking the release of substance P and that substance P antagonists are being developed which help depression. He says other stuff (I like his book, by the way, which you cannot get at the library:-)) The question isn't whether there are valid medical reasons for trying opiates, there are, the question is whether you will become addicted to them. To me this centers on whether you use them in an abusive fashion--ie to get high--and whether you are prone to addiction. See my pdoc wouldn't hesitate to prescribe opiates if that was what I needed. He does not believe that people become addicted when you medicate them with the "right" substance. He also doesn't believe addiction is an issue for me. It sounds like your pdoc agrees with this philosophy but your therapist wants to second guess this. Does she have good reason to think this will be a problem for you?
> > > well the parnate is being added to the oxycontin; so parnate doesn't have to carry the whole weight, nor will oxycontin.Parnate's pretty robust. You may not need more--although I am still on Neurontin, which surprising does offer some mood support and helps with the anxiety.
> > > I have ambivelent feelings. She is the smartest therapist I've ever had which is really important to me. She is able to teach me things about relating which make my life easier. She keeps me very focused, which is also important to me. She has a lot of experience with dissociative disorders, although my inside kids are not close to her, like my last therapist: that's a long story. She is very into EMDR, which hasn't helped me very much in my work with her, but sometimes I guess it's been good. She is wonderful on the phone with me when I am in crisis; never gets upset that I called and has a pager so she calls right back if she is in town. So those are her positives.This is a tremendous list of positives.
> > >With many of my past therapists it was frustrating for me to be quicker than they were, and just smarter in a certain type of way. I don't have that problem with her.
I really understand this point, although my best therapist was not smarter than me (she just really knew what she was doing and it's not brain surgery as they say but a real art). And my smartest therapist was not the best on for me. I think finding a good therapist is very difficult. It took me 20 years to find the one that unlocked the door to my personal bunker from he** and helped me clean house. These people are few and far between.
>
> Her negatives are that she is always believes she is right, and once she takes a stand, she won't back down.Shelli, you might think about writing her a letter and reading it to her in therapy. She can take the letter and think about it later. I find letters are helpful when people close their minds, especially if you keep it in the tone of "I feel". She sounds like a keeper, but ironing out your relationship issues with her would be a great thing, not just for you and her, not just for her (she could probably use some loving feedback in this area), but also for you and your future relationships.
> > The AD effects are strong.
> That's amazing --you've been taking it less than a week now? I'm not anticipating that for me, although I have heard that parnate takes effect faster than nardil. But a week vs five weeks?Well, I felt the Parnate on day 1. I felt Moclobemide on day 1. These are activating drugs. You feel them right away or at least I do. But my pdoc said I'd feel it right away also.
> There are side effects--mainly sleep related.
> We'll work on those.Yes, we will :-) Welcome to the club.
Lorraine
Posted by shelliR on August 7, 2001, at 12:33:18
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 7, 2001, at 11:04:05
Hi Lorraine, Elizabeth et.al.:
>
> I just wanted to say that when I address something in the heading to Shelli or elizabeth it is never meant to be exclusive--any and all readers, writers, thinker are welcome to join in.
I support that fully.
>> > In the meantime, my pdoc gave me the okay to up my oxycontin (10mg bid to 10mg bid + 10mg prn).
> You may not need it, but I guess it's good for keeping your therapist at bay.No, I do think I need it, at least until parnate hopefully kicks in.
>> > My therapist said on the phone over the weekend that I was exhibiting addictive behavior;
>
> Shelli, do you have an addictive past?
No. At one point I got pretty high up on valium (30mg a day) but that was only for one week. And then I got completely off of it. So, really no other addictions, except I am a true sugar/starch addict. If I bought a cake I would eat the whole thing. I have learned out to deal with that by not buying "whole " things. That is easy now, because I live alone, but at other times it has been a struggle. It is an absolute addiction though. Once I start, I can't stop, unless I am at someone's house or at a restaurant (and embarrassment saves me) and I even throw things out so I won't eat them. This is not a serious problem in my life, but I do have the feeling of what an addiction is, rather than wanting to take a drug that is potentially addicting because I don't want to feel depressed. The difference between sugar and say alcohol is that if I don't have sugar, I don't crave it.
> I wonder if you could do this generally with her. I mean what is she doing second guessing your meds anyway. We all "self-medicate" to the extent that we make do with what we have reducing doses, increasing doses--this is not considered a big deal normallyshe is a very opinionated person. I don't hold things back from her; we just "fight" at times. I made a commitment to her about only taking drugs that my pdoc prescribes (because I was taking vicodin on my own). So then I broke that commitment so I had to deal with how to proceed from there. Because my pdoc stepped in and said it was okay, I am back sticking to the commitment. This is really the only issue she has ever threatened me with, so I'm not all the time thinking is she going to terminate with me or anything. She is totally unflexable on this one because she thinks I'm in danger of becoming an addict. I don't agree, and I don't really care all that much when I am feeling very depressed. If my pdoc had said no, I would have supplemented with drugs off the internet and terminated with her. I couldn't tolerate that level of depression. And I knew that I was starting parnate, so it was a lifetime decision.
>
> > > > but I really wanted to work out attachment issues with her--not just switch therapists again and move the attachment to someone else like I always do. Then after attachment, work on intimate relationship issues.
>
> Shelli--do you have attachment issues with your therapist? Is she a surrogate parent in some way?
Attachment is a very complicated issue. There was a thread relating to that a month or so back and if you read the posts between marie, judy and I, you will get a sense, I think, about what it means to me. http://www.dr-bob.org/babble/social/20010717/msgs/7666.html>
> > > >I've already exposed all my shame with her, so I don't want to start over. (but if I've really worked out my shame issues with her why does it seem so scary to bring them up with someone else?)
>
> Shame is a big, big, big, big ,big deal. I think. It takes a lot of faith in someone to work through shame issues with them. I'm not sure I could do that with someone who threatens to withdraw their approval of me. Also I'm wondering if working out attachment issues with someone who threatens to abandon you is best. Shelli, if you can't leave her now (and I understand how hard it is to do that and how hard it is to start with someone new) then maybe you should write her a letter about this stuff. Because it sounds like you guys have some things to work out here and it could be good for you to do this more immediate work on your relationship with her. (Shelli, I know I'm being pushy--so just take what you find useful and toss the rest. Judgmentalism is a huge issue with me. I'm allergic to it. :-)Yes, you are being pushy :-). And that's okay--you care. But I'm pretty clear on this because I've worked with her for four years now and know what we can work out and what is just a waste of time and energy to keep pushing. The only issue about working together has been the meds. She has this strange thing about MDs. (Maybe because she's married to one, and at one point she was in medical school). She thinks if you're with a doctor you do exactly what he/she tells you to do, or you leave and find another doctor. Anyway, it's her belief system, I don't buy it completely. I think you also do what you have to to survive in life and if it means self-medicating, I don't have a problem with that. But I always tell my pdocs what I have done, always tell them if I am supplementing and if they can't handle working with me, it's their choice. Her complaint is that I tell after, not before.
>
> > > >[re shame worked out] shelli--i had lot of shame issues that I worked out with my therapist and have disclosed to people who are very close to me (husband, friends). I don't think it would bother me to talk to a new therapist about them, but I haven't disclosed some to my mother (and I should just for healing) or my brother (might never be able to). Part of it is choosing people that it is safe to disclose things to. I don't think the "vulnerability" goes away--I think that it quits running you life though. Or, better way to look at it, loses its power slowly over time.I really want to get the medication thing straight before I make any changes in my life. I have not disclosed some of my shame issues to anyone but her, and several other past therapists. But I have gotten the furthest on shame issues with her. I don't feel a need to share them with anyone else at this point. I am still working, I guess, on sharing them with her.
>
> > > >[re why do I care what she thinks]
> Huge issue for me Shelli--isn't this what "shame" is all about? I attended a Recovery Inc meeting last week where someone was talking about an encounter he had with his landlord and said "i realize i didn't have to let the bridge down". These guys have their own lingo--but the point was that there was the external world and the internal world and that we choose how much of the external world to allow in. Somehow this "bridge" concept clicked for me as an image. This make me think that Recovery inc might have something of value for you. You might check them out (they are everywhere).I'm not generally interested in support groups, but that does sound interesting. I was in a support group for several years with other women who had been sexually or emotionally abused and it was good but then I got to a point where I wanted to spend my time outside of therapy living, doing stuff, not focusing on pain, or how to do good things for yourself. I do a lot of nice things for myself and am pretty forgiving of myself. I have to work really hard on not letting people hurt me--really minor things hook right into my depression , and so far I can only deal with that cognitively, since that is my strongest function. And that is a very big thing that I recognize that I have to continue to work on.
>
>
> I'm doing well, actually. Yesterday, I took my second dose at 12:45 (instead of 1:30) and I exercised. I was able to sleep pretty well so that's encouraging.Very encouraging. Are you up to 20mg a day or 10?
>
> > > > Thanks for letting me write a book here;
>
> I'm glad you did. We share some issues.
Thanks.> Yeah, I used to do that (it's actually great here, i can request books online and then pick them at my local library). The problem is that when I hibernate, I stop going out. So now that I am in an up-swing, I could start this again.
I'm so glad that you are in an upswing; I don't think MAOIs poop out quickly in the same way SSRIs do.Shelli
>
Posted by Lorraine on August 7, 2001, at 12:37:29
In reply to Re: jumping in - Shelli, Lorriane, et.al. » Elizabeth, posted by shelliR on August 6, 2001, at 22:45:47
Hi: Shelli, Elizabeth, others:
> Well, I see it that way because I am so detached from it. When I stopped talking to my SIL it really drove her crazy; it still does. She'll call my mother and tell her that I didn't say hello, etc. But she has never said to me, "hey what's going on?" or "what don't you acknowlege me?" so it gives me a lot of power in the relationship. Although when I stopped talking to her it didn't have to do with power, more with self-preservation. But with such a judmental person, power is not a bad thing to have.
My MIL is vary judgmental. After years of trying to please her (10), I took her for a walk and told her that I was done trying to please her, that I thought she had always disliked me and that there was nothing that I could do that would change that, that it was painful for me to be around her and that I would no longer stay in her house, although she was free to visit us. What a load off my mind that was. I was respectful and loving during the talk. I'm not sure now 5 years later--with SIL hating me because of it--that it was the "right" thing. It was the only thing to do at the time to protect myself. But now I'm wondering about that concept of simply not extending the bridge to people who are hurtful to me as opposed to banishing them from the kingdom. It's an area I need to work on.
> > >in other words tried to figure it all out and not miss a step so that she wouldn't know. The funny thing is that she would not have cared; it was just impulse on my part to "be normal." Nothing precipitated it that I could figure out,
The drive to be normal, when you have a shame based core is pretty compelling in my case at least.
> > > I was raped at gun point in September of my senior year of college and I still have a lot of things I can't remember about it. It did not affect sex at all at the time, but my therapist thinks that I have never really dealt with it and that it is still affecting me. I was twenty and didn't tell my parents because I thought their knowledge would be more of a burden to me than a help. I finally told them about five years ago.Shelli--this is terrible. Don't you have some PTSD from this?
>
> There was a daytime tv show called "Queen for a day", when I was very very young, where three women would come on and tell how horrible their lifes were and the audience would vote for the one who had the worst life and she would win a refrigerator or a dishwasher or something like that.I didn't know that's what that show was about. I thought it was about people who embodied the highest notion of motherhood.
> > >I just had the feeling when I was writing about my rape that I was on that show: I was physically abused at age____, sexually abused at age_____, raped at 20. Do I get a refrigerator? :-)
Not exactly a refrigerator. Some how I think we could both be contestants, but I'm hoping you would win :-) It gives me some comfort though to see someone else who struggles with some of the same stuff I struggle with. I read a very moving article called "Depression and Spiritual Growth" http://chandra.astro.indianaedu/bipoloar/spirit.htm Anyway, he says we emotional depth, authenticity, compassion and strength. The article is great. I keep it in my emergency kit. He talks compellingly about suicide and why it is important that we resist it.
>
> What's the difference between cylert and concerta. I could look it up, but then I think I'd lose this post. I could look it up later!Concerta is a stimulant-like Ritalin, but 10-12 hr steady release; Cylert is pemoline, a stimuland that has some liver risk associated with it.
Lorraine
Posted by Elizabeth on August 7, 2001, at 15:05:26
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 7, 2001, at 11:04:05
> I just wanted to say that when I address something in the heading to Shelli or elizabeth it is never meant to be exclusive--any and all readers, writers, thinker are welcome to join in.
Same here -- we're not an exclusive clique or something. :-) This particular post is a response to things Lorraine said, but I'd be pleased if other people were reading too.
> That's how I started out too. Then day 2 5mg am and 5mg pm.
I started out on 10 mg q.d. That was fine, but when I started taking 20 mg in a single dose, my blood pressure would shoot up (from low-normal to 180/100 or so) about 1/2 hour after I took the Parnate.
Hmm, the "delete" button on this keyboard doesn't seem to be working (fortunately, "backspace" is an okay substitute). Anyone have any idea what's up with that?
> I'm not sure I could do that with someone who threatens to withdraw their approval of me. Also I'm wondering if working out attachment issues with someone who threatens to abandon you is best.
I concur on both pointts. This kind of behaviour -- making threats when she doesn't approve of something you do, etc. -- seems very unprofessional to me.
> Huge issue for me Shelli--isn't this what "shame" is all about?
That sounds right to me: rejection sensitivity, social or interpersonal anxiety, etc. are all connected to being worried what other people think about you.
> I attended a Recovery Inc meeting last week where someone was talking about an encounter he had with his landlord and said "i realize i didn't have to let the bridge down".
What's Recovery Inc?
> I'm doing well, actually. Yesterday, I took my second dose at 12:45 (instead of 1:30) and I exercised. I was able to sleep pretty well so that's encouraging.
How far apart are you spacing the doses?
> The problem is that when I hibernate, I stop going out.
I wouldn't describe it as hibernating, but one of the sure signs that I'm depressed is if I withdraw completely (even on the net).
> So now that I am in an up-swing, I could start this again.
I think it's a good idea to take advantage of times you are doing better. Not only does it utilise time more efficiently, I think it also might help to limit how far you crash when the good time ends.
> What is atarax?
A brand of hydroxyzine, a prescription-only "drowsy" antihistamine. Very sedating. Also very effective for itching, but it always gives me the munchies so I rarely use it.
> Yes, but I don't see your position as "bad" just lower on the list of alternatives than perhaps you have placed it. Jensen says the following: "since the opiates are a brain transmitte, they can fail like anyh other chemical systeim in the grain.
Wow, that really got mangled. :-) It's true, though: opioids activate the same receptors as endogenous chemicals produced by our own bodies. In general, drugs don't really do anything new: they just increase or decrease the amount, or imitate or block the action, of something we already have.
> The question isn't whether there are valid medical reasons for trying opiates, there are, the question is whether you will become addicted to them. To me this centers on whether you use them in an abusive fashion--ie to get high--and whether you are prone to addiction.
That's exactly right. If you don't abuse drugs, you won't get addicted (in the true sense of addicted -- pharmacologic dependence is not the same thing as addiction). Of course, some people have a much harder time resisting the temptation to take more than the necessary amount of a prescribed drug than others, but "medical addicts" (people who become addicted to a drug that was originally prescribed for a medical reason) are the exception, not the rule. Clinicians who work with addicts are biased because they see the patients who do become addicted, not the ones who don't.
> See my pdoc wouldn't hesitate to prescribe opiates if that was what I needed. He does not believe that people become addicted when you medicate them with the "right" substance.
I think it's possible. It's much riskier, though, to leave someone to self-medicate with street drugs; if they're taking a prescribed medication that's being monitored properly, there is much less chance that they will get into trouble with it.
Take care everybody.
-elizabeth
Posted by Elizabeth on August 7, 2001, at 15:46:31
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 7, 2001, at 12:33:18
[re oxycodone]
> No, I do think I need it, at least until parnate hopefully kicks in.Once you feel the Parnate starting to work (and I do believe it will work at least partially for you), my advise is to try to taper off the oxycodone *very* gradually. You might need to switch to the immediate-release formulation at some point (since the lowest strength OxyContin comes in is 10 mg, IIRC).
> > Shelli, do you have an addictive past?
>
> No. At one point I got pretty high up on valium (30mg a day) but that was only for one week. And then I got completely off of it.That's not addiction. I'm going to be unpacking my books later today; I'll post the definition of addiction that's given in DSM-IV. (I'm not a big fan of DSM-IV, but in this case I think they got it right, or at least came close. The definition underscores the fact that tolerance and "physical dependence" do not constitute addiction, although they can be signs of a possible addiction.)
> So, really no other addictions, except I am a true sugar/starch addict.
Heh -- did I ever tell you what I think the 4 food groups really are? (Starch, starch, carbohydrates, and starch.)
> Once I start, I can't stop, unless I am at someone's house or at a restaurant (and embarrassment saves me) and I even throw things out so I won't eat them.
It sounds like there might be something wrong with the mechanism that tells you when you're full (I think the hypothalamus is supposed to be in charge of this sort of thing). I experienced something similar on Nardil, and I do think it gave me a sense of what it's like to be an addict.
> The difference between sugar and say alcohol is that if I don't have sugar, I don't crave it.
Cravings are an essential feature of anything that is truly an "addiction," IMO.
> I made a commitment to her about only taking drugs that my pdoc prescribes (because I was taking vicodin on my own). So then I broke that commitment so I had to deal with how to proceed from there.
This is just my opinion, of course, but I don't see it as appropriate for her to be pressuring you into making "commitments" like that in the first place.
> This is really the only issue she has ever threatened me with, so I'm not all the time thinking is she going to terminate with me or anything. She is totally unflexable on this one because she thinks I'm in danger of becoming an addict.
I wonder why she believes that so strongly? I really do think she's crossing a professional boundary by making threats like that to you, even if it is only around that one issue. It seems to me that she might have personal issues of her own surrounding addiction.
> If my pdoc had said no, I would have supplemented with drugs off the internet and terminated with her.
I'm glad your pdoc is being reasonable, because it's much easier to get into trouble with drugs if they're not being monitored by a physician.
> ...I've worked with her for four years now and know what we can work out and what is just a waste of time and energy to keep pushing.
The rigidity/inflexibility that she's exhibiting really does bother me. It strikes me as something that she needs to work out rather than taking it out on her clients.
> She thinks if you're with a doctor you do exactly what he/she tells you to do, or you leave and find another doctor.
See, I think that regardless of whether or not it's necessary to follow your doctor's orders to the letter, that's an issue between you and your doctor, and it's not your therapist's business.
> I think you also do what you have to to survive in life and if it means self-medicating, I don't have a problem with that. But I always tell my pdocs what I have done, always tell them if I am supplementing and if they can't handle working with me, it's their choice. Her complaint is that I tell after, not before.
I think that you *should* try to decide on a plan with your doctor before implementing it, if possible, but if there's a problem and it can't wait, I don't think that there's anything wrong with taking it into your own hands.
> I really want to get the medication thing straight before I make any changes in my life. I have not disclosed some of my shame issues to anyone but her, and several other past therapists. But I have gotten the furthest on shame issues with her. I don't feel a need to share them with anyone else at this point. I am still working, I guess, on sharing them with her.
If I were in your situation, I'd have a hard time even speaking to her about meds. Like I said, it's not really her business. Ideally, I think one should be able to be completely open with a therapist; if a therapist tried to manipulate or threaten me the way yours has, I'd consider it to be interfering not only with the doctor-patient relationship, but also with my trust in her.
I think the important thing is whether you're doing what you believe is right -- not whether you're doing what your therapist believes is right.
> I do a lot of nice things for myself and am pretty forgiving of myself. I have to work really hard on not letting people hurt me--really minor things hook right into my depression , and so far I can only deal with that cognitively, since that is my strongest function.
This struck me in the context of your conflict with your therapist. Do you feel hurt by her threats? I'm actually kind of impressed that you can tolerate the way she's acted; I'm not sure I'd be willing to stay with a therapist under that kind of circustances. (Then again, my priorities regarding talk therapy vs. medication are probably very different from yours.)
> I'm so glad that you are in an upswing; I don't think MAOIs poop out quickly in the same way SSRIs do.
I've heard an awful lot of stories about MAOI and SSRI poop-out, actually. And Nardil definitely pooped out on me, both times I tried it. I hope that Parnate continues working in the long term for both of you.
-elizabeth
Posted by shelliR on August 7, 2001, at 20:26:45
In reply to Re: Update » shelliR, posted by Elizabeth on August 7, 2001, at 8:31:56
> So Valium works for you for panic attacks? That's weird. How much do you take?
I generally don't have panic attacks; they are more heavy duty dissociative attacks combined with anxiety. I don't know if I ever had a panic attack without concurrent dissociation. Valium has the effect of grounding me, and doing it within a short period of time. Between 5 and 10mg generally does the trick.> > My therapist said on the phone over the weekend that I was exhibiting addictive behavior; I replied that
> > I was exhibiting the behavior of someone horribly depressed who is trying to stay alive and *really* doesn't
> > want to go into the hospital *again*.
>
> I really don't think your therapist is in a position to make value judgments like that.
I'll reply to that when I process all that you guys have said about her behavior and when I have more time to write. It is getting dark and I have to go turn into a pumpkin...uh, I mean printer.
>
> > I asked my pdoc about a switch to buprenorphine instead of oxycontin because of the less addictive possibility, but
> > he didn't think it was worth it. (See I was trying to show my non-addictive behavior. :-) )
> Jeez. I think he's probably right, although you might try switching to buprenorphine if the OxyContin loses its effect: I think you're less likely to become tolerant to buprenorphine. (I could be wrong about that, of course. I've never even taken oxycodone.)
>
Well, I've already become tolerant to oxy in that it's taking 3 a day rather than two to eradicate the depression. But he doesn't seem concerned. (I wonder if anything concerns this guy?) Actually I think I have to be just as vigilent in observing myself in relation to prescribed drugs as I do when the drugs are not prescribed. I saw my gyn today and she agreed that habituation is not the worst thing in the world. I LOVE her. She is very open, and very informed. Sees shades of gray. The best type of physician.
> > So I am still with my therapist (she didn't really believe he'd add more oxy as a prn), and we've agreed not to talk
> > about medication.
> That's probably for the best. Your therapist isn't an MD, is she? (For a while I was in the odd position of seeing an MD therapist and another MD for meds.)Well, they're doing pilot programs where psychologists are doing an extra two or three years post doc and can prescribe meds. I think the pilot studies are being done in the army. My therapist will be first in line if it comes to that. And guess what! I would not let her be my medicating psychologist. (surprise, surprise.) It's an interesting idea and I can see both possible good coming out of it, as well as possible problems. After all what will psychiatrists do then? Who will need them if psychologists will do the same thing as a lesser fee. Elizabeth, you better think about this! Though the APA is such a strong lobby, I'll be surprised if it gets put into effect; my good friend who is a psychologist thinks things look headed in that direction. It's a complicated thing, I think.
>
>
> This stuff is very foreign to me. How does one "work on attachment issues?" (And what are attachment issues, anyway?)
see reference to a psychsocial babble thread (http://www.dr-bob.org/babble/social/20010717/msgs/7666.html) if you're up to reading about transference/countertransference/attachment issues).> What's your therapist's approach/school of thought, if you know?
Really a mixture, although she works a lot with dissociative disorder using hypnosis and now more often EMDR. And she deals with what is immediate first, like how are you going to get through tomorrow if you're fall apart, and uses a cognitive approach in many instances. I would hope she would adapt to the needs of the client, but I don't see her of course with anyone else.
>
> > But I do feel a lack of respect for me eminating
> > because of the codone/contin and have felt it before regarding several things I've done that she strongly disagrees with.
> Therapists aren't superhuman. They make judgments and have subjective opinions just like everybody else does.
>
absolutely.> > Have you felt anything different yet, since halving your dose? (i.e., not as well?)
> Yes; it doesn't seem to be helping as much. I hope that I can find a level that isn't toxic but still works.
When is your pdoc coming back? Are you presently doing therapy also?
>
>
> Looking at later posts:
>
>
>
> > > I've never tried getting medication from outside the U.S.
> Is that because you'd have to pay out of pocket?
>
> That, and the hassle. A lot of things. If it were something truly distinctive then I might consider it, but just for a different (and possibly less effective) formulation of a drug I can get here? Nah. I have thought about asking my pdoc if he'll show me how to give it to myself IM so that I don't have to do the whole lying down thing in the middle of the day.It's actually not much of a hassle getting drugs outside the country. Less hassle than giving yourself a shot, I would think.
Would you do this if you were out? I mean lying down is pretty easy when you're home, right!Shelli
Posted by Elizabeth on August 8, 2001, at 5:21:49
In reply to Re: Update » Elizabeth, posted by shelliR on August 7, 2001, at 20:26:45
> > So Valium works for you for panic attacks? That's weird. How much do you take?
>
> I generally don't have panic attacks; they are more heavy duty dissociative attacks combined with anxiety. I don't know if I ever had a panic attack without concurrent dissociation.Ahh that might explain it.
> Valium has the effect of grounding me, and doing it within a short period of time. Between 5 and 10mg generally does the trick.
Valium is like that: it works fast because of the way it is distributed. (5-10 mg is nothing. < g >)
> Well, I've already become tolerant to oxy in that it's taking 3 a day rather than two to eradicate the depression.
Does that mean that they aren't lasting as long? That can be an early sign of tolerance.
> I saw my gyn today and she agreed that habituation is not the worst thing in the world. I LOVE her. She is very open, and very informed. Sees shades of gray. The best type of physician.
She sounds great, yeah.
> Well, they're doing pilot programs where psychologists are doing an extra two or three years post doc and can prescribe meds.
I know, and I think that's a big mistake. There are all sorts of problems that come up: can they prescribe multiple drugs at a time? can they prescribe to medical patients who are already taking lots of other stuff? can they prescribe drugs that aren't considered to be "psychiatric drugs" for off-label uses or for side effects? can they order lab tests? etc. And of course: does a post-doctoral fellowship really prepare them to be able to do these things?
> My therapist will be first in line if it comes to that. And guess what! I would not let her be my medicating psychologist. (surprise, surprise.)
I think I could have guessed that. < g > I wouldn't see a psychologist to prescribe medications at all. (My best psychotherapy experiences have been with psychiatrists, not psychologists, social workers, or "counselors.")
> > > Have you felt anything different yet, since halving your dose? (i.e., not as well?)
> > Yes; it doesn't seem to be helping as much. I hope that I can find a level that isn't toxic but still works.
> When is your pdoc coming back? Are you presently doing therapy also?He's getting back in about a week, I think. Presently I'm seeing him for an hour every week. No separate therapist. Right now we're mostly dealing with meds; after we get that straightened out I'll think about whether I want to find a therapist, continue seeing my pdoc regularly, or just see him once a month for "medication management." Probably it will be the latter, as I haven't found talk therapy to be of much use for me.
> It's actually not much of a hassle getting drugs outside the country.
It is if you want to be completely legitimate about it! I'm really uninterested in buying drugs on the internet "grey market."
> Less hassle than giving yourself a shot, I would think.
I don't think IM injections are that hard to give, actually. Much easier than IV, for sure.
> Would you do this if you were out? I mean lying down is pretty easy when you're home, right!
Yeah, exactly; that limits where I can go and how much time I can spend there. I could give myself a shot anywhere private (bathroom, car, etc.). Really I'm hoping that the desipramine will turn out to be magic and I won't need buprenorphine anymore, but what are the chances of that? :-/
-elizabeth
Posted by Lorraine on August 8, 2001, at 10:41:34
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 7, 2001, at 12:33:18
Hi Shelli, elizabeth:
> No, I do think I need it, at least until parnate hopefully kicks in.Only you will know what works and what is needed.
> > > So, really no other addictions, except I am a true sugar/starch addict. Once I start, I can't stop, unless I am at someone's house or at a restaurant (and embarrassment saves me) and I even throw things out so I won't eat them.sugar addiction is real; so is starch addiction. I broke both addictions when I went low carb. Now I am very careful. If I start eating sugar or carbs (vacation or something), I have to really watch myself afterward to get off them again.
Shelli--just want to say that it's pretty easy to second guess you therapist decision from the peanut gallary but you are the one who knows her value and limitations and whether she is who you should be seeing right now. You seem to see things clearly and, amazingly, you seem to be able to pull back from her views when they are not useful. Good for you. There is also something for you to learn in her limitations--they force you to protect yourself emotionally in an involved situation. My husband is a general all-round good guy, but he has his limitations like the rest of us mortals. When I was in a toxic work environment that was really destroying me, he failed to see the danger in my continuing to work for an abusive boss--all he could see was the glitter and the gold of this "once in a lifetime" position. At the time, I verified my sense of reality through him--not realizing that he had this fault. One of the lessons I had to learn was to pull back from my enmeshment with him and discern whether his opinion was useful or not. It is a really important lesson and you seem to have a handle on it.> > > Yes, you are being pushy :-). And that's okay--you care. But I'm pretty clear on this
See what I mean? This is a healthy habit.
> > > I really want to get the medication thing straight before I make any changes in my life. I have not disclosed some of my shame issues to anyone but her, and several other past therapists.
The medication thing has to be in place first. And then you will only need to disclose to those people you choose and to whom it is appropriate. In my case, it helped to know that I was value and loved notwithstanding these shameful events.
> > > I'm not generally interested in support groups, but that does sound interesting.Well, I have a strong need for community right now.
> Very encouraging. Are you up to 20mg a day or 10?
Still 10. I'll move to 15 after I see someone re my hormones later this month or when I feel that 10 isn't cutting it. 10 is managable for me right now.
How is Parnate treating you?
Posted by Lorraine on August 8, 2001, at 11:31:37
In reply to Re: Update -- Lorraine and others, posted by Elizabeth on August 7, 2001, at 15:05:26
> I started out on 10 mg q.d. That was fine, but when I started taking 20 mg in a single dose, my blood pressure would shoot up (from low-normal to 180/100 or so) about 1/2 hour after I took the Parnate.
Start low, go slow might be in order sounds like. I'll keep this in mind.
>
> Hmm, the "delete" button on this keyboard doesn't seem to be workingFaulty keyboard, or you spilled water on it? (if so turn it upside down and let it dry out)
> > > That sounds right to me: rejection sensitivity, social or interpersonal anxiety, etc. are all connected to being worried what other people think about you.
Actually, I read an article on the "self-presentational theory of social anxiety"--which predicts that the likelihood and intensity of social anxiety increases as people become more motivated to make a particluar desired impression and less certain that they will do so successfully. Pretty much fit my SA to a tee.
> What's Recovery Inc?It's a support group for people with mental illnesses. I wrote a report in the "social" section of pyschobabble describing it last week.
> > > How far apart are you spacing the doses?8 am and approximately 1pm, but I may move them closer. Woke up at 4 am last night, couldn't get back to sleep easily.
> > > I think it's a good idea to take advantage of times you are doing better. Not only does it utilise time more efficiently, I think it also might help to limit how far you crash when the good time ends.that's the hard part of this illness--riding the waves up and down and mainly trying to stay afloat when things come crashing down.
>
> > Yes, but I don't see your position as "bad" just lower on the list of alternatives than perhaps you have placed it. Jensen says the following: "since the opiates are a brain transmitte, they can fail like anyh other chemical systeim in the grain.
>
> Wow, that really got mangled. :-)Yeah, but look how fast I typed it < vbg >
> > > See my pdoc wouldn't hesitate to prescribe opiates if that was what I needed. He does not believe that people become addicted when you medicate them with the "right" substance.
>
> I think it's possible.It's an interesting idea anyway. He also believes that you won't get side effects if the drug is right for you.
Next post
> > > I'll post the definition of addiction that's given in DSM-IV. (I'm not a big fan of DSM-IV, but in this case I think they got it right, or at least came close. The definition underscores the fact that tolerance and "physical dependence" do not constitute addiction, although they can be signs of a possible addiction.)
Addiction is widely misunderstood.
> > > She thinks if you're with a doctor you do exactly what he/she tells you to do, or you leave and find another doctor.
I suspect this is actually an issue your therapist has with her own relative power visa vie the medical profession and she wants you to know who is "boss"--probably her particular quirk.
> > > I think that you *should* try to decide on a plan with your doctor before implementing it, if possible, but if there's a problem and it can't wait, I don't think that there's anything wrong with taking it into your own hands.
I agree. I usually talk with my pdoc about starting doses, and normal min and max normal doses and then he sets me free to operate in that range, reporting back and getting direction as needed.
> > > I do a lot of nice things for myself and am pretty forgiving of myself. I have to work really hard on not letting people hurt me--really minor things hook right into my depression , and so far I can only deal with that cognitively, since that is my strongest function.
Ditto
not letting other people hurt me
not letting other people determine my worth
not determining my self worth based on what I do
not determining my self worth based on social or professional status
not determining my self worth based on the stock market
not determining my self worth based on what other's think of me
> > >I hope that Parnate continues working in the long term for both of you.Last post
> > > Valium is like that: it works fast because of the way it is distributed. (5-10 mg is nothing. < g >)How is it distributed?
> > >I wouldn't see a psychologist to prescribe medications at all. (My best psychotherapy experiences have been with psychiatrists, not psychologists, social workers, or "counselors.")My experience has been that psychologists are more gifted in talk therapy and psychiatrists or psychopharmacologists are more gifted in meds. By the way, elizabeth, what do you talk about in talk therapy? You sound like your issues are solely medical in nature. Is this right? No split personalities, no alters, no abuse--although I would think you would have social anxiety given the age of onset of your disease. I just saw your response on how you don't find talk therapy useful. I go in spells with it. If I find myself being maladaptive in my responses to something, I go back in. Also---and very interesting to me--one of my most successful bouts with therapy and for my husband as well--was with a social worker, who had developed a cognitive approach to issues. She ran a group like a class, giving homework and so forth. She was very talanted. Before my husband went to her class he believed that the way he did things was "right" and that others who failed to live up to his way of doing things were, well, flawed. Under her guidance, he came to see that his punctuality and exactness were actually driven by anxiety rather than correctness. It kind of destroyed his judgmental bubble. Yeah!!!
> > > > Have you felt anything different yet, since halving your dose? (i.e., not as well?)
> > > Yes; it doesn't seem to be helping as much. I hope that I can find a level that isn't toxic but still works.elizabeth, you can add an MAO to a TCA without a washout is my understanding. This might be the ticket for you.
> > It's actually not much of a hassle getting drugs outside the country.
>
> It is if you want to be completely legitimate about it! I'm really uninterested in buying drugs on the internet "grey market."elizabeth, it's easy to do it legitimately--that's how I did it. You just fax a script to a Canadian pharmacy and they mail you the meds together with a copy of your script (to clear customs)--it takes about 5 days to get your meds.
Lorraine
Posted by shelliR on August 8, 2001, at 11:43:26
In reply to Re: Update » shelliR, posted by Elizabeth on August 8, 2001, at 5:21:49
>
> > Well, I've already become tolerant to oxy in that it's taking 3 a day rather than two to eradicate the depression.
>
> Does that mean that they aren't lasting as long? That can be an early sign of tolerance.
I know I am becoming tolerant because sometimes 10mg is not enough and the depression is breaking through. Still, I don't worry too much about habituation. Life is too short to waste depressed and I have started parnate. Speaking of which,
today is my second day. So far no side effects or AD effects, but I am not expecting the anti-depressant effects to manifest as quickly as they did with Lorraine. That would be a nice surprise, but I am remembering my nardi experience. Still, I have had very good luck with drugs which don't make me feel drugged from the beginning. So I am optimistic and trying to be patient. It is fairly easy with the oxycontin to get me through.
>>
> > Well, they're doing pilot programs where psychologists are doing an extra two or three years post doc and can prescribe meds.
>
> I know, and I think that's a big mistake. There are all sorts of problems that come up: can they prescribe multiple drugs at a time? can they prescribe to medical patients who are already taking lots of other stuff? can they prescribe drugs that aren't considered to be "psychiatric drugs" for off-label uses or for side effects? can they order lab tests? etc. And of course: does a post-doctoral fellowship really prepare them to be able to do these things?Geez, Elizabeth. You sound exactly like a graduate of MIT who wants to go to medical school. :-)
>
> > My therapist will be first in line if it comes to that. And guess what! I would not let her be my medicating psychologist. (surprise, surprise.)
>
> I think I could have guessed that. < g > I wouldn't see a psychologist to prescribe medications at all. (My best
>psychotherapy experiences have been with psychiatrists, not psychologists, social workers, or "counselors.")I did placements on psych units as an undergraduate with the lamest residents. If I had to pick for therapy between psychiatrists vs. psychologists, (not knowing the individual), I'd go for the psychologist any time. They spend much more
of their time learning developmental stages and are better trained to do therapy. Sometimes residents don't even do therapy in their assignments, just basic hospital management of patients. The only counselors I've ever gone to have been body therapists also; one PhD in counseling; the other a MA. I can't understand why anyone would get a PhD in counseling, because that degree is not generally recognized by insurance companies. But it is as difficult, if not more so, to get into a clinical program for psychology,as medical school, because there are very limited spaces per school, like generally 8-12. So it may have been more practical for her to go on in counseling, especially if she was not willing to move (i.e., husband's job, kids in school here).Anyway, it is incredibly hot and I wish we would get one rain day for my flowers. Have you learned to drive yet?
Shelli
Posted by shelliR on August 8, 2001, at 20:28:02
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 8, 2001, at 10:41:34
Hi Lorraine, all
> Shelli--just want to say that it's pretty easy to second guess you therapist decision from the peanut gallary but you are the one who knows her value and limitations and whether she is who you should be seeing right now. You seem to see things clearly and, amazingly, you seem to be able to pull back from her views when they are not useful. Good for you. There is also something for you to learn in her limitations--they force you to protect yourself emotionally in an involved situation. My husband is a general all-round good guy, but he has his limitations like the rest of us mortals. When I was in a toxic work environment that was really destroying me, he failed to see the danger in my continuing to work for an abusive boss--all he could see was the glitter and the gold of this "once in a lifetime" position. At the time, I verified my sense of reality through him--not realizing that he had this fault. One of the lessons I had to learn was to pull back from my enmeshment with him and discern whether his opinion was useful or not. It is a really important lesson and you seem to have a handle on it.
>
> > > > Yes, you are being pushy :-). And that's okay--you care. But I'm pretty clear on this
>I've been thinking about both of your reactions to my therapist and thinking about what I am feeling about therapy in general right now. I am surprised and not surprised that my pdoc is allowing me to increase the oxy. In one sense he had previously said he could not justify raising it, but when I told him how much I was hurting and how much another hospitalization would disrupt my life, I wasn't really surprised that he increased it. Plus a hospitalization wouldn't have helped the pain, just keep me alive until the parnate kicks in, *if* it does. (I am optimistic, still)
It is hard to me to understand how both my last pdoc and my therapist could render such critical judgments about my choices in trying to deal with such horrible pain when they had no solutions. Well, like the saying "unless you have walked in another's shoes." I lost a lot of both my childhood and early adulthood; I'm really not willing to lose more of my life if I have any options. I don't get how they don't get that and I do see it as their problem, not a character flaw of mine.
Once before my therapist and I had a conflict about my life, which didn't involve her either. She expressed her disapproval that I set my business up as a corporation in order not to lose a specific gov't benefit. She said that it was not unlawful, but not in the spirit of the law; I told her that when she showed me her tax returns (and that of her MD husband) we then might approach the topic of the spirit of the law on equal ground!
Anyway, the fact that my therapist is so opinionated is really a pain at times, but she has never "hit" me, as they say "below the belt"; she has never hurt touched any sensitive points (shame issues) with her opinions, or I wouldn't/couldn't tolerate it. And I think I need to learn to accept peoples blind spots; just as I assume they accept mine. Only of course I don't see mine (or don't have any! :-)
btw, did you read any of the thread about attachment? Do you know what I mean now?
Aside from feeling a bit depressed, I am feeling a bit down tonight (two different things for me).
I bought a new treadmill (my other one died over the weekend), so I am up and running (well walking very fast) again which is good. But I don't get an endorphine release high; I can't figure that one out because I walk fast and push myself by setting inclines and I do it for 45 minutes. Any ideas why it's never affected my depression? Mostly the fact that it helps control my weight motivates me to do it.
>>
> > > > I'm not generally interested in support groups, but that does sound interesting.
> Well, I have a strong need for community right now.
Well, I remember you said you missed the community of work. Are you looking for any community, or are you still feeling that you need to be around more people who understand depression? Does a sense of community mean fitting into a group of some sort, e.g. work group, support group, etc. I mean what does that phrase mean for you?
>So you think 10mg of parnate is really making a huge difference?
Also, btw, my gyn doesn't think there is any reliable test for hormone levels, including the saliva test.
> How is Parnate treating you?
No complaints, no ad affects yet.Shelli
Posted by Lorraine on August 8, 2001, at 23:53:50
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 8, 2001, at 20:28:02
Hi Shelli, all
> > > It is hard to me to understand how both my last pdoc and my therapist could render such critical judgments about my choices in trying to deal with such horrible pain when they had no solutions.
It's pretty annoying isn't it--sort of like metting out advice from an ivory tower with nice clean gloves. This is why I'm always a bit in the face about things like length of wash-out periods, drug alternatives during wash-out and length of time before a med becomes effective and influences my mood.
> > >I lost a lot of both my childhood and early adulthood; I'm really not willing to lose more of my life if I have any options.I totally relate to the concept of lost time. The life train leaves the station and you are either on board or marking time by the side of the tracks. My FIL (whom I adore) visits; I am either vitally there or not; if my illness prevents me from being fully present, then that time is irretrievably lost and he is 76 so how many more opportunities are there. Or my child is 11, she will only be 11 once. It's an important age (they all are). I can't afford to miss it. In 7 years, she is out of the house, gone to find her own life, her childhood is gone. Well, here we are Shelli, this ticking clock thing drives me absolutely nut:-(
> > >I told her that when she showed me her tax returns (and that of her MD husband) we then might approach the topic of the spirit of the law on equal ground!I do like this, yes!
> > >And I think I need to learn to accept peoples blind spots; just as I assume they accept mine. Only of course I don't see mine (or don't have any! :-)
Except of course, your therapist< vbg >?
> > > > btw, did you read any of the thread about attachment? Do you know what I mean now?
You shamed me into it. I think I understand. My kids always say "look at this", "watch this, Mommy", "come listen to my new guitar piece, Mom". It's like their life only comes fully alive when I am there to witness it. My husband is the same way. His idea of a great day is to do anything and have me watch him. These is something about this--validate me by letting me be the center of your universe. It is supposed to be (according to my therapist) very important for kids to get their fill of this. The other piece--which I have thought about a lot--is the drive toward symbiosis with another person. Symbiosis, the melding of two into one. I felt it the first time I breast fed my children. I was transported. Also--at least for me--the need to be fully known and loved. I get this stuff in other ways--not with my therapist. You see where the children come in, and symbiosis of sorts with my husband (there is something like patina that comes with time), and being fully known and loved by husband and dear friends. I think I understand what you are talking about. Do I sound on track?
>
> Aside from feeling a bit depressed, I am feeling a bit down tonight (two different things for me).Sorry to hear this. I hope the Parnate kicks in soon.
> >
> > > > > I'm not generally interested in support groups, but that does sound interesting.
> > Well, I have a strong need for community right now.
> Well, I remember you said you missed the community of work. Are you looking for any community, or are you still feeling that you need to be around more people who understand depression? Does a sense of community mean fitting into a group of some sort, e.g. work group, support group, etc. I mean what does that phrase mean for you?Community is something that I never had when I was growing up. We moved and moved and moved and moved. Each new school year, I stood before that class (quaking in my SA) and introduced myself to a new group of classmates. We weren't army brats, so this group wasn't a bunch of drifters like us, they had all grown up together. We had no consistent family friends; we didn't go to church; noone knew us. We were always strangers. So a need for community is pretty strong with me in it's own right. Then when I get very depressed and start thinking that I may not win the lottery this time around on my game of med roulette, I feel like there is not enough holding me to this earth and I need to be here for my children, my husband, my mother, my friends. This specific need then becomes the need for others like me (depressed folk) to anchor me, to teach me their strategies, to lend me that look of sympathy that comes only from someone who Knows.
> > > So you think 10mg of parnate is really making a huge difference?Bear in mind, I am almost always on puny doses of drugs. Moclobemide was 75 mg (the average dose, i think is 300 and above); Selegiline 5 mg; Wellbutrin 100 (drove me out of my skin). I understand that for most people Parnate is between 20 and 40 mg. I wouldn't be surprised if I end up here or 5 mg higher. I am biting my nails and cuticles again--an indication that I am probably a bit overstimulated. What can I say, I take small doses and I feel things quickly--Effexor took the longest for me to feel positive effects from.
>
> Also, btw, my gyn doesn't think there is any reliable test for hormone levels, including the saliva test.She may be right. I don't think saliva testing has been used in controlled experiments. And I know--from personal experience-- that serum testing is pure b.s. What can I say? Women's needs haven't topped the medical research lists...
> > How is Parnate treating you?
> No complaints, no ad affects yet.Yea! What's your titrating schedule? By the way, I'm seeing my pdoc on Friday and will ask him re sleeping.
Lorraine
>
> Shelli
Posted by shelliR on August 9, 2001, at 0:20:15
In reply to Re: Update -- Shelli et al., posted by Elizabeth on August 7, 2001, at 15:46:31
>> > Once I start, I can't stop, unless I am at someone's house or at a restaurant (and embarrassment saves me) and I even throw things out so I won't eat them.
>
> It sounds like there might be something wrong with the mechanism that tells you when you're full (I think the hypothalamus is supposed to be in charge of this sort of thing). I experienced something similar on Nardil, and I do think it gave me a sense of what it's like to be an addict.No it's not about being hungry or full. Because I might not eat it all at one sitting. When I'm full, I'll wait until I'm not full then start on a cake for instance, again. And I won't eat anything else, no meals, just cake.
>
> > The difference between sugar and say alcohol is that if I don't have sugar, I don't crave it.
>
> Cravings are an essential feature of anything that is truly an "addiction," IMO.
Well there is something than other than habituation. It's sort of like the alcoholic can't take one drink thing. I'm sitting here not craving, sugar, carbs. But if I start on sugar then the cravings begin. So yes there is craving, but it's got to be set off.
>
re therapy terminations.I was talking to my therapist friend today about whether she would terminate a patient, who lets say, can't control her drinking, won't go to any support groups around it, and no therapy work is really being done. All the time is spent just cleaning up the damage in her life because of her addiction (relationships, drunk driving etc.) You could either work with this person with the hope that with your influence and support she would finally get into a program for her addiction, or you could feel like this is a losing battle and I'm not going to waste my time. We both decided we would probably choose the later, because it is so frustrating to work with addicts who won't admit, or do anything about their addiction.
So I think my therapist believes that if I self-medicate, I will go straight downhill, sabotaging any therapeutic work we could do. Except I've been self-medicating for almost four years now; premenstually only for the first three; more often in the last year. And I have not as yet gone straight downhill. It must be hard for her to give up a presumption that she has invested so much in, apparently.
> I wonder why she believes that so strongly? I really do think she's crossing a professional boundary by making threats like that to you, even if it is only around that one issue. It seems to me that she might have personal issues of her own surrounding addiction.
I very much doubt that she has her own issues, but maybe in her family. Or she is just very opinionated ; on my
behalf:-)
>
>
>
> > She thinks if you're with a doctor you do exactly what he/she tells you to do, or you leave and find another doctor.
>
> See, I think that regardless of whether or not it's necessary to follow your doctor's orders to the letter, that's an issue between you and your doctor, and it's not your therapist's business.
I agree; but pdocs seem to want to communicate with therapists and vice-versa. Sometimes I think it's social, or networking., rather than a necessity for the benefit of the patient. My last pdoc and this therapist had lunch together (my pdoc told me this, not my therapist). And I thought, how nice, perhaps they'll become friends. And how odd they didn't invite me. < g >
Also, I think at this point she thinks I choose pdocs who will give me opiates and she is right. So there is some question on her part about my choices :-)good night, all.
Shelli
Posted by Elizabeth on August 9, 2001, at 9:29:29
In reply to Re: Update -- Lorraine and others » Elizabeth, posted by Lorraine on August 8, 2001, at 11:31:37
> > I started out on 10 mg q.d. That was fine, but when I started taking 20 mg in a single dose, my blood pressure would shoot up (from low-normal to 180/100 or so) about 1/2 hour after I took the Parnate.
>
> Start low, go slow might be in order sounds like. I'll keep this in mind.Well, I didn't have any problem with 10 mg, and I think the spontaneous hypertension that I got is the exception, rather than the rule. So increasing in increments of 5 mg seems at least conservative enough to me.
> Faulty keyboard, or you spilled water on it? (if so turn it upside down and let it dry out)
I think it must have just been a temporary lapse, because it's working fine now. I didn't spill anything on it (good thing since it's not my keyboard!).
> Actually, I read an article on the "self-presentational theory of social anxiety"--which predicts that the likelihood and intensity of social anxiety increases as people become more motivated to make a particular desired impression and less certain that they will do so successfully. Pretty much fit my SA to a tee.
That seems reasonable. There is definitely a temperamental aspect to it: some people are born shy.
> > What's Recovery Inc?
>
> It's a support group for people with mental illnesses. I wrote a report in the "social" section of pyschobabble describing it last week.Ahh. Mental illnesses in general? Sounds like it could be a very diverse group.
> 8 am and approximately 1pm, but I may move them closer. Woke up at 4 am last night, couldn't get back to sleep easily.
I found that spacing them as little as 2 hours apart was fine; when I was taking 60 mg/day, I would just take one every couple hours (or whenever I remembered < g >). (30 mg definitely was not enough for me, BTW.)
> that's the hard part of this illness--riding the waves up and down and mainly trying to stay afloat when things come crashing down.
It sure is. I hope the Parnate will smooth things out for you.
> > Wow, that really got mangled. :-)
>
> Yeah, but look how fast I typed it < vbg >Two words: tortoise. hare.
> It's an interesting idea anyway. He also believes that you won't get side effects if the drug is right for you.
I'm more dubious about that. Just about any active drug has side effects. My experience has been that the ones without side effects don't have much effect at all (I'm thinking specifically of the non-drowsy antihistamines).
> Addiction is widely misunderstood.
That's for sure, and you can see it even on this board. I think it's sad how some people use the word "addict" as an insult. I mean, seriously: addicts are human beings with a serious illness.
> I agree. I usually talk with my pdoc about starting doses, and normal min and max normal doses and then he sets me free to operate in that range, reporting back and getting direction as needed.
That's how my pdoc and I operate too.
> How is it [Valium] distributed?
It gets taken up into the CNS very fast, then redistributed throughout the body. So it "hits" rapidly, but it doesn't work for nearly as long as you'd expect it to based on its elimination half-life.
> My experience has been that psychologists are more gifted in talk therapy and psychiatrists or psychopharmacologists are more gifted in meds.
That's what you might expect based on their training. But my experience with "talk" therapy has been that the match between client and therapist -- the "click" is how I think of it -- is more important than the particular type of therapy being practised.
> By the way, elizabeth, what do you talk about in talk therapy? You sound like your issues are solely medical in nature. Is this right? No split personalities, no alters, no abuse--although I would think you would have social anxiety given the age of onset of your disease.
That pretty much sums it up, yes. My childhood was pretty normal (other than some peculiar sleep problems which I've had all my life), certainly there was nothing that would explain my depression.
> I just saw your response on how you don't find talk therapy useful. I go in spells with it. If I find myself being maladaptive in my responses to something, I go back in.
That seems reasonable.
> Also---and very interesting to me--one of my most successful bouts with therapy and for my husband as well--was with a social worker, who had developed a cognitive approach to issues. She ran a group like a class, giving homework and so forth.
That sounds like CBT to me, yes.
> Before my husband went to her class he believed that the way he did things was "right" and that others who failed to live up to his way of doing things were, well, flawed.
I think that's a very common world view. I'm pleased to hear that your husband was able to change; IMO, that shows a lot of character.
> elizabeth, you can add an MAO to a TCA without a washout is my understanding. This might be the ticket for you.
I've thought about it. MAOIs and TCAs can be used together, yes. In the past I've tried to add TCAs to MAOIs without serum level monitoring, but I wasn't able to tolerate the tricylics (nortriptyline and amoxapine) at anywhere near the expected dose range (I only got up to 75 mg of each of those). Now I'm thinking that this might have been in part because I wasn't metabolising them adequately. Desipramine has such mild side effects that I tolerated it fine even at very high levels.
-elizabeth
Posted by Elizabeth on August 9, 2001, at 9:59:43
In reply to Re: Update » Elizabeth, posted by shelliR on August 8, 2001, at 11:43:26
> I know I am becoming tolerant because sometimes 10mg is not enough and the depression is breaking through. Still, I don't worry too much about habituation. Life is too short to waste depressed and I have started parnate.
That's how I feel: I think that even if you needed ever-increasing doses, it would be preferable to remaining depressed. (The DEA and state medical boards may not feel the same way, however.)
> Speaking of which, today is my second day. So far no side effects or AD effects, but I am not expecting the anti-depressant effects to manifest as quickly as they did with Lorraine.
My experience has been that MAOIs work faster than ADs are "supposed" to work (with some improvement being noticeable after 1 week). I've often wondered about the assumption that all ADs will take several weeks to start working -- is that really true, or does it only apply to TCAs?
> Geez, Elizabeth. You sound exactly like a graduate of MIT who wants to go to medical school. :-)
How odd! (What would such a person sound like, anyway? < g >)
> I did placements on psych units as an undergraduate with the lamest residents.
Residents can be pretty lame. They're just starting out, after all. (IMO they really ought to be supervised, at least the 1st-year ones.)
> If I had to pick for therapy between psychiatrists vs. psychologists, (not knowing the individual), I'd go for the psychologist any time.
This is what I would have expected, but my actual experience has been different. I don't think that the specific training that psychologists, social workers, et al. get is really all that relevant to how good they are as therapists (for me, anyway).
> I can't understand why anyone would get a PhD in counseling, because that degree is not generally recognized by insurance companies.
They might have gotten the degree before managed care became widespread?
> Anyway, it is incredibly hot and I wish we would get one rain day for my flowers. Have you learned to drive yet?
I was afraid you'd ask that. :-)
> I was talking to my therapist friend today about whether she would terminate a patient, who lets say, can't control her drinking, won't go to any support groups around it, and no therapy work is really being done. All the time is spent just cleaning up the damage in her life because of her addiction (relationships, drunk driving etc.) You could either work with this person with the hope that with your influence and support she would finally get into a program for her addiction, or you could feel like this is a losing battle and I'm not going to waste my time. We both decided we would probably choose the later, because it is so frustrating to work with addicts who won't admit, or do anything about their addiction.
I think it's frustrating in general to deal with people who have problems they won't admit to or try to change; it's not unique to addictions.
-elizabeth
Posted by Lorraine on August 9, 2001, at 9:59:57
In reply to Re: Update » Lorraine, posted by Elizabeth on August 9, 2001, at 9:29:29
> > > Actually, I read an article on the "self-presentational theory of social anxiety"--which predicts that the likelihood and intensity of social anxiety increases as people become more motivated to make a particular desired impression and less certain that they will do so successfully. Pretty much fit my SA to a tee. > > > >
> That seems reasonable. There is definitely a temperamental aspect to it: some people are born shy.Yes, but people who have SA are not necessarily shy, although they can be.
>
> > > What's Recovery Inc?
> Ahh. Mental illnesses in general? Sounds like it could be a very diverse group.Could be, but my meeting only had 3 others in it and at least 2 were depressed.
> > > I found that spacing them as little as 2 hours apart was fine;
I may end up doing that and basically taking my whole dose in the am.
> > >(30 mg definitely was not enough for me, BTW.)
No, of course, not. I think I am a slow metabolizer (so drugs build up in my system quickly) and you are a slow metabolizer (or a partial non-metabolizer?) so that you need more drug to have an effect.
> > > It sure is. I hope the Parnate will smooth things out for you.Right now it is. I've also stopped taking the estratest, although I'll probably go back on it in a new formula that has progesterone in it.
> > It's an interesting idea anyway. He also believes that you won't get side effects if the drug is right for you.
>
> I'm more dubious about that.Me too.
> > Addiction is widely misunderstood.
>
> That's for sure, and you can see it even on this board. I think it's sad how some people use the word "addict" as an insult. I mean, seriously: addicts are human beings with a serious illness.Watched Traffic on Sunday--great movie.
> > How is it [Valium] distributed?
>
> It gets taken up into the CNS very fast, then redistributed throughout the body. So it "hits" rapidly, but it doesn't work for nearly as long as you'd expect it to based on its elimination half-life.Unless the effects that you want are not CNS but body effects, like breath rate?
> > > That's what you might expect based on their training. But my experience with "talk" therapy has been that the match between client and therapist -- the "click" is how I think of it -- is more important than the particular type of therapy being practised.Clicking is important especially if you need to be vulnerable to make progress, but my experience with CBT is that vulnerability and disclosure aren't as important and so "click" isn't either.
> > >My childhood was pretty normal (other than some peculiar sleep problems which I've had all my life), certainly there was nothing that would explain my depression.elizabeth, did you get SA as a result of having early onset depression?
> > > I think that's a very common world view. I'm pleased to hear that your husband was able to change; IMO, that shows a lot of character.
My husband is great. You marry one person and then 20 years later you are both different, having changed so much. The trick to marriage is to keep connected through all that change. My husband says that with all of the change I have gone through and my depression, he realizes that it is the prenumbra of me that he loves---it's like there is me and then there is who I might be at any given moment (actually he uses quantum physic metaphors to make his point).
>
> > elizabeth, you can add an MAO to a TCA without a washout is my understanding. This might be the ticket for you.I reread this--I'm wrong I think. You can add TCAs to MAOs but not visa versa, right?
When's your pdoc home? And how are you coping day to day? I see my pdoc tomorrow re sleep. Last night I upped the Neurontin from 300 to 500 and slept like a rock. Not sure this approach will last, who knows?
Posted by Elizabeth on August 9, 2001, at 16:42:05
In reply to Re: Update » Elizabeth, posted by Lorraine on August 9, 2001, at 9:59:57
> Yes, but people who have SA are not necessarily shy, although they can be.
Point taken.
> Could be, but my meeting only had 3 others in it and at least 2 were depressed.
That still leaves room for a lot of diversity. "Depression" is a big umbrella.
> > I found that spacing them as little as 2 hours apart was fine;
>
> I may end up doing that and basically taking my whole dose in the am.That might be helpful, although once you are at steady state, it shouldn't make much difference at what times you take it.
> I think I am a slow metabolizer (so drugs build up in my system quickly) and you are a slow metabolizer (or a partial non-metabolizer?) so that you need more drug to have an effect.
People who metabolise drugs slowly need to take lower doses; people who metabolise them rapidly need higher doses. Also, not all drugs are metabolised via the same pathways -- so someone who metabolises tricyclics slowly (like, say, me) might not have a problem metabolising, for example, Parnate. Usually these problems arise from drug interactions or enzyme deficiencies. Some people are just sensitive to side effects without having any sort of metabolic quirk.
> > It gets taken up into the CNS very fast, then redistributed throughout the body. So it "hits" rapidly, but it doesn't work for nearly as long as you'd expect it to based on its elimination half-life.
>
> Unless the effects that you want are not CNS but body effects, like breath rate?I think those are probably centrally mediated, actually.
> Clicking is important especially if you need to be vulnerable to make progress, but my experience with CBT is that vulnerability and disclosure aren't as important and so "click" isn't either.
Yes. I think that CBT tries too hard to take the "click" out of the picture -- to be uniform regardless of the personality of the therapist -- probably because cognitive-behavioural psychologists would like to be able to claim "objective" results. (Of course, these results are rated in a completely subjective fashion.)
> elizabeth, did you get SA as a result of having early onset depression?
No, I wouldn't say so. (I've always had some performance anxiety, though.)
> I reread this--I'm wrong I think. You can add TCAs to MAOs but not visa versa, right?
You can do either as long as you're careful. Starting with the TCA alone and then adding the MAOI is the preferred order.
> When's your pdoc home?
The important thing for me is not when he's home, but when he's back at the office. :-) (Middle of next week.)
> And how are you coping day to day?
Well enough.
> I see my pdoc tomorrow re sleep. Last night I upped the Neurontin from 300 to 500 and slept like a rock. Not sure this approach will last, who knows?
I've found that most sedating drugs stop working after a couple days, so that I need to increase the dose. Ambien is the one exception.
-elizabeth
Posted by shelliR on August 9, 2001, at 19:07:12
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 8, 2001, at 23:53:50
> Hi Lorraine, all
>>
> > > > > btw, did you read any of the thread about attachment? Do you know what I mean now?
>
> You shamed me into it.
I didn't mean to, just thought it was easier than me explaining again.>I think I understand. My kids always say "look at this", "watch this, Mommy", "come listen to my new guitar piece, Mom". It's like their life only comes fully alive when I am there to witness it. My husband is the same way. His idea of a great day is to do anything and have me watch him. These is something about this--validate me by letting me be the center of your universe. It is supposed to be (according to my therapist) very important for kids to get their fill of this. The other piece--which I have thought about a lot--is the drive toward symbiosis with another person. Symbiosis, the melding of two into one. I felt it the first time I breast fed my children. I was transported. Also--at least for me--the need to be fully known and loved. I get this stuff in other ways--not with my therapist. You see where the children come in, and symbiosis of sorts with my husband (there is something like patina that comes with time), and being fully known and loved by husband and dear friends. I think I understand what you are talking about. Do I sound on track?
>
Not really. Because some of the people writing in that thread and also many in my real life, have children, and I don't think the hole left from abuse and lack of protection/safety/mothering can be filled by parenting. It is the pain of something lost, really, developmental stages lost, and while children and spouse are very satisfying emotionally, (I hope), I think the other work is an inner work of griefing, etc. Actually I think it is best if it is worked out before motherhood, because an adult who still feels that emptiness/hurt might expect too much from her children--put too much pressure on them to "need" her. It may be that somewhere along the line, someone did mother you, or meet that need, or it may be something you worked out either with or without therapy.
> > Aside from feeling a bit depressed, I am feeling a bit down tonight (two different things for me).
> Sorry to hear this. I hope the Parnate kicks in soon.Today I had a migraine, hopefully not from the parnate. I didn't catch it early enough, like you said in a previous post, timing can matter. If I take advil, etc. at the first tiny sign, somethings that can avert the migraine. My migraines are fairly mild as far as migraines, but still annoying (pain behind my eye, sick in my stomach, but no vomiting or anything)
> > >
> > > > So you think 10mg of parnate is really making a huge difference?
>
> Bear in mind, I am almost always on puny doses of drugs. Moclobemide was 75 mg (the average dose, i think is 300 and above); Selegiline 5 mg; Wellbutrin 100 (drove me out of my skin). I understand that for most people Parnate is between 20 and 40 mg. I wouldn't be surprised if I end up here or 5 mg higher. I am biting my nails and cuticles again--an indication that I am probably a bit overstimulated. What can I say, I take small doses and I feel things quickly--Effexor took the longest for me to feel positive effects from.So are you saying "yes" ? < g >
>
>
< What's your titrating schedule? By the way, I'm seeing my pdoc on Friday and will ask him re sleeping.My pdoc wants me to go up other day by 5mg until I reach 30mg. He says he will be very happy if I can tolerate 30mg, but he doesn't have a ceiling. He's not worried about sleep; he thinks we can medicate that also. :-)
So tomorrow I will go up to 15mg and if I have another migraine I will probably go back down to 10mg for longer. He'll be away next week
later,
Shelli
Posted by Elizabeth on August 9, 2001, at 21:53:28
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 9, 2001, at 19:07:12
> Today I had a migraine, hopefully not from the parnate.
Some people do get headaches on MAOIs. Unfortunately, the triptans (which are serotonin agonists) can't be used safely with MAOIs.
A lot of the people I know who get migraines seem to have mood or anxiety disorders as well. I'm interested in the relationship, if there is one.
> My pdoc wants me to go up other day by 5mg until I reach 30mg. He says he will be very happy if I can tolerate 30mg, but he doesn't have a ceiling. He's not worried about sleep; he thinks we can medicate that also. :-)
If you have trouble tolerating meds, increasing it in increments of 5 mg is probably a good idea. It also might help to take it in divided doses to the extent that you're able.
I think he's right to be optimistic about the sleep thing. There's bound to be something that will work for you, and sedative-hypnotics are generally safe to take with MAOIs.
Best of luck to you, as always.
-elizabeth
Posted by Lorraine on August 10, 2001, at 0:21:33
In reply to Re: Update » Lorraine, posted by Elizabeth on August 9, 2001, at 16:42:05
> > > That still leaves room for a lot of diversity. "Depression" is a big umbrella.
Too broad an umbrella for drug selection efficacy, but not for CBT--which is how this group is oriented.
> > I may end up doing that and basically taking my whole dose in the am.
>
> That might be helpful, although once you are at steady state, it shouldn't make much difference at what times you take it.That should have been the case with Effexor also, but wasn't. I think sometimes there is more of a kick shortly after the drug is taken---although, honestly, if I took Effexor at 11 am I was fine with sleep at 3pm, I had difficulties.
>
> > >Some people are just sensitive to side effects without having any sort of metabolic quirk.Wouldn't you then expect that they would not reach a therapeutic dose before having side effects? You're right; it could just be sensitivity to side effects although low doses of some drugs, Effexor and Adderal, did work. I'll have to see what the break down is of drugs I've quit b/c of side effects and drugs I've abandoned b/c I could only achieve a partial response.
>
> > > Clicking is important especially if you need to be vulnerable to make progress, but my experience with CBT is that vulnerability and disclosure aren't as important and so "click" isn't either.
>
> Yes. I think that CBT tries too hard to take the "click" out of the picture -- to be uniform regardless of the personality of the therapist -- probably because cognitive-behavioural psychologists would like to be able to claim "objective" results. (Of course, these results are rated in a completely subjective fashion.)The CBT people I have seen act more like teachers than therapists.
>
> > elizabeth, did you get SA as a result of having early onset depression?
>
> No, I wouldn't say so.That's a stroke of luck, I'd say. The other kids didn't know about your depression and your depression didn't make you an odd duck socially? Good for you.
>
> I've found that most sedating drugs stop working after a couple days, so that I need to increase the dose. Ambien is the one exception.I'll keep that in mind. Thanx.
Lorraine
Posted by Lorraine on August 10, 2001, at 0:56:06
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 9, 2001, at 19:07:12
Hi Shelli:
> > You shamed me into it.
> I didn't mean to, just thought it was easier than me explaining again.You were right; it was an extensive thread. I was teasing about the shame.
>
> >I think I understand. My kids always say "look at this", "watch this, Mommy", "come listen to my new guitar piece, Mom". It's like their life only comes fully alive when I am there to witness it. My husband is the same way. His idea of a great day is to do anything and have me watch him. These is something about this--validate me by letting me be the center of your universe. It is supposed to be (according to my therapist) very important for kids to get their fill of this. The other piece--which I have thought about a lot--is the drive toward symbiosis with another person. Symbiosis, the melding of two into one. I felt it the first time I breast fed my children. I was transported. Also--at least for me--the need to be fully known and loved. I get this stuff in other ways--not with my therapist. You see where the children come in, and symbiosis of sorts with my husband (there is something like patina that comes with time), and being fully known and loved by husband and dear friends. I think I understand what you are talking about. Do I sound on track?
> >
> Not really. Because some of the people writing in that thread and also many in my real life, have children, and I don't think the hole left from abuse and lack of protection/safety/mothering can be filled by parenting.Fair enough. But what about the wanting to be at the center, wanting undiluted attention--not in a general way, but that thing that kids do "look at me"; Mommy listen to me.
> > >while children ... are very satisfying emotionally, (I hope), I think the other work is an inner work of griefing, etc.
My children forced me to do a lot of internal work in order to be a good mother---still when my youngest was turning 7 or so, I found that I had manuevered myself into a position of abandoning my children emotionally, the same way that I had been abandoned. Namely, my career was on such a hot track, that I was never home and didn't have time for them. I'm not sure I would have done the depth of work that I did without them because I would have been doing it for "me" and I'm not sure that would have been enough motivation for me. I really could not bear the thought of doing to them what had been done to me.
> > >Actually I think it is best if it is worked out before motherhood, because an adult who still feels that emptiness/hurt might expect too much from her children--put too much pressure on them to "need" her. It may be that somewhere along the line, someone did mother you, or meet that need, or it may be something you worked out either with or without therapy.
It's hard to say. I can't know your reality to know that difference. Certainly, it sounds like your abuse was more intense and deliberate than mine was. I know that I have always thought that I didn't really have a childhood. In fact, I didn't want to have children--they terrified me, plus I didn't understand "play" very well. I had my children to prevent my husband from leaving me. He desperately wanted children and would have left the relationship if I hadn't been willing to do this. Once I had my first child, everything change inside me. I used to say that it was like finding this remarkable sun roon in your house that you never knew was there. I don't know how much was hormone driven and how much was that I was so masculine in my career approach that I had blinders on the feminine. I'm glad I did it now, of course. It has given me an opportunity to build the family that I never had. I worry about the issue of enmeshment though also, it will be very hard on me when they leave home. I know that I have to start filling other pieces of my life so that there will not be so great a vacuum when they leave.
Ho, ho, shelli, here I am going on and on about the kids, well, you know that my mom and I have actually done some pretty intensive healing. she came to my therapy a couple of time and then I wrote her the letter that all mothers live in fear of receiving and read it to her. And, she, for whatever reason managed to stay with me toe-to-toe during this--it must have been very tough for her. And, then, my mother's abuse was neglect, which while not wonderful is much more forgivable than physical abuse. I do know that working through this stuff was pure he** though for me. Still, I may not have done the work without the kids pushing me from behind
> > > Today I had a migraine, hopefully not from the parnate.
Let's hope.
> > > > > So you think 10mg of parnate is really making a huge difference?
> >
>
> So are you saying "yes" ? < g >Yes.
> >
> < What's your titrating schedule? By the way, I'm seeing my pdoc on Friday and will ask him re sleeping.
>
> My pdoc wants me to go up other day by 5mg until I reach 30mg. He says he will be very happy if I can tolerate 30mg, but he doesn't have a ceiling. He's not worried about sleep; he thinks we can medicate that also. :-)Good. I have gotten a headache on this, but I think it is bruxism (teeth grinding) related--which is still med related.
>
> So tomorrow I will go up to 15mg and if I have another migraine I will probably go back down to 10mg for longer. He'll be away next weekWhat is with these guys and there vacations< vbg >?
Take careLorraine
Posted by Elizabeth on August 10, 2001, at 12:39:47
In reply to Re: Update » Elizabeth, posted by Lorraine on August 10, 2001, at 0:21:33
> > That still leaves room for a lot of diversity. "Depression" is a big umbrella.
>
> Too broad an umbrella for drug selection efficacy, but not for CBT--which is how this group is oriented.So it's a self-help CBT group as well as a support group? That's cool. There's a similar group (SMART Recovery) aimed specifically at addictions.
(I remain unconvinced that CBT has any specific effect in depression.)
> > That might be helpful, although once you are at steady state, it shouldn't make much difference at what times you take it.
>
> That should have been the case with Effexor also, but wasn't.Immediate release or XR? The immediate-release formulation can cause quite a roller coaster. Before Effexor XR was available, I remember a lot of people complaining about that.
> >Some people are just sensitive to side effects without having any sort of metabolic quirk.
>
> Wouldn't you then expect that they would not reach a therapeutic dose before having side effects?There's a good chance of that. It's just been my experience that there is wide variability in people's ability to tolerate side effects. And of course, some people are more bothered by particular side effects than others; some are more willing to wait if they believe the side effects will subside with time; etc.
> You're right; it could just be sensitivity to side effects although low doses of some drugs, Effexor and Adderal, did work.
Can you tell me more about what Effexor and Adderall did, and what doses you were on? The effective ranges for both these drugs are quite variable.
> I'll have to see what the break down is of drugs I've quit b/c of side effects and drugs I've abandoned b/c I could only achieve a partial response.
I'd be interested to see the results. :-)
> The CBT people I have seen act more like teachers than therapists.
Yes, exactly. They want to take the human element out of therapy because they're concerned with being "objective" and "scientific." But my experience has been that the human element is the most important (perhaps the *only* important) aspect of talk therapy.
> > > elizabeth, did you get SA as a result of having early onset depression?
> >
> > No, I wouldn't say so.
>
> That's a stroke of luck, I'd say. The other kids didn't know about your depression and your depression didn't make you an odd duck socially?I was an odd duck for other reasons -- I was labelled "highly gifted" when I was very young, I was reading long before most people my age, etc. I did have some social troubles when I was 10 or 11 (that was the time that I think I was depressed but didn't see a doctor or anything for it). I wasn't very interested in hanging out with other kids, so I became very isolated. Mostly I tried to immerse myself in school work as a form of distraction or sublimation.
About pdocs taking vacations: for unknown reasons, a large percentage of pdocs take a big vacation in August. I think they must all be holing up in a hotel in Paris or some kind of psychiatrists-only resort or something. :-)
Klonopin is usually effective for treating antidepressant-induced bruxism, I think. It also might help you sleep.
-elizabeth
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