![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 294 to 318 of 434. Go back in thread:
Posted by Elizabeth on August 31, 2001, at 9:16:05
In reply to Re: Parnate stuff » Elizabeth, posted by Lorraine on August 29, 2001, at 10:59:03
> Washouts apply to other drugs as well though...Is there not washout TCA to TCA?
It's not really a big deal with non-MAOI ADs, no.
> > > It's been about a month, although I increase my dosage about 2 weeks ago.
> >
> > How much are you taking now?
>
> 15 mg.Okay...I wouldn't base your conclusions as to how well it will work on how well it's working at 15 mg. (The minimum effective dose is usually 30, although I think that some effects become noticeable at 20.)
> Thanks for this input on sleeping meds, elizabeth. I really wanted your take on this. Actually, my hunch is if I keep taking 600-800 Neurontin at bed and use Ambien to sleep, I'll make it through the night.
Go with your hunch. (Works for me. < g >)
> I've read that long term use shouldn't be a problem with these (at least in terms of withdrawal or addiction).
Yes, that's true.
> But what do you think of the habituation issue--ie that you lose the ability to go to sleep without them.
I don't know about Neurontin; I never had that problem with Ambien.
-elizabeth
Posted by SLS on August 31, 2001, at 12:17:55
In reply to Re: Parnate stuff » Lorraine, posted by Elizabeth on August 31, 2001, at 9:16:05
> > Washouts apply to other drugs as well though...Is there not washout TCA to TCA?
>
> It's not really a big deal with non-MAOI ADs, no.Dear Elizabeth,
How long of a washout period do you think is sufficient when switching from Effexor to Nardil?
Thanks.
- Scott
Posted by Elizabeth on August 31, 2001, at 14:39:56
In reply to Re: Parnate stuff » Elizabeth, posted by SLS on August 31, 2001, at 12:17:55
> How long of a washout period do you think is sufficient when switching from Effexor to Nardil?
2 weeks is the conservative estimate. I'm not going to make any less-conservative recommendations, if that's okay. :-)
-elizabeth
Posted by SLS on August 31, 2001, at 15:41:01
In reply to Re: Parnate stuff » SLS, posted by Elizabeth on August 31, 2001, at 14:39:56
> > How long of a washout period do you think is sufficient when switching from Effexor to Nardil?
>
> 2 weeks is the conservative estimate. I'm not going to make any less-conservative recommendations, if that's okay. :-)
>
> -elizabeth
Thanks.My NYU guy agrees with you. I just needed a second expert opinion. You do rate in my eyes.
So, desipramine is treating you well? That's great to hear. How has it made things different?
Oldies but goodies.
Smiles...
- Scott
Posted by shelliR on August 31, 2001, at 16:42:29
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 29, 2001, at 0:36:06
Lorraine
still getting no antidepressant effects from the wellbutrin and am adjusting to it I think. It's hard to tell, I'll be out of town next week (Southwest) and getting everything in place before I go always makes me crazy. I only see my accountant once a year for business taxes (with extentions due Sept 10 (?)). I'm always crazy (and, always going away) so the fact that I remember this makes me not blame it on the wellbutrin.
>
> Are you feeling activated?
Extremely. When I get very anxious (and my depression is at least somewhat under control), I get very hyper. Yesterday in doing errands (bank, postoffice, accountant, etc), I probably would have been diagnosed as bipolar II . I was extremely verbal and I talked to everyone. I don't think I crossed any lines into totally inappropriate, but only because I was very aware of how hyper I was. Also, when I get tired, I can't sleep, but then generally move beyond that in the day. Sometimes when I am feeling activated but more mellow, I think wow, is this how high energy people feel? This would be nice.re continuing wellbutrin:
I'll be in a very mellow, non-pressured familar place, mostly by myself. So I am going to try to go up to 300mg. If that does nothing for the depression, I'm ready to move on. My pdoc put a limit on how high I can go on the oxy, but I have learned not to totally believe him. (If you recall, he told me no limit Monday!). He told me the first time he can't justify going up, but when I was unbearably depressed, he raised it. He may be saying this is a limit because he does want me to use judgment. In order not to be depressed, I would need to go up 10mg: (again the can't cut the *tablet* thing :-) ) and to sustain that state through the day and evening, it would be 20mg. My depression is tolerable now, but just so, depending on the time of day. Like I took doseII at 3pm and 5mg of valium, and I am very tired, but feeling good.I have an idea but I'm not sure if this is really a bad thing to do. I'd love to hear what you think and please, believe me--I am very strong in making decisions and would not hold you at all accountable. Instead of going up on the oxy, I was thinking of supplementing with a much lower dose of vicodin, since it is so much less potent. Then if it gets to the point where that is no longer working, I'll move up 10mg on oxy. I have vicodin here so there's no issue there. It's the issue of not telling my pdoc. He thinks I should increase the oxy, not add another opiate. But I'm pretty sure that has to do with writing prescriptions for both as a psychiatrist. (he hold me in the hospital it would really raise a red flag). I've never kept anything from my pdocs before, but I feel like it's my body and I'm the one at risk if he's going to set a limit on the oxy. This would allow me to go up much slower. Though in my heart I do not think my pdoc would let me really suffer. If you feel comfortable, feedback please.
> > > >It’s so scary to me how depressed I am when the oxy wears off--like when I wake up, or if I don't overlap doses; I truly don’t think I could stay alive without it.
> I'm glad you have it. You have strong survival skills. Without the oxy, you would check yourself into a hospital, right?I guess so. I would at least try that first. (Or maybe buphrenorphine, before the hospital). I have very strong feelings that I can not kill myself because it would totally mess up the rest of my parents' life. They love me very much and would not get over it. There's a few other people who it would affect very deeply, (sister, niece, nephew, close close friends), but it would not mess up their lives.
Also, when I'm not depressed, there is so much about life that I am still learning or find fascinating, etc. My depression is mostly not "I'm a worthless person" depression. It is as close to physical pain as I can imagine. That's another reason it does not feel so strange to take a narcotic to alieviate it.
> So, he's just this odd mixture and you need to extract your allotment of time from him. Ok. I picture him like a gnome without any time to spare.Well maybe he's 5'6" < g >
>
> Absent minded? Self-important?
I wouldn't say self-important or absent minded. I'm actually really not sure yet. It's sort of like a spoiled little boy thing--like knowing he can get away with it. I'll have to find out his birth order. Because he has first child (of same sex) success, but also a lack of responsiblity. I would guess youngest son. I'll have to ask him. (After I tell him he shouldn't wear white shirts, because he looks so much better with his orange and lime shirts. :-))
>
> >and he’s definitely rather not explain anything to you. But he would rather explain than listen, if that makes any sense.
Type A, can't stand to sit still and listen? Has to interrupt b/c he's gotta keep moving and in control?I'm exactly sure about that either yet. I think it's about having a map in his head and feeling it's not necessary to share, because he knows where he is going, or when to create a new map. So it's a control thing in that sense, but I'm not sure it's a competitive control thing. And also he thinks it wastes time, because he knows where we're going.
> > > > And I also have to say, "I can’t leave until you explain to me…., or else he’d get me out in literally five minutes with my drug schedule and scripts but no questions answered.
> At least you are willing to do that and hold his feet to the fire for your full 8 or is it 15 minutes?more like 8.
> > > > He has *never * asked "do you have any questions" :- )
> Most patients don't. My pdoc never asks this either. I just badger him with questions anyway. Mine is more absent professor type actually.Details, please. dress, body type, age, etc.
>>
> > > > > >I've tried nardil with just about every conceivable adjunct possiblity because it's the only AP that's ever helped
> You tried all this stuff with Nardil? Jeez--
well all stimulents except for concerta, and all APs were one day trials.
> OK,OK,OK. See I thought the term pills included both tablets:
good point.
[re parnate]
> Parnate is still a happening thing, although I am losing my temper a bit more.
Do you normally have a temper and ADs control that, or is the temper coming from the activating effect of parnate?
Update on parnate, please.Shelli
p.s., leaving Sunday. I'll still be on the net next week to some extent because not much happens after 10pm there.
Posted by Zo on August 31, 2001, at 16:47:57
In reply to Re: (brief hijack) » Zo, posted by Elizabeth on August 29, 2001, at 9:10:33
Posted by shelliR on August 31, 2001, at 17:32:39
In reply to Re: Update » shelliR, posted by Elizabeth on August 29, 2001, at 9:42:54
> Well, that could be chalked up to adrafinil being unavailable in the US. Fear of the unknown and all. But the BP elevation is more suggestive. Were you on a MAOI when you took Provigil, and if so what dose and how was your BP? All I have to go on about modafinil-MAOI interactions is my own reaction.You going to be frustrated with all questions about how much, because it's all a blur to me. My pdoc had her nurse-practitioner go through all my records and do the whole drug history thing, but I can't find it. So many of my failed drugs were at low doses, except I went pretty high up on topomax and serzone. I think I forgot the serzone/nardil combination in my list. Mostly my pdoc was the type that kept saying you didn't try it long enough, or you didn't go high enough. I was pretty stupid in the long trial thing. But those were the drugs that made me tired, or had no effect--not drugs I couldn't tolerate well. Topomax was my last straw. I feel no way every again am I going to completely waste three weeks of my life sleeping unless I have a signed written guarantee.
>
> > > So you find opioids activating too?
> > Yes, feeling PMS, tired and sick in my stomach. Take vicodin, wait 45 minutes, then go out and mow the lawn. :-)
> That's me! :-) (Nice to know I'm not alone.)That's what makes it so hard to turn away from. Takes away depression, adds energy. Except for tolerance (*big* except), it's the perfect drug for me and it sounds like for you also.
>
> > From what I've read the fentanyl patch often doesn't last as long as it's supposed to, and it's not good to change it more often.
> AFAIK you should change it as often as you need to. But you're right that it often doesn't last as long as it's supposed to -- that's a problem with many opioid analgesics (including buprenorphine and OxyContin).I mean, does oxycontin last twelve hours for anyone? I can see someone landing in a hospital being treated for horrific pain by an inflexible doctor and they'd be in horrible pain for four hours!
>>
> > So what's your next step with meds? (or life?)
>
> Meds: hoping to try a stimulant with DMI.
Concerta was my favorite: (actually the only one I could tolerate), if your insurance pays for it.Life: learning how to drive. (I did, at least, get a learner's permit.)
Congratulations. That is way cool (as my fourteen year old niece would say) :-)
Really, that's going to be a big upgrade for your other-than-city life.Shelli
Posted by Lorraine on September 3, 2001, at 20:48:59
In reply to Re: Parnate stuff » Lorraine, posted by Elizabeth on August 31, 2001, at 9:16:05
Elizabeth:
I was gone for the long weekend up near the Russion River in Northern California and so my delay in responding.
[re Parnate]
> > > > It's been about a month, although I increase my dosage about 2 weeks ago to 15 mg.> Okay...I wouldn't base your conclusions as to how well it will work on how well it's working at 15 mg. (The minimum effective dose is usually 30, although I think that some effects become noticeable at 20.)
I won't make it to 20, I don't think. When I went to 15, I started becoming irritable and cranky. I had hoped this would abate with time, but it didn't, so I stepped back down to 12.5, which left me with insufficient mood support and irritable to boot. So, I think, I'm off the Parnate and on to Nardil after a 5 day washout period on amphetamines and neurontin.
[re Ambien] Is this a strange medication or what????!! I'm not sure I get it yet. I take the pill 10 mg and take 800 neurontin (actually chewing them slightly so that the caps will process quicker), then wait 30 minutes, then lay down and feel like there is no way I can sleep. Maybe 30 minutes pass, then I start counting my breaths (which is what I do to still my mind) and tell myself I only have to count 20 breaths (breath in 1, 2; breath out 1,2,3,4). By breath 10 or so I'm asleep, but I don't know what to attribute it to. I never feel like I am coming on to the Ambien. Does this sound right?
> I don't know about Neurontin; I never had that problem with Ambien.I'm glad to hear that the Ambien is neither addictive nor habituating. I went out and bought ear plugs to help with the sleeping also.
So you are going to try augmenting your Desipramine with stimulants, I read. Adderal worked well with me. I read in the archives of Psychobabble that Desipramine and Nardil are a good combination--that the Desipramine avoided the weight gain issues with Nardil.
How are your driving lessons going? I tried to buy the book you recommended, but it's out of print so I've requested notification from Amazon of used copy sales (here's your chance!< g >)
Posted by Lorraine on September 3, 2001, at 21:45:26
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 31, 2001, at 16:42:29
Shelli:
What, both of us gone the same time. Well, I'm home now (big sigh).
> still getting no antidepressant effects from the wellbutrin and am adjusting to it I think.This is unfortunate.
> > > Are you feeling activated?
> Extremely. When I get very anxious (and my depression is at least somewhat under control), I get very hyper.I never got beyond the activation = anxiety phase with Wellbutrin.
> re continuing wellbutrin:
> I'll be in a very mellow, non-pressured familar place, mostly by myself. So I am going to try to go up to 300mg. If that does nothing for the depression, I'm ready to move on.It's nice to try this is a non-pressured environment where you can watch your reactions, although I find that sometimes I can miss seeing my depression if I am not around people. My depression is so apparent in my avoidance behavior and in the fact that my voice lowers an octive. Sometimes I can hear this voice thing in other people as well (like my best friend who also has depression on and off).
> > > My pdoc put a limit on how high I can go on the oxy, but I have learned not to totally believe him.
I agree that he sounds like he is just trying to keep you honest and accountable.
> > > [re oxy]Like I took doseII at 3pm and 5mg of valium, and I am very tired, but feeling good.
You don't mind feeling very tired? that would drive me nuts. I hate sedation.
> > > I have an idea but I'm not sure if this is really a bad thing to do. I'd love to hear what you think and please, believe me--I am very strong in making decisions and would not hold you at all accountable.Shelli, you are very strong period. I don't worry about whether you would feel pressure to conform to my opinion or even elizabeth's.
> > >Instead of going up on the oxy, I was thinking of supplementing with a much lower dose of vicodin, since it is so much less potent. Then if it gets to the point where that is no longer working, I'll move up 10mg on oxy. I have vicodin here so there's no issue there. It's the issue of not telling my pdoc. He thinks I should increase the oxy, not add another opiate.
Have you explained to him that you want to move up on your doses more gradually?
> > > But I'm pretty sure that has to do with writing prescriptions for both as a psychiatrist. (he hold me in the hospital it would really raise a red flag).
I would worry about the drug interactions and beyond that I might try it. (Dr. Koop has a good interaction checker).
I've never kept anything from my pdocs before, but I feel like it's my body and I'm the one at risk if he's going to set a limit on the oxy.
I don't think he is going to set a limit really. so perhaps honesty should rule the day. I haven't kept anything from my pdoc. I sort of figure that he is willing to take fairly substantial risks with me and I owe him honesty. I am also pretty confident that once you breach the "trust", all that risk taking gets withdrawn. More important for me to maintain the relationship than mess we my meds in a way he would be uncomfortable with. My goal is to enhance his comfort level. Whew! Having said all that, I don't think you should add the vicoden without his knowledge and consent:-(
[re: When things fall apart] I would at least try that first. (Or maybe buphrenorphine, before the hospital). I have very strong feelings that I can not kill myself because it would totally mess up the rest of my parents' life.
Well, that's the kids for me and my husband and mother and a few close friends.
> > > Also, when I'm not depressed, there is so much about life that I am still learning or find fascinating, etc.
This is good to recognize and remember when you need to.
> > >My depression is mostly not "I'm a worthless person" depression. It is as close to physical pain as I can imagine.
That's an odd way of putting it. But I think it is accurate for me as well.
> > >And also he thinks it wastes time, because he knows where we're going.
This would definately bother me, but then I like to have a lot more control and understanding about my medical stuff than most doctors are willing to indulge.
> > > > > He has *never * asked "do you have any questions" :- )
> > Most patients don't. My pdoc never asks this either. I just badger him with questions anyway. Mine is more absent professor type actually.
>
> Details, please. dress, body type, age, etc.Tall, sixty-something, lean, stooped, wirey hair. Passionate about his craft, tendency to think aloud, always willing to think and give full weight to what you say unless it is in accordance with orthodox medicine:-)
> > > OK,OK,OK. See I thought the term pills included both tablets:
> good point.Yeah, but I was still able to drive you nuts with it< vbg >
> > > Update on parnate, please.Temper and irritation became a fairly major issue so I scales back from 15mg to 12.5 with the end result being that I lacked mood support and was irritable to boot. So I think I'm on to Nardil. By the way, did you say you tried Nardil augmented with Desipramine? In the archives, someone raved about this combo.
Let us know how the Wellbutrin fairs in your continued trials.
Lorraine
>
> Shelli
> p.s., leaving Sunday. I'll still be on the net next week to some extent because not much happens after 10pm there.
Posted by Lorraine on September 4, 2001, at 21:25:50
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 3, 2001, at 21:45:26
Doing my washout from Parnate to Nardil with adderal and neurontin. Took 10 mg adderal this morning, fine. Took second 10 mg adderal this afternoon, started feeling funny. Tingling moving up my neck to my head and headache coming on, waited a little (not long) felt worse. Took blood pressure 165/97, i think. Took antidote crushed it under tongue, blood pressure came down, right away and within an hour or so was clearly normal, although high for me on MAO. I feel very hungover. Not an experience I want to repeat necessarily.
Posted by shelliR on September 5, 2001, at 11:15:08
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 3, 2001, at 21:45:26
Hi Lorraine.
> What, both of us gone the same time. Well, I'm home now (big sigh).big sigh of relief? I don't know if long weekends fit under the heading of vacations.
re continuing wellbutrin:
> > I'll be in a very mellow, non-pressured familar place, mostly by myself. So I am going to try to go up to 300mg. If that does nothing for the depression, I'm ready to move on.
> It's nice to try this is a non-pressured environment where you can watch your reactions, although I find that sometimes I can miss seeing my depression if I am not around people.My primary depression is there, whether people are around or not. That's why I call it so physical. I have had two days of 300mg of wellbutrin with very little improvement. It is so much easier to tolerate being depressed when I don't have to work--at least this type of depression.
But then I have also another type of depression/anxiety/angst that has to do with people and fitting in in life and that is much more apparent when I am around people, especially new people or people I don't know well. I'm not sure whether that could be medicated and if so, I'm not sure what I would have to give up in exchange.
In the last few days small things have made me realize that I have both very strong right and left brain hemispheres. But I can only be in one side or the other; my transitions are incredibly slow. Anyway I am really excited about realizing that. Maybe a small corpus colluseum (sp?). So maybe if my neurotic existential depression/anxiety was medicated, I would also lose my excitement at these useless discoveries.An example: For months I've been using :-) because I know it is the sign for smile. But I was thinking okay, first colon, then dash then parenthesis. For the first time last month I SAW that OF COURSE it is a smile sideways. I felt so stupid, because I am so visual. Then some other similar things came to mind and I realized when I am in left brain mode (i.e., writing posts, I am totally out of visual mode), so that was really fun to realize and I felt less stupid.
Anyway, I can only write things like that on the board because the post is directed to you. If it was directed to the whole board, I'd feel that I was totally boring everyone.
I'll take my chances on boring you < g >.
> > > > [re oxy]Like I took doseII at 3pm and 5mg of valium, and I am very tired, but feeling good.
> You don't mind feeling very tired? that would drive me nuts. I hate sedation.Well I have always been a spurt person--put total energy out then become really tired later. And I do felt strange about being so tired in the afternoon (sort of ashamed), and sometimes when I'm not home, it felt really bad. But that was a side effect that I *was* willing to accept. And if I can sleep for even 20 minutes to half-hour in the afternoon, I am totally energized the whole evening. I think not having children made it easier for me and working for myself. Still, it's amazing to have all this energy on wellbutrin, and if it doesn't work as my main AD, I can see it as an adjunct (rather than stimulants, for example)
BTW, I have asked my pdoc to do a nardil/wellbutrin combo, but he was less than enthusiastic. He said he has another idea first (which of course he didn't share with me). I think with him if I really insist on trying something, he will prescribe it for me. But since the oxycontin is making life even more than bearable (when I am up to the right amount), I will try to be patient with his ideas.
> Shelli, you are very strong period. I don't worry about whether you would feel pressure to conform to my opinionThat's good. I do have certain vulnerabilies that make me feel not very strong. And don't say (please) that everyone does--because not everyone wants to die because of their vulnerabilities.
> or even elizabeth's.
*even* Elizabeth's < g >. I get different things from both of you.
> Have you explained to him that you want to move up on your doses more gradually?He is not ideal in the area of accepting explanations. He says, "take as much oxy as you need, don't worry". That's his most often response to me: "don't worry" It's definitely a dismissal as well as reassurance. But let's not go there. :-)
> I would worry about the drug interactions and beyond that I might try it. (Dr. Koop has a good interaction checker).
I've already combined oxy and vicodin a couple of times for bad migraines.
> I've never kept anything from my pdocs before, but I feel like it's my body and I'm the one at risk if he's going to set a limit on the oxy.
> I don't think he is going to set a limit really. so perhaps honesty should rule the day. I haven't kept anything from my pdoc. I sort of figure that he is willing to take fairly substantial risks with me and I owe him honesty. I am also pretty confident that once you breach the "trust", all that risk taking gets withdrawn. More important for me to maintain the relationship than mess we my meds in a way he would be uncomfortable with.My goal is to enhance his comfort level.
??????? *his*? I think maybe I read that out of context.Whew! Having said all that, I don't think you should add the vicoden without his knowledge and consent:-(
>
I think I just caught your thought process in real time. < g >. I think you're right. I didn't feel at all guilty not telling him about the mixing for migraines because it might have become too complicated and I've only done it twice. But in general trust is incredibly important
> > > >And also he thinks it wastes time, because he knows where we're going.
> This would definately bother me, but then I like to have a lot more control and understanding about my medical stuff than most doctors are willing to indulge.Well, of course this is not a perfect match. But we've been there before. :-)
>> > Details, please. dress, body type, age, etc.
> Tall, sixty-something, lean, stooped, wirey hair. Passionate about his craft, tendency to think aloud, always willing to think and give full weight to what you say unless it is in accordance with orthodox medicine:-)Passionate is good. And he listens and thinks too. Sounds good; can't remember what that feels like. I wonder why he (and some people in general) are stooped.
>
>
>
> > > > OK,OK,OK. See I thought the term pills included both tablets:
> > good point.
> Yeah, but I was still able to drive you nuts with it< vbg >Oh, my, did it show? < vbg >
> Update on parnate, please.
> Temper and irritation became a fairly major issue so I scales back from 15mg to 12.5 with the end result being that I lacked mood support and was irritable to boot. So I think I'm on to Nardil. By the way, did you say you tried Nardil augmented with Desipramine? In the archives, someone raved about this combo.Does Desipramine have a brand name? I can't recall what that is off the top of my head.
I have a feeling that you will not be as sensitive to nardil as you were to parnate. Aside from sleep disturbance and afternoon fatigue (which I think is partially just my own blood sugar patterns), I was not at all conscious of taking a drug.
I wouldn't be disappointed if the nardil didn't kick in as quickly as parnate. I've never read about immediate anti-depressant with nardil. (Hopefully YMMV) If you get the afternoon fatigue or have difficulty sleeping, I'm sure you can work on that after. As for sleeping at night, I do need something to stay asleep. That has been a small price to pay considering that I feel that nardil really saved my life.
Be patient if my responses are not immediate. It turns out that by the time it's 10pm, I'm totally exhausted (no naps, so far). It takes more energy for me to write because I'm not used to using a laptop.
shelli
Posted by Lorraine on September 6, 2001, at 10:29:25
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 5, 2001, at 11:15:08
Shelli:
>
> > What, both of us gone the same time. Well, I'm home now (big sigh).
>
> big sigh of relief?Yes, still happy to be home, although I do love the place I was visiting-- a friends house that was homesteaded during the California land rush. No running water, 1300 acres in the middle of nowhere. It was beautiful and he is a good friend.
> re continuing wellbutrin:
> > > My primary depression is there, whether people are around or not. That's why I call it so physical. I have had two days of 300mg of wellbutrin with very little improvement. It is so much easier to tolerate being depressed when I don't have to work--at least this type of depression.Sorry the Wellbutrin isn't kicking in grand force for you. For me being enervated is a large part of my depression so if I am on an activating drug and "get busy" things seem ok. Then if I slow down and talk with people, it is very obvious that I am still in my depression. I guess I try to distract myself a lot.
> > > But then I have also another type of depression/anxiety/angst that has to do with people and fitting in in life and that is much more apparent when I am around people, especially new people or people I don't know well. I'm not sure whether that could be medicated and if so, I'm not sure what I would have to give up in exchange.Sounds like a bit of Social Anxiety? I know I have some.
> In the last few days small things have made me realize that I have both very strong right and left brain hemispheres.What an interesting thing to notice. Then your transition into the artist mode is a transition from one hemisphere to another.
>> > >Still, it's amazing to have all this energy on wellbutrin, and if it doesn't work as my main AD, I can see it as an adjunct (rather than stimulants, for example).
I found Moclobemide very activating as well. I only had to leave it because of the anxiety it caused me--which was not as bad as Wellbutrin, but too much for me.
> > > BTW, I have asked my pdoc to do a nardil/wellbutrin combo, but he was less than enthusiastic. He said he has another idea first (which of course he didn't share with me).Sounds like he has some plan mapped out in his head for your course of treatment. Maybe he derives cues from your reactions to the various drugs he tries you on.
> > >I do have certain vulnerabilies that make me feel not very strong. And don't say (please) that everyone does--because not everyone wants to die because of their vulnerabilities.
Your vulnerabilities sound very tender, more like wounds? Is there shame attached?
> > >He says, "take as much oxy as you need, don't worry". That's his most often response to me: "don't worry" It's definitely a dismissal as well as reassurance. But let's not go there. :-)
He's in the driver's seat as long as he knows where he is going and you are enjoying the view so to speak....
> > >[re trust and pdoc] My goal is to enhance his comfort level.
> ??????? *his*? I think maybe I read that out of context.You said you got this further on in your post. But just to make clear, I see the relationship with pdocs as a two way street. They have a certain amount of liability exposure for making more aggressive drug choices and need some assurance that we can be trusted to handle those drugs or they will become more conservative--which, when you are treatment resistant is not helpful. So I work on his comfort level. I'm a good girl; I report back; I don't throw him any loops and in turn, he is willing to try what he thinks will really work for me and not worry about liability issue. Now my therapist, on the other hand, works on my comfort level;-)---see the wink?
> > > > >And also he thinks it wastes time, because he knows where we're going.
> > This would definately bother me, but then I like to have a lot more control and understanding about my medical stuff than most doctors are willing to indulge.
>
> Well, of course this is not a perfect match. But we've been there before. :-)Shelli, I just have an incredible distrust of doctors and their abilities. I know it's unfair, but there it is. I'm sure my heavy handed participation in the drug selection for me is no better than your pdocs informed plan. At worst, we are both random and if that's the case, then it doesn't matter whose plan you follow so long as you don't unnecessarily retrace your steps.
>
> > >Passionate is good. And he listens and thinks too. Sounds good; can't remember what that feels like. I wonder why he (and some people in general) are stooped.He is stooped because of mild scholiosis (sp?)--curvature of the spine.
I'm off Parnate now. First day I tried using adderal during my washout period and had a mild hypertensive crises. I say mild to appease the medical gods because my blood pressure (165/96?) didn't approach a medical emergency. To me though the crises was extreme--very bad headache and terrible stiff neck. I took the antidote, relatively early (within 15 or 20 minutes of onset--hey, it was my first time, I wasn't sure what was going on). That really wiped me out. I'd say I was down for the count for 2 days. Yesterday, was filled with severe hot flash types
of symptoms and I don't know if this was from withdrawal from Parnate, the hypertensive crises, or the fact that I went of estrogen about 4 weeks ago. Plus, now that I am off the Parnate, I think it was causing some sexual dysfunction.I start the Nardil on Saturday. The sleep disruption thing is very upsetting to me and I'm not sure how I will fair with that side effect. Last night I took a valium in addition to the ambien and neurontin and slept well. But I'm not sure I want a benzo habit.
> > > I have a feeling that you will not be as sensitive to nardil as you were to parnate. Aside from sleep disturbance and afternoon fatigue (which I think is partially just my own blood sugar patterns), I was not at all conscious of taking a drug.I hope you are right. The afternoon fatigue though seems common and I don't think it's your blood sugar pattern. I started another thread on it and from the responses I got (n=3) it seems that blood pressure reaches a natural low between 3 and 4 pm daily; one person was medicated for low blood pressure while on MAOs; another adjusted over time (but didn't take his blood pressure.) My hunch is it's blood pressure related and because I took mine during on of these slumps and it was so clearly low my plan is to use salt tablets (there is a buffered type that is recommended--Thermosomething) and drink plenty of water and see if that helps. It will be my little experiment, I'll let you know.
> > >I wouldn't be disappointed if the nardil didn't kick in as quickly as parnate. I've never read about immediate anti-depressant with nardil.Unfortunately, I think you are right
[re desipramine and nardil]: Desipramine is the TCA that elizabeth is one right now and I believe that desipramine is it's brand name. If you do go back to Nardil, this combo might be worth a shot. Desipramine has a reputation for being activating, but, according to elizabeth, is better for sleep cycles than MAOs.
How is your vacation treating you otherwise?
Lorraine
Posted by shelliR on September 6, 2001, at 13:34:24
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 6, 2001, at 10:29:25
Hi Lorraine.
re continuing wellbutrin:
>Sorry the Wellbutrin isn't kicking in grand force for you. For me being ener is a large part of my depression so if I am on an activating drug and "get busy" things seem ok. Then if I slow down and talk with people, it is very obvious that I am still in my depression. I guess I try to distract myself a lot.In some ways being energized is helpful when I'm depressed. At other times, when I hurt so badly I can't stand it, sleep has always been my only escape from the pain. And that is not an option on wellbutrin (for better and worse).
> > > > But then I have also another type of depression/anxiety/angst that has to do with people and fitting in in life and that is much more apparent when I am around people, especially new people or people I don't know well. I'm not sure whether that could be medicated and if so, I'm not sure what I would have to give up in exchange.
> Sounds like a bit of Social Anxiety? I know I have some.I don't know if it's social anxiety, per say. I've never thought of it that way, but maybe it is a specific type. I talk very easily with people and generally have the feeling that I am interesting and entertaining. I am very light in the company of others, which is probably something that would surprise you--considering the intensity of my posts.
Most of my anxiety re people is how to navigate through life solo. My closest friend (male) remarried two years ago and so my immediate world has changed.
On this vacation I am fine by myself--have this really cute little house and cable to watch the US open, plus short rides bring me into incredible natural beauty and awesome art. But when I am around couples vacationing together, I get very anxious about myself and go back to my little house.
> > > > BTW, I have asked my pdoc to do a nardil/wellbutrin combo, but he was less than enthusiastic. He said he has another idea first (which of course he didn't share with me).
> Sounds like he has some plan mapped out in his head for your course of treatment. Maybe he derives cues from your reactions to the various drugs he tries you on.I think he only pretends he has a plan. And depending on what he wants to do next, I may really push the nardil/wellbutrin combo, although the nardil was totally not working any more for me.
>> He's in the driver's seat as long as he knows where he is going and you are enjoying the view so to speak....
No, I don't see it that way. I see us sharing the driver's seat. (He probably sees me as a backseat driver. < g >) I wanted to try Parnate; he wasn't enthusiastic but wrote the prescription. I had wanted to try wellbutrin before, he thought it was too complicated as a base drug, but when I wanted to go back on nardil, he brought up trying wellbutrin as *his* idea. It's much more of a personality thing--like he has to feel like he's in control, than it is really a control thing. At least so far. I would not take a drug I'm not comfortable with and it remains to be seen if he is willing to be a little bit risky with nardil and wellbutrin. (He doesn't like to work with MAOIs). But I am curious about his next idea. It was his idea to go to oxy, which I think was the right thing to do in terms of less ups and downs than vicidin. I actually don't believe he even had his next idea yet when he said that.
> I'm off Parnate now. First day I tried using adderal during my washout period and had a mild hypertensive crises. I say mild to appease the medical gods because my blood pressure (165/96?) didn't approach a medical emergency. To me though the crises was extreme--very bad headache and terrible stiff neck. I took the antidote, relatively early (within 15 or 20 minutes of onset--hey, it was my first time, I wasn't sure what was going on). That really wiped me out.
Yes, I had the same thing happen with adrafinil and nardil, and didn't have a antidote. I drove quickly to the pharmacy to take my BP, which also was up to 165 or so. I can't believe in retrospect I didn't drive to the hospital. But I had been taking nardil for so long without any hypertensive reactions that I didn't even own a cuff. But it didn't affect me at all after the incident. I did buy a cuff, though.
I'd say I was down for the count for 2 days. Yesterday, was filled with severe hot flash types
> of symptoms and I don't know if this was from withdrawal from Parnate, the hypertensive crises, or the fact that I went of estrogen about 4 weeks ago.probably not worth it to even try to figure that one out
Plus, now that I am off the Parnate, I think it was causing some sexual dysfunction.
I don't think I had any sexual dysfunction on nardil, but it's really hard to tell if it had a small effect because I was on it almost my entire adult life. Opiates make me feel very sensual, but they definitely interfere with full orgasmic release.
> I start the Nardil on Saturday. The sleep disruption thing is very upsetting to me and I'm not sure how I will fair with that side effect. Last night I took a valium in addition to the ambien and neurontin and slept well. But I'm not sure I want a benzo habit.
>
See, I don't get that kind of thinking. I see it as you go around once and then it's over. (as far as I know, yet) So life should be as positive as possible. If a benzo at night keeps you on an antidepressant that works, it sort of strikes me as puritanical to worry about a "habit".
> > > >I wouldn't be disappointed if the nardil didn't kick in as quickly as parnate. I've never read about immediate anti-depressant with nardil.
>
> Unfortunately, I think you are right
>
> [re desipramine and nardil]: Desipramine is the TCA that elizabeth is one right now and I believe that desipramine is it's brand name.Oh yea, it looked familiar. I tried TCAs in my early twenties and they totally spaced me out. I'd be afraid to try again I think. I never got past one day on them, but I'm not sure which TCAs I tried; it was so long ago.
>
re nardil: I don't think I got the sleeping side effect until it kicked it for me.BTW, still no wellbutrin AD effect--today my fourth day on 300mg. No side effects, either now. But I did get some encouragement on the board, and it did take forever for nardil, so the trial goes on, at least until I see my pdoc on Monday.
>
Shelli
Posted by Lorraine on September 7, 2001, at 9:23:57
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 6, 2001, at 13:34:24
Hi Shelli:
> In some ways being energized is helpful when I'm depressed. At other times, when I hurt so badly I can't stand it, sleep has always been my only escape from the pain. And that is not an option on wellbutrin (for better and worse).Sounds like hypersomnia (my personal favorite when meds don't prevent it), which also falls in the category of atypical depression.
> > >I am very light in the company of others, which is probably something that would surprise you--considering the intensity of my posts.Wouldn't really surprise me. I think you're funny.
> > > Most of my anxiety re people is how to navigate through life solo. My closest friend (male) remarried two years ago and so my immediate world has changed.This would be very hard for me. As hard as it is to go on vacation with my family which wants to "do" something all the time. This would be harder. It would be good for you to find another single close friend to do things with---support groups? Not for abuse survivors (I think you said you were tired of those), but maybe just a NDMDA group?
>
> On this vacation I am fine by myself--have this really cute little house and cable to watch the US openWe've been watching it too.
> > >, plus short rides bring me into incredible natural beauty and awesome art. But when I am around couples vacationing together, I get very anxious about myself and go back to my little house.
We give up so much for this illness, it seems. Day to day we don't have to notice, but then we do something and the loss is so stark.
> > > I think he only pretends he has a plan. And depending on what he wants to do next,That may be as good as "having" a plan. It maintains forward momentum.
> > >(He probably sees me as a backseat driver. < g >) I wanted to try Parnate; he wasn't enthusiastic but wrote the prescription.
Back seat drivers are good for control freaks--they drive them nuts:-)
> > > Yes, I had the same thing happen with adrafinil and nardil, and didn't have a antidote. I drove quickly to the pharmacy to take my BP, which also was up to 165 or so. I can't believe in retrospect I didn't drive to the hospital.
Didn't go to the hospital or take an antidote???? What happened? did you pressure come down on its own?
> > > I start the Nardil on Saturday. The sleep disruption thing is very upsetting to me and I'm not sure how I will fair with that side effect. Last night I took a valium in addition to the ambien and neurontin and slept well. But I'm not sure I want a benzo habit.
> >
> See, I don't get that kind of thinking. I see it as you go around once and then it's over. (as far as I know, yet) So life should be as positive as possible. If a benzo at night keeps you on an antidepressant that works, it sort of strikes me as puritanical to worry about a "habit".You are making me think:-) I think you are probably right, it is some puritanical nonsense loop that I run through my head. I probably need to get over it now. I've been taking valium and ambien to sleep the last couple of nights. Partly because I still have a bad neck aches from the hypertensive crises. I have slept well.
> >BTW, still no wellbutrin AD effect--today my fourth day on 300mg. No side effects, either now. But I did get some encouragement on the board, and it did take forever for nardil, so the trial goes on, at least until I see my pdoc on Monday.
I'll be anxious to see what he says and what his plan is :-)
Lorraine
Posted by Lorraine on September 7, 2001, at 10:14:23
In reply to Re: Parnate stuff » Elizabeth, posted by Lorraine on September 3, 2001, at 20:48:59
elizabeth: You didn't respond to my 9/3 message and i miss you.:-)
> Elizabeth:
>
> I was gone for the long weekend up near the Russion River in Northern California and so my delay in responding.
>
> [re Parnate]
> > > > > It's been about a month, although I increase my dosage about 2 weeks ago to 15 mg.
>
> > Okay...I wouldn't base your conclusions as to how well it will work on how well it's working at 15 mg. (The minimum effective dose is usually 30, although I think that some effects become noticeable at 20.)
>
> I won't make it to 20, I don't think. When I went to 15, I started becoming irritable and cranky. I had hoped this would abate with time, but it didn't, so I stepped back down to 12.5, which left me with insufficient mood support and irritable to boot. So, I think, I'm off the Parnate and on to Nardil after a 5 day washout period on amphetamines and neurontin.
>
> [re Ambien] Is this a strange medication or what????!! I'm not sure I get it yet. I take the pill 10 mg and take 800 neurontin (actually chewing them slightly so that the caps will process quicker), then wait 30 minutes, then lay down and feel like there is no way I can sleep. Maybe 30 minutes pass, then I start counting my breaths (which is what I do to still my mind) and tell myself I only have to count 20 breaths (breath in 1, 2; breath out 1,2,3,4). By breath 10 or so I'm asleep, but I don't know what to attribute it to. I never feel like I am coming on to the Ambien. Does this sound right?
>
>
> > I don't know about Neurontin; I never had that problem with Ambien.
>
> I'm glad to hear that the Ambien is neither addictive nor habituating. I went out and bought ear plugs to help with the sleeping also.
>
> So you are going to try augmenting your Desipramine with stimulants, I read. Adderal worked well with me. I read in the archives of Psychobabble that Desipramine and Nardil are a good combination--that the Desipramine avoided the weight gain issues with Nardil.
>
> How are your driving lessons going? I tried to buy the book you recommended, but it's out of print so I've requested notification from Amazon of used copy sales (here's your chance!< g >)
Posted by Lorraine on September 7, 2001, at 15:30:10
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 6, 2001, at 13:34:24
Shelli:
I was thinking about the post by Zo on August 21 re "Buprenorphine--just started trial-Elizabeth" and thought of you and your quandry about oxy and dosing. Isn't one way to get around your dosing problem to have your oxy ground and compounded by a compounding pharmacy into smaller doses? This could be in pill or lotion form. My pdoc had mentioned to me that one of his patients was having a lot of side effects and was allergic to certain meds and that they started compounding them into lotions that she applies on her skin, which seemed to help. Anyway just a thought.
Posted by shelliR on September 7, 2001, at 22:08:05
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 7, 2001, at 9:23:57
Hi Lorraine
re: oversleeping
> Sounds like hypersomnia (my personal favorite when meds don't prevent it), which also falls in the category of atypical depression.well, don't most people who are depressed (and not simultaneously hyper) want to get in bed and pull the covers over their head when they are depressed?
Is this only part of atypical depression? I suppose that type A depressives might decide that a good long walk might help? Or immersing themselves in their work. Most workaholics though, are not depressives; they are people who are at their best in that arena.
> > > >I am very light in the company of others, which is probably something that would surprise you--considering the intensity of my posts.
> Wouldn't really surprise me. I think you're funny.I'm much more entertaining in person. :-)
> > > > Most of my anxiety re people is how to navigate through life solo. My closest friend (male) remarried two years ago and so my immediate world has changed.> This would be very hard for me. As hard as it is to go on vacation with my family which wants to "do" something all the time. This would be harder. It would be good for you to find another single close friend to do things with---support groups? Not for abuse survivors (I think you said you were tired of those), but maybe just a NDMDA group?
maybe. there's lots of things to do to meet people; I'm probably support grouped out. I can't imagine going on a vacation with a friend--too intense, although it would make me feel less vulnerable. All my friends at the moment are married. I keep planning on going to a function of the vegetarian association where I live, but I always find some excuse not to go. Not out of fear, more out of laziness. Food is not a stimulating subject for me, but there might be interesting people. I entertain myself very well, so I don't have a lot of incentive. I did try going to a movie club--movie, then discussion, but I got really bored listening to people analyze the movie. The people I listen to on NPR are a lot smarter and more interesting, and I don't have to get out of my car. (Bad attitude.)
One of my married friends has nothing in common with her husband; it's a very strange relationship (with no children, nor any planned). She is usually up to coming along, if I want to do something that I don't feel comfortable doing alone, like going to a concert. And I do that for her, also.
>
> > > > Yes, I had the same thing happen with adrafinil and nardil, and didn't have a antidote. I drove quickly to the pharmacy to take my BP, which also was up to 165 or so. I can't believe in retrospect I didn't drive to the hospital.
> Didn't go to the hospital or take an antidote???? What happened? did you pressure come down on its own?Yes, I keep taking my BP and it never got to 170. Within about fifteen minutes it was back down to normal. This happened twice; the first time I was pretty scared but figured they'd call an ambulance for me if necessary. When I was on parnate I was better prepared (with cuff). None of my pdocs have recommended keeping an antidote with me. If I go back on nardil (especially with wellbutrin), I'll be better prepared.
>>
> You are making me think:-)
Well thinking is good, right? :-)> I'll be anxious to see what he says and what his plan is :-)
As long as the oxy is working , I am really not feeling depressed. I would like to increase the wellbutrin again. I'd do it tommrrow, but I don't want take any chance in messing up my last day here. I've put in a lot of time with the wellbutrin with no anti-depressant effects (I can tell because I wake still up still in a very bad depression until the morning oxy kicks in), but as long as I've hung in this long--I'd like to see what happens in another ten days or so, working up to 450mg.
It is really nice to take such a complete break from work. I could extend this vacation if I didn't have work obligations and if the U.S. open continued. It's sort of centering me, and my friend and I are e-mailing back and forth about it. (We are both tennis obsessed; that's how we got to be such good friends. He still plays; and I watch the matches on tv)
Good luck tomorrow with nardil.
Shelli
Posted by shelliR on September 7, 2001, at 23:16:49
In reply to Re: Compounding pharmacy options » shelliR, posted by Lorraine on September 7, 2001, at 15:30:10
> Shelli:
>
> I was thinking about the post by Zo on August 21 re "Buprenorphine--just started trial-Elizabeth" and thought of you and your quandry about oxy and dosing. Isn't one way to get around your dosing problem to have your oxy ground and compounded by a compounding pharmacy into smaller doses? This could be in pill or lotion form. My pdoc had mentioned to me that one of his patients was having a lot of side effects and was allergic to certain meds and that they started compounding them into lotions that she applies on her skin, which seemed to help. Anyway just a thought.Actually that might have been a good idea for my first increase. At this point I realize that I probably need to go up a full dose to feel the anti-depressant effects. I am taking my old doses, and strattling an extra one in the middle, to keep the dose down somewhat. But if I am suffering too much I will take my own advice to you, re going around once. :-) Unlike opiates, however; in my experience, I have never had to raise my dose of benzos for sleep.
You should have thought of this earlier. < g >
Shelli
Posted by Lorraine on September 8, 2001, at 12:53:48
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 7, 2001, at 22:08:05
Shelli
>
> re: oversleeping
> > Sounds like hypersomnia (my personal favorite when meds don't prevent it), which also falls in the category of atypical depression.
>
> well, don't most people who are depressed (and not simultaneously hyper) want to get in bed and pull the covers over their head when they are depressed?
> Is this only part of atypical depressionPeople without atypical depression may develop insomnia instead of over sleeping. Atypical includes symptoms of rejection sensitivity, over-eating, and a generally heavy feeling or "leaden paralysis".
> > >I can't imagine going on a vacation with a friend--too intense, although it would make me feel less vulnerable.
This is generally? You don't like vacationing with friends? And you feel uneasy vacationing alone--at least at times? (I'm not going to suggest tour groups.)
> > >Not out of fear, more out of laziness.
Not avoidance? My avoidance feels like laziness (leaden paralysis), but I suspect it's actually avoidance which is social anxiety based.
> > > One of my married friends has nothing in common with her husband; it's a very strange relationship (with no children, nor any planned). She is usually up to coming along, if I want to do something that I don't feel comfortable doing alone, like going to a concert. And I do that for her, also.I do this with a friend. I've gone to Argentina and Santa Fe with her. It's kind of freeing to be without the family sometimes.
[re your hypertensive crises} Shelli I still have a headache (not severe) in the back of my skull and my neck is really stiff. This is Friday and the crises was Tuesday. Did this stuff linger for you also? I'm trying to figure out if this means that the hypertensive crises has not resolved or if these are residual effects of a hypertensive crises. Now, I can hear you say, what does it matter--why split that hair? Well, I want the hypertensive crises to be resolved before I start the Nardil.
> > You are making me think:-)
> Well thinking is good, right? :-)Yes, it always is.
> > > I'll be anxious to see what he says and what his plan is :-)
>
> As long as the oxy is working , I am really not feeling depressed. I would like to increase the wellbutrin again. I'd do it tommrrow, but I don't want take any chance in messing up my last day here. I've put in a lot of time with the wellbutrin with no anti-depressant effects (I can tell because I wake still up still in a very bad depression until the morning oxy kicks in), but as long as I've hung in this long--I'd like to see what happens in another ten days or so, working up to 450mg.It's interesting how much you are willing to stick with it on this one. Is it because it at least has no side effects?
> Good luck tomorrow with nardil.
I've decided to play it safe and wait at least one more day.
Lorraine
Posted by Elizabeth on September 8, 2001, at 21:05:09
In reply to Re: Hypertensive crises, update, posted by Lorraine on September 4, 2001, at 21:25:50
> Doing my washout from Parnate to Nardil with adderal and neurontin. Took 10 mg adderal this morning, fine. Took second 10 mg adderal this afternoon, started feeling funny. Tingling moving up my neck to my head and headache coming on, waited a little (not long) felt worse. Took blood pressure 165/97, i think.
That's about the point where I was instructed by my pdoc to take nifedipine. (BTW, "bite and swallow" seems to work better than SL.)
> Took antidote crushed it under tongue, blood pressure came down, right away and within an hour or so was clearly normal, although high for me on MAO. I feel very hungover. Not an experience I want to repeat necessarily.
Nifedipine made me feel hungover too.
-e
Posted by shelliR on September 9, 2001, at 0:11:21
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 8, 2001, at 12:53:48
Hi Lorraine,
> People without atypical depression may develop insomnia instead of over sleeping. Atypical includes symptoms of rejection sensitivity, over-eating, and a generally heavy feeling or "leaden paralysis".Well, let's see. oversleeping-yes; overeating-no;
leaden paralysis-um, does horrible pain in the chest fit under leaden paralysis?
> > > >I can't imagine going on a vacation with a friend--too intense, although it would make me feel less vulnerable.
>
> This is generally? You don't like vacationing with friends? And you feel uneasy vacationing alone--at least at times? (I'm not going to suggest tour groups.)well, I used to go to the beach with friends, and that was totally relaxing. I would never consider going to the beach by myself, and my body is definitely not bathing suit ready, anyway. I think it probably will never be again, anyway I much prefer the southwest mountains. Hint. I fell in love with it here when I came out for a few years to take photo workshops. And I keep coming back.
Except for a few *really* bad hate myself/want to die moments, it's been a very nice week for me. I don't feel lonely. And I don't think many friends would come here with and let me spend about a third of my time watching the US Open. The funny thing is I always come here during the US open; I would feel guilty watching so much and not working if I was at home, plus as I said it sort of connects me while I'm here.
> > > >Not out of fear, more out of laziness.
> Not avoidance? My avoidance feels like laziness (leaden paralysis), but I suspect it's actually avoidance which is social anxiety based.Almost any social anxiety I have is related to being around single men. (Do I like them; do they like me, stuff.) Pretty much in other situations, I'm pretty comfortable. I hate doing things just to meet people, and most things I enjoy can be quite solitary. When you went to the depression groups, did the people seem interesting and depressed, or just depressed? (excluding the other babbler)
>
>> I do this with a friend. I've gone to Argentina and Santa Fe with her.
hum, southwest mountains, art, not argentina.
as the game goes, getting pretty hot < g >.
>
>
> [re your hypertensive crises} Shelli I still have a headache (not severe) in the back of my skull and my neck is really stiff. This is Friday and the crises was Tuesday. Did this stuff linger for you also? I'm trying to figure out if this means that the hypertensive crises has not resolved or if these are residual effects of a hypertensive crises. Now, I can hear you say, what does it matter--why split that hair?I don't even *get* the difference between residual effects and an unresolved hypertensive crisis. Really.
>Well, I want the hypertensive crises to be resolved before I start the Nardil.
Well, that makes sense, but you could also say you want to wait to start nardil until all the residual effects are gone. That's why I'm confused.
BTW, I had no residual effects after the episode. But my BP didn't go that high. For me I had a strong tightening of my shoulder muscles (well right on either side of my neck) and my pulse went way down. Looking back, I don't know how I even knew it was a hypertensive reaction. I had always heard a horrible headache in the back of the head. And I guess I was hypervigilent because my pdoc said she would not support my decision to try adrafinil, and I knew something felt different. It was the only stimulent I have tolerated, aside from concerta, which I have tried only recently. Concerta remains on my possible go back to list, along with nardil.
>
>
> > > > I'll be anxious to see what he says and what his plan is :-)
> > As long as the oxy is working , I am really not feeling depressed. I would like to increase the wellbutrin again....
>
> It's interesting how much you are willing to stick with it on this one. Is it because it at least has no side effects?I guess so. That and the fact that I am not feeling desperate as soon as the oxy kicks in. Also, because this is how nardil felt. No side effects; long time to kick in. So it seems worth hanging in there; like not much to lose aside from getting myself up higher on oxy.
Another important factor is that I don't even have a clue what to try next, except to go back to nardil with oxy. Suggestions would be *greatly* appreciated. No antipsychcotics or tricyclics. I think I've tried every mood stabilizer.
>
>
>
> > Good luck tomorrow with nardil.
> I've decided to play it safe and wait at least one more day.I probably would wait until the stiffness and headache go away if you can wait it out. Have you tried a muscle relaxer for the stiffness? (not a benzo, a real one :-)
Welcome back Elizabeth, if you read this. (and I hope and expect that you will). Any suggestions from you would also be appreciated. I see my pdoc monday, and I'm interested in what he has to say. My guess is that he'll have me continue the wellbutrin and up the dosage.
Shelli
Posted by Lorraine on September 9, 2001, at 12:46:15
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 9, 2001, at 0:11:21
Hi Shelli:
> > [re atypical depression] People without atypical depression may develop insomnia instead of over sleeping. Atypical includes symptoms of rejection sensitivity, over-eating, and a generally heavy feeling or "leaden paralysis".
>
> Well, let's see. oversleeping-yes; overeating-no;
> leaden paralysis-um, does horrible pain in the chest fit under leaden paralysis?I think by leaden paralysis they mean heaviness in the limbs. Elizabeth is the one who turned me on to the concept of atypical depression. It is useful to know because atypical depression apparently responds to MAOs well.
> > >[re vacationing alone] And I don't think many friends would come here with and let me spend about a third of my time watching the US Open. The funny thing is I always come here during the US open; I would feel guilty watching so much and not working if I was at home, plus as I said it sort of connects me while I'm here.Only a very good friend would allow you to do this--but those are the only friends worth having anyway. With my husband, it took a while for us to learn that we don't have to do everything in tandem. It's harder to work out with friends b/c you are not around them so much I think, but it is the evolved way to relate. While you watch the US open, I'll be at the art galleries....
>
> > > When you went to the depression groups, did the people seem interesting and depressed, or just depressed? (excluding the other babbler)Great question. I would say--it is a group of 25+ people--that of that group there are maybe 3 or 4 people that I might want to know. I've only gone 3 times so those 3 people may shift. If it turns out that there is only 1 person worth knowing, then I am a very lucky person anyway. What I need is to be in the "advanced" group, but there isn't one. My husband thinks I join these groups so that I can be a care-giver for those more needy, but what I would love is a group where people have already done a lot of intensive work and are stuggling with the day to day issues. Even the people that I don't want to befriend have some interesting points. Like a woman brought up the need for structure in our lives and talked about that. That is an important issue for me.
> > > Well, that makes sense, but you could also say you want to wait to start nardil until all the residual effects are gone. That's why I'm confused.Yeah, ok, but a crick in the neck can take weeks to go away.
> > > Another important factor is that I don't even have a clue what to try next, except to go back to nardil with oxy. Suggestions would be *greatly* appreciated. No antipsychcotics or tricyclics. I think I've tried every mood stabilizer.I'd be curious what elizabeth thinks of a Nardil and Desipramine combo.
> > >Have you tried a muscle relaxer for the stiffness? (not a benzo, a real one :-)
Aspirin work for the pain and Valium is a muscle relaxant.
In closing, Shelli, a little tennis gift for you, --a poem about Venus Williams by Al Letson Jr., who read it aloud at a Slam Poetry contest in Los Angeles and was kind enough to send me a copy of it.
The Second Planet From a Star
by Al Letson
I am waiting
for Venus Williams
to save me.Like some
great Masi-Amazon warrior
stepping out the foliage
of the jungle,
to open green fields
outlined in white,
with sword in hand.
Prepared to do battle
using breath of flame.
spiting words like...."I didn't come to play
good tennis,
I came to win!"Beads,
singing like Medusa's hair
flailing against gravity
as tennis racket
hits the full moon
across the net,
and I'm stretch back
20 years
to an uncoordinated
painfully skinny kid
holding a tennis racket in hand
sweat saturating the grip
as the coach on the other side
of the court hollers"YOU'RE PLAYING LIKE A GIRL, ALFIE!"
That's when I feel her slender fingers,
wrap around my shoulder,
and gently push me aside.Eyes of marble and onyx
stare down the little man
across the net
and…… SERVE!"Hummin' cummin' atcha'"
A little green globe
zooming through the atmosphere
narrowing in on it's target,
and at 100 miles per hour,
man, you better hit or get hit!And he decides to get hit
BAM!!!And I'm standing on the sideline
Screaming "15 LOVE!"
and don't know what the hell
I'm talking about.
as the goddess of love
stretches her statuesque arms in the airand SERVE, and SERVE, and SERVE!!!
Calling forth hail stones
shaped like tennis balls,
to rain from the sky
pounding into his premature balding head
while he's screaming at the top of his lungsSTOP (BAM!)
STOP (BAM!)
STOP (BAM!)and when she does,
she rocks back and forth
left to right,
waiting for the volley
that will never come.Standing over the bully-coach.
I'm sayin'
"Who's playin' like a girl now?
Who's playin' like a girl now!?!?!"
What!!!"and when I turn around,
she is gone.
The second planet from the star
we know so well.
flung back into the cosmos, where she belongs
leaving me to fast forward
twenty years,
back to the Future
to a man
slightly uncomfortable
with his height, weight,
and lack of athleticism
watching her on the TV screen,
as my daughter crawls on the floor
before me,
making me think of her.Every time Venus whacks
another ball into the Stratosphere,
I'm caught up in the fact
that my daughter will face
obstacles I will never have to see
just because of her sex.At that moment,
At that instant,
overcome by memories of an event
that never even happened,
I wanna grab my daughter up in my arms
and tell her,
tell her,"Baby, these flawed genes
I pass down to you,
May not have the stuff of
Venus Williams, or Mia Hamm.
You may not write novels
like Edwidge Danticot,
Or Joyce Carol Oats.
You may never see the moon so close
you can almost smell it,
that you could taste it,
like May Jamison.
But wherever your talents lie
It will be beautiful,
and you will be beautiful
for who you are
weakness,
strengths
and all.And if they ever tell you,
"your playing like a girl"
Be proud.
And know that you will win
like
a
woman. "Lorraine
Posted by Lorraine on September 10, 2001, at 20:24:39
In reply to Re: Hypertensive crises, update » Lorraine, posted by Elizabeth on September 8, 2001, at 21:05:09
> > Doing my washout from Parnate to Nardil with adderal and neurontin. Took 10 mg adderal this > > >[re hypertensive crises]Took blood pressure 165/97, i think.
>
> That's about the point where I was instructed by my pdoc to take nifedipine. (BTW, "bite and swallow" seems to work better than SL.)I think if I had to do it over again, I would start the nifedipine right when the headache starts rather than based on the blood pressure. I still have a bit of a throbbing headache in the base of the back of my head. I don't know if this is hypertensive hangover; parnate withdrawal or a side effect of the nifedipine.
I did actually bite, put under the tongue for about 2 second and then swallowed.
>
> Nifedipine made me feel hungover too.
>elizabeth: are you still on buprenorphine? Just wondering. Is the Desipramine still doing you good? Did you see the comment I made (earlier post--no need to go back to it tho) about augment Nardil with Desipramine or vica versa. Someone on the board reported good success with this.
I'm on to Nardil, started yesterday. No hypertensive episode so I'll call that success.
Lorraine
Posted by shelliR on September 10, 2001, at 23:11:56
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 9, 2001, at 12:46:15
Hi Lorraine,
Back from my vacation, and *not* relieved. All in all it was really nice. I was able to fight my insecurity enough to really enjoy the peace, beauty and art. It definitely is insecurity, not lonliness. I absolutely love dry heat and feel so much healthier in the SW, always. Of course, it was also wonderful to take a complete break from work. I saw such awesome photographs; it greatly greatly humbled me.
I think I might check out places in Arizona as a second base. (Still spending the majority of my time on the east coast.) If I can get some work there, and computer generate all my work, (the direction I am headed anyway), I might be able to break even on renting a little house/studio. (first rent; maybe later buy). I love the Santa Fe area, but it just gets too darn cold. Plus not the right population for my work, I don't think, although one of my clients moved out there and he manages Winton Marcelis. So I might have a in with the rich and famous. :-) You know, Ophrah, Jane Fonda, Julia Roberts, etc. HA. Near scottsdale is what I am thinking about in AZ.
> > > > When you went to the depression groups, did the people seem interesting and depressed, or just depressed? (excluding the other babbler)
> Great question. I would say--it is a group of 25+ people--that of that group there are maybe 3 or 4 people that I might want to know. I've only gone 3 times so those 3 people may shift. If it turns out that there is only 1 person worth knowing, then I am a very lucky person anyway. What I need is to be in the "advanced" group, but there isn't one. My husband thinks I join these groups so that I can be a care-giver for those more needy, but what I would love is a group where people have already done a lot of intensive work and are stuggling with the day to day issues. Even the people that I don't want to befriend have some interesting points. Like a woman brought up the need for structure in our lives and talked about that. That is an important issue for me.Lucky, if you are getting something out of the group, and it sounds like you are-- minimally, at least.
> I'd be curious what elizabeth thinks of a Nardil and Desipramine combo.
Is that what you're looking toward with the nardil, if it's only partially effective?
> > > >Have you tried a muscle relaxer for the stiffness? (not a benzo, a real one :-)
> Aspirin work for the pain and Valium is a muscle relaxant.
Valium doesn't work for me (or most people) as a muscle relaxer. Or if it did, you have to take enough to pretty much knock you out. I've never heard of a doc giving valium anymore for muscle pulls, etc.; it's generally only used as a sedative now.
>
>
> In closing, Shelli, a little tennis gift for you, --a poem about Venus Williams by Al Letson Jr., who read it aloud at a Slam Poetry contest in Los Angeles and was kind enough to send me a copy of it.Thanks. I liked reading it, though I imagine that hearing it and seeing who's reading it, has a fuller impact. I think the Williams sisters are pretty cool, especially considering their father. Mom must have had some influence re sensitivity.
>So you have started nardil. So far, okay?
I will start nardil tomorrow with wellbutrin. Saw my pdoc today. He wanted to go to remeron next (with wellbutrin), and I burst out crying and said I want to go on nardil, again. He was a bit nervous about the combo. I have read on this site about two people who have done that combination. Someone said in a post last year that it is mentioned on Dr. Bob's psychobabble tips, but I couldn't find it. I'm going to look again, if I can't find it, I may e-mail Dr, Bob. Anyway, I realized after my appointment that I never asked him about taking an antidote. . He did check that I had a BP cuff, but that's about all. There is a more than minute chance for me to have a hypertensive reaction
So I went back in again, caught him in the hall, and he told me that I should watch for my diabolic BP going above 110. I have never even paid attention to that number, and I didn't get the opportunity to ask him why. Also, he said he didn't want me to take a nifedipine-type antidote and I should call him and go to the hospital.
I'm going fax him tomorrow and ask him what the deal is; why can't I have one--isn't that what they would give me at the hospital, anyway? He told me he responds to faxes because he checks them every fifteen minutes. I guess he doesn't check his messages. (?) Anyway, at least someone on this staff can tell me what he says. I really want to do this combo and am going to be totally bummed if I have a reaction. He said to start with 15mg tomorrow; I think I'll start with 7.5 or less.
When he left he said, "don't worry, I will make sure you get better." And I replied that he will blame me for not trying remeron. And then he said, "Please don't feel guilty, you are feeling bad enough. It's okay that you don't want to try remeron now." That was about the nicest thing he's ever said to me.
So now we are doing nardil together. BTW, I read your post to Elizabeth about taking the antidote earlier, but I think I might actually wait a bit longer. I think it may well be the nifedipine that made you sick and maybe you could have waited a little longer to see if it was still going up. I don't know, but that's a possiblity. I did some research before on nifedipine with MAOIs and there are really contrary views about giving it to patients. If I remember correctly (and I may not, really), I think some pdocs think their MAOI patients might take it too early and then the nifedipine might make them very sick.
I don't remember how bad your headache was, though. My reaction was shoulder tightness, so there was no real pain involved. But you might ask your pdoc about exactly when he thinks you should take it. I don't know how fast it works ; I guess that would determine how high to go up before taking the antidote.
What dose did you start with nardil?
later, keep me posted,
Shelli
Posted by Lorraine on September 11, 2001, at 13:10:13
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 10, 2001, at 23:11:56
Hi Shelli,
Back from my vacation, and *not* relieved.
That's a good sign:-0
It definitely is insecurity, not lonliness.
Yeah, I rarely, rarely get lonely. Insecurity about being alone?
I love the Santa Fe area
Me too. I wasn't wild about Sedona though.
but it just gets too darn cold. Plus not the right population for my work, I don't think, although one of my clients moved out there and he manages Winton Marcelis. So I might have a in with the rich and famous. :-) You know, Ophrah, Jane Fonda, Julia Roberts, etc. HA.
I don't know--the tourists might be interested, but it might entail a different work schedule or mailing prints when done. There is a ton of foot traffic.
> > I'd be curious what elizabeth thinks of a Nardil and Desipramine combo.
>
> Is that what you're looking toward with the nardil, if it's only partially effective?It's what I think is the next obvious step. I started Nardil at 15 mg and, of course, like it very much. (I know I'm not supposed to be able to tell, but I do feel a slight boost and I do feel more hunger than usual.) So as usual I'm optimistic. I guess that's fine--this random walk through pharmacology. May as well be optimistic.
> > > > >Have you tried a muscle relaxer for the stiffness? (not a benzo, a real one :-)
> > Aspirin work for the pain and Valium is a muscle relaxant.
> Valium doesn't work for me (or most people) as a muscle relaxerI've only needed the valium at night--it knocks me out anyway even splitting the smallest tablet. But the stiffness and headache seem better whether this is because I have another MAO in my system or because time heals, I don't know.
> > >I imagine that hearing it and seeing who's reading it, has a fuller impact. I'm sure you are right. The guy who wrote it was a slight black man who had two daughters.> > > I will start nardil tomorrow with wellbutrin. Saw my pdoc today. He wanted to go to remeron next (with wellbutrin), and I burst out crying and said I want to go on nardil, again. He was a bit nervous about the combo. I have read on this site about two people who have done that combination.
I don't know of anyone on that combo though I am sure someone here has tried itAnyway, I realized after my appointment that I never asked him about taking an antidote. . He did check that I had a BP cuff, but that's about all. There is a more than minute chance for me to have a hypertensive reaction So I went back in again, caught him in the hall, and he told me that I should watch for my diabolic BP going above 110. I have never even paid attention to that number, and I didn't get the opportunity to ask him why. Also, he said he didn't want me to take a nifedipine-type antidote and I should call him and go to the hospital.
Shelli-- I was in genuine pain, excruciating headache, intense throbbing at the base of my skull--I still have slight remnants of it. I would be very uncomfortable without the antidote. So you call him and he acalls you back in fifteen minutes or worse it's half an hour and you are in the emergency room and they are making you wait. It just seems to happen very quickly and I know elizabeth had a bad experience in the emergency room. I'm aware of the controvery re the antidote. There is actually a good discussion of it in the tips section--a rebutttal to the concerns that I thought was pretty convincing. I think that doctors follow standard medical procedures until it's their head and then they take the antidote. (Isn't that a vicious thought?)
>
> > >I'm going fax him tomorrow and ask him what the deal is; why can't I have one--isn't that what they would give me at the hospital, anyway?Good.
> > >He said to start with 15mg tomorrow; I think I'll start with 7.5 or less.
I thought the lowest dose was 7.5 mg and my pharmicist told me that I could not split the tablets--he could be wrong, but you might want to check.
> > > So now we are doing nardil together. BTW, I read your post to Elizabeth about taking the antidote earlier, but I think I might actually wait a bit longer. I think it may well be the nifedipine that made you sick and maybe you could have waited a little longer to see if it was still going up. I don't know, but that's a possiblity.
You know what I ought to do a search for it here and if that comes up dry post it as a general question. It is a very good point--whether the antidote itself makes you ill.
> > >But you might ask your pdoc about exactly when he thinks you should take it.He said at the first sign of an intensive headache that didn't feel like any headache I had ever had. But then I read an old post of elizabeth's saying something like bp of 165/95 and I followed that instead.
> > >I don't know how fast it works ; I guess that would determine how high to go up before taking the antidote.
It's pretty quick. I don't know how long unmedicated hypertensive crises last ordinarily.
Good luck to you shelli on the Nardil combo. I'm glad your pdoc was able to sympathize with you--it was a big step for him and made you feel better to boot. :-)Lorraine
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.