Psycho-Babble Medication Thread 86944

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Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch

Posted by MB on December 26, 2001, at 19:07:21

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB, posted by Mitch on December 26, 2001, at 18:28:14

Well, I tried the Gabitril for a few more days at 12mg just to see (heck, maybe something would have clicked and it would have gotten better). It just got worse so yesterday, I only took 8mg and today I took none. Got the AE switched to Trileptal and will start that tomorrow night. I am in the middle of quitting caffeine so it might get weird differentiating Trileptal side-effects with caffeine withdrawal. I think now is a good time to start keeping a medication journal.

You mention low dose of Prozac, but the doc said he wants me on 60mg minimum for OCD (says higher doses needed for OCD than for depression). This seems really high to me, since I've only taken 20 mg before (when I talked to him the first time, I made a mistake and said I had taken 40 mg before). I guess if it helps with the obsessed thinking, I can put up with no sex life...well, maybe for a while. Do you know if Adderal (as it is a dopaminergic) will help with Prozac induced anorgasmia?

MB


> Hi, I am back. Been on the road. I had no problems stopping it (Gabitril). I immediately went back to Neurontin, but at a lower dose (300mg/day). I think low-dose Prozac+low-dose Klonopin might work great.
>
> Mitch

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB

Posted by Mitch on December 27, 2001, at 15:09:22

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch, posted by MB on December 26, 2001, at 19:07:21

> Well, I tried the Gabitril for a few more days at 12mg just to see (heck, maybe something would have clicked and it would have gotten better). It just got worse so yesterday, I only took 8mg and today I took none. Got the AE switched to Trileptal and will start that tomorrow night. I am in the middle of quitting caffeine so it might get weird differentiating Trileptal side-effects with caffeine withdrawal. I think now is a good time to start keeping a medication journal.

Good luck with the Trileptal. It made me pretty nauseous though. It didn't seem to dull my thinking however and seemed to have an antidepressant effect. I am REAL touchy with anything that causes nausea. You might do fine with it, though.

>
> You mention low dose of Prozac, but the doc said he wants me on 60mg minimum for OCD (says higher doses needed for OCD than for depression). This seems really high to me, since I've only taken 20 mg before (when I talked to him the first time, I made a mistake and said I had taken 40 mg before). I guess if it helps with the obsessed thinking, I can put up with no sex life...well, maybe for a while. Do you know if Adderal (as it is a dopaminergic) will help with Prozac induced anorgasmia?
>
> MB


Wow! 60mg! I know that folks with OCD need a pretty high dose. I just wonder if that much would be too destabilizing (worsen cycling). FWIW, I found that Zoloft gave me the least trouble with reduced libido, anorgasmia, etc. It blocks the dopamine transporter a lot more than the other SSRi's. But of course YMMV. Have you ever tried Neurontin for ruminations/OCD?? It helps some people. Maybe you can take Trileptal+Neurontin and not need an SSRI for the OCD? Just a thought.

Mitch

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch

Posted by MB on December 27, 2001, at 16:09:56

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB, posted by Mitch on December 27, 2001, at 15:09:22


> Good luck with the Trileptal. It made me pretty nauseous though. It didn't seem to dull my thinking however and seemed to have an antidepressant effect. I am REAL touchy with anything that causes nausea. You might do fine with it, though.


I hope this works (Trileptal). My stomach seems to do well with medicine that cause nausea. Today is my second day off of the Gabitril and I still feel weird, but I think some of that must be caffeine withdrawal. Today is first day off of all caffeine. I hear day three will be the worst, then it will get better. I thought about waitng until then to start Trileptal, but I want to get up and moving on some kind of regimen; the waves of anxiety/depression are getting so bad. Did you think trileptal had an anti-anxiety effect?


> > You mention low dose of Prozac, but the doc said he wants me on 60mg minimum for OCD (says higher doses needed for OCD than for depression). This seems really high to me, since I've only taken 20 mg before (when I talked to him the first time, I made a mistake and said I had taken 40 mg before). I guess if it helps with the obsessed thinking, I can put up with no sex life...well, maybe for a while. Do you know if Adderal (as it is a dopaminergic) will help with Prozac induced anorgasmia?
> >
> > MB
>
>
> Wow! 60mg! I know that folks with OCD need a pretty high dose. I just wonder if that much would be too destabilizing (worsen cycling). FWIW, I found that Zoloft gave me the least trouble with reduced libido, anorgasmia, etc. It blocks the dopamine transporter a lot more than the other SSRi's. But of course YMMV. Have you ever tried Neurontin for ruminations/OCD?? It helps some people. Maybe you can take Trileptal+Neurontin and not need an SSRI for the OCD? Just a thought.
>
> Mitch


Well, I'll try the Prozac, but I've decided I'm not going to take anything that makes me more uncomfortable than the original symptoms. That's been my experience with the SSRIs in the past. The mood stabalizer is supposed to mitigate the anxiogenic side effects of the Prozac. I'm keeping my fingers crossed.

MB

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB

Posted by Mitch on December 27, 2001, at 19:01:58

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch, posted by MB on December 27, 2001, at 16:09:56

> I hope this works (Trileptal). My stomach seems to do well with medicine that cause nausea. Today is my second day off of the Gabitril and I still feel weird, but I think some of that must be caffeine withdrawal. Today is first day off of all caffeine. I hear day three will be the worst, then it will get better. I thought about waitng until then to start Trileptal, but I want to get up and moving on some kind of regimen; the waves of anxiety/depression are getting so bad. Did you think trileptal had an anti-anxiety effect?


You are lucky you can handle nausea-provoking meds! Unfortunately, I didn't get too much of an anti-anxiety effect from Trileptal. As far as mood stabilizers that helped with anxiety/agitation I would have to say that Lithium, Neurontin, Depakote, and Topamax worked the best.


> Well, I'll try the Prozac, but I've decided I'm not going to take anything that makes me more uncomfortable than the original symptoms. That's been my experience with the SSRIs in the past. The mood stabalizer is supposed to mitigate the anxiogenic side effects of the Prozac. I'm keeping my fingers crossed.
>
> MB


Well....Prozac tends to provoke more anxiety than the other SSRI's and tends to be the most activating. Also, I haven't found mood stabilizers to "mitigate" adverse effects of antidepressants very well. Then can reduce hypomania and agitation that AD's can cause, but I think all the flak you are going to catch from taking antidepressants is going to have more to do with the AD itself and the dosage used despite whatever mood stabilizers are in place. I think it would be best to find the least destabilizing antidepressant that will help with GAD/OCD sfx, THEN find which mood stabilizer works the best on your cycling. But that's just an opinion.

Mitch

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch

Posted by MB on December 27, 2001, at 22:04:47

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB, posted by Mitch on December 27, 2001, at 19:01:58


< cut >

>I think it would be best to find the least destabilizing antidepressant that will help with GAD/OCD sfx, THEN find which mood stabilizer works the best on your cycling. But that's just an opinion.
>
> Mitch


Yeah, I figure once I get on a mood stabilizer that is both tolorable and effective, I'll have to go through the same process with the SSRIs (find one that's tolorable and effective), and then, later, do the same with the stimulants. I've tried all the SSRIs, and I liked Prozac the best (but I was also smoking weed and drinking on it, so I wouldn't have noticed anxiety/rage anyway. I found Serzone the most tolorable. No restlessness, no fatigue, no anxiety, and no anorgasmia. I haven't heard good results of treating OCD with Serzone. Have you? I'll ask my doc about it. Also, do you think the Adderal will counteract the sexual side effects of the Prozac? Just wondered since sometimes Wellbutrin is used for this (both are dopaminergic).

Anyway, enough about me. How are you doing on your medications (was it Neurontin, Celexa, Klonopin and Wellbutrin)? The only time I could handle Wellbutrin without rage attacks was with a benzo. Probably the best combo I've been on for anxiety and depression was Xanax and Wellbutrin (did nothing for my OCD though).

MB

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB

Posted by Mitch on December 27, 2001, at 22:48:33

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch, posted by MB on December 27, 2001, at 22:04:47

> Yeah, I figure once I get on a mood stabilizer that is both tolorable and effective, I'll have to go through the same process with the SSRIs (find one that's tolorable and effective), and then, later, do the same with the stimulants. I've tried all the SSRIs, and I liked Prozac the best (but I was also smoking weed and drinking on it, so I wouldn't have noticed anxiety/rage anyway. I found Serzone the most tolorable. No restlessness, no fatigue, no anxiety, and no anorgasmia. I haven't heard good results of treating OCD with Serzone. Have you?

You are kind of begging your own question there! :) You found Serzone the most tolerable and you must have noticed its effect on your OCD-you said "no anxiety".
You may already have found your "SSRI". Serzone is a weak SSri-BTW. It just also happens to antagonize 5-HT2a receptors.


> I'll ask my doc about it. Also, do you think the Adderal will counteract the sexual side effects of the Prozac? Just wondered since sometimes Wellbutrin is used for this (both are dopaminergic).

It might. But, I have found that switching the med that is causing the problem is a superior solution to finding an additional med to "reverse" side-effects.

> Anyway, enough about me. How are you doing on your medications (was it Neurontin, Celexa, Klonopin and Wellbutrin)? The only time I could handle Wellbutrin without rage attacks was with a benzo. Probably the best combo I've been on for anxiety and depression was Xanax and Wellbutrin (did nothing for my OCD though).
>
> MB

That's my combo. I "like" Zoloft better than the Celexa and I have added back a little Zoloft lately. But the sertraline just shreds my guts (IBS probs). I have also heard that Zoloft can be effective for depersonalization/derealization and I get that sfx from other meds easily-that might explain why I respond to sertraline better than the other SSRi's. The Wellbutrin is there just because of seasonal depression. Things would be pretty black right now if it wasn't for the WB. But, I am getting headaches, elevated heart rate, blurry vision (worse than nortripytline), and it doesn't help with ADHD as well as the Zoloft+nortripytline combination (both very low dose). To be honest, I think after this seasonal spell starts diminishing (in 3-4 weeks)I will probably be back on Neurontin+Klonopin+Zoloft+Nortriptyline.

Mitch

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch

Posted by MB on December 28, 2001, at 0:44:40

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB, posted by Mitch on December 27, 2001, at 22:48:33

> > Yeah, I figure once I get on a mood stabilizer that is both tolorable and effective, I'll have to go through the same process with the SSRIs (find one that's tolorable and effective), and then, later, do the same with the stimulants. I've tried all the SSRIs, and I liked Prozac the best (but I was also smoking weed and drinking on it, so I wouldn't have noticed anxiety/rage anyway. I found Serzone the most tolorable. No restlessness, no fatigue, no anxiety, and no anorgasmia. I haven't heard good results of treating OCD with Serzone. Have you?
>
> You are kind of begging your own question there! :) You found Serzone the most tolerable and you must have noticed its effect on your OCD-you said "no anxiety".
> You may already have found your "SSRI". Serzone is a weak SSri-BTW. It just also happens to antagonize 5-HT2a receptors.
>
>
> > I'll ask my doc about it. Also, do you think the Adderal will counteract the sexual side effects of the Prozac? Just wondered since sometimes Wellbutrin is used for this (both are dopaminergic).
>
> It might. But, I have found that switching the med that is causing the problem is a superior solution to finding an additional med to "reverse" side-effects.
>
> > Anyway, enough about me. How are you doing on your medications (was it Neurontin, Celexa, Klonopin and Wellbutrin)? The only time I could handle Wellbutrin without rage attacks was with a benzo. Probably the best combo I've been on for anxiety and depression was Xanax and Wellbutrin (did nothing for my OCD though).
> >
> > MB
>
> That's my combo. I "like" Zoloft better than the Celexa and I have added back a little Zoloft lately. But the sertraline just shreds my guts (IBS probs). I have also heard that Zoloft can be effective for depersonalization/derealization and I get that sfx from other meds easily-that might explain why I respond to sertraline better than the other SSRi's. The Wellbutrin is there just because of seasonal depression. Things would be pretty black right now if it wasn't for the WB. But, I am getting headaches, elevated heart rate, blurry vision (worse than nortripytline), and it doesn't help with ADHD as well as the Zoloft+nortripytline combination (both very low dose). To be honest, I think after this seasonal spell starts diminishing (in 3-4 weeks)I will probably be back on Neurontin+Klonopin+Zoloft+Nortriptyline.
>
> Mitch


Wellbutrin made my eyes blurry too...maybe anticholinergic action? I guess when I said "no anxiety" with the Serzone, I should have said "no increased anxiety," which is still really important. I'll talk to the doc before it's time to start the SSRI and see what he says. So you take the Wellbutrin for seasonal depression? Interesting. I remember that in the early nineties, the consensus was that SAD had something to do with the short days affecting seratonin production (or something like that) and that SSRIs were supposed to be the best for that. Has the consensus changed? I guess it just goes to show that what *works* is more important than whatever psychobiological theory is popular at the time.

That's great that the Neurontin works for you. I took it for restless leg syndrom and found no side effect (but no wanted effect either).

Oh wait, maybe I missed something. Does your seasonal depression have to do with the stress of the holidays or because of the limited daylight?

MB

 

Re: methadone shellir

Posted by Elizabeth on December 28, 2001, at 14:29:55

In reply to Re: methadone JahL, posted by shellir on December 22, 2001, at 16:21:53

> I don't know if it is habituating, like other opiates, etc.

Yes, methadone is a full opioid receptor agonist, and it can be really hard to come off of it if you're on a high dose. Withdrawal from methadone can be especially hard because, although withdrawal symptoms don't hit as hard as they do if you're coming off of, say, heroin, they last much longer.

> I have just gotten out of four hospitals, forced by handcuffs when my friend took me to the emergency room and I was sent to a prison-looking hospital in washington, d.c.

A lot of state psychiatric hospitals have that requirement, that patients be restrained while they're being transported there. State hospitals do often get patients who are violent, but I think it's terrible that they insist on treating everybody that way.

> Then I've been at supposedly the best psychiatric hospital in pennsylvania, and I know you'll love this--they told me I need extensive therapy and discharged me.

*sigh* I'm sorry you're having such a time getting decent care, Shelli. People with histories
of abuse or trauma often need talk therapy, but that doesn't mean that they should be deprived of medication. Also, if you've tried lots of different talk therapies without success, you shouldn't be expected to continue regardless of your diagnosis. And nobody should ever be forced or coerced into talk therapy.

You have my best wishes and hopes, as always.

-elizabeth

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB

Posted by Mitch on December 28, 2001, at 18:07:22

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch, posted by MB on December 28, 2001, at 0:44:40

> Wellbutrin made my eyes blurry too...maybe anticholinergic action? I guess when I said "no anxiety" with the Serzone, I should have said "no increased anxiety," which is still really important. I'll talk to the doc before it's time to start the SSRI and see what he says. So you take the Wellbutrin for seasonal depression? Interesting. I remember that in the early nineties, the consensus was that SAD had something to do with the short days affecting seratonin production (or something like that) and that SSRIs were supposed to be the best for that. Has the consensus changed? I guess it just goes to show that what *works* is more important than whatever psychobiological theory is popular at the time.

Well, what I "heard" about seasonal affective disorder is that the "activating" SSRi's tend to be most effective (Prozac/Zoloft). I took Prozac for several years and it would be very helpful. The trouble is I can't tolerate anything close to a "standard" dose with an SSRI, due to hypomania, GI distress, and insomnia/agitation. I took Adderall two years ago at this time and poof!, no depression at all but I was very edgy, cool, aloof, robotic, etc. Pstims and stim-like AD's work the best for the seasonal depression for me-probably because I can tolerate them a little better. Also, the more sedative SSRi's and TCA's tend to make me very melancholic-very, very blue. Wow, if I could get the effectiveness of Adderall for seasonal depression (and its lack of cycling)without increasing anxiety I would have it made. I would really prefer to not have to take any AD's at all. Just a mood stabilizer and a stimulant. I have thought about Provigil. I wonder if Neurontin+Provigil would be enough? If I can get off AD's my cycling almost quits entirely.

>
> That's great that the Neurontin works for you. I took it for restless leg syndrom and found no side effect (but no wanted effect either).
>
> Oh wait, maybe I missed something. Does your seasonal depression have to do with the stress of the holidays or because of the limited daylight?
>
> MB

I really can map it by how much light there is. I am depressed now, I am just not ruminating and agitated about it. I am just not interesting in doing much of anything. The presence of the holidays makes it worse because there is more stufff to do that I normally would be interested in doing and I don't give a damn. I guess with meds in place it is more of a mild dysthymia/anhedonia thing. Hey, it beats a full-blown depressive episode by a whole lot-I am not going to gripe much. Things have been a whole lot worse than this!

Mitch

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch

Posted by MB on December 28, 2001, at 23:14:07

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB, posted by Mitch on December 28, 2001, at 18:07:22

> Well, what I "heard" about seasonal affective disorder is that the "activating" SSRi's tend to be most effective (Prozac/Zoloft). I took Prozac for several years and it would be very helpful. The trouble is I can't tolerate anything close to a "standard" dose with an SSRI, due to hypomania, GI distress, and insomnia/agitation. I took Adderall two years ago at this time and poof!, no depression at all but I was very edgy, cool, aloof, robotic, etc. Pstims and stim-like AD's work the best for the seasonal depression for me-probably because I can tolerate them a little better. Also, the more sedative SSRi's and TCA's tend to make me very melancholic-very, very blue. Wow, if I could get the effectiveness of Adderall for seasonal depression (and its lack of cycling)without increasing anxiety I would have it made. I would really prefer to not have to take any AD's at all. Just a mood stabilizer and a stimulant. I have thought about Provigil. I wonder if Neurontin+Provigil would be enough? If I can get off AD's my cycling almost quits entirely.


What about Neurontin + Adderal and just increase your Kolopin dose until the anxiety from the Adderall is tolorable? Or does increasing the Klonopin too high cause other problems? Klonopin can make you depressed, can't it?


> > That's great that the Neurontin works for you. I took it for restless leg syndrom and found no side effect (but no wanted effect either).
> >
> > Oh wait, maybe I missed something. Does your seasonal depression have to do with the stress of the holidays or because of the limited daylight?
> >
> > MB
>
> I really can map it by how much light there is. I am depressed now, I am just not ruminating and agitated about it. I am just not interesting in doing much of anything. The presence of the holidays makes it worse because there is more stufff to do that I normally would be interested in doing and I don't give a damn. I guess with meds in place it is more of a mild dysthymia/anhedonia thing. Hey, it beats a full-blown depressive episode by a whole lot-I am not going to gripe much. Things have been a whole lot worse than this!
>
> Mitch


Yeah, I am starting to pull out of a very depressed place. My cycling seems to have periods of three days or less (is that possible, or is rapid cycling like that merely situational?) I'm feeling much better now. The caffeine withdrawal is subsiding. I can already tell that this Trileptal is going to be better than the Gabitril. Although I'm only at 100 mg at night (for the time being) I think I can tell it's more tolorable. I'm almost thinking it might have some AD properties...although this morning I was afraid it was making me crash. Maybe I'm just cycling. Hmmm. At least I don't feel like I'm on PCP with my head in a cocoon!!

MB

Oh, by the way, what do you mean about the Adderall making you robotic?

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB

Posted by Mitch on December 29, 2001, at 8:36:28

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch, posted by MB on December 28, 2001, at 23:14:07

> What about Neurontin + Adderal and just increase your Kolopin dose until the anxiety from the Adderall is tolorable? Or does increasing the Klonopin too high cause other problems? Klonopin can make you depressed, can't it?


You bring up something that I had thought about since that experiment. I was just taking Neurontin+Adderall (nothing for panic). It seems that everytime I try to get off a serotonergic med I start getting very, very, anxious. And that anxiety keeps me so preoccupied (OCD-like), I become somewhat socially chilly and unspontaneous. Then, that sets the stage for panic to creep back in. Everything else is just fine however. I slept excellent-not too much or little, no interrupted sleep. I was focused all day long and not drowsy, yawning, forgetting where I was at work, etc. Everything was just a bunch of little tasks to complete, one at a time-no procrastinating. Time even had this very discrete "unitized" feel about it-I did't have any *big* ideas really, just a lot of smaller task-oriented ideas-no hypomania or grandiosity. I didn't experience *any* mood cycling at all. Ordinary everyday events didn't seem *boring* any more-it was just stuff to do. That's when my pdoc was convinced I had ADHD (but still believed I was also atypical bipolar). The problem is I need some form of serotonergic med for my anxiety probs., but antidepressants trigger cycling. I wonder if Neurontin+pstim+Klonopin (mildly serotonergic) or Neurontin+pstim+Lithium would do the trick??

> Oh, by the way, what do you mean about the Adderall making you robotic?

That is a term I picked up from reading about ADHD and children taking stimulants for it. It is a mild form of "sterotyped" behavior. It is somewhat "tic-like" in the sense that you "go through the motions" in a very literal deliberate way that doesn't seem "normally spontaneous". But, without the pstim I would often start several different things at once and be stopping, and starting them all to try to get them done and fail at most of them, and then forget half of what I was going to accomplish! (that would be an ineffecient silly form of spontaneity-the opposite).

> Yeah, I am starting to pull out of a very depressed place. My cycling seems to have periods of three days or less (is that possible, or is rapid cycling like that merely situational?) I'm feeling much better now. The caffeine withdrawal is subsiding. I can already tell that this Trileptal is going to be better than the Gabitril. Although I'm only at 100 mg at night (for the time being) I think I can tell it's more tolorable. I'm almost thinking it might have some AD properties...although this morning I was afraid it was making me crash. Maybe I'm just cycling. Hmmm. At least I don't feel like I'm on PCP with my head in a cocoon!!
>
> MB
>

My mood cycling is approximately 20 days. There are people that have cycles in less than 48 hrs (ultra-rapid cyclers). As far as the situational element of it goes-you can figure that out by mood-charting (faithfully). You will see the pattern emerge. I thought a lot of my cycling was situational-but when I got the paper and pencil out and start keeping track-a very persistent pattern emerged. That is an entity that is separate from the seasonal depressions. It still happens-it is just the "baseline" drops considerably.

I definitely experienced an AD+improved attentional effect from the Trileptal. That "crash" is probably the short half-life of the Trileptal (you need to take it two-three times a day to keep a fairly steady level). Go slow on the titration! It sounds like your pdoc has figured out that you are going to be a little med-sensitive-that's a good sign.
good luck,

Mitch

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch

Posted by MB on December 30, 2001, at 20:59:36

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB, posted by Mitch on December 29, 2001, at 8:36:28

> > What about Neurontin + Adderal and just increase your Kolopin dose until the anxiety from the Adderall is tolorable? Or does increasing the Klonopin too high cause other problems? Klonopin can make you depressed, can't it?
>
>
> You bring up something that I had thought about since that experiment. I was just taking Neurontin+Adderall (nothing for panic). It seems that everytime I try to get off a serotonergic med I start getting very, very, anxious. And that anxiety keeps me so preoccupied (OCD-like), I become somewhat socially chilly and unspontaneous. Then, that sets the stage for panic to creep back in. Everything else is just fine however. I slept excellent-not too much or little, no interrupted sleep. I was focused all day long and not drowsy, yawning, forgetting where I was at work, etc. Everything was just a bunch of little tasks to complete, one at a time-no procrastinating. Time even had this very discrete "unitized" feel about it-I did't have any *big* ideas really, just a lot of smaller task-oriented ideas-no hypomania or grandiosity. I didn't experience *any* mood cycling at all. Ordinary everyday events didn't seem *boring* any more-it was just stuff to do. That's when my pdoc was convinced I had ADHD (but still believed I was also atypical bipolar). The problem is I need some form of serotonergic med for my anxiety probs., but antidepressants trigger cycling. I wonder if Neurontin+pstim+Klonopin (mildly serotonergic) or Neurontin+pstim+Lithium would do the trick??


Yeah, Maybe the benzo/AE/pstim (Klonopin/Neurontin/Adderall) would work to fix cylcing, anxiety and attention problems...but you did mention that your anxiety was "OCD-like" for which an SSRI might do better than Klonopin (but, like you said, you risk cycling with the SSRI). Neurontin/pstim/Li? Does the lithium have an anti-anxiety effect for you? Would the weight gain issue with litium worry you?


> My mood cycling is approximately 20 days. There are people that have cycles in less than 48 hrs (ultra-rapid cyclers). As far as the situational element of it goes-you can figure that out by mood-charting (faithfully). You will see the pattern emerge. I thought a lot of my cycling was situational-but when I got the paper and pencil out and start keeping track-a very persistent pattern emerged. That is an entity that is separate from the seasonal depressions. It still happens-it is just the "baseline" drops considerably.


Journaling or charting is hard for me. First of all, focussing is hard, and then, when I *do* focus, I obsess over the perfection of the chart...as if a mistake is going to be the end of the world. For now, my poor friends can be my journal. I babble at manic length about where my mind is and what meds I'm on...then I ask them later what I said. Very inaccurate, but if they make a mistake I can get mad at them instead of myself < g > heh heh heh...

> I definitely experienced an AD+improved attentional effect from the Trileptal. That "crash" is probably the short half-life of the Trileptal (you need to take it two-three times a day to keep a fairly steady level). Go slow on the titration! It sounds like your pdoc has figured out that you are going to be a little med-sensitive-that's a good sign.
> good luck,
>
> Mitch


Yeah, I though Trileptal was screwing with my concentration, but it was the caffeine withdrawal. I ran into a stressful social situation (resulting in a 4 hr drive) so I slipped off of the coffee wagon . The concentration returned (but so did the anxiety). I start my caffeine detox again tomorrow so I can enjoy the leveling effects of trileptal without the caffeine anxiety. On the trileptal, my chronic negativity and cynicism are gone (only at 150 mg), but there is still a painful dysphoria. I guess the AD and pstim will help with that. Amphetamine still seems scary to me. Did you find Adderall addictive at therapeutic doses? I was addicted to crank as a kid. I told my doctor that (that I was scared) and he said that at therapeutic doses I wouldn't be getting "high" and would have no desire to abuse it. Do you think that is true?

MB

 

Re: GABITRIL (tiagabine) new anti-anxiety drug?????

Posted by leonard60 on December 30, 2001, at 21:43:39

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch, posted by MB on December 30, 2001, at 20:59:36

is GABITRIL any thing like gabapentin

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB

Posted by Mitch on December 30, 2001, at 22:11:15

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch, posted by MB on December 30, 2001, at 20:59:36

> Yeah, Maybe the benzo/AE/pstim (Klonopin/Neurontin/Adderall) would work to fix cylcing, anxiety and attention problems...but you did mention that your anxiety was "OCD-like" for which an SSRI might do better than Klonopin (but, like you said, you risk cycling with the SSRI). Neurontin/pstim/Li? Does the lithium have an anti-anxiety effect for you? Would the weight gain issue with litium worry you?

Yes, the Lithium does have something of an anxiolytic effect. I was on lithium monotherapy for many years. It is just during the seasonal depressions I would get so tired... and the lithium didn't address that very well. Not that I ever wasn't at "high-enough" doses. I was up to 1500mg/day for a few months (about 1.2 blood level-wise). I never found more than 600mg/day to be of any additional benefit. I never experienced any major weight gain from Lithium. Depakote was a different story, though (but that was still about 15-20lbs. at most).

As far as the "OCD-like" quality to anxiety-I really think it would be more accurate to say it was GAD-like "ruminations". The "OCD-likeness" of it had mostly to do with the repetitive (and "stuck") aspect of it. I don't *do* rituals (checking-counting, etc.)-I would obsessively worry about situations-what I said-what was said in return-what I plan to say later-like a negative rehearsal of sorts-a waste of time that just makes you feel crappy. Also, a lot of "catastrophic thinking" which is typical of people with GAD. But, I don't feel uncomfortable looking at it as related to OCD-because I think it is.


> Journaling or charting is hard for me. First of all, focussing is hard, and then, when I *do* focus, I obsess over the perfection of the chart...as if a mistake is going to be the end of the world. For now, my poor friends can be my journal. I babble at manic length about where my mind is and what meds I'm on...then I ask them later what I said. Very inaccurate, but if they make a mistake I can get mad at them instead of myself < g > heh heh heh...

Yep, you have got that "stuck switch" situation that SSri's help. It is interesting that people with ADD hyper-focus and get "stuck" like folks with OCD (getting fussy and perfectionistic). Also social anxiety is related to perfectionism, too (evaluation anxiety). I am starting to see this type of symptom complex emerge the more I read and post here-this blend of bipolar, SP, ADHD, OCD/GAD. I am just hypothesizing here, but I think (my opinion!), this is all an information processing problem that involves major structures in the brain simultaneously underfunctioning and overfunctioning. I think at bottom it results in some form of an "attentional syndrome" that can manifest as over-focusing (GAD/OCD/SP), and also a lack of focus (BP, ADHD). The negative emotional "fallout" is a result of screwed-up information sharing between different functional and structural parts of the brain.

> Yeah, I though Trileptal was screwing with my concentration, but it was the caffeine withdrawal. I ran into a stressful social situation (resulting in a 4 hr drive) so I slipped off of the coffee wagon . The concentration returned (but so did the anxiety). I start my caffeine detox again tomorrow so I can enjoy the leveling effects of trileptal without the caffeine anxiety. On the trileptal, my chronic negativity and cynicism are gone (only at 150 mg), but there is still a painful dysphoria. I guess the AD and pstim will help with that. Amphetamine still seems scary to me. Did you find Adderall addictive at therapeutic doses? I was addicted to crank as a kid. I told my doctor that (that I was scared) and he said that at therapeutic doses I wouldn't be getting "high" and would have no desire to abuse it. Do you think that is true?
>
> MB


Well, I was only on Adderall for a couple of months. It was very effective-and at only 5mg/day. I never wanted to take more of it. I got a little euphoric the first day or two on it-then I was just alert and slept ok. As far as abuse goes-all you can do is try it and see. If you find that you are focused and alert and still want to take *more* to get a buzz-then that would probably be a danger sign. I never liked "speed" that much. If I was going to get "addicted" to something, opiates would be the most likely thing for me (I "liked" pain killers after surgery-etc. probably a little *too* much).

Mitch

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? leonard60

Posted by Mitch on December 31, 2001, at 10:33:01

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug?????, posted by leonard60 on December 30, 2001, at 21:43:39

> is GABITRIL any thing like gabapentin

In short no. Gabitril helps prevent GABA from being scavenged (blocks reuptake). Levels of GABA then build up and since it is an inhibitory neurotransmitter, this can help "stabilize" neuronal firing and help control seizures.

Gabapentin's molecule "looks like" the inhibitory neurotransmitter GABA, but its mechanism doesn't appear to be "GABA-ergic". Evidently, there are specific sites in the hippocampus where it acts as a selective calcium-ion channel blocker which also "stabilizes" neuronal firing but in a more selective region of the brain.

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch

Posted by MB on January 1, 2002, at 15:22:34

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB, posted by Mitch on December 30, 2001, at 22:11:15

> > Yeah, Maybe the benzo/AE/pstim (Klonopin/Neurontin/Adderall) would work to fix cylcing, anxiety and attention problems...but you did mention that your anxiety was "OCD-like" for which an SSRI might do better than Klonopin (but, like you said, you risk cycling with the SSRI). Neurontin/pstim/Li? Does the lithium have an anti-anxiety effect for you? Would the weight gain issue with litium worry you?
>
> Yes, the Lithium does have something of an anxiolytic effect. I was on lithium monotherapy for many years. It is just during the seasonal depressions I would get so tired... and the lithium didn't address that very well. Not that I ever wasn't at "high-enough" doses. I was up to 1500mg/day for a few months (about 1.2 blood level-wise). I never found more than 600mg/day to be of any additional benefit. I never experienced any major weight gain from Lithium. Depakote was a different story, though (but that was still about 15-20lbs. at most).


I'm pretty obsessive about not gaining weight. 20 lbs would freak me out. When you gained weight on the Depakote, was it because the Depakote made you hungrier? I gained 20 lbs on Paxil, but I was exercising and eating the same amount of food. That freaked me out (I wasn't over eating and I still got fat).


> As far as the "OCD-like" quality to anxiety-I really think it would be more accurate to say it was GAD-like "ruminations". The "OCD-likeness" of it had mostly to do with the repetitive (and "stuck") aspect of it. I don't *do* rituals (checking-counting, etc.)-I would obsessively worry about situations-what I said-what was said in return-what I plan to say later-like a negative rehearsal of sorts-a waste of time that just makes you feel crappy. Also, a lot of "catastrophic thinking" which is typical of people with GAD. But, I don't feel uncomfortable looking at it as related to OCD-because I think it is.


What you described is EXACTLY the kind of ruminating I go through. I *do* have a few weird rituals, though. For example, after I flush the toilet, I can't be standing on tile (I have to be standing on carpet) when the toilet is finished filling back up. This is a modification of one I've had since third grade: I had to be in bed and under the covers before the bathtub was done draining or it meant I'd have to sell my soul to Satan. Now where in the hell did a third grader come up with *that* one? Pretty bizzare. As I've gotten older, the rituals have gotten fewer, but the ruminating (e.g., having fight in my head with people that I plan to see later that day, etc.) hasn't changed and it reminds me exactly of what you described above.


> > Journaling or charting is hard for me. First of all, focussing is hard, and then, when I *do* focus, I obsess over the perfection of the chart...as if a mistake is going to be the end of the world. For now, my poor friends can be my journal. I babble at manic length about where my mind is and what meds I'm on...then I ask them later what I said. Very inaccurate, but if they make a mistake I can get mad at them instead of myself < g > heh heh heh...
>
> Yep, you have got that "stuck switch" situation that SSri's help. It is interesting that people with ADD hyper-focus and get "stuck" like folks with OCD (getting fussy and perfectionistic). Also social anxiety is related to perfectionism, too (evaluation anxiety). I am starting to see this type of symptom complex emerge the more I read and post here-this blend of bipolar, SP, ADHD, OCD/GAD. I am just hypothesizing here, but I think (my opinion!), this is all an information processing problem that involves major structures in the brain simultaneously underfunctioning and overfunctioning. I think at bottom it results in some form of an "attentional syndrome" that can manifest as over-focusing (GAD/OCD/SP), and also a lack of focus (BP, ADHD). The negative emotional "fallout" is a result of screwed-up information sharing between different functional and structural parts of the brain.
>
> > Yeah, I though Trileptal was screwing with my concentration, but it was the caffeine withdrawal. I ran into a stressful social situation (resulting in a 4 hr drive) so I slipped off of the coffee wagon . The concentration returned (but so did the anxiety). I start my caffeine detox again tomorrow so I can enjoy the leveling effects of trileptal without the caffeine anxiety. On the trileptal, my chronic negativity and cynicism are gone (only at 150 mg), but there is still a painful dysphoria. I guess the AD and pstim will help with that. Amphetamine still seems scary to me. Did you find Adderall addictive at therapeutic doses? I was addicted to crank as a kid. I told my doctor that (that I was scared) and he said that at therapeutic doses I wouldn't be getting "high" and would have no desire to abuse it. Do you think that is true?
> >
> > MB
>
>
> Well, I was only on Adderall for a couple of months. It was very effective-and at only 5mg/day. I never wanted to take more of it. I got a little euphoric the first day or two on it-then I was just alert and slept ok. As far as abuse goes-all you can do is try it and see. If you find that you are focused and alert and still want to take *more* to get a buzz-then that would probably be a danger sign. I never liked "speed" that much. If I was going to get "addicted" to something, opiates would be the most likely thing for me (I "liked" pain killers after surgery-etc. probably a little *too* much).
>
> Mitch


Yeah, I figure the first few days I'll give the Adderall to a friend and have them give me my doses so if I *do* get a craving to use more I won't me able to. This is what I have to do with Vicodin when I get hurt. Last time I was in charge of my own Vicodin I went through 20 in a 24 hr period. I wonder how addictive personality fits into this strange spectrum of mood/attention/obsession problems. The more I hang out here, the more it seems these things are not discrete disorders, but inextricably related in some fashion.

MB

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB

Posted by Mitch on January 1, 2002, at 16:43:40

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch, posted by MB on January 1, 2002, at 15:22:34

> > I never experienced any major weight gain from Lithium. Depakote was a different story, though (but that was still about 15-20lbs. at most).
>
>
> I'm pretty obsessive about not gaining weight. 20 lbs would freak me out. When you gained weight on the Depakote, was it because the Depakote made you hungrier? I gained 20 lbs on Paxil, but I was exercising and eating the same amount of food. That freaked me out (I wasn't over eating and I still got fat).

Oh yes, I definitely had an increased appetite on it. The nice thing about Depakote is that it *does* have an anxiolytic effect about it. You get kind of tired and comfortable and *hungry*! I noticed at work I was going to the cafeteria grazing around the snack machines a lot more. It was similar to Remeron as far as munchies goes (but Remeron was FAR worse). Actually, I don't think the increased weight was entirely from appetite. I saw something about Depakote in some Epilepsy journal saying there was a definite "metabolic syndrome" associated with Depakote. It slows you down..period. If you get very manic and you are chronically anorexic, Depakote probably would be ideal. I wonder however, if T4 (thyroxine) added to Depakote would counteract the "metabolic slowing" and at the same time reduce cycling (and maybe enhance any antidepressant effects it could have)??? I haven't read anything about that combo being tried. I would be curious if anyone had tried it and whether it worked or not. Why? Well, Depakote was the only MS that I have taken that can reliably axe hypomania/mixed state agitation-no matter what. Grouchiness, social phobia, uncomplicated depression.. I found Neurontin works better.

>
>
> > As far as the "OCD-like" quality to anxiety-I really think it would be more accurate to say it was GAD-like "ruminations". The "OCD-likeness" of it had mostly to do with the repetitive (and "stuck") aspect of it. I don't *do* rituals (checking-counting, etc.)-I would obsessively worry about situations-what I said-what was said in return-what I plan to say later-like a negative rehearsal of sorts-a waste of time that just makes you feel crappy. Also, a lot of "catastrophic thinking" which is typical of people with GAD. But, I don't feel uncomfortable looking at it as related to OCD-because I think it is.
>
>
> What you described is EXACTLY the kind of ruminating I go through. I *do* have a few weird rituals, though. For example, after I flush the toilet, I can't be standing on tile (I have to be standing on carpet) when the toilet is finished filling back up. This is a modification of one I've had since third grade: I had to be in bed and under the covers before the bathtub was done draining or it meant I'd have to sell my soul to Satan. Now where in the hell did a third grader come up with *that* one? Pretty bizzare. As I've gotten older, the rituals have gotten fewer, but the ruminating (e.g., having fight in my head with people that I plan to see later that day, etc.) hasn't changed and it reminds me exactly of what you described above.


Yepper, those are definitely OCD symptoms. However, you have to keep in mind the all important qualifier-Does this cause discomfort if you don't perform the ritual? I say that because I wonder if some of this stuff is really like behavioural "tics". If you stopped yourself consciously from doing it-do you get agitated/anxious? In other words, do you just "find yourself" doing these things and don't "mind" doing them, and if you didn't do them would it really make any difference? (A ritualistic "habit" rather than an important "ritual")

> > > Yeah, I though Trileptal was screwing with my concentration, but it was the caffeine withdrawal. I ran into a stressful social situation (resulting in a 4 hr drive) so I slipped off of the coffee wagon . The concentration returned (but so did the anxiety). I start my caffeine detox again tomorrow so I can enjoy the leveling effects of trileptal without the caffeine anxiety. On the trileptal, my chronic negativity and cynicism are gone (only at 150 mg), but there is still a painful dysphoria. I guess the AD and pstim will help with that. Amphetamine still seems scary to me. Did you find Adderall addictive at therapeutic doses? I was addicted to crank as a kid. I told my doctor that (that I was scared) and he said that at therapeutic doses I wouldn't be getting "high" and would have no desire to abuse it. Do you think that is true?
> > >
> > > MB
> >
> >
> > Well, I was only on Adderall for a couple of months. It was very effective-and at only 5mg/day. I never wanted to take more of it. I got a little euphoric the first day or two on it-then I was just alert and slept ok. As far as abuse goes-all you can do is try it and see. If you find that you are focused and alert and still want to take *more* to get a buzz-then that would probably be a danger sign. I never liked "speed" that much. If I was going to get "addicted" to something, opiates would be the most likely thing for me (I "liked" pain killers after surgery-etc. probably a little *too* much).
> >
> > Mitch
>
>
> Yeah, I figure the first few days I'll give the Adderall to a friend and have them give me my doses so if I *do* get a craving to use more I won't me able to. This is what I have to do with Vicodin when I get hurt. Last time I was in charge of my own Vicodin I went through 20 in a 24 hr period. I wonder how addictive personality fits into this strange spectrum of mood/attention/obsession problems. The more I hang out here, the more it seems these things are not discrete disorders, but inextricably related in some fashion.
>
> MB


Yes, my pdoc tells me that "it's all the same thing!"-but there isn't a *label* for it, yet. There is just a couple of handfuls of differential diagnoses and comorbid conditions. Also, I think *personality disorders* for the most part are cop-outs-a "miscellaneous bin" of sorts to toss people into.

It sounds like the Trileptal is doing you some good. I definitely got an antidepressant effect and some improved attentional qualities with it. It was just the damn nausea! BTW, that nausea didn't kick in for me until I got to 300mg/day. So, watch out. I found that 75mg tid was my upper limit. Maybe if I would have stayed there for a month I could have upped the dose without the nausea-who knows?

Mitch

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch

Posted by MB on January 1, 2002, at 23:42:51

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB, posted by Mitch on January 1, 2002, at 16:43:40


> Oh yes, I definitely had an increased appetite on it. The nice thing about Depakote is that it *does* have an anxiolytic effect about it. You get kind of tired and comfortable and *hungry*! I noticed at work I was going to the cafeteria grazing around the snack machines a lot more. It was similar to Remeron as far as munchies goes (but Remeron was FAR worse).


I took Remeron for several days. I must have averaged about 7000 calories a day while I was on it. Besides worrying about getting fat, I was concerned about the cost of keeping up with such an appetite!! Plus, I couldn't function during the day on it. I was only taking 15 milligrams, though...I guess the smnolence gets better at higher doses, but I didn't want to risk. By the way, does Depakote have any antihistamine properties to it? Any drug like that (tricyclics, neuroleptics, allergy medicine, etc.) make me SOOO tired and hungry.


> Actually, I don't think the increased weight was entirely from appetite. I saw something about Depakote in some Epilepsy journal saying there was a definite "metabolic syndrome" associated with Depakote. It slows you down..period. If you get very manic and you are chronically anorexic, Depakote probably would be ideal. I wonder however, if T4 (thyroxine) added to Depakote would counteract the "metabolic slowing" and at the same time reduce cycling (and maybe enhance any antidepressant effects it could have)??? I haven't read anything about that combo being tried. I would be curious if anyone had tried it and whether it worked or not. Why? Well, Depakote was the only MS that I have taken that can reliably axe hypomania/mixed state agitation-no matter what. Grouchiness, social phobia, uncomplicated depression.. I found Neurontin works better.


I think Paxil gave me some kind of "metabolic syndrome" because I really packed on the pounds. I didn't gain for the first nine months, but then it came on rapidly. At the same time the weight gain started, I got really fatigued: slept approx 14 hrs/day. That's why I got off of it...also, I was still anxious all the time (but without the physical symptoms). Maybe the anxiety was because I had to triple my caffeine intake to combat the fatigue? I sure hope that the Trileptal doesn't slow the metabolism. I figure that Prozac will since Zoloft and Effexor and Paxil made me porky in the long run. I'm on T4 right now, and I don't notice any difference between the way I feel now and the way I felt 7 yrs ago when I started. Tests show I need it, though.


> > > As far as the "OCD-like" quality to anxiety-I really think it would be more accurate to say it was GAD-like "ruminations". The "OCD-likeness" of it had mostly to do with the repetitive (and "stuck") aspect of it. I don't *do* rituals (checking-counting, etc.)-I would obsessively worry about situations-what I said-what was said in return-what I plan to say later-like a negative rehearsal of sorts-a waste of time that just makes you feel crappy. Also, a lot of "catastrophic thinking" which is typical of people with GAD. But, I don't feel uncomfortable looking at it as related to OCD-because I think it is.
> >
> >
> > What you described is EXACTLY the kind of ruminating I go through. I *do* have a few weird rituals, though. For example, after I flush the toilet, I can't be standing on tile (I have to be standing on carpet) when the toilet is finished filling back up. This is a modification of one I've had since third grade: I had to be in bed and under the covers before the bathtub was done draining or it meant I'd have to sell my soul to Satan. Now where in the hell did a third grader come up with *that* one? Pretty bizzare. As I've gotten older, the rituals have gotten fewer, but the ruminating (e.g., having fight in my head with people that I plan to see later that day, etc.) hasn't changed and it reminds me exactly of what you described above.
>
>
> Yepper, those are definitely OCD symptoms. However, you have to keep in mind the all important qualifier-Does this cause discomfort if you don't perform the ritual? I say that because I wonder if some of this stuff is really like behavioural "tics". If you stopped yourself consciously from doing it-do you get agitated/anxious? In other words, do you just "find yourself" doing these things and don't "mind" doing them, and if you didn't do them would it really make any difference? (A ritualistic "habit" rather than an important "ritual")


No, if the toilet's filling back up and my feet are on the bathroom tile, I feel panicked as if my very soul is at stake. Sometimes I'll force myself to stand on the tile and let the toilet fill just to prove that nothing will happen. The sensation is one of immanent evil or impending doom. I do have some behavioral tics, though. I'll get a word stuck in my head and spell it over and over by "writing" the letters of the word on my index finger with my thumb. Once I realize I'm doing it, it doesn't bother me to stop.


> > > > Yeah, I though Trileptal was screwing with my concentration, but it was the caffeine withdrawal. I ran into a stressful social situation (resulting in a 4 hr drive) so I slipped off of the coffee wagon . The concentration returned (but so did the anxiety). I start my caffeine detox again tomorrow so I can enjoy the leveling effects of trileptal without the caffeine anxiety. On the trileptal, my chronic negativity and cynicism are gone (only at 150 mg), but there is still a painful dysphoria. I guess the AD and pstim will help with that. Amphetamine still seems scary to me. Did you find Adderall addictive at therapeutic doses? I was addicted to crank as a kid. I told my doctor that (that I was scared) and he said that at therapeutic doses I wouldn't be getting "high" and would have no desire to abuse it. Do you think that is true?
> > > >
> > > > MB
> > >
> > >
> > > Well, I was only on Adderall for a couple of months. It was very effective-and at only 5mg/day. I never wanted to take more of it. I got a little euphoric the first day or two on it-then I was just alert and slept ok. As far as abuse goes-all you can do is try it and see. If you find that you are focused and alert and still want to take *more* to get a buzz-then that would probably be a danger sign. I never liked "speed" that much. If I was going to get "addicted" to something, opiates would be the most likely thing for me (I "liked" pain killers after surgery-etc. probably a little *too* much).
> > >
> > > Mitch
> >
> >
> > Yeah, I figure the first few days I'll give the Adderall to a friend and have them give me my doses so if I *do* get a craving to use more I won't me able to. This is what I have to do with Vicodin when I get hurt. Last time I was in charge of my own Vicodin I went through 20 in a 24 hr period. I wonder how addictive personality fits into this strange spectrum of mood/attention/obsession problems. The more I hang out here, the more it seems these things are not discrete disorders, but inextricably related in some fashion.
> >
> > MB
>
>
> Yes, my pdoc tells me that "it's all the same thing!"-but there isn't a *label* for it, yet. There is just a couple of handfuls of differential diagnoses and comorbid conditions. Also, I think *personality disorders* for the most part are cop-outs-a "miscellaneous bin" of sorts to toss people into.
>
> It sounds like the Trileptal is doing you some good. I definitely got an antidepressant effect and some improved attentional qualities with it. It was just the damn nausea! BTW, that nausea didn't kick in for me until I got to 300mg/day. So, watch out. I found that 75mg tid was my upper limit. Maybe if I would have stayed there for a month I could have upped the dose without the nausea-who knows?
>
> Mitch


I seem to be tolorating the Trileptal really well. I'm at the 300mg/day dose and doing fine. After 5 days of taking 300mg at bedtime, I'm supposed to move to 150mg t.i.d. I don't notice that much from it. I haven't broken anything since I started it, though. Hmmm...that's gotta mean *something*...

Are you going to discuss a possible med change when you see the doctor next? How are you feeling now that the holidays are over? I feel like I can try to get on with my life again...phew!!

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB

Posted by Mitch on January 2, 2002, at 10:15:59

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch, posted by MB on January 1, 2002, at 23:42:51

> I took Remeron for several days. I must have averaged about 7000 calories a day while I was on it. Besides worrying about getting fat, I was concerned about the cost of keeping up with such an appetite!! Plus, I couldn't function during the day on it. I was only taking 15 milligrams, though...I guess the smnolence gets better at higher doses, but I didn't want to risk. By the way, does Depakote have any antihistamine properties to it? Any drug like that (tricyclics, neuroleptics, allergy medicine, etc.) make me SOOO tired and hungry.


I don't think it has much antihistaminic action if at all. It might be its potentiation of GABA in the brain. But that is just speculation, usually when a "mechanism" is found out about a particular med it often is something that most people wouldn't have thought of.


> > > > As far as the "OCD-like" quality to anxiety-I really think it would be more accurate to say it was GAD-like "ruminations". The "OCD-likeness" of it had mostly to do with the repetitive (and "stuck") aspect of it. I don't *do* rituals (checking-counting, etc.)-I would obsessively worry about situations-what I said-what was said in return-what I plan to say later-like a negative rehearsal of sorts-a waste of time that just makes you feel crappy. Also, a lot of "catastrophic thinking" which is typical of people with GAD. But, I don't feel uncomfortable looking at it as related to OCD-because I think it is.
> > >
> > >
> > > What you described is EXACTLY the kind of ruminating I go through. I *do* have a few weird rituals, though. For example, after I flush the toilet, I can't be standing on tile (I have to be standing on carpet) when the toilet is finished filling back up. This is a modification of one I've had since third grade: I had to be in bed and under the covers before the bathtub was done draining or it meant I'd have to sell my soul to Satan. Now where in the hell did a third grader come up with *that* one? Pretty bizzare. As I've gotten older, the rituals have gotten fewer, but the ruminating (e.g., having fight in my head with people that I plan to see later that day, etc.) hasn't changed and it reminds me exactly of what you described above.
> >
> >
> > Yepper, those are definitely OCD symptoms. However, you have to keep in mind the all important qualifier-Does this cause discomfort if you don't perform the ritual? I say that because I wonder if some of this stuff is really like behavioural "tics". If you stopped yourself consciously from doing it-do you get agitated/anxious? In other words, do you just "find yourself" doing these things and don't "mind" doing them, and if you didn't do them would it really make any difference? (A ritualistic "habit" rather than an important "ritual")
>
>
> No, if the toilet's filling back up and my feet are on the bathroom tile, I feel panicked as if my very soul is at stake. Sometimes I'll force myself to stand on the tile and let the toilet fill just to prove that nothing will happen. The sensation is one of immanent evil or impending doom. I do have some behavioral tics, though. I'll get a word stuck in my head and spell it over and over by "writing" the letters of the word on my index finger with my thumb. Once I realize I'm doing it, it doesn't bother me to stop.


Yeah, that definitely is an OCD ritual. Are you taking an SSri (or other med) for it now (is Trileptal and T4 your only meds)?


> > It sounds like the Trileptal is doing you some good. I definitely got an antidepressant effect and some improved attentional qualities with it. It was just the damn nausea! BTW, that nausea didn't kick in for me until I got to 300mg/day. So, watch out. I found that 75mg tid was my upper limit. Maybe if I would have stayed there for a month I could have upped the dose without the nausea-who knows?
> >
> > Mitch
>
>
> I seem to be tolorating the Trileptal really well. I'm at the 300mg/day dose and doing fine. After 5 days of taking 300mg at bedtime, I'm supposed to move to 150mg t.i.d. I don't notice that much from it. I haven't broken anything since I started it, though. Hmmm...that's gotta mean *something*...
>
> Are you going to discuss a possible med change when you see the doctor next? How are you feeling now that the holidays are over? I feel like I can try to get on with my life again...phew!!

I kind of doubt it. The only thing that I might bring up is Provigil as a swap from Wellbutrin. I have read more than a couple of posts here saying that it helped with SP symptoms. The Wellbutrin has kept me out of major depression and helps with assertiveness, but it tends to worsen my "freezing" when I am around strangers. It would be nice to be alert and attentive through the day without being edgy. I wonder if my pdoc has some samples. I would be able to tell after a few days at most if it would do me any good.

Mitch

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch

Posted by MB on January 2, 2002, at 16:42:13

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB, posted by Mitch on January 2, 2002, at 10:15:59


> > No, if the toilet's filling back up and my feet are on the bathroom tile, I feel panicked as if my very soul is at stake. Sometimes I'll force myself to stand on the tile and let the toilet fill just to prove that nothing will happen. The sensation is one of immanent evil or impending doom. I do have some behavioral tics, though. I'll get a word stuck in my head and spell it over and over by "writing" the letters of the word on my index finger with my thumb. Once I realize I'm doing it, it doesn't bother me to stop.
>
>
> Yeah, that definitely is an OCD ritual. Are you taking an SSri (or other med) for it now (is Trileptal and T4 your only meds)?


Right now, I'm only on the Trileptal and T4. I'm supposed to add the Prozac soon. Last night was the third night that I took 300 mg of Trileptal. This morning, I really realized how sleepy it is making me. It's not a bad sleepiness. I think antihistamine sleepiness feels *awful*, but this feeling is just kinda relaxing...almost like a benzo...but I worry about being able to go back to school this Monday to continue the year. Yesterday, I spent 14 hrs sleeping. What have you heard through the grapevine; have people been building tolorances to Trileptal sedation?


> > > It sounds like the Trileptal is doing you some good. I definitely got an antidepressant effect and some improved attentional qualities with it. It was just the damn nausea! BTW, that nausea didn't kick in for me until I got to 300mg/day. So, watch out. I found that 75mg tid was my upper limit. Maybe if I would have stayed there for a month I could have upped the dose without the nausea-who knows?
> > >
> > > Mitch
> >
> >
> > I seem to be tolorating the Trileptal really well. I'm at the 300mg/day dose and doing fine. After 5 days of taking 300mg at bedtime, I'm supposed to move to 150mg t.i.d. I don't notice that much from it. I haven't broken anything since I started it, though. Hmmm...that's gotta mean *something*...
> >
> > Are you going to discuss a possible med change when you see the doctor next? How are you feeling now that the holidays are over? I feel like I can try to get on with my life again...phew!!
>
> I kind of doubt it. The only thing that I might bring up is Provigil as a swap from Wellbutrin. I have read more than a couple of posts here saying that it helped with SP symptoms. The Wellbutrin has kept me out of major depression and helps with assertiveness, but it tends to worsen my "freezing" when I am around strangers. It would be nice to be alert and attentive through the day without being edgy. I wonder if my pdoc has some samples. I would be able to tell after a few days at most if it would do me any good.
>
> Mitch


Wellbutrin makes me extremely irritable (unless I pop some Xanax when it starts to kick in). I don't know that much about Provigil. I took something called adrafinil (similar to modafinil??) years ago. I don't think I liked it...it was like drinking too much coffee. Do you know the differences between modafinil and adrafinil?

MB

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB

Posted by Mitch on January 2, 2002, at 22:13:55

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch, posted by MB on January 2, 2002, at 16:42:13

> Right now, I'm only on the Trileptal and T4. I'm supposed to add the Prozac soon. Last night was the third night that I took 300 mg of Trileptal. This morning, I really realized how sleepy it is making me. It's not a bad sleepiness. I think antihistamine sleepiness feels *awful*, but this feeling is just kinda relaxing...almost like a benzo...but I worry about being able to go back to school this Monday to continue the year. Yesterday, I spent 14 hrs sleeping. What have you heard through the grapevine; have people been building tolorances to Trileptal sedation?

Interesting. I felt noticeably *wired* when I was taking Trileptal (a definite stimulant like feeling-I even got up somewhat *early*). Maybe you ought to try 150mg twice daily before you increase to 150mg three times daily??
Oh BTW, I found Prozac very very activating. It may be that when you add in the Prozac you will see a reversal of the hypersomnia you are seeing now.


> Wellbutrin makes me extremely irritable (unless I pop some Xanax when it starts to kick in). I don't know that much about Provigil. I took something called adrafinil (similar to modafinil??) years ago. I don't think I liked it...it was like drinking too much coffee. Do you know the differences between modafinil and adrafinil?
>
> MB


I think that modafinil is a metabolite of adrafanil. I believe the FDA won't let adrafanil in due to liver toxicity concerns.
I have had *some* irritability attributable to the WB. But, it is very short lived-I don't ruminate/adrenalize for hours afterwards. That is nice because I have taken other meds that increased hostility and I couldn't *put it down* (Effexor, Remeron, Buspar).

Mitch

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch

Posted by MB on January 2, 2002, at 23:52:38

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB, posted by Mitch on January 2, 2002, at 22:13:55

> > Right now, I'm only on the Trileptal and T4. I'm supposed to add the Prozac soon. Last night was the third night that I took 300 mg of Trileptal. This morning, I really realized how sleepy it is making me. It's not a bad sleepiness. I think antihistamine sleepiness feels *awful*, but this feeling is just kinda relaxing...almost like a benzo...but I worry about being able to go back to school this Monday to continue the year. Yesterday, I spent 14 hrs sleeping. What have you heard through the grapevine; have people been building tolorances to Trileptal sedation?
>
> Interesting. I felt noticeably *wired* when I was taking Trileptal (a definite stimulant like feeling-I even got up somewhat *early*). Maybe you ought to try 150mg twice daily before you increase to 150mg three times daily??
> Oh BTW, I found Prozac very very activating. It may be that when you add in the Prozac you will see a reversal of the hypersomnia you are seeing now.


Well, at 150 mg, the Trileptal gave me insomnia. Then, when I increased the dose to 300 mg, I didn't notice a change until the third night at that dose, after which I slept 14 hrs. Maybe I'm just catching up on the sleep I missed when I first started taking it. Also, today was the third day without caffeine...that can cause hypersomnia too. I just took my bedtime dose an hour ago (I take it a little early so I can get it in with some food) and I don't notice any sleepiness. Maybe I'm adjusting! All in all, it is really tolorable. I realize how much I disliked the Gabitril!! One weird thing, though: When my last dose started to "kick in" I began to have the physical sensations of a panic attack but it never got too bad...just dissipated


> > Wellbutrin makes me extremely irritable (unless I pop some Xanax when it starts to kick in). I don't know that much about Provigil. I took something called adrafinil (similar to modafinil??) years ago. I don't think I liked it...it was like drinking too much coffee. Do you know the differences between modafinil and adrafinil?
> >
> > MB
>
>
> I think that modafinil is a metabolite of adrafanil. I believe the FDA won't let adrafanil in due to liver toxicity concerns.
> I have had *some* irritability attributable to the WB. But, it is very short lived-I don't ruminate/adrenalize for hours afterwards. That is nice because I have taken other meds that increased hostility and I couldn't *put it down* (Effexor, Remeron, Buspar).
>
> Mitch


What about Adderall, how did it affect hostility/anger? Also, have you heard about the Serzone--liver connection? I just read about that on Medline. I think I may not ask the doc about Serzone after all.

MB

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB

Posted by Mitch on January 3, 2002, at 9:28:11

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch, posted by MB on January 2, 2002, at 23:52:38

> > > Right now, I'm only on the Trileptal and T4. I'm supposed to add the Prozac soon. Last night was the third night that I took 300 mg of Trileptal. This morning, I really realized how sleepy it is making me. It's not a bad sleepiness. I think antihistamine sleepiness feels *awful*, but this feeling is just kinda relaxing...almost like a benzo...but I worry about being able to go back to school this Monday to continue the year. Yesterday, I spent 14 hrs sleeping. What have you heard through the grapevine; have people been building tolorances to Trileptal sedation?
> >
> > Interesting. I felt noticeably *wired* when I was taking Trileptal (a definite stimulant like feeling-I even got up somewhat *early*). Maybe you ought to try 150mg twice daily before you increase to 150mg three times daily??
> > Oh BTW, I found Prozac very very activating. It may be that when you add in the Prozac you will see a reversal of the hypersomnia you are seeing now.
>
>
> Well, at 150 mg, the Trileptal gave me insomnia. Then, when I increased the dose to 300 mg, I didn't notice a change until the third night at that dose, after which I slept 14 hrs. Maybe I'm just catching up on the sleep I missed when I first started taking it. Also, today was the third day without caffeine...that can cause hypersomnia too. I just took my bedtime dose an hour ago (I take it a little early so I can get it in with some food) and I don't notice any sleepiness. Maybe I'm adjusting! All in all, it is really tolorable. I realize how much I disliked the Gabitril!! One weird thing, though: When my last dose started to "kick in" I began to have the physical sensations of a panic attack but it never got too bad...just dissipated

I would hazard a guess that it will probably be a little while and at somewhat higher doses of Trileptal before you are going to see what it is going to be like taking longer-term. I believe the dose "target" for seizures (as monotheraphy) is 1200mg/day (600mg/bid). Usually when you get into the range used for epilepsy you are more likely to see a lot of unwanted side effects (I am thinking here of cognitive sfx). Maybe your pdoc will be "nice" and you will get a good response before you get "there". Trileptal is related to Tegretol. I knew someone in college that had been on lithium for about 20 years for bipolar (he was a Navy vet)and he complained about the cognitive sfx of his lithium and they switched him to Tegretol. He definitely liked it a lot better. It would be nice to hear about a Trileptal success since Tegretol can cause nasty blood disorders (rare, but dangerous).


>
>
> > > Wellbutrin makes me extremely irritable (unless I pop some Xanax when it starts to kick in). I don't know that much about Provigil. I took something called adrafinil (similar to modafinil??) years ago. I don't think I liked it...it was like drinking too much coffee. Do you know the differences between modafinil and adrafinil?
> > >
> > > MB
> >
> >
> > I think that modafinil is a metabolite of adrafanil. I believe the FDA won't let adrafanil in due to liver toxicity concerns.
> > I have had *some* irritability attributable to the WB. But, it is very short lived-I don't ruminate/adrenalize for hours afterwards. That is nice because I have taken other meds that increased hostility and I couldn't *put it down* (Effexor, Remeron, Buspar).
> >
> > Mitch
>
>
> What about Adderall, how did it affect hostility/anger? Also, have you heard about the Serzone--liver connection? I just read about that on Medline. I think I may not ask the doc about Serzone after all.
>
> MB

I had some intermittent grouchiness from it-but I don't think it was the Adderall so much as the fact I wasn't taking an SSRI with it (SSRI's really calm me down). The main thing about Adderall that was just so dramatic was the improved sleep quality, daytime alertness, and NO cycling. Nothing else ever just flattened it out like that-so weird.

Yes, I heard about the Serzone. I read about some isolated cases of liver probems associated with it before they had to include the warning in their script info., but I thought it was too rare to get that concerned. Actually, the thing about Serzone that I don't like is that it has too many metabolites (WB does too) and hits too many receptors (like Remeron).

Mitch

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch

Posted by MB on January 3, 2002, at 20:53:48

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB, posted by Mitch on January 3, 2002, at 9:28:11


> > Well, at 150 mg, the Trileptal gave me insomnia. Then, when I increased the dose to 300 mg, I didn't notice a change until the third night at that dose, after which I slept 14 hrs. Maybe I'm just catching up on the sleep I missed when I first started taking it. Also, today was the third day without caffeine...that can cause hypersomnia too. I just took my bedtime dose an hour ago (I take it a little early so I can get it in with some food) and I don't notice any sleepiness. Maybe I'm adjusting! All in all, it is really tolorable. I realize how much I disliked the Gabitril!! One weird thing, though: When my last dose started to "kick in" I began to have the physical sensations of a panic attack but it never got too bad...just dissipated
>
> I would hazard a guess that it will probably be a little while and at somewhat higher doses of Trileptal before you are going to see what it is going to be like taking longer-term. I believe the dose "target" for seizures (as monotheraphy) is 1200mg/day (600mg/bid). Usually when you get into the range used for epilepsy you are more likely to see a lot of unwanted side effects (I am thinking here of cognitive sfx). Maybe your pdoc will be "nice" and you will get a good response before you get "there". Trileptal is related to Tegretol. I knew someone in college that had been on lithium for about 20 years for bipolar (he was a Navy vet)and he complained about the cognitive sfx of his lithium and they switched him to Tegretol. He definitely liked it a lot better. It would be nice to hear about a Trileptal success since Tegretol can cause nasty blood disorders (rare, but dangerous).


So, what is the target dose of Trileptal in treating "rage attacks"? I haven't been diagnosed as bipolar, but I assume the dose to treat hypomania would be about the same needed to treat bad anger outbursts?? I'm at 450mg a day (150 tid). At this point, I don't think I would be willing to go any higher. I'm just starting to feel "icky". Not really sick, but a general malaise. I haven't really felt like leaving the house for about three days, and I feel like my depression is getting worse. Kinda depressed and chilled and headachy...I've come close to falling over in the shower a few times. That's OK when you're drunk because you feel so good, but when you feel shitty and you keep falling over, is it worth it? Also, I'm feeling a discomfort in my right side that I think is my liver. I've felt it a few times after I've had alcohol poisoning. I don't think I'm really happy with this stuff. But, then again, I've never been happy with medications: no benifit, all side effects. That's why I got the spect scan...figured that on the "right" med, I'd be willing to put up with the side effects, because I'd be feeling better in my mind. The AE merry-go-round is turning out to be very similar to the AD merry-go-round. How long do you give one of these meds (AE) before you know if the side effects are going to go away?

...starting to get discouraged,

>
> >
> >
> > > > Wellbutrin makes me extremely irritable (unless I pop some Xanax when it starts to kick in). I don't know that much about Provigil. I took something called adrafinil (similar to modafinil??) years ago. I don't think I liked it...it was like drinking too much coffee. Do you know the differences between modafinil and adrafinil?
> > > >
> > > > MB
> > >
> > >
> > > I think that modafinil is a metabolite of adrafanil. I believe the FDA won't let adrafanil in due to liver toxicity concerns.
> > > I have had *some* irritability attributable to the WB. But, it is very short lived-I don't ruminate/adrenalize for hours afterwards. That is nice because I have taken other meds that increased hostility and I couldn't *put it down* (Effexor, Remeron, Buspar).
> > >
> > > Mitch
> >
> >
> > What about Adderall, how did it affect hostility/anger? Also, have you heard about the Serzone--liver connection? I just read about that on Medline. I think I may not ask the doc about Serzone after all.
> >
> > MB
>
> I had some intermittent grouchiness from it-but I don't think it was the Adderall so much as the fact I wasn't taking an SSRI with it (SSRI's really calm me down). The main thing about Adderall that was just so dramatic was the improved sleep quality, daytime alertness, and NO cycling. Nothing else ever just flattened it out like that-so weird.
>
> Yes, I heard about the Serzone. I read about some isolated cases of liver probems associated with it before they had to include the warning in their script info., but I thought it was too rare to get that concerned. Actually, the thing about Serzone that I don't like is that it has too many metabolites (WB does too) and hits too many receptors (like Remeron).
>
> Mitch


That's too bad, because I thought Serzone was a good drug. I never got to stay on it more than a couple of weeks...got taken off of it because of a symptom that turned out not to be the Serzone. I would give it another try, but the liver thing scares me. I've drunk enough alcohol over the past ten years to kill 12 armies. My liver needs some kindness, probably for the rest of my life!

MB

 

Re: GABITRIL (tiagabine) new anti-anxiety drug????? MB

Posted by Mitch on January 4, 2002, at 10:25:25

In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? Mitch, posted by MB on January 3, 2002, at 20:53:48

>
> > > Well, at 150 mg, the Trileptal gave me insomnia. Then, when I increased the dose to 300 mg, I didn't notice a change until the third night at that dose, after which I slept 14 hrs. Maybe I'm just catching up on the sleep I missed when I first started taking it. Also, today was the third day without caffeine...that can cause hypersomnia too. I just took my bedtime dose an hour ago (I take it a little early so I can get it in with some food) and I don't notice any sleepiness. Maybe I'm adjusting! All in all, it is really tolorable. I realize how much I disliked the Gabitril!! One weird thing, though: When my last dose started to "kick in" I began to have the physical sensations of a panic attack but it never got too bad...just dissipated
> >
> > I would hazard a guess that it will probably be a little while and at somewhat higher doses of Trileptal before you are going to see what it is going to be like taking longer-term. I believe the dose "target" for seizures (as monotheraphy) is 1200mg/day (600mg/bid). Usually when you get into the range used for epilepsy you are more likely to see a lot of unwanted side effects (I am thinking here of cognitive sfx). Maybe your pdoc will be "nice" and you will get a good response before you get "there". Trileptal is related to Tegretol. I knew someone in college that had been on lithium for about 20 years for bipolar (he was a Navy vet)and he complained about the cognitive sfx of his lithium and they switched him to Tegretol. He definitely liked it a lot better. It would be nice to hear about a Trileptal success since Tegretol can cause nasty blood disorders (rare, but dangerous).
>
>
> So, what is the target dose of Trileptal in treating "rage attacks"? I haven't been diagnosed as bipolar, but I assume the dose to treat hypomania would be about the same needed to treat bad anger outbursts?? I'm at 450mg a day (150 tid). At this point, I don't think I would be willing to go any higher. I'm just starting to feel "icky". Not really sick, but a general malaise. I haven't really felt like leaving the house for about three days, and I feel like my depression is getting worse. Kinda depressed and chilled and headachy...I've come close to falling over in the shower a few times. That's OK when you're drunk because you feel so good, but when you feel shitty and you keep falling over, is it worth it? Also, I'm feeling a discomfort in my right side that I think is my liver. I've felt it a few times after I've had alcohol poisoning. I don't think I'm really happy with this stuff. But, then again, I've never been happy with medications: no benifit, all side effects. That's why I got the spect scan...figured that on the "right" med, I'd be willing to put up with the side effects, because I'd be feeling better in my mind. The AE merry-go-round is turning out to be very similar to the AD merry-go-round. How long do you give one of these meds (AE) before you know if the side effects are going to go away?
>
> ...starting to get discouraged,


Well, I *doubt* if the Trileptal would be messing with your liver much (it is mostly excreted by your kidneys), but the "ickiness" and "malaise" could be mild hyponatremia (low blood sodium) which the Trileptal can provoke. If you are dizzy that could be lowered blood pressure or orthostatic hypotension-have you checked your BP? I would call the doc and see if you can get a serum sodium done (perhaps a liver panel would be smart here, too). If it is ok, then the sfx might fade over a few days if you hold your dosage steady. You did mention that you haven't had any rage attacks on the Trileptal-right?
FWIW, the meds that helped me the most with hostility were low-dose SSRI, lithium, and Neurontin.



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