![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by OldSchool on March 24, 2002, at 22:41:18
Ive made up my mind that Im going to do ECT soon. I should have had it years ago. All I have to do is get my BP meds adjusted this week and then talk to my shrink about a shock doc consult. The bad thing is that I found out that they took the ECT unit out of the local hospital I was planning on having it done at. So now I have basically three options to have ECT at, two of them at teaching hospitals. And this means I will have to go inpatient for a while which I DO NOT LIKE. My psychiatrist doesnt want me inpatient for ECT he doesnt think I need to be inpatient at all, says I dont fit in there, etc.
Ive decided Im not going to waste my time with wussy unilateral ECT Im going to go with the real deal bilateral or bifrontal ECT. I already have it planned out what I want my shock doc to do. IM not going to agree to it unless my insurance company preapproves me for AT LEAST 10 ECT sessions, preferably 12. Because I have read that anything less than 10 to 12 sessions it wont hold and thus a total waste of time.
Im actually beginning to look forward to it believe it or not. I cant believe it, but ECT actually looks fun to me. I remember what rTMS was like, that was OK. There was one point where the rTMS had kind of a breakthrough effect, where I was sitting on this pier at Folly Beach in Charleston, SC watching dolphins swim in the ocean and everything started looking three dimensional again, colors started looking vibrant again. I was starting to get out of depression. But it pooped out after only a few hours. Big bummer. Im expecting this same effect with ECT only much stronger effect. I think I kinda already know what to expect somewhat from the rTMS experience. Just with ECT it will probably be WAY stronger.
I want a psychiatrist to see me for the first time normal. NO psychiatrist anywhere has seen me what I was like before depression hit me in late 97. When I was a healthy, non depressed, normal person. All theyve ever seen is the depressed me. They never have even seen the health me before.
Ive also come to the realization I could care less about memory loss side effects. I already cant remember diddly from my depression.
Honestly, ECT looks fun to me now. I enjoyed rTMS, it made my eyes water a little after each session but that was the only side effect. I think I will enjoy ECT as much as rTMS. rTMS is so wussy...I hope ECT is like a bazooka treatment for depression.
Old School
Posted by JohnX2 on March 24, 2002, at 23:03:31
In reply to Gonna do ECT for sure, posted by OldSchool on March 24, 2002, at 22:41:18
> Ive made up my mind that Im going to do ECT soon. I should have had it years ago. All I have to do is get my BP meds adjusted this week and then talk to my shrink about a shock doc consult. The bad thing is that I found out that they took the ECT unit out of the local hospital I was planning on having it done at. So now I have basically three options to have ECT at, two of them at teaching hospitals. And this means I will have to go inpatient for a while which I DO NOT LIKE. My psychiatrist doesnt want me inpatient for ECT he doesnt think I need to be inpatient at all, says I dont fit in there, etc.
>
> Ive decided Im not going to waste my time with wussy unilateral ECT Im going to go with the real deal bilateral or bifrontal ECT. I already have it planned out what I want my shock doc to do. IM not going to agree to it unless my insurance company preapproves me for AT LEAST 10 ECT sessions, preferably 12. Because I have read that anything less than 10 to 12 sessions it wont hold and thus a total waste of time.
>
> Im actually beginning to look forward to it believe it or not. I cant believe it, but ECT actually looks fun to me. I remember what rTMS was like, that was OK. There was one point where the rTMS had kind of a breakthrough effect, where I was sitting on this pier at Folly Beach in Charleston, SC watching dolphins swim in the ocean and everything started looking three dimensional again, colors started looking vibrant again. I was starting to get out of depression. But it pooped out after only a few hours. Big bummer. Im expecting this same effect with ECT only much stronger effect. I think I kinda already know what to expect somewhat from the rTMS experience. Just with ECT it will probably be WAY stronger.
>
> I want a psychiatrist to see me for the first time normal. NO psychiatrist anywhere has seen me what I was like before depression hit me in late 97. When I was a healthy, non depressed, normal person. All theyve ever seen is the depressed me. They never have even seen the health me before.
>
> Ive also come to the realization I could care less about memory loss side effects. I already cant remember diddly from my depression.
>
> Honestly, ECT looks fun to me now. I enjoyed rTMS, it made my eyes water a little after each session but that was the only side effect. I think I will enjoy ECT as much as rTMS. rTMS is so wussy...I hope ECT is like a bazooka treatment for depression.
>
> Old SchoolHi Old School,
I hope your ECT goes well.
I was wondering if you could give some refresher background of your TRD? What has been your main snag to date? AD poop out/lack of response, etc?
Regards,
John
Posted by OldSchool on March 25, 2002, at 11:37:56
In reply to Re: Gonna do ECT for sure » OldSchool, posted by JohnX2 on March 24, 2002, at 23:03:31
> > Ive made up my mind that Im going to do ECT soon. I should have had it years ago. All I have to do is get my BP meds adjusted this week and then talk to my shrink about a shock doc consult. The bad thing is that I found out that they took the ECT unit out of the local hospital I was planning on having it done at. So now I have basically three options to have ECT at, two of them at teaching hospitals. And this means I will have to go inpatient for a while which I DO NOT LIKE. My psychiatrist doesnt want me inpatient for ECT he doesnt think I need to be inpatient at all, says I dont fit in there, etc.
> >
> > Ive decided Im not going to waste my time with wussy unilateral ECT Im going to go with the real deal bilateral or bifrontal ECT. I already have it planned out what I want my shock doc to do. IM not going to agree to it unless my insurance company preapproves me for AT LEAST 10 ECT sessions, preferably 12. Because I have read that anything less than 10 to 12 sessions it wont hold and thus a total waste of time.
> >
> > Im actually beginning to look forward to it believe it or not. I cant believe it, but ECT actually looks fun to me. I remember what rTMS was like, that was OK. There was one point where the rTMS had kind of a breakthrough effect, where I was sitting on this pier at Folly Beach in Charleston, SC watching dolphins swim in the ocean and everything started looking three dimensional again, colors started looking vibrant again. I was starting to get out of depression. But it pooped out after only a few hours. Big bummer. Im expecting this same effect with ECT only much stronger effect. I think I kinda already know what to expect somewhat from the rTMS experience. Just with ECT it will probably be WAY stronger.
> >
> > I want a psychiatrist to see me for the first time normal. NO psychiatrist anywhere has seen me what I was like before depression hit me in late 97. When I was a healthy, non depressed, normal person. All theyve ever seen is the depressed me. They never have even seen the health me before.
> >
> > Ive also come to the realization I could care less about memory loss side effects. I already cant remember diddly from my depression.
> >
> > Honestly, ECT looks fun to me now. I enjoyed rTMS, it made my eyes water a little after each session but that was the only side effect. I think I will enjoy ECT as much as rTMS. rTMS is so wussy...I hope ECT is like a bazooka treatment for depression.
> >
> > Old School
>
> Hi Old School,
>
> I hope your ECT goes well.
>
> I was wondering if you could give some refresher background of your TRD? What has been your main snag to date? AD poop out/lack of response, etc?
>
> Regards,
> John
My problem is AD poopout. I get some AD effect from them, enough to keep me afloat and alive. Im not like super duper depressed or anything. I can sleep and stuff. I am just at like 30% though and want to get to 80% to 100%. Thats why I want to do ECT.Also, Im having the same sorts of problems with my blood pressure as with my depression. Its barely under control despite max doses of BP meds. The BP is causing more problems now than my depresssion. Im hoping ECT will help both problems, by loosening me up or whatever. I feel better when I take dopamine agonists like Amantadine too, but get kinda dizzy and confused feeling on those. Physically I feel much better on dopamine agonists. Less tightened up feeling
Old School
Posted by JohnX2 on March 25, 2002, at 22:20:58
In reply to Re: Gonna do ECT for sure, posted by OldSchool on March 25, 2002, at 11:37:56
> > > Ive made up my mind that Im going to do ECT soon. I should have had it years ago. All I have to do is get my BP meds adjusted this week and then talk to my shrink about a shock doc consult. The bad thing is that I found out that they took the ECT unit out of the local hospital I was planning on having it done at. So now I have basically three options to have ECT at, two of them at teaching hospitals. And this means I will have to go inpatient for a while which I DO NOT LIKE. My psychiatrist doesnt want me inpatient for ECT he doesnt think I need to be inpatient at all, says I dont fit in there, etc.
> > >
> > > Ive decided Im not going to waste my time with wussy unilateral ECT Im going to go with the real deal bilateral or bifrontal ECT. I already have it planned out what I want my shock doc to do. IM not going to agree to it unless my insurance company preapproves me for AT LEAST 10 ECT sessions, preferably 12. Because I have read that anything less than 10 to 12 sessions it wont hold and thus a total waste of time.
> > >
> > > Im actually beginning to look forward to it believe it or not. I cant believe it, but ECT actually looks fun to me. I remember what rTMS was like, that was OK. There was one point where the rTMS had kind of a breakthrough effect, where I was sitting on this pier at Folly Beach in Charleston, SC watching dolphins swim in the ocean and everything started looking three dimensional again, colors started looking vibrant again. I was starting to get out of depression. But it pooped out after only a few hours. Big bummer. Im expecting this same effect with ECT only much stronger effect. I think I kinda already know what to expect somewhat from the rTMS experience. Just with ECT it will probably be WAY stronger.
> > >
> > > I want a psychiatrist to see me for the first time normal. NO psychiatrist anywhere has seen me what I was like before depression hit me in late 97. When I was a healthy, non depressed, normal person. All theyve ever seen is the depressed me. They never have even seen the health me before.
> > >
> > > Ive also come to the realization I could care less about memory loss side effects. I already cant remember diddly from my depression.
> > >
> > > Honestly, ECT looks fun to me now. I enjoyed rTMS, it made my eyes water a little after each session but that was the only side effect. I think I will enjoy ECT as much as rTMS. rTMS is so wussy...I hope ECT is like a bazooka treatment for depression.
> > >
> > > Old School
> >
> > Hi Old School,
> >
> > I hope your ECT goes well.
> >
> > I was wondering if you could give some refresher background of your TRD? What has been your main snag to date? AD poop out/lack of response, etc?
> >
> > Regards,
> > John
>
>
> My problem is AD poopout. I get some AD effect from them, enough to keep me afloat and alive. Im not like super duper depressed or anything. I can sleep and stuff. I am just at like 30% though and want to get to 80% to 100%. Thats why I want to do ECT.
>
> Also, Im having the same sorts of problems with my blood pressure as with my depression. Its barely under control despite max doses of BP meds. The BP is causing more problems now than my depresssion. Im hoping ECT will help both problems, by loosening me up or whatever. I feel better when I take dopamine agonists like Amantadine too, but get kinda dizzy and confused feeling on those. Physically I feel much better on dopamine agonists. Less tightened up feeling
>
> Old School
Sorry about the ADs sucking.Do you bounce off 75-100% and drop back to 30% or do you just sort of settle into 30% on the ADs?
Regards,
John
Posted by JohnX2 on March 25, 2002, at 22:42:54
In reply to Re: Gonna do ECT for sure » OldSchool, posted by JohnX2 on March 25, 2002, at 22:20:58
> > > > Ive made up my mind that Im going to do ECT soon. I should have had it years ago. All I have to do is get my BP meds adjusted this week and then talk to my shrink about a shock doc consult. The bad thing is that I found out that they took the ECT unit out of the local hospital I was planning on having it done at. So now I have basically three options to have ECT at, two of them at teaching hospitals. And this means I will have to go inpatient for a while which I DO NOT LIKE. My psychiatrist doesnt want me inpatient for ECT he doesnt think I need to be inpatient at all, says I dont fit in there, etc.
> > > >
> > > > Ive decided Im not going to waste my time with wussy unilateral ECT Im going to go with the real deal bilateral or bifrontal ECT. I already have it planned out what I want my shock doc to do. IM not going to agree to it unless my insurance company preapproves me for AT LEAST 10 ECT sessions, preferably 12. Because I have read that anything less than 10 to 12 sessions it wont hold and thus a total waste of time.
> > > >
> > > > Im actually beginning to look forward to it believe it or not. I cant believe it, but ECT actually looks fun to me. I remember what rTMS was like, that was OK. There was one point where the rTMS had kind of a breakthrough effect, where I was sitting on this pier at Folly Beach in Charleston, SC watching dolphins swim in the ocean and everything started looking three dimensional again, colors started looking vibrant again. I was starting to get out of depression. But it pooped out after only a few hours. Big bummer. Im expecting this same effect with ECT only much stronger effect. I think I kinda already know what to expect somewhat from the rTMS experience. Just with ECT it will probably be WAY stronger.
> > > >
> > > > I want a psychiatrist to see me for the first time normal. NO psychiatrist anywhere has seen me what I was like before depression hit me in late 97. When I was a healthy, non depressed, normal person. All theyve ever seen is the depressed me. They never have even seen the health me before.
> > > >
> > > > Ive also come to the realization I could care less about memory loss side effects. I already cant remember diddly from my depression.
> > > >
> > > > Honestly, ECT looks fun to me now. I enjoyed rTMS, it made my eyes water a little after each session but that was the only side effect. I think I will enjoy ECT as much as rTMS. rTMS is so wussy...I hope ECT is like a bazooka treatment for depression.
> > > >
> > > > Old School
> > >
> > > Hi Old School,
> > >
> > > I hope your ECT goes well.
> > >
> > > I was wondering if you could give some refresher background of your TRD? What has been your main snag to date? AD poop out/lack of response, etc?
> > >
> > > Regards,
> > > John
> >
> >
> > My problem is AD poopout. I get some AD effect from them, enough to keep me afloat and alive. Im not like super duper depressed or anything. I can sleep and stuff. I am just at like 30% though and want to get to 80% to 100%. Thats why I want to do ECT.
> >
> > Also, Im having the same sorts of problems with my blood pressure as with my depression. Its barely under control despite max doses of BP meds. The BP is causing more problems now than my depresssion. Im hoping ECT will help both problems, by loosening me up or whatever. I feel better when I take dopamine agonists like Amantadine too, but get kinda dizzy and confused feeling on those. Physically I feel much better on dopamine agonists. Less tightened up feeling
> >
> > Old School
>
>
> Sorry about the ADs sucking.
>
> Do you bounce off 75-100% and drop back to 30% or do you just sort of settle into 30% on the ADs?
>
> Regards,
> JohnCan I ask what BP medicines you take?
John
Posted by OldSchool on March 25, 2002, at 22:59:21
In reply to Re: Gonna do ECT for sure » OldSchool, posted by JohnX2 on March 25, 2002, at 22:20:58
> > > > Ive made up my mind that Im going to do > Sorry about the ADs sucking.
>
> Do you bounce off 75-100% and drop back to 30% or do you just sort of settle into 30% on the ADs?
>
> Regards,
> John
I used to initially feel real good on ADs for the first few days or week, Id be 75% for a few days then settle down to 30% or 40 % consistent. Now I dont even get to 75% the first few days I just go to 30% but it is very consistent, no ups and downs or anything. Just shitty, fadeout problems, but very consistent AD effect what i do get.Old School
Posted by Mags on March 25, 2002, at 23:49:17
In reply to Gonna do ECT for sure, posted by OldSchool on March 24, 2002, at 22:41:18
Hi Old School, We will have to compare notes.Pls let me know your date you start. I have to get off lamictal first and then I go for it.
I will be lucky as I go to my local hospital for at least 12 Bilateral. My doc says same as you , don't bother with unilateral, go for bilateral and I know exactly what you mean about memory! What memory...depression sucks the memory right outta ya!
Good LuckMags
Posted by Zo on March 26, 2002, at 3:14:21
In reply to Gonna do ECT for sure, posted by OldSchool on March 24, 2002, at 22:41:18
I saw this *marvelous* show on PBS a while back, following a chronically, crucially depressed young man, a violinist, thru his course of ECT. . .And I can still remember the *smile* on his face, just beaming, when he became well enough to rejoin the orchestra. Honestly, it was like a different person. . .
Zo
Posted by JohnX2 on March 26, 2002, at 6:30:37
In reply to Re: Gonna do ECT for sure, posted by JohnX2 on March 25, 2002, at 22:42:54
Hi Old School,In one of your other posts, you indicated that Amantadine (and nmda antagonist and dopamine agonist) reduced your BP. You also indicate that it helps with your depression. I am curious if you have tried other direct acting dopaminergic medications (ex. Bromocriptine) with similar results? any failures?
Regards,
John
> > > > > Ive made up my mind that Im going to do ECT soon. I should have had it years ago. All I have to do is get my BP meds adjusted this week and then talk to my shrink about a shock doc consult. The bad thing is that I found out that they took the ECT unit out of the local hospital I was planning on having it done at. So now I have basically three options to have ECT at, two of them at teaching hospitals. And this means I will have to go inpatient for a while which I DO NOT LIKE. My psychiatrist doesnt want me inpatient for ECT he doesnt think I need to be inpatient at all, says I dont fit in there, etc.
> > > > >
> > > > > Ive decided Im not going to waste my time with wussy unilateral ECT Im going to go with the real deal bilateral or bifrontal ECT. I already have it planned out what I want my shock doc to do. IM not going to agree to it unless my insurance company preapproves me for AT LEAST 10 ECT sessions, preferably 12. Because I have read that anything less than 10 to 12 sessions it wont hold and thus a total waste of time.
> > > > >
> > > > > Im actually beginning to look forward to it believe it or not. I cant believe it, but ECT actually looks fun to me. I remember what rTMS was like, that was OK. There was one point where the rTMS had kind of a breakthrough effect, where I was sitting on this pier at Folly Beach in Charleston, SC watching dolphins swim in the ocean and everything started looking three dimensional again, colors started looking vibrant again. I was starting to get out of depression. But it pooped out after only a few hours. Big bummer. Im expecting this same effect with ECT only much stronger effect. I think I kinda already know what to expect somewhat from the rTMS experience. Just with ECT it will probably be WAY stronger.
> > > > >
> > > > > I want a psychiatrist to see me for the first time normal. NO psychiatrist anywhere has seen me what I was like before depression hit me in late 97. When I was a healthy, non depressed, normal person. All theyve ever seen is the depressed me. They never have even seen the health me before.
> > > > >
> > > > > Ive also come to the realization I could care less about memory loss side effects. I already cant remember diddly from my depression.
> > > > >
> > > > > Honestly, ECT looks fun to me now. I enjoyed rTMS, it made my eyes water a little after each session but that was the only side effect. I think I will enjoy ECT as much as rTMS. rTMS is so wussy...I hope ECT is like a bazooka treatment for depression.
> > > > >
> > > > > Old School
> > > >
> > > > Hi Old School,
> > > >
> > > > I hope your ECT goes well.
> > > >
> > > > I was wondering if you could give some refresher background of your TRD? What has been your main snag to date? AD poop out/lack of response, etc?
> > > >
> > > > Regards,
> > > > John
> > >
> > >
> > > My problem is AD poopout. I get some AD effect from them, enough to keep me afloat and alive. Im not like super duper depressed or anything. I can sleep and stuff. I am just at like 30% though and want to get to 80% to 100%. Thats why I want to do ECT.
> > >
> > > Also, Im having the same sorts of problems with my blood pressure as with my depression. Its barely under control despite max doses of BP meds. The BP is causing more problems now than my depresssion. Im hoping ECT will help both problems, by loosening me up or whatever. I feel better when I take dopamine agonists like Amantadine too, but get kinda dizzy and confused feeling on those. Physically I feel much better on dopamine agonists. Less tightened up feeling
> > >
> > > Old School
> >
> >
> > Sorry about the ADs sucking.
> >
> > Do you bounce off 75-100% and drop back to 30% or do you just sort of settle into 30% on the ADs?
> >
> > Regards,
> > John
>
> Can I ask what BP medicines you take?
>
> John
Posted by Mags on March 26, 2002, at 8:07:48
In reply to Re: Gonna do ECT for sure- Me too, posted by Mags on March 25, 2002, at 23:49:17
Hi folks,
Heard from pdoc this morning. My first ECT is set for April 16. I will be admitted the day before. Depending on how I do they will start with 2 a week and then bump it to three.....I am actually getting excited about it...it has given me back hope which I haven;t had for a looong time.
Wish me luck and I will keep you all posted.Mags
Posted by OldSchool on March 26, 2002, at 10:30:39
In reply to Re: Gonna do ECT for sure- Me too, posted by Mags on March 25, 2002, at 23:49:17
> Hi Old School, We will have to compare notes.Pls let me know your date you start. I have to get off lamictal first and then I go for it.
>
> I will be lucky as I go to my local hospital for at least 12 Bilateral. My doc says same as you , don't bother with unilateral, go for bilateral and I know exactly what you mean about memory! What memory...depression sucks the memory right outta ya!
> Good Luck
>
> MagsI dont have a date yet as I havent even seen the shock doc for a consult yet. But Ive decided I am definitely going to do it soon. Its been discussed many times with my regular psychiatrist and he thinks its a good idea. I have a few things I must do first, like get my blood pressure under control good, lately its not been under control. Also, I think I will need a MRI or some kind of scan to check out some back pain Ive had for years but ignored. I get shooting pains down my right side on and off, all the way to my toes sometimes. Its probably a herniated disk. Its not severe or anything and I just ignore it. But I dont want to have ECT til its checked out, as ECT has the reputation for causing back trouble. Im not worried about it.
As for unilateral, my attitude about it after reading and researching ECT for six months is why waste your time? They have to do a titration procedure for unilateral your first treatment, to find out the right dosage of electricity to use on you, which basically means your first treatment is a waste. With bilateral there is no initial titration procedure, everything is set and known ahead of time and your first treatment is good quality convulsion. Plus bilateral is much stronger.
As for memory, yes my memory is already shot from years of severe depression. I have "brain fog" all the time, Im always in a cognitive haze and have been so for four years. I frankly do not care if ECT causes memory loss, even if its severe.
My only concern is the inducement of epilepsy, which I think is overhyped by reading about it over on the anti-ECT websites. I could care less about memory loss.
take care,
Old school
Posted by OldSchool on March 26, 2002, at 10:38:43
In reply to Re: AD meds and BP response » JohnX2, posted by JohnX2 on March 26, 2002, at 6:30:37
>
> Hi Old School,
>
> In one of your other posts, you indicated that Amantadine (and nmda antagonist and dopamine agonist) reduced your BP. You also indicate that it helps with your depression. I am curious if you have tried other direct acting dopaminergic medications (ex. Bromocriptine) with similar results? any failures?
>The dopamine agonists dont really help with my depression all that much. I get some mood lift from them, some activation...increased sex drive. But they also make me a little confused (psychosis). I get happier on them but real relaxed. The thing I like about Amantadine is physically it makes me feel MUCH BETTER. More relaxed, I can breathe better, I dont get muscle twitches, I feel looser and not as anxious and stuff. A little more confident. I sleep better on Amantadine and it helps with a lot of physical aches and pains Ive complained about for years. Amantadine makes me feel less obsessive, less rigid minded, more fluid and looser, more like just "whatever."
I dont think its something Id want to stay on longterm though.
Amantadine makes me feel good but dizzy as hell.
Posted by OldSchool on March 26, 2002, at 10:44:56
In reply to Re: AD meds and BP response, posted by OldSchool on March 26, 2002, at 10:38:43
Here is my own prediction concerning my upcoming ECT. How much do you wanna bet that my blood pressure goes down a lot after ECT because I will be more relaxed? I think ECT will help my BP.
Posted by JohnX2 on March 26, 2002, at 13:29:52
In reply to Re: AD meds and BP response, posted by OldSchool on March 26, 2002, at 10:44:56
> Here is my own prediction concerning my upcoming ECT. How much do you wanna bet that my blood pressure goes down a lot after ECT because I will be more relaxed? I think ECT will help my BP.
From what I was reading about high blood pressure, it is often associated with a excess glucorcorticoid production state (do a web search). This may linked to a hyperacitive HPA (hypothalamaus-pituitary-adrenal-gland) axis. This is consistent with classic markers of depression. Hyperadrenal gland can cause dysfunctional noradrenargic system in general. You can acutally get this tested. The glucocorticoid receptors in the hypothalamus etc are desensitized to cortisol feedback and release too much of a substance ACTH. These causes too much secretion of cortisol (and high blood pressure) and continued depression. It may also make you agitated. CRF antagonists may fix this. Most ADs over time are thought to correct a malfunctioning feedback loop in the HPA axis. I would hope this would have an effect of fixing a hypercorisolemia state and possibly helping your bp. BTW, some people believe that NMDA antagonists may act as atypical CRF antagonists.
I believe some of the dopamine agonists reduce noradrenergic output by stimulating presyaptic d2/d3 recptors at the lower doses. Pramipexole I seem to recall has hypotensive effects at low doses (at is selective for presynaptice autoreceptors. At the higher doses, they are less selective and stimulate the post synaptic d2 receptors If I recall (may lead to the psychosis). I believe Bromocriptine depletes noradrenaline release at the lower doses.
This is all my quick-n-dirty conjecture, as always.
http://www.acnp.org/g4/GN401000049/Default.htm
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2067174&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2161850&dopt=AbstractHave you tried a mild atypical bp medicine like an alpha-2 agonist (clonidine, tenex)? This reduces norepinephrine release. Maybe a good handshake with an NRI AD. (OK a SWAG).
Regards
John
Posted by OldSchool on March 26, 2002, at 18:47:54
In reply to Re: AD meds and BP response » OldSchool, posted by JohnX2 on March 26, 2002, at 13:29:52
> > Here is my own prediction concerning my upcoming ECT. How much do you wanna bet that my blood pressure goes down a lot after ECT because I will be more relaxed? I think ECT will help my BP.
>
> From what I was reading about high blood pressure, it is often associated with a excess glucorcorticoid production state (do a web search). This may linked to a hyperacitive HPA (hypothalamaus-pituitary-adrenal-gland) axis. This is consistent with classic markers of depression. Hyperadrenal gland can cause dysfunctional noradrenargic system in general. You can acutally get this tested. The glucocorticoid receptors in the hypothalamus etc are desensitized to cortisol feedback and release too much of a substance ACTH. These causes too much secretion of cortisol (and high blood pressure) and continued depression. It may also make you agitated. CRF antagonists may fix this. Most ADs over time are thought to correct a malfunctioning feedback loop in the HPA axis. I would hope this would have an effect of fixing a hypercorisolemia state and possibly helping your bp. BTW, some people believe that NMDA antagonists may act as atypical CRF antagonists.
>
> I believe some of the dopamine agonists reduce noradrenergic output by stimulating presyaptic d2/d3 recptors at the lower doses. Pramipexole I seem to recall has hypotensive effects at low doses (at is selective for presynaptice autoreceptors. At the higher doses, they are less selective and stimulate the post synaptic d2 receptors If I recall (may lead to the psychosis). I believe Bromocriptine depletes noradrenaline release at the lower doses.
>
> This is all my quick-n-dirty conjecture, as always.
>
> http://www.acnp.org/g4/GN401000049/Default.htm
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2067174&dopt=Abstract
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2161850&dopt=Abstract
>
> Have you tried a mild atypical bp medicine like an alpha-2 agonist (clonidine, tenex)? This reduces norepinephrine release. Maybe a good handshake with an NRI AD. (OK a SWAG).
>
> Regards
> John
Yes, someone who is a doctor recently told me that when you have high blood pressure huge amounts of adrenaline are fluctuating in your body. Actually several MDs have told me this. I have tried Klonidine briefly, while in the hospital. It was a horrid medication. Extremely sedating. Its another old, dirty drug not used much anymore, like tricyclic antidepressants. I much prefer the modern class meds with good side effect profiles like ACE Inhibitors. But I know what your point is and know what you are trying to get at.You are probably right. All of this stuff is probably somehow related. Stress does all kinds of nasty things to the body...and the brain. Maybe 100 years from now doctors will have all this stuff figured out. Unfortunately, medical research moves so slowly I doubt any of us will live to see this kind of stuff evolve into anything real world. The corticosteroid theories and ideas are real hot now, but still purely research and experimental. To my knowledge, there is not one single real anti-corticosteroid drug available for any psychiatric disorder or for hypertension or anything else.
There is one weird drug I read about thats available its used to induce abortions. Its a corticosteroid antagonist. I read a Medline abstract that said it could be used to fight psychotic depression. Thats the only drug I know of thats currently available like that and there is no way Im putting a drug marketed for that in my body.
Like I said...maybe in fifty more years this stuff will pan out finally.
Old School
Posted by Elizabeth on March 26, 2002, at 23:47:02
In reply to Re: Gonna do ECT for sure- Me too, posted by OldSchool on March 26, 2002, at 10:30:39
> My only concern is the inducement of epilepsy, which I think is overhyped by reading about it over on the anti-ECT websites.
ECT lowers the seizure threshold. I very much doubt the claims that it often causes epilepsy. It was actually suggested to me as a possible alternative to anticonvulsants.
JohnX2's remarks about blood pressure are interesting. I'm sure everyone (or many of us, anyway) has heard about the association between cardiovascular disease and depression.
As for antiglucocorticoid drugs, ketoconazole is available and can be used off-label as an antidepressant. It also appears (IIRC) that the dexamethasone suppression test is a fairly good predictor of nonresponse (that is, people with normal cortisol responses to dexamethasone aren't likely to respond to ketoconazole).
-elizabeth
Posted by Elizabeth on March 26, 2002, at 23:50:24
In reply to Re: Gonna do ECT for sure » OldSchool, posted by Elizabeth on March 26, 2002, at 23:47:02
> ECT lowers the seizure threshold.
Argh, I meant *raises*. ECT *raises* the seizure threshold.
-elizabeth
Posted by JohnX2 on March 27, 2002, at 23:23:29
In reply to Re: AD meds and BP response, posted by OldSchool on March 26, 2002, at 18:47:54
> > > Here is my own prediction concerning my upcoming ECT. How much do you wanna bet that my blood pressure goes down a lot after ECT because I will be more relaxed? I think ECT will help my BP.
> >
> > From what I was reading about high blood pressure, it is often associated with a excess glucorcorticoid production state (do a web search). This may linked to a hyperacitive HPA (hypothalamaus-pituitary-adrenal-gland) axis. This is consistent with classic markers of depression. Hyperadrenal gland can cause dysfunctional noradrenargic system in general. You can acutally get this tested. The glucocorticoid receptors in the hypothalamus etc are desensitized to cortisol feedback and release too much of a substance ACTH. These causes too much secretion of cortisol (and high blood pressure) and continued depression. It may also make you agitated. CRF antagonists may fix this. Most ADs over time are thought to correct a malfunctioning feedback loop in the HPA axis. I would hope this would have an effect of fixing a hypercorisolemia state and possibly helping your bp. BTW, some people believe that NMDA antagonists may act as atypical CRF antagonists.
> >
> > I believe some of the dopamine agonists reduce noradrenergic output by stimulating presyaptic d2/d3 recptors at the lower doses. Pramipexole I seem to recall has hypotensive effects at low doses (at is selective for presynaptice autoreceptors. At the higher doses, they are less selective and stimulate the post synaptic d2 receptors If I recall (may lead to the psychosis). I believe Bromocriptine depletes noradrenaline release at the lower doses.
> >
> > This is all my quick-n-dirty conjecture, as always.
> >
> > http://www.acnp.org/g4/GN401000049/Default.htm
> > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2067174&dopt=Abstract
> > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2161850&dopt=Abstract
> >
> > Have you tried a mild atypical bp medicine like an alpha-2 agonist (clonidine, tenex)? This reduces norepinephrine release. Maybe a good handshake with an NRI AD. (OK a SWAG).
> >
> > Regards
> > John
>
>
> Yes, someone who is a doctor recently told me that when you have high blood pressure huge amounts of adrenaline are fluctuating in your body. Actually several MDs have told me this. I have tried Klonidine briefly, while in the hospital. It was a horrid medication. Extremely sedating. Its another old, dirty drug not used much anymore, like tricyclic antidepressants. I much prefer the modern class meds with good side effect profiles like ACE Inhibitors. But I know what your point is and know what you are trying to get at.
>
Tenex and Clonidine are also used for hyperactivity in ADHD. Tenex is more selective for the presynaptic alpha-2 noradrenergic feedback receptor and is not thought to be sedating like Clonodine (it is much cleaner). Clonidine is dirtier. Tenex is not a powerhouse BP med, but may be a helpful adjunct in psychiatry.John
Posted by OldSchool on March 28, 2002, at 20:52:42
In reply to Re: AD meds and BP response » OldSchool, posted by JohnX2 on March 27, 2002, at 23:23:29
>
> Tenex and Clonidine are also used for hyperactivity in ADHD. Tenex is more selective for the presynaptic alpha-2 noradrenergic feedback receptor and is not thought to be sedating like Clonodine (it is much cleaner). Clonidine is dirtier. Tenex is not a powerhouse BP med, but may be a helpful adjunct in psychiatry.Hmmmmmmm Im no expert at all on tenex and clonidine. I know I was on one of these, clonidine I think, in the hospital for a few days. I barely remember any of it cause I was so drugged up...it was just a blur. Anyway, everytime they gave me a clonidine Id fall asleep it was like the dirtiest, sedating drug. Later they switched me over to a modern class blood pressure med, an ACE inhibitor Prinivil. Thats when I finally started feeling normal...relaxed again. ACE Inhibitors rock...clonidine sucks hind tit as far as Im concerned.
Clonidine/Tenex might have some obscure uses in psychiatry, but my attitude is you can have these drugs.
BTW...did you know there is an ACE Inhibitor called captopril that is reported to have some mood elevating/antidepressant qualities? ACE Inhibitors have good side effect profiles.
Old School
>
This is the end of the 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.