Psycho-Babble Medication Thread 364549

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Re: Luvox to mood stabilizer? » KaraS

Posted by theo on July 10, 2004, at 12:17:38

In reply to Luvox to mood stabilizer?, posted by KaraS on July 9, 2004, at 20:51:16

Funny, I was not hospitalized but just stopped Luvox for OCD because it made my me more down and didn't lift me out of what I thought was wrong. My psychiatrist said lets drop the SSRI class period and try a mood stabilizer with antidepressant and activating properties, Lamictal. I'm currently at 50mg and going to 75-100mg. I feel "better" and am hoping this has been the problem all along, mixed depression with a mild form of ADD. I would highly suggest Lamictal but as you know or may not know, one has to titrate slowly so it could be 8 weeks before it can be evaluated truly as helpful or not. I hope this helps.

 

Re: Luvox to mood stabilizer?

Posted by KaraS on July 10, 2004, at 15:20:14

In reply to Re: Luvox to mood stabilizer?, posted by zeugma on July 9, 2004, at 22:12:18

> Dr. Daniel Amen, most famous for his use of MRI's in diagnosis of ADHD, recommends mood stabilizers for a subtype of the disorder he calls 'temporal lobe ADD.' It is supposed to share features with certain types of epilepsy, hence the use of mood stabilizers. The books that Amen and friends put out on ADD, depression and anxiety are among the glossiest you will find in the Psych section of Barnes and Noble, and are readily available.


Thank you!!!! I have Dr. Amen's most recent book but I was concentrating on what I thought was relevant to me and missed the parts that pertain to my friend. I'm going to have another look at the book soon.

All the best,
KaraS

 

Re: Luvox to mood stabilizer?

Posted by KaraS on July 10, 2004, at 15:23:27

In reply to Re: Luvox to mood stabilizer? » KaraS, posted by theo on July 10, 2004, at 12:17:38

> Funny, I was not hospitalized but just stopped Luvox for OCD because it made my me more down and didn't lift me out of what I thought was wrong. My psychiatrist said lets drop the SSRI class period and try a mood stabilizer with antidepressant and activating properties, Lamictal. I'm currently at 50mg and going to 75-100mg. I feel "better" and am hoping this has been the problem all along, mixed depression with a mild form of ADD. I would highly suggest Lamictal but as you know or may not know, one has to titrate slowly so it could be 8 weeks before it can be evaluated truly as helpful or not. I hope this helps.


Yes, thank you!!! Also very helpful. I will have to find out exactly what he's on. I'm very relieved now that I think my friend is on the right path.

Take care,
KaraS

 

Re: Luvox to mood stabilizer? » KaraS

Posted by zeugma on July 10, 2004, at 16:04:23

In reply to Re: Luvox to mood stabilizer?, posted by KaraS on July 10, 2004, at 15:20:14

> > Dr. Daniel Amen, most famous for his use of MRI's in diagnosis of ADHD, recommends mood stabilizers for a subtype of the disorder he calls 'temporal lobe ADD.' It is supposed to share features with certain types of epilepsy, hence the use of mood stabilizers. The books that Amen and friends put out on ADD, depression and anxiety are among the glossiest you will find in the Psych section of Barnes and Noble, and are readily available.
>
>
> Thank you!!!! I have Dr. Amen's most recent book but I was concentrating on what I thought was relevant to me and missed the parts that pertain to my friend. I'm going to have another look at the book soon.
>
> All the best,
> KaraS
>


You're welcome.

Do you have ADD?

 

Re: Luvox to mood stabilizer?

Posted by KaraS on July 10, 2004, at 16:26:17

In reply to Re: Luvox to mood stabilizer? » KaraS, posted by zeugma on July 10, 2004, at 16:04:23

> > > Dr. Daniel Amen, most famous for his use of MRI's in diagnosis of ADHD, recommends mood stabilizers for a subtype of the disorder he calls 'temporal lobe ADD.' It is supposed to share features with certain types of epilepsy, hence the use of mood stabilizers. The books that Amen and friends put out on ADD, depression and anxiety are among the glossiest you will find in the Psych section of Barnes and Noble, and are readily available.
> >
> >
> > Thank you!!!! I have Dr. Amen's most recent book but I was concentrating on what I thought was relevant to me and missed the parts that pertain to my friend. I'm going to have another look at the book soon.
> >
> > All the best,
> > KaraS
> >
>
>
> You're welcome.
>
> Do you have ADD?
>

I'm not sure if I have ADD or not. I know that I have trouble focusing and concentrating - that studying or working on spreadsheets takes me a lot longer than it takes other people. But I don't know if that's just a result of my depression or if it's ADD. OTOH, I've always done well in school. How does one distinguish whether it's depression or ADD?

 

Re: Luvox to mood stabilizer? » KaraS

Posted by zeugma on July 10, 2004, at 17:30:43

In reply to Re: Luvox to mood stabilizer?, posted by KaraS on July 10, 2004, at 16:26:17

> > > > Dr. Daniel Amen, most famous for his use of MRI's in diagnosis of ADHD, recommends mood stabilizers for a subtype of the disorder he calls 'temporal lobe ADD.' It is supposed to share features with certain types of epilepsy, hence the use of mood stabilizers. The books that Amen and friends put out on ADD, depression and anxiety are among the glossiest you will find in the Psych section of Barnes and Noble, and are readily available.
> > >
> > >
> > > Thank you!!!! I have Dr. Amen's most recent book but I was concentrating on what I thought was relevant to me and missed the parts that pertain to my friend. I'm going to have another look at the book soon.
> > >
> > > All the best,
> > > KaraS
> > >
> >
> >
> > You're welcome.
> >
> > Do you have ADD?
> >
>
> I'm not sure if I have ADD or not. I know that I have trouble focusing and concentrating - that studying or working on spreadsheets takes me a lot longer than it takes other people. But I don't know if that's just a result of my depression or if it's ADD. OTOH, I've always done well in school. How does one distinguish whether it's depression or ADD?


Trouble focusing is certainly a common symptom of both. i never really had to wonder about whether or not I had ADD, as I was diagnosed at the tender age of twelve- and this was before ADD even bore its present, relatively innocuous name. i was good in school in that those things which i 'got', i got quickly. unfortunately i was hopeless when it came to doing homework, and even now in grad school i slack off at every opportunity. though i am trying to motivate myself to slog through.

I am skeptical of Amen's taxonomies of ADD. According to him I would have 'limbic ADD,' ADD accompanied by depression. The medications he lists for this condition are the noradrenergic AD's: TCA's, Wellbutrin, Effexor, and Strattera, and these are in fact the meds that helped me. But this is because I have difficulty tolerating stimulants due to weight and sleep issues, and I unquestionably have chronic (lifelong, really) major depression as well. I recently dropped Provigil when I became severely depressed over the holiday last week and couldn't sleep. I upped the dose of nortriptyline so i could at least maintain my sleep through the worst of it (insomnia worsens my condition to an APPALLING degree).

My pdoc, to his credit, was sympathetic, and i was very open with him about my misery. he suggested that I try the provigil again at a low dose, now that my mood has evened out somewhat, and this morning I took 50 mg. It has a definite cognitive effect- there is a slight but significant 'delay' in my thought process which I actually find beneficial (it is calming and it is easier for me to coordinate my responses to events). No energizing effect that I can notice, and at 100 mg there was some sleep disruption which I can't tolerate, but now that i know what to 'look for' from this med there may be something I can use from it.

have you had beneficial effects from stimulants? I think that is am ore significant question than formal diagnosis. There are plenty of online tests available, there's one for example at strattera.com, but as someone in the education biz, I know it's all too easy to skew a test so takers get a desired result, if you know what i mean.

z

 

Re: Luvox to mood stabilizer?

Posted by KaraS on July 11, 2004, at 4:58:31

In reply to Re: Luvox to mood stabilizer? » KaraS, posted by zeugma on July 10, 2004, at 17:30:43

I wrote out a long response to your message but it never got posted. I'm so bummed. I'll have to try again tomorrow.

 

Re: Luvox to mood stabilizer?

Posted by Cairo on July 11, 2004, at 7:39:54

In reply to Luvox to mood stabilizer?, posted by KaraS on July 9, 2004, at 20:51:16

Kara,
We just returned from a consult with a specialist in Philadelphia at U of Penn for our teen who said to add low dose Seroquel (chose this over Risperdal because of weight gain issues) to her Lexapro. She has ADD, anxiety, social phobia and dysthymia and the Dr. said that the Seroquel will help "even" things out. Abilify is another one to look at. Lex helps somewhat, but was not enough. The Dr. said that at low doses, there's not much problem with the side effects of the atypical neuroleptics that everyone worries about. Good luck to you!

Cairo

 

Re: Luvox to mood stabilizer?

Posted by KaraS on July 11, 2004, at 16:52:51

In reply to Re: Luvox to mood stabilizer?, posted by Cairo on July 11, 2004, at 7:39:54

> Kara,
> We just returned from a consult with a specialist in Philadelphia at U of Penn for our teen who said to add low dose Seroquel (chose this over Risperdal because of weight gain issues) to her Lexapro. She has ADD, anxiety, social phobia and dysthymia and the Dr. said that the Seroquel will help "even" things out. Abilify is another one to look at. Lex helps somewhat, but was not enough. The Dr. said that at low doses, there's not much problem with the side effects of the atypical neuroleptics that everyone worries about. Good luck to you!
>
> Cairo

Thanks for your input!

 

Re: Zeugma, ADD diagnosis

Posted by KaraS on July 11, 2004, at 19:09:16

In reply to Re: Luvox to mood stabilizer? » KaraS, posted by zeugma on July 10, 2004, at 17:30:43

> > > > > Dr. Daniel Amen, most famous for his use of MRI's in diagnosis of ADHD, recommends mood stabilizers for a subtype of the disorder he calls 'temporal lobe ADD.' It is supposed to share features with certain types of epilepsy, hence the use of mood stabilizers. The books that Amen and friends put out on ADD, depression and anxiety are among the glossiest you will find in the Psych section of Barnes and Noble, and are readily available.
> > > >
> > > >
> > > > Thank you!!!! I have Dr. Amen's most recent book but I was concentrating on what I thought was relevant to me and missed the parts that pertain to my friend. I'm going to have another look at the book soon.
> > > >
> > > > All the best,
> > > > KaraS
> > > >
> > >
> > >
> > > You're welcome.
> > >
> > > Do you have ADD?
> > >
> >
> > I'm not sure if I have ADD or not. I know that I have trouble focusing and concentrating - that studying or working on spreadsheets takes me a lot longer than it takes other people. But I don't know if that's just a result of my depression or if it's ADD. OTOH, I've always done well in school. How does one distinguish whether it's depression or ADD?
>
>
> Trouble focusing is certainly a common symptom of both. i never really had to wonder about whether or not I had ADD, as I was diagnosed at the tender age of twelve- and this was before ADD even bore its present, relatively innocuous name. i was good in school in that those things which i 'got', i got quickly. unfortunately i was hopeless when it came to doing homework, and even now in grad school i slack off at every opportunity. though i am trying to motivate myself to slog through.

I always leave everything to the last minute too. Terrible problem with motivation. Between that and the difficulty concentrating, it's amazing that I managed to complete my graduate program. Being successful in work has been another matter. It's very tough to succeed when you're depressed, unmotivated and can't think straight. I can usually bluff my way through unless I have to do detailed spreadsheets or things that take me much too much time.

Perhaps you were lucky to get diagnosed early. At least you know what you're dealing with and have some things to help you - though it sounds like you're still looking because what you're using now sounds less than optimal.


>
> I am skeptical of Amen's taxonomies of ADD. According to him I would have 'limbic ADD,' ADD accompanied by depression. The medications he lists for this condition are the noradrenergic AD's: TCA's, Wellbutrin, Effexor, and Strattera, and these are in fact the meds that helped me. But this is because I have difficulty tolerating stimulants due to weight and sleep issues, and I unquestionably have chronic (lifelong, really) major depression as well. I recently dropped Provigil when I became severely depressed over the holiday last week and couldn't sleep. I upped the dose of nortriptyline so i could at least maintain my sleep through the worst of it (insomnia worsens my condition to an APPALLING degree).
>

I am also skeptical of his classifications that are too neat and clean from my point of view. I wonder if ADD really does fall into such specfic and different categories. I also question his work because (if I remember correctly) he has said in at least one of his books that there is no problem with tolerance. It doesn't happen. SAY WHAT???? Maybe if someone is truly ADHD, then it doesn't happen. I don't know. But I do know that these boards are filled with depressives who are dealing with poop-out of stimulants. Still, his MRIs are very impressive and he's done a lot of good research.

> My pdoc, to his credit, was sympathetic, and i was very open with him about my misery. he suggested that I try the provigil again at a low dose, now that my mood has evened out somewhat, and this morning I took 50 mg. It has a definite cognitive effect- there is a slight but significant 'delay' in my thought process which I actually find beneficial (it is calming and it is easier for me to coordinate my responses to events). No energizing effect that I can notice, and at 100 mg there was some sleep disruption which I can't tolerate, but now that i know what to 'look for' from this med there may be something I can use from it.
>

It's good that you have a doctor you can work with. That's half the battle.

> have you had beneficial effects from stimulants? I think that is am ore significant question than formal diagnosis. There are plenty of online tests available, there's one for example at strattera.com, but as someone in the education biz, I know it's all too easy to skew a test so takers get a desired result, if you know what i mean.
>
> z
Provigil made my limbs feel heavy and stiff like they were covered with cement. It was creepy.
I have not tried any stimulants yet except for generic methylphenidate. I took 5 mg. and it put me to sleep. I was too afraid to try anymore. I thought it might really knock me out too much. Sounds silly I know. I will eventually try Adderall and maybe try more of the Ritalin. You said that you could not tolerate the stimulants because of sleep. Did you take anything with them for sleep? What if you took Remeron? That's sedating and certainly sparks the appetite.

I am also skeptical of the strattera test. I think, as you suggested, that it is designed so that anyone taking it will end up thinking that he or she has ADD. It might be worth my checking out anyway as long as I keep that bias in mind. I am not leaning towards trying strattera at this time as it can make you slower and groggy. I desperately need things that will get me moving and give me energy. Then of course I'll have to deal with the insomnia.

Well, I hope that you are feeling much better than you did over the holiday. Holidays can be very depressing if you don't have anything fun to do or look forward to. I was pretty bummed out myself. It sounds like you're getting closer, though, to finding things that will work for you.

Take care,
Kara


 

Re: Zeugma, ADD diagnosis » KaraS

Posted by zeugma on July 12, 2004, at 13:37:49

In reply to Re: Zeugma, ADD diagnosis, posted by KaraS on July 11, 2004, at 19:09:16

sorry it's so long for me to reply to your post, I had to sleep upwards of 12 hours to recover from the weekend's insomnia, and also there are some posting problems that interfere with the 'include previous post' option.

It has been a mixed blessing having the ADHD diagnosis from an early age. At 12 I was hardly able to process it other than to think 'oh no, there's something wrong with my brain.' also my parents do not understand psychiatric illness, and essentially ignored the recommendations that were made, which was not helpful in terms of my subsequent academic career. they did put me in psychotherapy, but i will save the disasters this produced for PB Psychology, if i ever do choose to publicize them.

yes I've found some things that worked or work. Strattera unquestionably did work on some aspects of my ADHD. Once I went on it I started moving up in my profession, and it had a powerful motivating effect that was great. Unfortuantely two problems:

i used it concurrently with nortriptyline, and this was pharmacological redundancy, which amplified the s/e of each;

and Strattera has a fatiguing effect that is hard to explain on a pharmacological basis. This did not manifest in me immediately, rather it slowly intensified until my already severe lethargy became unbearable. Also, while it addresses such ADHD/depression issues such as brain fog and motivation, it fails to have the 'slowing' effect that Provigil and the stims I tried long ago had, and which is probably better suited to most types of ADHD, and which I prefer to the enforced 'alertness' of Strattera. Oh, and Provigil is calming, and I am one of those ultra-nervous types.

I never tried Remeron, and am rather disturbed by its ability to increase triglycerides- I have cholesterol problems already. Also I would want to put Remeron in place of my AD if I was going to do it at all, and I have seen no evidence that Remeron is a more potent AD than nortriptyline. I would probably benefit from remeron's alpha-2 antagonism, but I already get that from buspirone. I would rather stick with what I have and use Ambien.

I also have an order for Ritalin LA at my local pharmacy and should be getting it by the weekend. My pdoc encouraged me to 'mix and match' as needed, so I have other options besides the Provigil.

The insomnia was not nearly as bad last night, so perhaps it was the pot of coffee I had Saturday evening that worsened the insomnia (normally coffeedosn't cause that unless it's Starbuck's),or maybe it's the normal 'startup' of a new med (nortrip had plenty of those too).

I know you tried nortrip and had tachycardia problems. I was kept on a very low dose of nortrip by my pdoc because of bp problems. Eventually my body adjusted and I have been able to increase dosage without recurrence of the problem. Reactions are idiosyncratic of course, but a retrial of nortrip might be something to try, plus it has some efficacy in ADHD if you do have that.

Take care,

z

 

Re: Zeugma, ADD diagnosis

Posted by KaraS on July 15, 2004, at 1:19:09

In reply to Re: Zeugma, ADD diagnosis » KaraS, posted by zeugma on July 12, 2004, at 13:37:49

> sorry it's so long for me to reply to your post, I had to sleep upwards of 12 hours to recover from the weekend's insomnia, and also there are some posting problems that interfere with the 'include previous post' option.

Hi Zeugma,
I'm glad you got a chance to catch up on your sleep. (Even though you needed it, don't you feel really depressed after you've slept that long?) I almost missed responding to you entirely. I thought I owed you a response but couldn't find the thread. I gave up figuring that I must not owe you a reply. I could have sworn that I did a search on your name and everything. Then this evening I saw it quite by accident. Maybe I do have ADD! OTOH, maybe it's the rhodiola that I've been trying. I think it's have the opposite effect on me that it's supposed to. But that's another story.

At any rate, let me now respond to your comments.

>
> It has been a mixed blessing having the ADHD diagnosis from an early age. At 12 I was hardly able to process it other than to think 'oh no, there's something wrong with my brain.' also my parents do not understand psychiatric illness, and essentially ignored the recommendations that were made, which was not helpful in terms of my subsequent academic career. they did put me in psychotherapy, but i will save the disasters this produced for PB Psychology, if i ever do choose to publicize them.
>

It is so difficult to deal with a situation like yours or mine when the parents don't understand. It's hard enough to deal with the problem itself and then to have them compound it - especially since you were so young. You really weren't old enough to be your own advocate which is what the situation called for. As I'm sure you know, both fields of psychiatry and psychology are rife with treatment horror stories. Many years into the future they will probably look back on our methods the same way that we look at using leeches to cure illnesses.


> yes I've found some things that worked or work. Strattera unquestionably did work on some aspects of my ADHD. Once I went on it I started moving up in my profession, and it had a powerful motivating effect that was great. Unfortuantely two problems:
>
> i used it concurrently with nortriptyline, and this was pharmacological redundancy, which amplified the s/e of each;
>
> and Strattera has a fatiguing effect that is hard to explain on a pharmacological basis. This did not manifest in me immediately, rather it slowly intensified until my already severe lethargy became unbearable. Also, while it addresses such ADHD/depression issues such as brain fog and motivation, it fails to have the 'slowing' effect that Provigil and the stims I tried long ago had, and which is probably better suited to most types of ADHD, and which I prefer to the enforced 'alertness' of Strattera. Oh, and Provigil is calming, and I am one of those ultra-nervous types.
>

I don't really have any interest in trying Strattera right now. I need more energizing activity at the moment. I have been extremely nervous at times in the past but right now my depression is very clinically atypical. I couldn't stand anything that would make me more listless or tired. (If I'm reading your message correctly, you have an unusual combination of lethargy with anxiety. That must make it harder to treat you.) Provigil made my limbs feel too heavy and I haven't tried the stimulants yet other than Ritalin at 5 mg. which made me sleepy. I've been afraid to increase the dosage in case it would knock me out entirely. Did I ask you yet if you've had any problem with stimulant tolerance? Is that why you're not taking them currently?

I feel like I may have told you/asked you all of this previously. If so, please excuse me. I'm not feeling terribly sharp right now.


> I never tried Remeron, and am rather disturbed by its ability to increase triglycerides- I have cholesterol problems already. Also I would want to put Remeron in place of my AD if I was going to do it at all, and I have seen no evidence that Remeron is a more potent AD than nortriptyline. I would probably benefit from remeron's alpha-2 antagonism, but I already get that from buspirone. I would rather stick with what I have and use Ambien.
>

I wasn't aware of Remeron's cholesterol connection. I wouldn't be interested because of the sedation or the weight gain anyway which is why I never looked into it further.


> I also have an order for Ritalin LA at my local pharmacy and should be getting it by the weekend. My pdoc encouraged me to 'mix and match' as needed, so I have other options besides the Provigil.
>

I guess that makes sense. You know what you need at the time and can benefit by varying what you take.

> The insomnia was not nearly as bad last night, so perhaps it was the pot of coffee I had Saturday evening that worsened the insomnia (normally coffeedosn't cause that unless it's Starbuck's),or maybe it's the normal 'startup' of a new med (nortrip had plenty of those too).
>

I'm either having insomnia or I can't stop sleeping. I seem to rotate phases of both. Makes it harder to treat me as well.


> I know you tried nortrip and had tachycardia problems. I was kept on a very low dose of nortrip by my pdoc because of bp problems. Eventually my body adjusted and I have been able to increase dosage without recurrence of the problem. Reactions are idiosyncratic of course, but a retrial of nortrip might be something to try, plus it has some efficacy in ADHD if you do have that.
>
Take care,
>
> z

Encouraging that your body did adjust. Did your heart race also or was it just your blood pressure? I may someday retry nortriptyline. Maybe start with a really, really small dose.

Thanks so much for all of your info and feedback!

Kara

> >
>
>
>

 

Re: Zeugma, ADD diagnosis

Posted by zeugma on July 16, 2004, at 22:45:25

In reply to Re: Zeugma, ADD diagnosis, posted by KaraS on July 15, 2004, at 1:19:09

hi Kara,

Yes I feel much worse after sleeping a lot. The optimum for me moodwise is to sleep about 5 hours hours. Unfortunately I seem to require a time to repay the 'sleep debt,' and then I have this comatose sleep that is unpleasant. but if I don't do this (for example on weekends when I work all week) I start to feel myself 'running down' inside. In fact, on Fridays I always feel this, and the mood- and energy-elevating effect of little sleep turns to acute dysphoria.

I didn't experience any tachycardia on nortriptyline. I suspect I am relatively immune to this effect since it seems to be mediated through blockade of the muscarinic receptor, and I have reason to think that overactivity of this receptor helped cause my history of depression. depression has many causes, of course; that's why the TCA's are generally so effective, they are 'dirty' drugs, which can be a virtue.

The least anti-muscarinic TCA is desipramine, which is similar to Paxil in potency in this regard; did you ever experience this effect on Paxil, if you tried it? If nortriptlyine energized you, then you would definitely be energized by desipramine. Of course, the tachycardia could be an indirect result of NE stimulation. Did you ever take Wellbutrin (forgive me if you told me already) and if so what effect did it have?

I think you said you were on Effexor now? Is that energizing at all?

If you are having the cycle of insomnia/oversleeping, I wonder if it's because you have a reversed circadian cycle. I don't have one now, but at the price of diminished energy: my energy naturally seems to peak around 4 am. 100 mg of nortriptyline is helping with energy a little, and the Provigil may be having a small effect too. Are you thinking of trying Ritalin again? I'm actually thinking of taking a 'drug holiday' from nortrip for a night, and taking a little Ritalin LA and seeing if I can get any work done on my grad school thesis. I wrote a chapter in January on an all-nighter but that had me feeling awful for a week!


z

 

Re: Zeugma, ADD diagnosis

Posted by KaraS on July 17, 2004, at 1:33:15

In reply to Re: Zeugma, ADD diagnosis, posted by zeugma on July 16, 2004, at 22:45:25

> hi Kara,
>
> Yes I feel much worse after sleeping a lot. The optimum for me moodwise is to sleep about 5 hours hours. Unfortunately I seem to require a time to repay the 'sleep debt,' and then I have this comatose sleep that is unpleasant. but if I don't do this (for example on weekends when I work all week) I start to feel myself 'running down' inside. In fact, on Fridays I always feel this, and the mood- and energy-elevating effect of little sleep turns to acute dysphoria.
>
> I didn't experience any tachycardia on nortriptyline. I suspect I am relatively immune to this effect since it seems to be mediated through blockade of the muscarinic receptor, and I have reason to think that overactivity of this receptor helped cause my history of depression. depression has many causes, of course; that's why the TCA's are generally so effective, they are 'dirty' drugs, which can be a virtue.
>
> The least anti-muscarinic TCA is desipramine, which is similar to Paxil in potency in this regard; did you ever experience this effect on Paxil, if you tried it? If nortriptlyine energized you, then you would definitely be energized by desipramine. Of course, the tachycardia could be an indirect result of NE stimulation. Did you ever take Wellbutrin (forgive me if you told me already) and if so what effect did it have?
>
> I think you said you were on Effexor now? Is that energizing at all?
>
> If you are having the cycle of insomnia/oversleeping, I wonder if it's because you have a reversed circadian cycle. I don't have one now, but at the price of diminished energy: my energy naturally seems to peak around 4 am. 100 mg of nortriptyline is helping with energy a little, and the Provigil may be having a small effect too. Are you thinking of trying Ritalin again? I'm actually thinking of taking a 'drug holiday' from nortrip for a night, and taking a little Ritalin LA and seeing if I can get any work done on my grad school thesis. I wrote a chapter in January on an all-nighter but that had me feeling awful for a week!
>
>
> z
>

Z,
Yes, that's exactly how I am! Mood and energy- wise I do better on less sleep but health-wise I end up paying the price. Every saturday when I was working (I'm currently job hunting) I would crash and then feel horribly depressed and sluggish. I feel the best in terms of mood and motivation when I don't sleep at all but then I actually get physically sick (CFS). I'm always gauging my sleep in a balancing act of mood/energy vs. health. Not a great way to live but hopefully I'll find meds &/or supplements to help with this situation.

Also, I definitely have a reversed circadian cycle. My energy tends to peak in the early morning hours as well. I've always been a night owl and my attempts at resetting have not been successful for long. One of the biggest reasons for this is psychological. I just don't want to try to go to sleep when I'm finally feeling some energy and some sense of being alive. The normal 8-5 routine has always taken quite a toll on me. I have felt oppressed by the morning people of the world for quite some time now. (That was meant only half in jest.)

Have you had any success with resetting your cycle? Have you tried light box, melatonin, methylcobalamin?

Actually, I need to close right now as my neighbor just stopped over. I'll get back to you tomorrow about the meds and the rest of your message.

Take care,
Kara

 

Re: Zeugma, ADD diagnosis

Posted by zeugma on July 17, 2004, at 20:13:48

In reply to Re: Zeugma, ADD diagnosis, posted by KaraS on July 17, 2004, at 1:33:15

kara, just to answer a few things (exhausted from running- how can i run 6 miles and not have the energy to do the dishes?)- i was prescribed a light box years ago- it takes up half my apartment. the sleep doc told me to sit under it for half an hour at 6 am every morning. i was having trouble getting up at 6 pm, let alone 6 am! but he was dogmatic about it. i don't believe i was able to derive maximum benefit from the thing. when i did use it, it didn't help.

nortriptyline and buspirone, in combination, help me sleep at night. those are the only things that have gotten a semblance of a normal sleep schedule for me.

z

 

Re: Zeugma, ADD diagnosis

Posted by KaraS on July 17, 2004, at 21:08:31

In reply to Re: Zeugma, ADD diagnosis, posted by zeugma on July 17, 2004, at 20:13:48

> kara, just to answer a few things (exhausted from running- how can i run 6 miles and not have the energy to do the dishes?)- i was prescribed a light box years ago- it takes up half my apartment. the sleep doc told me to sit under it for half an hour at 6 am every morning. i was having trouble getting up at 6 pm, let alone 6 am! but he was dogmatic about it. i don't believe i was able to derive maximum benefit from the thing. when i did use it, it didn't help.
>
> nortriptyline and buspirone, in combination, help me sleep at night. those are the only things that have gotten a semblance of a normal sleep schedule for me.
>
> z


I can't believe that you can motivate yourself to run 6 miles! That's fantastic. Wish I could do that. As for the dishes, that one I completely understand.

It always surprises me when I hear of people taking nortriptyline for sleep (though I know lots of people do). It made me so hyper. I loved the energy though.

 

Re: Zeugma, ADD diagnosis

Posted by KaraS on July 17, 2004, at 21:41:02

In reply to Re: Zeugma, ADD diagnosis, posted by zeugma on July 16, 2004, at 22:45:25

> hi Kara,
>
> Yes I feel much worse after sleeping a lot. The optimum for me moodwise is to sleep about 5 hours hours. Unfortunately I seem to require a time to repay the 'sleep debt,' and then I have this comatose sleep that is unpleasant. but if I don't do this (for example on weekends when I work all week) I start to feel myself 'running down' inside. In fact, on Fridays I always feel this, and the mood- and energy-elevating effect of little sleep turns to acute dysphoria.
>
> I didn't experience any tachycardia on nortriptyline. I suspect I am relatively immune to this effect since it seems to be mediated through blockade of the muscarinic receptor, and I have reason to think that overactivity of this receptor helped cause my history of depression. depression has many causes, of course; that's why the TCA's are generally so effective, they are 'dirty' drugs, which can be a virtue.
>
> The least anti-muscarinic TCA is desipramine, which is similar to Paxil in potency in this regard; did you ever experience this effect on Paxil, if you tried it? If nortriptlyine energized you, then you would definitely be energized by desipramine. Of course, the tachycardia could be an indirect result of NE stimulation. Did you ever take Wellbutrin (forgive me if you told me already) and if so what effect did it have?
>
> I think you said you were on Effexor now? Is that energizing at all?
>
> If you are having the cycle of insomnia/oversleeping, I wonder if it's because you have a reversed circadian cycle. I don't have one now, but at the price of diminished energy: my energy naturally seems to peak around 4 am. 100 mg of nortriptyline is helping with energy a little, and the Provigil may be having a small effect too. Are you thinking of trying Ritalin again? I'm actually thinking of taking a 'drug holiday' from nortrip for a night, and taking a little Ritalin LA and seeing if I can get any work done on my grad school thesis. I wrote a chapter in January on an all-nighter but that had me feeling awful for a week!
>
>
> z
>


Hi Z,
I have also tried desipramine. Same effect on me as nortriptyline. In my mind they are the same drug. (BTW, how does anti-muscarinic differ from anticholinergic?)

I did have either tachycardia or irregular heart rate (I thought it was the latter, my pdoc insisted it was the former) from Celexa, believe it or not. That was a HORRIBLE medication.

I tried Wellbutrin in small amount. It didn't give me tachycardia but I had a strange allergic effect. I felt like I couldn't breathe. I thought it could perhaps have been due to excipients in the pill but recently I remembered that I also tried the extended relief capsule with the same result.

Provigil made my limbs feel like cement. Also very strange but a known side effect for some people.

Effexor was rather neutral for me. I took the XR form because I experienced what I felt was an irregular heartbeat on the regular pills. I could take the XR in the morning or at night and it wouldn't make much of a difference. Unfortunately the antidepressant effect was limited but i had virtually no side effects. No pain, no gain I guess.

Paxil did absolutely nothing for me except give me a hard time getting off of it.

Zoloft did nothing for me. Also couldn't even tell I was taking anything. Amazing sexual response when I was going off of it. Like nothing I could even begin to describe - the ultimate aphrodesiac. (Hmmm, maybe I should go on and off of it more often...)

I just took 5 mg. of selegiline to wake up my brain. I had just slept a lot and needed something desperately. It has helped a bit. I'm going to try 10 mg. sometime soon. Have you tried selegiline at all?

I've mentioned my experience with Ritalin in a few other posts, but I don't remember if I've said anything to you about it. I tried 5 mg. of generic methylphenidate and it made me so sleepy. Did you react like that to a small dose of it? Does that reaction seem like it might give more creedence to the argument that I have ADD? Or is it completely unrelated? I'll have to try the 10 mg. when I get up enough nerve and see what happens. I have yet to try anything that has a truly profound effect upon my focus or concentration (but when I find that, get antidepressant relief and normalize my sleep, I may actually be able to get a good job!!)

Have you decided whether to forego sleep for a night, take Ritalin and work on your thesis?

-Kara

 

Re: Zeugma, ADD diagnosis

Posted by zeugma on July 18, 2004, at 7:08:00

In reply to Re: Zeugma, ADD diagnosis, posted by KaraS on July 17, 2004, at 21:41:02

> > hi Kara,
> >
> > Yes I feel much worse after sleeping a lot. The optimum for me moodwise is to sleep about 5 hours hours. Unfortunately I seem to require a time to repay the 'sleep debt,' and then I have this comatose sleep that is unpleasant. but if I don't do this (for example on weekends when I work all week) I start to feel myself 'running down' inside. In fact, on Fridays I always feel this, and the mood- and energy-elevating effect of little sleep turns to acute dysphoria.
> >
> > I didn't experience any tachycardia on nortriptyline. I suspect I am relatively immune to this effect since it seems to be mediated through blockade of the muscarinic receptor, and I have reason to think that overactivity of this receptor helped cause my history of depression. depression has many causes, of course; that's why the TCA's are generally so effective, they are 'dirty' drugs, which can be a virtue.
> >
> > The least anti-muscarinic TCA is desipramine, which is similar to Paxil in potency in this regard; did you ever experience this effect on Paxil, if you tried it? If nortriptlyine energized you, then you would definitely be energized by desipramine. Of course, the tachycardia could be an indirect result of NE stimulation. Did you ever take Wellbutrin (forgive me if you told me already) and if so what effect did it have?
> >
> > I think you said you were on Effexor now? Is that energizing at all?
> >
> > If you are having the cycle of insomnia/oversleeping, I wonder if it's because you have a reversed circadian cycle. I don't have one now, but at the price of diminished energy: my energy naturally seems to peak around 4 am. 100 mg of nortriptyline is helping with energy a little, and the Provigil may be having a small effect too. Are you thinking of trying Ritalin again? I'm actually thinking of taking a 'drug holiday' from nortrip for a night, and taking a little Ritalin LA and seeing if I can get any work done on my grad school thesis. I wrote a chapter in January on an all-nighter but that had me feeling awful for a week!
> >
> >
> > z
> >
>
>
> Hi Z,
> I have also tried desipramine. Same effect on me as nortriptyline. In my mind they are the same drug. (BTW, how does anti-muscarinic differ from anticholinergic?)

That backs up what my pdoc told me, that desipramine and nortriptyline are virtually interchangeable in terms of clinical effect. Except that nortriptyline is less sedating. Except for some. Of course...

There are several kinds of cholinergic receptors, which are stimulated by the neurotransmitter acetylcholine, just like make different serotonergetic receptors can be stimulated by serotonin. The cholinergic receptors that I know of are the muscarinic and the nicotinic. Nicotinic receptors, as the name suggests, are stimulated by nicotine and blocked by Wellbutrin (hence its efficacy in stopping smoking). Nortriptyline probably blocks this receptor too, since it works just as well for this purpose as WB.
Muscarinic receptors are associated with the memory deficits of Alzheimer's disease, and anti-muscarinic potency is why the TCA's are called (misleadingly) 'dumb drugs.' They can cause memory problems, constipation, and tachycardia. I would argue however that a subset of depressed people have overactivity of these receptors, which causes early entry into REM sleep (see thread on Provigil) and which was taken as a diagnostic marker of endogeneous depression in the 60's. So the anti-muscarinic potency of these drugs is therapeutic, for some at least.


>
> I did have either tachycardia or irregular heart rate (I thought it was the latter, my pdoc insisted it was the former) from Celexa, believe it or not. That was a HORRIBLE medication.
>
> I tried Wellbutrin in small amount. It didn't give me tachycardia but I had a strange allergic effect. I felt like I couldn't breathe. I thought it could perhaps have been due to excipients in the pill but recently I remembered that I also tried the extended relief capsule with the same result.
>
> Provigil made my limbs feel like cement. Also very strange but a known side effect for some people.
>
> Effexor was rather neutral for me. I took the XR form because I experienced what I felt was an irregular heartbeat on the regular pills. I could take the XR in the morning or at night and it wouldn't make much of a difference. Unfortunately the antidepressant effect was limited but i had virtually no side effects. No pain, no gain I guess.
>
> Paxil did absolutely nothing for me except give me a hard time getting off of it.
>
> Zoloft did nothing for me. Also couldn't even tell I was taking anything. Amazing sexual response when I was going off of it. Like nothing I could even begin to describe - the ultimate aphrodesiac. (Hmmm, maybe I should go on and off of it more often...)
>
> I just took 5 mg. of selegiline to wake up my brain. I had just slept a lot and needed something desperately. It has helped a bit. I'm going to try 10 mg. sometime soon. Have you tried selegiline at all?

No, never tried selegiline. Only SSRI's (nausea and panic attacks), Wellbutrin (weird autonomic disturbances, I became very light-sensitive and uncoordinated and was literally walking into walls), various stimulants (calming response, cognitive benefit, but rapid weight loss, which was why i finally returned to TCA's, besides being somewhat effective for ADHD and very effective for depression they stimulate the appetite- I know most people are looking for the opposite effect but when I get depressed (which is always, off meds) I can't eat and slowly waste away. The stims caused me to quickly waste away). >
> I've mentioned my experience with Ritalin in a few other posts, but I don't remember if I've said anything to you about it. I tried 5 mg. of generic methylphenidate and it made me so sleepy. Did you react like that to a small dose of it? Does that reaction seem like it might give more creedence to the argument that I have ADD? Or is it completely unrelated? I'll have to try the 10 mg. when I get up enough nerve and see what happens. I have yet to try anything that has a truly profound effect upon my focus or concentration (but when I find that, get antidepressant relief and normalize my sleep, I may actually be able to get a good job!!)
>
> Have you decided whether to forego sleep for a night, take Ritalin and work on your thesis?
>
> -Kara

No, I was so wiped out by working in the morning, then picking up the Ritalin, then going for the long run, that I went right to sleep.

z

 

Re: Zeugma, ADD diagnosis » zeugma

Posted by SLS on July 18, 2004, at 7:54:46

In reply to Re: Zeugma, ADD diagnosis, posted by zeugma on July 18, 2004, at 7:08:00

Hi.

> That backs up what my pdoc told me, that desipramine and nortriptyline are virtually interchangeable in terms of clinical effect.

This is pretty much true. There are two important differences, though. First, there are people who respond to one and not the other. Second, unlike desipramine, the dosages of nortriptyline that someone will respond to for depression will fall within a therapeutic window, outside of which, the quality of response is reduced. It is actually possible to take too much and lose the antidepressant effect. However, the blood levels of nortriptyline are well studied, and the therapeutic range has been established as being between 50-150 ng/mL. Simple blood tests will help with dosing. Most people end up taking 75mg. I don't know how true this is, but at one time, many clinicians felt that if a patient responded well to desipramine, they were less likely to respond to nortriptyline and vice versa. If you don't respond to one, don't rule out the other.

> Muscarinic receptors are associated with the memory deficits of Alzheimer's disease, and anti-muscarinic potency is why the TCA's are called (misleadingly) 'dumb drugs.'

I take imipramine 300mg, and I feel pretty dumb. I know much of my problem is due to the depression itself, and some might even be due to Lamictal 300mg. How would you guess that much imipramine would affect me - or anyone else for that matter? Do you think the negative congnitive effects are exaggerated? I do enter REM early. It bugs the hell out of me to think that a drug is making me dumber than I am to begin with! Damn these illnesses.

>:-(

Regarding sleep, I discovered a little trick a long time ago that helps me from suffering a worsening of depression when I need to catch up on sleep. Regardless of what time you go to bed, wake up at the same time every day, get out of bed, expose yourself to bright light, do anything that will bring yourself to a state of full wakefullness, and then go back to bed and sleep as long as you like. This resets the circadian clock and prevents a phase delay. It usually works for me.

:-)


- Scott

 

Re: Zeugma, ADD diagnosis » SLS

Posted by zeugma on July 18, 2004, at 15:36:37

In reply to Re: Zeugma, ADD diagnosis » zeugma, posted by SLS on July 18, 2004, at 7:54:46

> Hi.
> Hi Scott.


> > That backs up what my pdoc told me, that desipramine and nortriptyline are virtually interchangeable in terms of clinical effect.
>
> This is pretty much true. There are two important differences, though. First, there are people who respond to one and not the other. Second, unlike desipramine, the dosages of nortriptyline that someone will respond to for depression will fall within a therapeutic window, outside of which, the quality of response is reduced. It is actually possible to take too much and lose the antidepressant effect. However, the blood levels of nortriptyline are well studied, and the therapeutic range has been established as being between 50-150 ng/mL. Simple blood tests will help with dosing. Most people end up taking 75mg. I don't know how true this is, but at one time, many clinicians felt that if a patient responded well to desipramine, they were less likely to respond to nortriptyline and vice versa. If you don't respond to one, don't rule out the other.

I would describe myself as partially TCA (nortriptyline-) responsive. I have 'atypically typical' depression- that is, I have most of the symptoms of what is classically called 'melancholia,' including mood improvement in evening, poor appetite, insomnia- which are symptoms which have responded to nortriptyline. I also have extreme 'rejection sensitivity', which Mulder and Joyce, who have done extensive recent work on subtypes of depression and differential response, have tagged as pivotal to their construct of 'atypical' depression, and which they found does not respond to NOR (their representative TCA). In fact this symptom has not responded to anything, so maybe it doesn't matter :) I have no reason to think desipramine would be better than NOR in this respect, since rejection sensitivity seems to be responsive to strong SRI's (although seemingly not in my case).
>
> > Muscarinic receptors are associated with the memory deficits of Alzheimer's disease, and anti-muscarinic potency is why the TCA's are called (misleadingly) 'dumb drugs.'
>
> I take imipramine 300mg, and I feel pretty dumb. I know much of my problem is due to the depression itself, and some might even be due to Lamictal 300mg. How would you guess that much imipramine would affect me - or anyone else for that matter? Do you think the negative congnitive effects are exaggerated? I do enter REM early. It bugs the hell out of me to think that a drug is making me dumber than I am to begin with! Damn these illnesses.

Well, my thought on this is that possibly a lot of the cognitive impairment you say you have is due to distorted self-perception generated by depression itself. Cognitive impairment does not come through in your posts. Do you find this idea plausible? I suspect that a kind of anosognia (blindness to one's self) is involved in severe depression, and this may be reflected in the findings of hippocampal abnormalities; the hippocampus is involved in spatial learning and probably self-perception as well.

But to answer your question. Yes, I think the cognitive liabilities of the TCA's are overstated. But so much of this is subject to interindividual variation': anti-muscarinic drugs aren't going to be 'dumb' for someone who is hyper-muscarinic. And everything is relative to the disorder one is considering: TCA's are considered a second-line treatment for ADHD, which is a cognitive disorder. So maybe they impair short-term memory, but improve other cognitive measures.

Do you think 300 mg imipramine is helping you? Or do you think that lowering the dose, or possibly substituting another TCA, would help? Did you respond to amitriptyline? That is the 'dumbest' TCA of all, but has a slightly different profile from imipramine. It seems, from what you've said in other posts, that you've built up a tolerance to the TCA's and MAOI's (excuse my use of euphemism). But there doesn't seem to be much else out there in terms of severe depression. Maybe Xyrem? I suggest that because it suppresses cataplexy, like the TCA's and MAOI's, but appears to work by an entirely different mechanism. The anti-cataplectic effects of AD's are presumed to stem from their REM-suppressing effects early in the sleep cycle, so maybe Xyrem gets the same job done in a novel way?
>
> >:-(
>
> Regarding sleep, I discovered a little trick a long time ago that helps me from suffering a worsening of depression when I need to catch up on sleep. Regardless of what time you go to bed, wake up at the same time every day, get out of bed, expose yourself to bright light, do anything that will bring yourself to a state of full wakefullness, and then go back to bed and sleep as long as you like. This resets the circadian clock and prevents a phase delay. It usually works for me.
>
> :-)
> Hmmm. Haven't tried that one. Might be a good idea. :-)
>
> - Scott

-z

 

Re: Zeugma, ADD diagnosis

Posted by KaraS on July 18, 2004, at 15:47:54

In reply to Re: Zeugma, ADD diagnosis, posted by zeugma on July 18, 2004, at 7:08:00

Z,

My responses are spread out throughout this whole message.


> > > hi Kara,
> > >
> > > Yes I feel much worse after sleeping a lot. The optimum for me moodwise is to sleep about 5 hours hours. Unfortunately I seem to require a time to repay the 'sleep debt,' and then I have this comatose sleep that is unpleasant. but if I don't do this (for example on weekends when I work all week) I start to feel myself 'running down' inside. In fact, on Fridays I always feel this, and the mood- and energy-elevating effect of little sleep turns to acute dysphoria.
> > >
> > > I didn't experience any tachycardia on nortriptyline. I suspect I am relatively immune to this effect since it seems to be mediated through blockade of the muscarinic receptor, and I have reason to think that overactivity of this receptor helped cause my history of depression. depression has many causes, of course; that's why the TCA's are generally so effective, they are 'dirty' drugs, which can be a virtue.
> > >
> > > The least anti-muscarinic TCA is desipramine, which is similar to Paxil in potency in this regard; did you ever experience this effect on Paxil, if you tried it? If nortriptlyine energized you, then you would definitely be energized by desipramine. Of course, the tachycardia could be an indirect result of NE stimulation. Did you ever take Wellbutrin (forgive me if you told me already) and if so what effect did it have?
> > >
> > > I think you said you were on Effexor now? Is that energizing at all?
> > >
> > > If you are having the cycle of insomnia/oversleeping, I wonder if it's because you have a reversed circadian cycle. I don't have one now, but at the price of diminished energy: my energy naturally seems to peak around 4 am. 100 mg of nortriptyline is helping with energy a little, and the Provigil may be having a small effect too. Are you thinking of trying Ritalin again? I'm actually thinking of taking a 'drug holiday' from nortrip for a night, and taking a little Ritalin LA and seeing if I can get any work done on my grad school thesis. I wrote a chapter in January on an all-nighter but that had me feeling awful for a week!
> > >
> > >
> > > z
> > >
> >
> >
> > Hi Z,
> > I have also tried desipramine. Same effect on me as nortriptyline. In my mind they are the same drug. (BTW, how does anti-muscarinic differ from anticholinergic?)
>
> That backs up what my pdoc told me, that desipramine and nortriptyline are virtually interchangeable in terms of clinical effect. Except that nortriptyline is less sedating. Except for some. Of course...
>


Actually, I think you have that backwards. It's the desipramine that is the less sedating. Nortriptyline is often used by many to help with sleep while desipramine never helps anyone sleep. (Judging from your depth of knowledge, I'm guessing that you probably mistyped.)


> There are several kinds of cholinergic receptors, which are stimulated by the neurotransmitter acetylcholine, just like make different serotonergetic receptors can be stimulated by serotonin. The cholinergic receptors that I know of are the muscarinic and the nicotinic. Nicotinic receptors, as the name suggests, are stimulated by nicotine and blocked by Wellbutrin (hence its efficacy in stopping smoking). Nortriptyline probably blocks this receptor too, since it works just as well for this purpose as WB.


Thank you for explaining that to me. I find it fascinating that nortriptyline will also work for quiting smoking (as only someone who has tried many medications could find such a bit of info like that fascinating). Too bad all of the people forking over so much money for Wellbutrin don't know that.


> Muscarinic receptors are associated with the memory deficits of Alzheimer's disease, and anti-muscarinic potency is why the TCA's are called (misleadingly) 'dumb drugs.' They can cause memory problems, constipation, and tachycardia. I would argue however that a subset of depressed people have overactivity of these receptors, which causes early entry into REM sleep (see thread on Provigil) and which was taken as a diagnostic marker of endogeneous depression in the 60's. So the anti-muscarinic potency of these drugs is therapeutic, for some at least.
>


Very interesting. I didn't realize that they could measure entry into REM sleep back in the 60's (or that they even knew what REM sleep was back then).


> > I did have either tachycardia or irregular heart rate (I thought it was the latter, my pdoc insisted it was the former) from Celexa, believe it or not. That was a HORRIBLE medication.
> >
> > I tried Wellbutrin in small amount. It didn't give me tachycardia but I had a strange allergic effect. I felt like I couldn't breathe. I thought it could perhaps have been due to excipients in the pill but recently I remembered that I also tried the extended relief capsule with the same result.
> >
> > Provigil made my limbs feel like cement. Also very strange but a known side effect for some people.
> >
> > Effexor was rather neutral for me. I took the XR form because I experienced what I felt was an irregular heartbeat on the regular pills. I could take the XR in the morning or at night and it wouldn't make much of a difference. Unfortunately the antidepressant effect was limited but i had virtually no side effects. No pain, no gain I guess.
> >
> > Paxil did absolutely nothing for me except give me a hard time getting off of it.
> >
> > Zoloft did nothing for me. Also couldn't even tell I was taking anything. Amazing sexual response when I was going off of it. Like nothing I could even begin to describe - the ultimate aphrodesiac. (Hmmm, maybe I should go on and off of it more often...)
> >
> > I just took 5 mg. of selegiline to wake up my brain. I had just slept a lot and needed something desperately. It has helped a bit. I'm going to try 10 mg. sometime soon. Have you tried selegiline at all?
>
> No, never tried selegiline. Only SSRI's (nausea and panic attacks), Wellbutrin (weird autonomic disturbances, I became very light-sensitive and uncoordinated and was literally walking into walls), various stimulants (calming response, cognitive benefit, but rapid weight loss, which was why i finally returned to TCA's, besides being somewhat effective for ADHD and very effective for depression they stimulate the appetite- I know most people are looking for the opposite effect but when I get depressed (which is always, off meds) I can't eat and slowly waste away. The stims caused me to quickly waste away). >


Well I certainly did go on and on about my experiences with different meds. Sorry about that. It was late and I was rambling.

Regarding your meds reactions:
And I thought my Wellbutrin experience was strange! How awful for you. And you got panic attacks from the SSRIs' - even Paxil? The stimulants always relaxed you, even at higher doses? Is that because of your ADD? (I'm wondering if I increase the Ritalin and it still puts me to sleep, whether that is a good indicator that I have ADD?)

My depression has varied over the years. I have at times had more major depression and at other times more atypical type. When it's atypical (as now) I don't have to worry about eating but more often than not I have major depression and if I'm not on any medication I can't sleep or eat at all either. I would not be here if it weren't for these meds. I know that for me there is a strong genetic predisposition. I've been battling depression my entire adult life but I don't really understand why my type of depression changes so much. Makes it hard to find one biochemical reason/malfunction to explain it (as you believe yours is related to nicotinic receptors.)


> > I've mentioned my experience with Ritalin in a few other posts, but I don't remember if I've said anything to you about it. I tried 5 mg. of generic methylphenidate and it made me so sleepy. Did you react like that to a small dose of it? Does that reaction seem like it might give more creedence to the argument that I have ADD? Or is it completely unrelated? I'll have to try the 10 mg. when I get up enough nerve and see what happens. I have yet to try anything that has a truly profound effect upon my focus or concentration (but when I find that, get antidepressant relief and normalize my sleep, I may actually be able to get a good job!!)
> >
> > Have you decided whether to forego sleep for a night, take Ritalin and work on your thesis?
> >
> > -Kara
>
> No, I was so wiped out by working in the morning, then picking up the Ritalin, then going for the long run, that I went right to sleep.
>
> z
>
>

By the way, what field are you in? I'd ask what your thesis is about but I don't know that you'd want to give that kind of info away on a board like this. I'm curious, though, if your field is related at all to what we've been discussing.

Take care,
K

 

Re: Zeugma, ADD diagnosis

Posted by KaraS on July 18, 2004, at 15:54:48

In reply to Re: Zeugma, ADD diagnosis » zeugma, posted by SLS on July 18, 2004, at 7:54:46

Thanks Scott. You don't know how useful that piece of information is for me on setting sleep cycle. (On second thought, you probably do.)

 

Re: Zeugma, ADD diagnosis » KaraS

Posted by zeugma on July 18, 2004, at 19:06:57

In reply to Re: Zeugma, ADD diagnosis, posted by KaraS on July 18, 2004, at 15:47:54

> Z,
>
> My responses are spread out throughout this whole message.

hi Kara,

so are mine.
>
>
>
>
> > > > hi Kara,
> > > >
> > > > Yes I feel much worse after sleeping a lot. The optimum for me moodwise is to sleep about 5 hours hours. Unfortunately I seem to require a time to repay the 'sleep debt,' and then I have this comatose sleep that is unpleasant. but if I don't do this (for example on weekends when I work all week) I start to feel myself 'running down' inside. In fact, on Fridays I always feel this, and the mood- and energy-elevating effect of little sleep turns to acute dysphoria.
> > > >
> > > > I didn't experience any tachycardia on nortriptyline. I suspect I am relatively immune to this effect since it seems to be mediated through blockade of the muscarinic receptor, and I have reason to think that overactivity of this receptor helped cause my history of depression. depression has many causes, of course; that's why the TCA's are generally so effective, they are 'dirty' drugs, which can be a virtue.
> > > >
> > > > The least anti-muscarinic TCA is desipramine, which is similar to Paxil in potency in this regard; did you ever experience this effect on Paxil, if you tried it? If nortriptlyine energized you, then you would definitely be energized by desipramine. Of course, the tachycardia could be an indirect result of NE stimulation. Did you ever take Wellbutrin (forgive me if you told me already) and if so what effect did it have?
> > > >
> > > > I think you said you were on Effexor now? Is that energizing at all?
> > > >
> > > > If you are having the cycle of insomnia/oversleeping, I wonder if it's because you have a reversed circadian cycle. I don't have one now, but at the price of diminished energy: my energy naturally seems to peak around 4 am. 100 mg of nortriptyline is helping with energy a little, and the Provigil may be having a small effect too. Are you thinking of trying Ritalin again? I'm actually thinking of taking a 'drug holiday' from nortrip for a night, and taking a little Ritalin LA and seeing if I can get any work done on my grad school thesis. I wrote a chapter in January on an all-nighter but that had me feeling awful for a week!
> > > >
> > > >
> > > > z
> > > >
> > >
> > >
> > > Hi Z,
> > > I have also tried desipramine. Same effect on me as nortriptyline. In my mind they are the same drug. (BTW, how does anti-muscarinic differ from anticholinergic?)
> >
> > That backs up what my pdoc told me, that desipramine and nortriptyline are virtually interchangeable in terms of clinical effect. Except that nortriptyline is less sedating. Except for some. Of course...
> >
>
>
> Actually, I think you have that backwards. It's the desipramine that is the less sedating. Nortriptyline is often used by many to help with sleep while desipramine never helps anyone sleep. (Judging from your depth of knowledge, I'm guessing that you probably mistyped.)
>
> I mistyped, and didn't realize that it's a relatively simple matter to move up and down this column... I can be be so bad with the obvious (no, it's not cognitive blunting from the TCA). Always been like this.
> > There are several kinds of cholinergic receptors, which are stimulated by the neurotransmitter acetylcholine, just like make different serotonergetic receptors can be stimulated by serotonin. The cholinergic receptors that I know of are the muscarinic and the nicotinic. Nicotinic receptors, as the name suggests, are stimulated by nicotine and blocked by Wellbutrin (hence its efficacy in stopping smoking). Nortriptyline probably blocks this receptor too, since it works just as well for this purpose as WB.
>
>
>
>
> Thank you for explaining that to me. I find it fascinating that nortriptyline will also work for quiting smoking (as only someone who has tried many medications could find such a bit of info like that fascinating). Too bad all of the people forking over so much money for Wellbutrin don't know that.
>
> It gets worse, actually. I read that clomipramine actually treats certain kinds of brain cancers, but rather than generating excitement in the pharma world, there's a frantic attempt to synthesize drugs that will have clomipramine's anticancer effect AND will be on patent for a couple of years. In the meantime I imagine a poor soul with brain cancer will die an untimely death unless he or she stumbles across the same article i did, and demands the drug that was first synthesized in 1958... we're at the crossroads of medicine and commerce, and as always let the buyer beware... I would be willing to bet that not one oncologist or brain cancer specialist in a thousand has heard of this, as it serves no commercial interest as yet.Enough of this...
>
>
> > Muscarinic receptors are associated with the memory deficits of Alzheimer's disease, and anti-muscarinic potency is why the TCA's are called (misleadingly) 'dumb drugs.' They can cause memory problems, constipation, and tachycardia. I would argue however that a subset of depressed people have overactivity of these receptors, which causes early entry into REM sleep (see thread on Provigil) and which was taken as a diagnostic marker of endogeneous depression in the 60's. So the anti-muscarinic potency of these drugs is therapeutic, for some at least.
> >
>
>
> Very interesting. I didn't realize that they could measure entry into REM sleep back in the 60's (or that they even knew what REM sleep was back then).
>
> Yes, a fellow with the evocative name of William Dement discovered REM in 1953.
> > > I did have either tachycardia or irregular heart rate (I thought it was the latter, my pdoc insisted it was the former) from Celexa, believe it or not. That was a HORRIBLE medication.
> > >
> > > I tried Wellbutrin in small amount. It didn't give me tachycardia but I had a strange allergic effect. I felt like I couldn't breathe. I thought it could perhaps have been due to excipients in the pill but recently I remembered that I also tried the extended relief capsule with the same result.
> > >
> > > Provigil made my limbs feel like cement. Also very strange but a known side effect for some people.
> > >
> > > Effexor was rather neutral for me. I took the XR form because I experienced what I felt was an irregular heartbeat on the regular pills. I could take the XR in the morning or at night and it wouldn't make much of a difference. Unfortunately the antidepressant effect was limited but i had virtually no side effects. No pain, no gain I guess.
> > >
> > > Paxil did absolutely nothing for me except give me a hard time getting off of it.
> > >
> > > Zoloft did nothing for me. Also couldn't even tell I was taking anything. Amazing sexual response when I was going off of it. Like nothing I could even begin to describe - the ultimate aphrodesiac. (Hmmm, maybe I should go on and off of it more often...)
> > > Yes, depressives need all the joy they can get. Buspirone is something of an aphrodisiac as well, and the recently rejected gepirone promised to be such, as well. And gepirone would have been 'extended release.' Oh well...One encouraging thing about nortriptyline and TCA's is that they're not associated with anything like the degree of sexual dysfunction that SSRI's are. Selegilene, incidentally, is supposed to be pro-sexual as well, like most other meds indicated for Parkinson's. I think there have been studies that depressives are at greater risk for Parkinson's than the general population. But I digress again...
> > > I just took 5 mg. of selegiline to wake up my brain.

I know that feeling. We'll see if Provigil can wake me up. As of yet I'm not sure.

I had just slept a lot and needed something desperately. It has helped a bit. I'm going to try 10 mg. sometime soon. Have you tried selegiline at all?
> >No, but it sounds interesting. I think it's been shown effective for ADD, in the 5-15 mg range. Have you noticed any benefits?

> > No, never tried selegiline. Only SSRI's (nausea and panic attacks), Wellbutrin (weird autonomic disturbances, I became very light-sensitive and uncoordinated and was literally walking into walls), various stimulants (calming response, cognitive benefit, but rapid weight loss, which was why i finally returned to TCA's, besides being somewhat effective for ADHD and very effective for depression they stimulate the appetite- I know most people are looking for the opposite effect but when I get depressed (which is always, off meds) I can't eat and slowly waste away. The stims caused me to quickly waste away). >
>
>
> Well I certainly did go on and on about my experiences with different meds. Sorry about that. It was late and I was rambling.
No apologies needed. I need only the slightest pretext to digress myself.>
> Regarding your meds reactions:
> And I thought my Wellbutrin experience was strange! How awful for you. And you got panic attacks from the SSRIs' - even Paxil?
Never tried it.
The stimulants always relaxed you, even at higher doses? Is that because of your ADD? (I'm wondering if I increase the Ritalin and it still puts me to sleep, whether that is a good indicator that I have ADD?)
> I'm not sure. And I'm not sure if response to stims is an accurate guage of presence or not of ADD, but it's a place to start. If it made you sleepy, that sounds like a pretty benign reaction, and a higher dose might just knock you out... or it might not. I do know that some with ADD get groggy on it. Not sure if it's diagnostic.
> My depression has varied over the years. I have at times had more major depression and at other times more atypical type. When it's atypical (as now) I don't have to worry about eating but more often than not I have major depression and if I'm not on any medication I can't sleep or eat at all either. I would not be here if it weren't for these meds. I know that for me there is a strong genetic predisposition. I've been battling depression my entire adult life but I don't really understand why my type of depression changes so much. Makes it hard to find one biochemical reason/malfunction to explain it (as you believe yours is related to nicotinic receptors.)
> I think there might be a primary malfunction that then knocks other systems off balance too. Chronic depression seems to create a state where it seems impossible to imagine NOT being depressed, even if things are OK at the moment. I feel like 'depression' is my normal state, although I certainly feel less depressed than when I couldn't eat. but I still feel depressed. It comes out in the way I plan my energy expenditures, for example (like you described with your CFS). I always feel depleted, and I feel my mood pull downward after any kind of elevation. It feels natural, actually, and I don't know how I would react if it were otherwise.
>
> > > I've mentioned my experience with Ritalin in a few other posts, but I don't remember if I've said anything to you about it. I tried 5 mg. of generic methylphenidate and it made me so sleepy. Did you react like that to a small dose of it? Does that reaction seem like it might give more creedence to the argument that I have ADD? Or is it completely unrelated? I'll have to try the 10 mg. when I get up enough nerve and see what happens. I have yet to try anything that has a truly profound effect upon my focus or concentration (but when I find that, get antidepressant relief and normalize my sleep, I may actually be able to get a good job!!)
> > >
> > > Have you decided whether to forego sleep for a night, take Ritalin and work on your thesis?
> > >
> > > -Kara
> >
> > No, I was so wiped out by working in the morning, then picking up the Ritalin, then going for the long run, that I went right to sleep.
> >
> > z
> >
> >
>
> By the way, what field are you in? I'd ask what your thesis is about but I don't know that you'd want to give that kind of info away on a board like this. I'm curious, though, if your field is related at all to what we've been discussing.
>
> Take care,
> K
>
I study (or maybe I should say 'studied') philosophy. I would love to write something relevant to depression/dissociation/sense of self. That's one of my goals.

take care,

z

 

Re: Zeugma, ADD diagnosis

Posted by KaraS on July 20, 2004, at 0:13:52

In reply to Re: Zeugma, ADD diagnosis » KaraS, posted by zeugma on July 18, 2004, at 19:06:57

> > Z,
> >
> > My responses are spread out throughout this whole message.
>
> hi Kara,
>
> so are mine.
> >
> >
> >
> >
> > > > > hi Kara,
> > > > >
> > > > > Yes I feel much worse after sleeping a lot. The optimum for me moodwise is to sleep about 5 hours hours. Unfortunately I seem to require a time to repay the 'sleep debt,' and then I have this comatose sleep that is unpleasant. but if I don't do this (for example on weekends when I work all week) I start to feel myself 'running down' inside. In fact, on Fridays I always feel this, and the mood- and energy-elevating effect of little sleep turns to acute dysphoria.
> > > > >
> > > > > I didn't experience any tachycardia on nortriptyline. I suspect I am relatively immune to this effect since it seems to be mediated through blockade of the muscarinic receptor, and I have reason to think that overactivity of this receptor helped cause my history of depression. depression has many causes, of course; that's why the TCA's are generally so effective, they are 'dirty' drugs, which can be a virtue.
> > > > >
> > > > > The least anti-muscarinic TCA is desipramine, which is similar to Paxil in potency in this regard; did you ever experience this effect on Paxil, if you tried it? If nortriptlyine energized you, then you would definitely be energized by desipramine. Of course, the tachycardia could be an indirect result of NE stimulation. Did you ever take Wellbutrin (forgive me if you told me already) and if so what effect did it have?
> > > > >
> > > > > I think you said you were on Effexor now? Is that energizing at all?
> > > > >
> > > > > If you are having the cycle of insomnia/oversleeping, I wonder if it's because you have a reversed circadian cycle. I don't have one now, but at the price of diminished energy: my energy naturally seems to peak around 4 am. 100 mg of nortriptyline is helping with energy a little, and the Provigil may be having a small effect too. Are you thinking of trying Ritalin again? I'm actually thinking of taking a 'drug holiday' from nortrip for a night, and taking a little Ritalin LA and seeing if I can get any work done on my grad school thesis. I wrote a chapter in January on an all-nighter but that had me feeling awful for a week!
> > > > >
> > > > >
> > > > > z
> > > > >
> > > >
> > > >
> > > > Hi Z,
> > > > I have also tried desipramine. Same effect on me as nortriptyline. In my mind they are the same drug. (BTW, how does anti-muscarinic differ from anticholinergic?)
> > >
> > > That backs up what my pdoc told me, that desipramine and nortriptyline are virtually interchangeable in terms of clinical effect. Except that nortriptyline is less sedating. Except for some. Of course...
> > >
> >
> >
> > Actually, I think you have that backwards. It's the desipramine that is the less sedating. Nortriptyline is often used by many to help with sleep while desipramine never helps anyone sleep. (Judging from your depth of knowledge, I'm guessing that you probably mistyped.)
> >
> > I mistyped, and didn't realize that it's a relatively simple matter to move up and down this column... I can be be so bad with the obvious (no, it's not cognitive blunting from the TCA). Always been like this.
> > > There are several kinds of cholinergic receptors, which are stimulated by the neurotransmitter acetylcholine, just like make different serotonergetic receptors can be stimulated by serotonin. The cholinergic receptors that I know of are the muscarinic and the nicotinic. Nicotinic receptors, as the name suggests, are stimulated by nicotine and blocked by Wellbutrin (hence its efficacy in stopping smoking). Nortriptyline probably blocks this receptor too, since it works just as well for this purpose as WB.
> >
> >
> >
> >
> > Thank you for explaining that to me. I find it fascinating that nortriptyline will also work for quiting smoking (as only someone who has tried many medications could find such a bit of info like that fascinating). Too bad all of the people forking over so much money for Wellbutrin don't know that.
> >
> > It gets worse, actually. I read that clomipramine actually treats certain kinds of brain cancers, but rather than generating excitement in the pharma world, there's a frantic attempt to synthesize drugs that will have clomipramine's anticancer effect AND will be on patent for a couple of years. In the meantime I imagine a poor soul with brain cancer will die an untimely death unless he or she stumbles across the same article i did, and demands the drug that was first synthesized in 1958... we're at the crossroads of medicine and commerce, and as always let the buyer beware... I would be willing to bet that not one oncologist or brain cancer specialist in a thousand has heard of this, as it serves no commercial interest as yet.Enough of this...
> >
> >
> > > Muscarinic receptors are associated with the memory deficits of Alzheimer's disease, and anti-muscarinic potency is why the TCA's are called (misleadingly) 'dumb drugs.' They can cause memory problems, constipation, and tachycardia. I would argue however that a subset of depressed people have overactivity of these receptors, which causes early entry into REM sleep (see thread on Provigil) and which was taken as a diagnostic marker of endogeneous depression in the 60's. So the anti-muscarinic potency of these drugs is therapeutic, for some at least.
> > >
> >
> >
> > Very interesting. I didn't realize that they could measure entry into REM sleep back in the 60's (or that they even knew what REM sleep was back then).
> >
> > Yes, a fellow with the evocative name of William Dement discovered REM in 1953.
> > > > I did have either tachycardia or irregular heart rate (I thought it was the latter, my pdoc insisted it was the former) from Celexa, believe it or not. That was a HORRIBLE medication.
> > > >
> > > > I tried Wellbutrin in small amount. It didn't give me tachycardia but I had a strange allergic effect. I felt like I couldn't breathe. I thought it could perhaps have been due to excipients in the pill but recently I remembered that I also tried the extended relief capsule with the same result.
> > > >
> > > > Provigil made my limbs feel like cement. Also very strange but a known side effect for some people.
> > > >
> > > > Effexor was rather neutral for me. I took the XR form because I experienced what I felt was an irregular heartbeat on the regular pills. I could take the XR in the morning or at night and it wouldn't make much of a difference. Unfortunately the antidepressant effect was limited but i had virtually no side effects. No pain, no gain I guess.
> > > >
> > > > Paxil did absolutely nothing for me except give me a hard time getting off of it.
> > > >
> > > > Zoloft did nothing for me. Also couldn't even tell I was taking anything. Amazing sexual response when I was going off of it. Like nothing I could even begin to describe - the ultimate aphrodesiac. (Hmmm, maybe I should go on and off of it more often...)
> > > > Yes, depressives need all the joy they can get. Buspirone is something of an aphrodisiac as well, and the recently rejected gepirone promised to be such, as well. And gepirone would have been 'extended release.' Oh well...One encouraging thing about nortriptyline and TCA's is that they're not associated with anything like the degree of sexual dysfunction that SSRI's are. Selegilene, incidentally, is supposed to be pro-sexual as well, like most other meds indicated for Parkinson's. I think there have been studies that depressives are at greater risk for Parkinson's than the general population. But I digress again...
> > > > I just took 5 mg. of selegiline to wake up my brain.
>
> I know that feeling. We'll see if Provigil can wake me up. As of yet I'm not sure.
>
> I had just slept a lot and needed something desperately. It has helped a bit. I'm going to try 10 mg. sometime soon. Have you tried selegiline at all?
> > >No, but it sounds interesting. I think it's been shown effective for ADD, in the 5-15 mg range. Have you noticed any benefits?
>
> > > No, never tried selegiline. Only SSRI's (nausea and panic attacks), Wellbutrin (weird autonomic disturbances, I became very light-sensitive and uncoordinated and was literally walking into walls), various stimulants (calming response, cognitive benefit, but rapid weight loss, which was why i finally returned to TCA's, besides being somewhat effective for ADHD and very effective for depression they stimulate the appetite- I know most people are looking for the opposite effect but when I get depressed (which is always, off meds) I can't eat and slowly waste away. The stims caused me to quickly waste away). >
> >
> >
> > Well I certainly did go on and on about my experiences with different meds. Sorry about that. It was late and I was rambling.
> No apologies needed. I need only the slightest pretext to digress myself.>
> > Regarding your meds reactions:
> > And I thought my Wellbutrin experience was strange! How awful for you. And you got panic attacks from the SSRIs' - even Paxil?
> Never tried it.
> The stimulants always relaxed you, even at higher doses? Is that because of your ADD? (I'm wondering if I increase the Ritalin and it still puts me to sleep, whether that is a good indicator that I have ADD?)
> > I'm not sure. And I'm not sure if response to stims is an accurate guage of presence or not of ADD, but it's a place to start. If it made you sleepy, that sounds like a pretty benign reaction, and a higher dose might just knock you out... or it might not. I do know that some with ADD get groggy on it. Not sure if it's diagnostic.
> > My depression has varied over the years. I have at times had more major depression and at other times more atypical type. When it's atypical (as now) I don't have to worry about eating but more often than not I have major depression and if I'm not on any medication I can't sleep or eat at all either. I would not be here if it weren't for these meds. I know that for me there is a strong genetic predisposition. I've been battling depression my entire adult life but I don't really understand why my type of depression changes so much. Makes it hard to find one biochemical reason/malfunction to explain it (as you believe yours is related to nicotinic receptors.)
> > I think there might be a primary malfunction that then knocks other systems off balance too. Chronic depression seems to create a state where it seems impossible to imagine NOT being depressed, even if things are OK at the moment. I feel like 'depression' is my normal state, although I certainly feel less depressed than when I couldn't eat. but I still feel depressed. It comes out in the way I plan my energy expenditures, for example (like you described with your CFS). I always feel depleted, and I feel my mood pull downward after any kind of elevation. It feels natural, actually, and I don't know how I would react if it were otherwise.
> >
> > > > I've mentioned my experience with Ritalin in a few other posts, but I don't remember if I've said anything to you about it. I tried 5 mg. of generic methylphenidate and it made me so sleepy. Did you react like that to a small dose of it? Does that reaction seem like it might give more creedence to the argument that I have ADD? Or is it completely unrelated? I'll have to try the 10 mg. when I get up enough nerve and see what happens. I have yet to try anything that has a truly profound effect upon my focus or concentration (but when I find that, get antidepressant relief and normalize my sleep, I may actually be able to get a good job!!)
> > > >
> > > > Have you decided whether to forego sleep for a night, take Ritalin and work on your thesis?
> > > >
> > > > -Kara
> > >
> > > No, I was so wiped out by working in the morning, then picking up the Ritalin, then going for the long run, that I went right to sleep.
> > >
> > > z
> > >
> > >
> >
> > By the way, what field are you in? I'd ask what your thesis is about but I don't know that you'd want to give that kind of info away on a board like this. I'm curious, though, if your field is related at all to what we've been discussing.
> >
> > Take care,
> > K
> >
> I study (or maybe I should say 'studied') philosophy. I would love to write something relevant to depression/dissociation/sense of self. That's one of my goals.
>
> take care,
>
> z


z,
I am positive I posted a response to this but who knows where it went! I carefully selected out pieces to respond to so that it would be easy to read again and everything. I'm either becoming a total space shot or Dr. Bob needs to work on this program. At any rate, I'll try to reproduce it. (If they both show up, I'm going to scream!!)

That's totally disgusting about the clomipramine. It's surprising that a TCA would treat brain cancer, don't you think? But more than likely MANY a poor soul will die because this is not available to them. It's always about the money!

As for selegiline, I've only tried the 5 mg. so far. It may give me a slightly increased ability to focus but it's mild. I'll have to see what the 10 mg. does. Wonder if I should try that in one dose or break it up during the day?

Yes, depression does always manage to put a damper on things. It's like gravity - always there just waiting to drag you back down.

I think you would write a really good article or even book "relevant to depression/dissociation/sense of self" as you are very articulate and have first-hand knowledge of the topic.

-K

 

clomipramine's anticancer effects, etc.

Posted by zeugma on July 22, 2004, at 13:40:09

In reply to Re: Zeugma, ADD diagnosis, posted by KaraS on July 20, 2004, at 0:13:52

hi kara,

I think the 50 mg of Provigil is helping a little. If anything it's making me more introspective, more introverted, which is good in a way- I can listen to music and concentrate on it more, and I can read for longer periods. It also might intensify the negative thoughts when they come. Do you find the selegilene is 'speeding' you up a little? any extra energy? Provigil definitely slows me, but that's what stimulants have always done as far as i recall. I've got the Ritalin LA on my kitchen table, but am under strict orders from my pdoc not to change anything until I call him tomorrow. I'm curious about what the Ritalin will do to me now (last time I took it I was 18).

As for clomipramine's anticancer properties:http://www.iconmag.co.uk/chlomipramine.htm

like you i love learning new and (sometimes unfortunately) obscure things about these drugs. it's clear from studying the development and deployment of psychotropic drugs that we do not live in the best of all possible worlds.

-z


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