Psycho-Babble Medication Thread 382683

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Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS

Posted by King Vultan on August 28, 2004, at 10:30:30

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? King Vultan, posted by KaraS on August 27, 2004, at 21:52:02

He does use the term "hypersensitivity" to describe the problem with the DA autoreceptor, but from my understanding of how receptors operate, this does not imply a malfunctioning autoreceptor per se, but rather, that there are too many of them. The hypersensitivity comes about because the larger number of receptors than normal creates an exaggerated response to the neurotransmission.

In this case, what we are talking about is hypersensitive presynaptic dopamine autoreceptors. Autoreceptors are inibitory, and they play an important role in neurotransmission by tending to brake or slow down the firing rate of the neuron when the autoreceptor is stimulated. This sounds kind of counterproductive, but there has to be some kind of mechanism limiting the ultimate firing rate of the neuron and to give the neuron some feedback on exactly how much dopamine there is around it in the synapse. The more dopamine there is around the neuron, the greater chance that some will come into contact with these presynaptic autoreceptors and hence slow the firing rate of the neuron. Otherwise, the neuron would just keep pumping out more and more dopamine in an unregulated manner.

However, if a person has hypersensitive dopamine autoreceptors (too many of them), the too large number of receptors will produce an exaggerated response. In this case, even a small amount of dopamine in the synapse may be enough to trigger the autoreceptors to reduce the neuron's firing rate. A larger amount, such as might occur from taking a stimulant, may have such an inhibitory effect that it shuts down the neuron entirely, and with no dopamine now being emitted by the neuron, the net effect may very well be fatigue and sleepiness.

The net result of all of this is a dopamine system that winds up functioning at too low of a level because there are too many of these stupid inhibitory autoreceptors, and they are constantly telling the dopamine neuron not to fire any faster when it really should be. This could manifest itself as a variety of different conditions, including dysthymia, depression, anhedonia, CFS, and ADD. I have at least some symptoms of all of these, so this mechanism could very well be a major part of my problem. The more I think about it, the more sense it seems to make.

Todd

 

Re: 2nd Q on paradoxical stim. response - z, anybody?

Posted by SLS on August 28, 2004, at 11:16:53

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS, posted by King Vultan on August 28, 2004, at 10:30:30

> The net result of all of this is a dopamine system that winds up functioning at too low of a level because there are too many of these stupid inhibitory autoreceptors

I know. Mine were never taught right either.

Jay Goldstein had some interesting ideas on treatement algorithms for CFS that were also relevant to depression. I don't think he practices anymore, though. He used to have his own website.


- Scott

 

Re: 2nd Q on paradoxical stim. response - z, anybody?

Posted by dazedandconfused on August 28, 2004, at 12:40:00

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS, posted by King Vultan on August 28, 2004, at 10:30:30

> He does use the term "hypersensitivity" to describe the problem with the DA autoreceptor, but from my understanding of how receptors operate, this does not imply a malfunctioning autoreceptor per se, but rather, that there are too many of them. The hypersensitivity comes about because the larger number of receptors than normal creates an exaggerated response to the neurotransmission.
>
> In this case, what we are talking about is hypersensitive presynaptic dopamine autoreceptors. Autoreceptors are inibitory, and they play an important role in neurotransmission by tending to brake or slow down the firing rate of the neuron when the autoreceptor is stimulated. This sounds kind of counterproductive, but there has to be some kind of mechanism limiting the ultimate firing rate of the neuron and to give the neuron some feedback on exactly how much dopamine there is around it in the synapse. The more dopamine there is around the neuron, the greater chance that some will come into contact with these presynaptic autoreceptors and hence slow the firing rate of the neuron. Otherwise, the neuron would just keep pumping out more and more dopamine in an unregulated manner.
>
> However, if a person has hypersensitive dopamine autoreceptors (too many of them), the too large number of receptors will produce an exaggerated response. In this case, even a small amount of dopamine in the synapse may be enough to trigger the autoreceptors to reduce the neuron's firing rate. A larger amount, such as might occur from taking a stimulant, may have such an inhibitory effect that it shuts down the neuron entirely, and with no dopamine now being emitted by the neuron, the net effect may very well be fatigue and sleepiness.
>
> The net result of all of this is a dopamine system that winds up functioning at too low of a level because there are too many of these stupid inhibitory autoreceptors, and they are constantly telling the dopamine neuron not to fire any faster when it really should be. This could manifest itself as a variety of different conditions, including dysthymia, depression, anhedonia, CFS, and ADD. I have at least some symptoms of all of these, so this mechanism could very well be a major part of my problem. The more I think about it, the more sense it seems to make.
>
> Todd

King Vultan,
Dude, you're smart. Real smart:) I relate to this as well, but my CFS/fibro fog/Add brain has a hard time comprehending this.

a. Would you mind a simple summary of this?
b. What is the answer to this paradoxical reaction (i.e; what would work if stims don't?)

thanks,
dazed

 

Re: 2nd Q on paradoxical stim. response - z, anybody?

Posted by zeugma on August 28, 2004, at 17:17:54

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? King Vultan, posted by KaraS on August 27, 2004, at 21:52:02

hi kara,

if Todd is right, then it would take Ritalin about as long as an AD to kick in and have its desired effect (am i correct in assuming this?) btw the NE system has been posited to be in the same state of disequilibrium in melancholic depression, and imipramine has been surmised to work by desensitizing the alpha-2 autoreceptor. Studies to test this hypothesis by adding an alpha-2 antagonist to impramine or other TCA have been inconclusive or outright failures, however. Also, buspirone desensitizes the inhibitory 5HT-1A presynaptic receptor, yet it is commonly regarded as a weak drug at best.

-z

 

Re: 2nd Q on paradoxical stim. response - z, anybody? King Vultan

Posted by KaraS on August 28, 2004, at 18:51:20

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS, posted by King Vultan on August 28, 2004, at 10:30:30

> He does use the term "hypersensitivity" to describe the problem with the DA autoreceptor, but from my understanding of how receptors operate, this does not imply a malfunctioning autoreceptor per se, but rather, that there are too many of them. The hypersensitivity comes about because the larger number of receptors than normal creates an exaggerated response to the neurotransmission.
>
> In this case, what we are talking about is hypersensitive presynaptic dopamine autoreceptors. Autoreceptors are inibitory, and they play an important role in neurotransmission by tending to brake or slow down the firing rate of the neuron when the autoreceptor is stimulated. This sounds kind of counterproductive, but there has to be some kind of mechanism limiting the ultimate firing rate of the neuron and to give the neuron some feedback on exactly how much dopamine there is around it in the synapse. The more dopamine there is around the neuron, the greater chance that some will come into contact with these presynaptic autoreceptors and hence slow the firing rate of the neuron. Otherwise, the neuron would just keep pumping out more and more dopamine in an unregulated manner.
>
> However, if a person has hypersensitive dopamine autoreceptors (too many of them), the too large number of receptors will produce an exaggerated response. In this case, even a small amount of dopamine in the synapse may be enough to trigger the autoreceptors to reduce the neuron's firing rate. A larger amount, such as might occur from taking a stimulant, may have such an inhibitory effect that it shuts down the neuron entirely, and with no dopamine now being emitted by the neuron, the net effect may very well be fatigue and sleepiness.
>
> The net result of all of this is a dopamine system that winds up functioning at too low of a level because there are too many of these stupid inhibitory autoreceptors, and they are constantly telling the dopamine neuron not to fire any faster when it really should be. This could manifest itself as a variety of different conditions, including dysthymia, depression, anhedonia, CFS, and ADD. I have at least some symptoms of all of these, so this mechanism could very well be a major part of my problem. The more I think about it, the more sense it seems to make.
>
> Todd


THANK YOU!!!

Now I understand and I'm glad that my researching and questioning may have been able to help you out as well.

- Kara

 

Re: 2nd Q on paradoxical stim. response - z, anybody? zeugma

Posted by KaraS on August 28, 2004, at 19:02:48

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody?, posted by zeugma on August 28, 2004, at 17:17:54

> hi kara,
>
> if Todd is right, then it would take Ritalin about as long as an AD to kick in and have its desired effect (am i correct in assuming this?) btw the NE system has been posited to be in the same state of disequilibrium in melancholic depression, and imipramine has been surmised to work by desensitizing the alpha-2 autoreceptor. Studies to test this hypothesis by adding an alpha-2 antagonist to impramine or other TCA have been inconclusive or outright failures, however. Also, buspirone desensitizes the inhibitory 5HT-1A presynaptic receptor, yet it is commonly regarded as a weak drug at best.
>
> -z


Hi z,

I wonder about the longer period of time for Ritalin theory. I wonder if anyone else has had that experience. I guess I could do that experiment to find out. Re Buspar: Don't you hate it when theoretically something should work out and it doesn't? (Buspar did nothing for me but make me nauseous.) I think I need serotonin, NE and DA boosting which makes me wonder if all of my autoreceptor systems are hypersensitive or whether I just have too much MAO.

Thanks for your input.

Kara

 

Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS

Posted by zeugma on August 29, 2004, at 12:26:16

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? zeugma, posted by KaraS on August 28, 2004, at 19:02:48

hi z,
>
> I wonder about the longer period of time for Ritalin theory. I wonder if anyone else has had that experience. I guess I could do that experiment to find out. Re Buspar: Don't you hate it when theoretically something should work out and it doesn't? (Buspar did nothing for me but make me nauseous.) I think I need serotonin, NE and DA boosting which makes me wonder if all of my autoreceptor systems are hypersensitive or whether I just have too much MAO.
>
> Thanks for your input.
>
> Kara

I have never heard of a 2-week lag to Ritalin response either. I do know that some ADHD kids get sedated from it, so what's usually done is try Adderall instead, and failing that, a second-line agent like Wellbutrin or Strattera. I *would* actually recommend Strattera, as nortriptyline stimulated you and Strattera would not cause the tachycardia, except that I developed a severe depression on it after a year. It's too bad reboxetine isn't available in the US. Cymbalta would also be a possibility....

Just out of curiousity what kind of reaction do you have to caffeine? I know a few people who have a cup of coffee at bedtime, because it sedates them.

-z

 

Re: 2nd Q on paradoxical stim. response - z, anybody?

Posted by paulbwell on August 29, 2004, at 12:56:46

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS, posted by zeugma on August 29, 2004, at 12:26:16

If I wake to early, say 6am, then pop 2 10mg Methylphenidate, I'm good for another few hours sound, warm headed cosy sleep, yum.

Go figure?

 

Re: 2nd Q on paradoxical stim. response - z, anybody? dazedandconfused

Posted by King Vultan on August 29, 2004, at 13:30:29

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody?, posted by dazedandconfused on August 28, 2004, at 12:40:00


>
>
>
> King Vultan,
> Dude, you're smart. Real smart:) I relate to this as well, but my CFS/fibro fog/Add brain has a hard time comprehending this.
>
> a. Would you mind a simple summary of this?
> b. What is the answer to this paradoxical reaction (i.e; what would work if stims don't?)
>
> thanks,
> dazed


Well, thanks, but I have to question how smart I am given that it's taken me ten years and ten different ADs to figure out that my problem is fundamentally dopaminergic, and without Kara's post, it might have taken me ten more years to come up with the hypothesis postulated by Dr. Goldstein as to the specifics of the problem. What it all boils down to is that some people may have dopamine systems functioning at too low a level because they have too many dopamine autoreceptors, which are inhibitory. This may also produce a paradoxical response to dopaminergic drugs, such as stimulants, because the moment any extra dopamine is available, the excessive number of autoreceptors react to this and inappropriately tell the dopamine neuron to slow down its firing rate. As dopamine is an important component of alertness, one may then become fatigued and sleepy, not at all what you would typically expect upon taking a stimulant.

If this hypothesis is correct, the question still remains how to treat the problem. In other cases where a person has an excessive number of receptors, the typical strategy is to try to stimulate those receptors and get them to downregulate, or reduce in number. This is one of the aspects of how SSRIs are thought to work, as some of the serotonin made available by blocking reuptake is utilized to stimulate 5-HT1A presynaptic autoreceptors, reducing the number of these inhibitory receptors and thus allowing the serotonin neuron to attain a higher and more normal firing rate.

In the dopamine situation we've been discussing, what would seem to be the thing to do would be to find a drug dopaminergic enough to have some effect in downregulating the autoreceptors (which might take weeks or months) while simultaneously not making a person so fatigued and sleepy that he or she is not able to function. Unfortunately, this may be a rather tall order. If the stimulants don't work, some of the other drugs that I mentioned, such as Wellbutrin, Parnate, or selegiline might, depending on the individual. In my case, I haven't tried selegiline, but neither Wellbutrin nor Parnate makes me sleepy; I just started Parnate last week and am hopeful this does the trick for me. So far, I am quite encouraged, but I have felt that way about other ADs in the past that wound up not working out in the end.

Todd

 

Re: 2nd Q on paradoxical stim. response - z, anybody? zeugma

Posted by KaraS on August 29, 2004, at 13:52:20

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS, posted by zeugma on August 29, 2004, at 12:26:16

> hi z,
> >
> > I wonder about the longer period of time for Ritalin theory. I wonder if anyone else has had that experience. I guess I could do that experiment to find out. Re Buspar: Don't you hate it when theoretically something should work out and it doesn't? (Buspar did nothing for me but make me nauseous.) I think I need serotonin, NE and DA boosting which makes me wonder if all of my autoreceptor systems are hypersensitive or whether I just have too much MAO.
> >
> > Thanks for your input.
> >
> > Kara
>
> I have never heard of a 2-week lag to Ritalin response either. I do know that some ADHD kids get sedated from it, so what's usually done is try Adderall instead, and failing that, a second-line agent like Wellbutrin or Strattera. I *would* actually recommend Strattera, as nortriptyline stimulated you and Strattera would not cause the tachycardia, except that I developed a severe depression on it after a year. It's too bad reboxetine isn't available in the US. Cymbalta would also be a possibility....
>
> Just out of curiousity what kind of reaction do you have to caffeine? I know a few people who have a cup of coffee at bedtime, because it sedates them.
>
> -z

Fortunately caffeine is very stimulating for me! Yay! I'd never have made it through school, grad school or work without it. Ironically, selegiline also has somewhat of a paradoxical response on me. I feel a bit tired at first (I had to drink a cup of coffee to stay awake on my temp job the other day after taking 5 mg. of it). That evening I finally felt the stimulation when I wanted to go to sleep. Adrenal fatigue might also explain some of my responses though I don't know why caffeine continues to work so well. I'm heading towards trying Cymbalta next for a variety of reasons.

How are you doing? I seem to recall you've been having some trouble with sleep?

Kara

 

Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS

Posted by zeugma on August 29, 2004, at 17:50:13

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? zeugma, posted by KaraS on August 29, 2004, at 13:52:20

> > hi z,
> > >
> > > I wonder about the longer period of time for Ritalin theory. I wonder if anyone else has had that experience. I guess I could do that experiment to find out. Re Buspar: Don't you hate it when theoretically something should work out and it doesn't? (Buspar did nothing for me but make me nauseous.) I think I need serotonin, NE and DA boosting which makes me wonder if all of my autoreceptor systems are hypersensitive or whether I just have too much MAO.
> > >
> > > Thanks for your input.
> > >
> > > Kara
> >
> > I have never heard of a 2-week lag to Ritalin response either. I do know that some ADHD kids get sedated from it, so what's usually done is try Adderall instead, and failing that, a second-line agent like Wellbutrin or Strattera. I *would* actually recommend Strattera, as nortriptyline stimulated you and Strattera would not cause the tachycardia, except that I developed a severe depression on it after a year. It's too bad reboxetine isn't available in the US. Cymbalta would also be a possibility....
> >
> > Just out of curiousity what kind of reaction do you have to caffeine? I know a few people who have a cup of coffee at bedtime, because it sedates them.
> >
> > -z
>
> Fortunately caffeine is very stimulating for me! Yay! I'd never have made it through school, grad school or work without it. Ironically, selegiline also has somewhat of a paradoxical response on me. I feel a bit tired at first (I had to drink a cup of coffee to stay awake on my temp job the other day after taking 5 mg. of it). That evening I finally felt the stimulation when I wanted to go to sleep. Adrenal fatigue might also explain some of my responses though I don't know why caffeine continues to work so well. I'm heading towards trying Cymbalta next for a variety of reasons.
>
> How are you doing? I seem to recall you've been having some trouble with sleep?
>
> Kara

hi kara,

yes, i've had trouble sleeping, due to Provigil, which has made me severely limit my caffeine intake. So far the limiting has had its desired effect, and I've been able to sleep a reasonable amount every night. Otherwise I've been doing better, and feeling more alert when I should be. Of course the Provigil has other s/e, which I am trying to ameliorate before my next pdoc appt. so I can discuss what would be a reasonable target dosage (generally it's 200 mg for Provigil and I think I probably need that much to function 'normally'). But the insomnia, which is absolutely intolerable, is better.

Are you taking seligiline PRN? I'm doing that with Ritalin 10mg because I don't have much of it and am trying to see what the Provigil can do on its own. Are you finding selegiline has antidepressant properties?

Caffeine works by entirely different mechanisms than the prescribed stims, and works even in animals whose genes have been tailored to not respond to Provigil, Ritalin, amphetamine, and anything else that you can throw at a lab rat to wake them up. Completely crazy stuff.

-z

 

Re: 2nd Q on paradoxical stim. response - z, anybody?

Posted by KaraS on August 29, 2004, at 19:43:50

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS, posted by zeugma on August 29, 2004, at 17:50:13

> > > hi z,
> > > >
> > > > I wonder about the longer period of time for Ritalin theory. I wonder if anyone else has had that experience. I guess I could do that experiment to find out. Re Buspar: Don't you hate it when theoretically something should work out and it doesn't? (Buspar did nothing for me but make me nauseous.) I think I need serotonin, NE and DA boosting which makes me wonder if all of my autoreceptor systems are hypersensitive or whether I just have too much MAO.
> > > >
> > > > Thanks for your input.
> > > >
> > > > Kara
> > >
> > > I have never heard of a 2-week lag to Ritalin response either. I do know that some ADHD kids get sedated from it, so what's usually done is try Adderall instead, and failing that, a second-line agent like Wellbutrin or Strattera. I *would* actually recommend Strattera, as nortriptyline stimulated you and Strattera would not cause the tachycardia, except that I developed a severe depression on it after a year. It's too bad reboxetine isn't available in the US. Cymbalta would also be a possibility....
> > >
> > > Just out of curiousity what kind of reaction do you have to caffeine? I know a few people who have a cup of coffee at bedtime, because it sedates them.
> > >
> > > -z
> >
> > Fortunately caffeine is very stimulating for me! Yay! I'd never have made it through school, grad school or work without it. Ironically, selegiline also has somewhat of a paradoxical response on me. I feel a bit tired at first (I had to drink a cup of coffee to stay awake on my temp job the other day after taking 5 mg. of it). That evening I finally felt the stimulation when I wanted to go to sleep. Adrenal fatigue might also explain some of my responses though I don't know why caffeine continues to work so well. I'm heading towards trying Cymbalta next for a variety of reasons.
> >
> > How are you doing? I seem to recall you've been having some trouble with sleep?
> >
> > Kara
>
> hi kara,
>
> yes, i've had trouble sleeping, due to Provigil, which has made me severely limit my caffeine intake. So far the limiting has had its desired effect, and I've been able to sleep a reasonable amount every night. Otherwise I've been doing better, and feeling more alert when I should be. Of course the Provigil has other s/e, which I am trying to ameliorate before my next pdoc appt. so I can discuss what would be a reasonable target dosage (generally it's 200 mg for Provigil and I think I probably need that much to function 'normally'). But the insomnia, which is absolutely intolerable, is better.
>
> Are you taking seligiline PRN? I'm doing that with Ritalin 10mg because I don't have much of it and am trying to see what the Provigil can do on its own. Are you finding selegiline has antidepressant properties?
>
> Caffeine works by entirely different mechanisms than the prescribed stims, and works even in animals whose genes have been tailored to not respond to Provigil, Ritalin, amphetamine, and anything else that you can throw at a lab rat to wake them up. Completely crazy stuff.
>
> -z

z,
I'm so glad that your insomnia is under control. There's nothing worse. If you can't sleep, you can't function - as I'm sure you know only too well. How much Provigil are you taking now? I had that wierd reaction some people get to it. I felt like my limbs were made of concrete. It was so strange.

I have tried selegiline a few different times, not really as the need arises but more with the thought of trying it out for possibly taking it steadily. It would not be good on an as needed basis, since I don't get the stimulation until so many hours later. For that reason and because I think right now I may have some adrenal fatigue, I think it's best that I not take selegiline at all. Later on, when I'm feeling better and the patch comes out (fingers crossed here), I'll almost certainly try it.

That's interesting about coffee. I'm sure glad it works that way!! I've read some posts by people who drink green tea or take green tea extract (not decaf versions) and they say that they think so much more clearly than when they drink coffee and without the jitteriness of coffee. Have you read any of those posts or tried green tea? I think the last poster said that he or she takes 3 bags in a cup of hot water. Yucko on the taste but it sure sounded like it worked well for him or her.

Why doesn't Cymbalta have the side effect profile of being stimulating when it prevents the reuptake of NE? Does it have to do with the location of the reuptake?

BTW, you've often mentioned your text books and you know so much about this stuff. Are you in medical school now?

-K

 

Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS

Posted by zeugma on August 30, 2004, at 5:24:36

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody?, posted by KaraS on August 29, 2004, at 19:43:50

That's interesting about coffee. I'm sure glad it works that way!! I've read some posts by people who drink green tea or take green tea extract (not decaf versions) and they say that they think so much more clearly than when they drink coffee and without the jitteriness of coffee. Have you read any of those posts or tried green tea? I think the last poster said that he or she takes 3 bags in a cup of hot water. Yucko on the taste but it sure sounded like it worked well for him or her.>>


I tried green tea as a result of those posts. I was actually going through a lot of anxiety at the time, and the idea was to have something 'stimulating yet calming.' The green tea was OK but could not replace coffee on the one hand, or display marked anxiolytic effects on the other. When I was younger, I used to drink 20 cups of black tea a night (I was totally nocturnal, and would sit and write on an old manual typewriter). Then I went back to college and discovered that if I had a cup of coffee during EVERY class, I wouldn't fall asleep or drift off. It worked for a while but then the narcolepsy or whatever it was got worse, after I graduated from college and tried to work a number of jobs. Constantly fired because I simply never felt 'awake' no matter how much coffee i drank (and i drank huge amounts).

Why doesn't Cymbalta have the side effect profile of being stimulating when it prevents the reuptake of NE? Does it have to do with the location of the reuptake?>>

This is something that is very important, but little seems to be known about it. Lilly marketed Strattera with the claim that Strat blocked NE reuptake in the prefrontal cortex while TCA's blocked it in the brainstem. Strattera did have a maked subjective difference from nortriptyline in that it made me feel totally 'clear', which was an improvement over how I felt without it. It did work on some symptoms of ADHD, and also on the narcolepsy or whatever, but eventually did produce the fatigue that most noticed when they started the drug. I think that's because it has extra pharmacological properties than advertised. It could be that Cymbalta does too, but time will tell.

BTW, you've often mentioned your text books and you know so much about this stuff. Are you in medical school now?>>

No, I'm spending most of my time trying to figure out my brain on my own, which does seem to have some therapeutic effect, in that it allows me to connect the effects a medication has on me with some property of the drug, and I know by now (in my mid-thirties) that I don't do well with things I don't understand. I'm in philosophy, and I've been in grad school for ages now, mostly because finishing anything produces dysphoria so i have little incentive to get my degree (Linkadge had a post about the role of D1 receptors in completion, and the stims I am taking are actually helping with this).

I'm currently taking 100 mg Provigil. I would like to take more, but need to get the s/e ironed out (still wary of insomnia, and Provigil seems to reverse nortriptyline-induced analgesia, bringing back the abdominal pain that miraculously disappeared when i started nortrip).


How soon do you think you'll be starting Cymbalta?

-z
-z

 

Re: 2nd Q on paradoxical stim. response - z, anybody? zeugma

Posted by KaraS on August 30, 2004, at 13:56:22

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS, posted by zeugma on August 30, 2004, at 5:24:36

> That's interesting about coffee. I'm sure glad it works that way!! I've read some posts by people who drink green tea or take green tea extract (not decaf versions) and they say that they think so much more clearly than when they drink coffee and without the jitteriness of coffee. Have you read any of those posts or tried green tea? I think the last poster said that he or she takes 3 bags in a cup of hot water. Yucko on the taste but it sure sounded like it worked well for him or her.>>
>
>
> I tried green tea as a result of those posts. I was actually going through a lot of anxiety at the time, and the idea was to have something 'stimulating yet calming.' The green tea was OK but could not replace coffee on the one hand, or display marked anxiolytic effects on the other. When I was younger, I used to drink 20 cups of black tea a night (I was totally nocturnal, and would sit and write on an old manual typewriter). Then I went back to college and discovered that if I had a cup of coffee during EVERY class, I wouldn't fall asleep or drift off. It worked for a while but then the narcolepsy or whatever it was got worse, after I graduated from college and tried to work a number of jobs. Constantly fired because I simply never felt 'awake' no matter how much coffee i drank (and i drank huge amounts).

That "constantly fired" must have been very hard on you. I was able to hold down jobs even though I was depressed and exhausted (also a total night owl and the 8-5 is very tough on me) until the last few years. I was let go from my last job because of being slow. It was devastating for me - particluarly considering my rejection sensitivity. And, if I hadn't left my previous job to move out west, I would eventually have lost that one too if I hadn't found adequate anti-d help (and ADD help?) soon. It's so frustrating when it's out of your control. (But I'm sure I don't need to tell you that.)

> Why doesn't Cymbalta have the side effect profile of being stimulating when it prevents the reuptake of NE? Does it have to do with the location of the reuptake?>>
>
> This is something that is very important, but little seems to be known about it. Lilly marketed Strattera with the claim that Strat blocked NE reuptake in the prefrontal cortex while TCA's blocked it in the brainstem. Strattera did have a maked subjective difference from nortriptyline in that it made me feel totally 'clear', which was an improvement over how I felt without it. It did work on some symptoms of ADHD, and also on the narcolepsy or whatever, but eventually did produce the fatigue that most noticed when they started the drug. I think that's because it has extra pharmacological properties than advertised. It could be that Cymbalta does too, but time will tell.

Maybe someday they will come up with a cleaner Strattera - like Lexapro vs. Celexa. Do you know if they're working on it?

> BTW, you've often mentioned your text books and you know so much about this stuff. Are you in medical school now?>>
>
> No, I'm spending most of my time trying to figure out my brain on my own, which does seem to have some therapeutic effect, in that it allows me to connect the effects a medication has on me with some property of the drug, and I know by now (in my mid-thirties) that I don't do well with things I don't understand. I'm in philosophy, and I've been in grad school for ages now, mostly because finishing anything produces dysphoria so i have little incentive to get my degree (Linkadge had a post about the role of D1 receptors in completion, and the stims I am taking are actually helping with this).

I saw that post by Linkadge. It was really fascinating to me.

I think it's truly amazing how much you've been able to teach yourself about psychotropic meds. I thought I knew a lot until I came here. (Nonetheless, I'm glad I found this site. It's been such a comfort to finally connect with others who have my issues or similar ones.) Are there any books or text books that you could recommend that could help me learn more about all of this?

> I'm currently taking 100 mg Provigil. I would like to take more, but need to get the s/e ironed out (still wary of insomnia, and Provigil seems to reverse nortriptyline-induced analgesia, bringing back the abdominal pain that miraculously disappeared when i started nortrip).

How frustrating about the abdominal pain coming back. It seems we're always trying to hit a moving target.

> How soon do you think you'll be starting Cymbalta?

I've just recently decided to move it up on my list of things to try. The 2 things that I was planning on trying soon (not together) were SJW and selegiline. For several reasons, they're both off of the list now - though i have to look into one more thing about SJW which could put it back on the list. If not, then I'll probaby call my doctor (who I haven't seen in quite a while) and make an appointment to get Cymbalta. I also want to see what a few of the others' experiences are with it first as I'm quite strapped financially right now and that would be a large expense. It would be taken as a gamble though if I thought it could get me functional again fairly soon.


-K

 

Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS

Posted by zeugma on August 31, 2004, at 6:45:35

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? zeugma, posted by KaraS on August 30, 2004, at 13:56:22

> > That's interesting about coffee. I'm sure glad it works that way!! I've read some posts by people who drink green tea or take green tea extract (not decaf versions) and they say that they think so much more clearly than when they drink coffee and without the jitteriness of coffee. Have you read any of those posts or tried green tea? I think the last poster said that he or she takes 3 bags in a cup of hot water. Yucko on the taste but it sure sounded like it worked well for him or her.>>
> >
> >
> > I tried green tea as a result of those posts. I was actually going through a lot of anxiety at the time, and the idea was to have something 'stimulating yet calming.' The green tea was OK but could not replace coffee on the one hand, or display marked anxiolytic effects on the other. When I was younger, I used to drink 20 cups of black tea a night (I was totally nocturnal, and would sit and write on an old manual typewriter). Then I went back to college and discovered that if I had a cup of coffee during EVERY class, I wouldn't fall asleep or drift off. It worked for a while but then the narcolepsy or whatever it was got worse, after I graduated from college and tried to work a number of jobs. Constantly fired because I simply never felt 'awake' no matter how much coffee i drank (and i drank huge amounts).
>
> That "constantly fired" must have been very hard on you. I was able to hold down jobs even though I was depressed and exhausted (also a total night owl and the 8-5 is very tough on me) until the last few years. I was let go from my last job because of being slow. It was devastating for me - particluarly considering my rejection sensitivity. And, if I hadn't left my previous job to move out west, I would eventually have lost that one too if I hadn't found adequate anti-d help (and ADD help?) soon. It's so frustrating when it's out of your control. (But I'm sure I don't need to tell you that.)
>

It was very frustrating. It took a long time to find a job that was undemanding enough for me to keep. I was always getting the comment that I looked sick and sleepless, even if I had slept 12 hours the night (or day! my sleep schedule was completely chaotic) before. I still was getting the comment that I looked like I never slept last year, at the first full-time job that I've ever been able to keep. The ironic thing was that before trying stimulants, but on AD's, I was sleeping regularly, usually getting exactly eight hours of sleep. It bothered me that people still said that even though I was finally sleeping well! Obviously, I still suffered from profound exhaustion and the sleep I get is not really restorative, so I am always operating at a profound energy deficit. Stimulants help with the daytime energy, but then I can't sleep as well at night... well, it's a matter of balancing s/e with therapeutic effects.

And I am highly 'rejection sensitive' as well. Getting fired was no fun, besides the practical issues of having no money. The shocking thing is that provigil is actually helping with this. It's why I want to give it a trial up to 200 mg despite the side effects (and you're right, it's a moving target).

> > Why doesn't Cymbalta have the side effect profile of being stimulating when it prevents the reuptake of NE? Does it have to do with the location of the reuptake?>>
> >
> > This is something that is very important, but little seems to be known about it. Lilly marketed Strattera with the claim that Strat blocked NE reuptake in the prefrontal cortex while TCA's blocked it in the brainstem. Strattera did have a maked subjective difference from nortriptyline in that it made me feel totally 'clear', which was an improvement over how I felt without it. It did work on some symptoms of ADHD, and also on the narcolepsy or whatever, but eventually did produce the fatigue that most noticed when they started the drug. I think that's because it has extra pharmacological properties than advertised. It could be that Cymbalta does too, but time will tell.
>
> Maybe someday they will come up with a cleaner Strattera - like Lexapro vs. Celexa. Do you know if they're working on it?


Strattera is actually an isomer of atomoxetine. Lilly had about 20 years to play around with the molecule before releasing it. For clean, pure NE reuptake inhibition, I think desipramine is still the best option, in the U.S. at least. I probably asked you this before, but did that give you tachycardia also? >


> > BTW, you've often mentioned your text books and you know so much about this stuff. Are you in medical school now?>>
> >
> > No, I'm spending most of my time trying to figure out my brain on my own, which does seem to have some therapeutic effect, in that it allows me to connect the effects a medication has on me with some property of the drug, and I know by now (in my mid-thirties) that I don't do well with things I don't understand. I'm in philosophy, and I've been in grad school for ages now, mostly because finishing anything produces dysphoria so i have little incentive to get my degree (Linkadge had a post about the role of D1 receptors in completion, and the stims I am taking are actually helping with this).
>
> I saw that post by Linkadge. It was really fascinating to me.

What I've been thinking about, ever since reading that textbook I was quoting from, is how motivation and reward can be dissociated. When I saw Linkadge's post it explained something that had always puzzled me- how I could be motivated, and not anhedonic, but still feel unable to derive any satisfaction from accomplishing anything. The systems have been completely dissociated in my case. It's why I always felt better when I let my mind fog over, although that conflicted with my goals and ruined my self-image. I think Provigil can help me with this, if I can get past its side effects.
>
> I think it's truly amazing how much you've been able to teach yourself about psychotropic meds. I thought I knew a lot until I came here. (Nonetheless, I'm glad I found this site. It's been such a comfort to finally connect with others who have my issues or similar ones.) Are there any books or text books that you could recommend that could help me learn more about all of this?
>

A really good book is David Healy's "The Antidepressant Era". he's got a new one called ""Let Them Eat Prozac"" that is about the SSRI-suicide link. The first one is out in paperback. It's a brilliant study of how the concept 'antidepressant' has evolved.
And he has really good taste in poetry (check out to epigraphs to any of his books :)).

> > I'm currently taking 100 mg Provigil. I would like to take more, but need to get the s/e ironed out (still wary of insomnia, and Provigil seems to reverse nortriptyline-induced analgesia, bringing back the abdominal pain that miraculously disappeared when i started nortrip).
>
> How frustrating about the abdominal pain coming back. It seems we're always trying to hit a moving target.

yes, the target moves more the older we get. I can put up with side effects- I'm just worried all these drugs are destroying my intestines or something. If I go back to the gastroenterologist I know what he'll tell me. That I'm on too many meds :) I would like to be on the minimum possible, but I don't see how else I can control my symptoms.
>
> > How soon do you think you'll be starting Cymbalta?
>
> I've just recently decided to move it up on my list of things to try. The 2 things that I was planning on trying soon (not together) were SJW and selegiline. For several reasons, they're both off of the list now - though i have to look into one more thing about SJW which could put it back on the list. If not, then I'll probaby call my doctor (who I haven't seen in quite a while) and make an appointment to get Cymbalta. I also want to see what a few of the others' experiences are with it first as I'm quite strapped financially right now and that would be a large expense. It would be taken as a gamble though if I thought it could get me functional again fairly soon.

That would definitely be worth it! The preliminary reports, from people here trying it, are encouraging. maybe you could get free meds from one of the programs that offer this? I know someone who gets Lexapro for free, although I think Cymbalta is going to prove far superior to Lexapro in terms of actually getting people better. what is it about SJW that you're investigating?

-z
>
>
> -K
>
>

 

textbook

Posted by zeugma on August 31, 2004, at 6:59:38

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS, posted by zeugma on August 31, 2004, at 6:45:35

the name of the textbook is "Synaptic Self".

 

Re: 2nd Q on paradoxical stim. response - z, anybody? zeugma

Posted by KaraS on August 31, 2004, at 23:42:45

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS, posted by zeugma on August 31, 2004, at 6:45:35

> > > That's interesting about coffee. I'm sure glad it works that way!! I've read some posts by people who drink green tea or take green tea extract (not decaf versions) and they say that they think so much more clearly than when they drink coffee and without the jitteriness of coffee. Have you read any of those posts or tried green tea? I think the last poster said that he or she takes 3 bags in a cup of hot water. Yucko on the taste but it sure sounded like it worked well for him or her.>>
> > >
> > >
> > > I tried green tea as a result of those posts. I was actually going through a lot of anxiety at the time, and the idea was to have something 'stimulating yet calming.' The green tea was OK but could not replace coffee on the one hand, or display marked anxiolytic effects on the other. When I was younger, I used to drink 20 cups of black tea a night (I was totally nocturnal, and would sit and write on an old manual typewriter). Then I went back to college and discovered that if I had a cup of coffee during EVERY class, I wouldn't fall asleep or drift off. It worked for a while but then the narcolepsy or whatever it was got worse, after I graduated from college and tried to work a number of jobs. Constantly fired because I simply never felt 'awake' no matter how much coffee i drank (and i drank huge amounts).
> >
> > That "constantly fired" must have been very hard on you. I was able to hold down jobs even though I was depressed and exhausted (also a total night owl and the 8-5 is very tough on me) until the last few years. I was let go from my last job because of being slow. It was devastating for me - particluarly considering my rejection sensitivity. And, if I hadn't left my previous job to move out west, I would eventually have lost that one too if I hadn't found adequate anti-d help (and ADD help?) soon. It's so frustrating when it's out of your control. (But I'm sure I don't need to tell you that.)
> >
>
> It was very frustrating. It took a long time to find a job that was undemanding enough for me to keep. I was always getting the comment that I looked sick and sleepless, even if I had slept 12 hours the night (or day! my sleep schedule was completely chaotic) before. I still was getting the comment that I looked like I never slept last year, at the first full-time job that I've ever been able to keep. The ironic thing was that before trying stimulants, but on AD's, I was sleeping regularly, usually getting exactly eight hours of sleep. It bothered me that people still said that even though I was finally sleeping well! Obviously, I still suffered from profound exhaustion and the sleep I get is not really restorative, so I am always operating at a profound energy deficit. Stimulants help with the daytime energy, but then I can't sleep as well at night... well, it's a matter of balancing s/e with therapeutic effects.

It definitely sounds like you've had your share of stuff to deal with. Were you so exhausted because you had worn yourself out so during college by not sleeping much? Have you read anything about adrenal fatigue? It's more of a holistic concept. Most mainstream doctors don't recognize anything between normal and full-fledged Addison's disease, but the holistic ones do see a stage where the adrenals are weak and failing, yet not completely dead. I have recently come to the conclusion that condition pertains to me. I have gone without adequate sleep for a long time for a number of reasons. People are always commenting on how I'm always yawning. I've been trying to take things (meds and supplements) that are supposed to be stimulating, yet they make me more tired. As you know, I've been trying to figure out why. One of the possibilities has to do with adrenal fatigue. I think I've been trying to whip a sick or injured horse. If that's the case, then stimulants would be a short-term fix but would make me worse off in the long-run. So my next step is trying to get healthy physically so that I can properly treat my depression. So, the next anti-d I try will be something that has a good chance of being more neutral along the stimulation-sedation spectrum.


> And I am highly 'rejection sensitive' as well. Getting fired was no fun, besides the practical issues of having no money. The shocking thing is that provigil is actually helping with this. It's why I want to give it a trial up to 200 mg despite the side effects (and you're right, it's a moving target).

I wonder why that would be. Isn't rejection sensitivity tied more to serotonin?

> > > Why doesn't Cymbalta have the side effect profile of being stimulating when it prevents the reuptake of NE? Does it have to do with the location of the reuptake?>>
> > >
> > > This is something that is very important, but little seems to be known about it. Lilly marketed Strattera with the claim that Strat blocked NE reuptake in the prefrontal cortex while TCA's blocked it in the brainstem. Strattera did have a maked subjective difference from nortriptyline in that it made me feel totally 'clear', which was an improvement over how I felt without it. It did work on some symptoms of ADHD, and also on the narcolepsy or whatever, but eventually did produce the fatigue that most noticed when they started the drug. I think that's because it has extra pharmacological properties than advertised. It could be that Cymbalta does too, but time will tell.
> >
> > Maybe someday they will come up with a cleaner Strattera - like Lexapro vs. Celexa. Do you know if they're working on it?
>
>
> Strattera is actually an isomer of atomoxetine. Lilly had about 20 years to play around with the molecule before releasing it. For clean, pure NE reuptake inhibition, I think desipramine is still the best option, in the U.S. at least. I probably asked you this before, but did that give you tachycardia also? >

Yes, the first time that I took desipramine, my heart felt like it was going to explode. I was certain I was having a heart attack. I don't remember if you have tried it but I'm guessing that you have. What was your experience with it?


> > > BTW, you've often mentioned your text books and you know so much about this stuff. Are you in medical school now?>>
> > >
> > > No, I'm spending most of my time trying to figure out my brain on my own, which does seem to have some therapeutic effect, in that it allows me to connect the effects a medication has on me with some property of the drug, and I know by now (in my mid-thirties) that I don't do well with things I don't understand. I'm in philosophy, and I've been in grad school for ages now, mostly because finishing anything produces dysphoria so i have little incentive to get my degree (Linkadge had a post about the role of D1 receptors in completion, and the stims I am taking are actually helping with this).

I do get some satisfaction from finishing things but I rarely get to that point because of the lack of motivation to begin with. It does help to understand the situation. I feel that the more I learn about things the more I have a chance of getting it "fixed". OTOH, I find it also makes me quite mad that things aren't functioning the way they should. The knowledge can be a double-edged sword I guess.


> > I saw that post by Linkadge. It was really fascinating to me.
>
> What I've been thinking about, ever since reading that textbook I was quoting from, is how motivation and reward can be dissociated. When I saw Linkadge's post it explained something that had always puzzled me- how I could be motivated, and not anhedonic, but still feel unable to derive any satisfaction from accomplishing anything. The systems have been completely dissociated in my case. It's why I always felt better when I let my mind fog over, although that conflicted with my goals and ruined my self-image. I think Provigil can help me with this, if I can get past its side effects.

I hope the Provigil can help you with that too. Too bad about the side effects. Wish it were cleaner for you.

> > I think it's truly amazing how much you've been able to teach yourself about psychotropic meds. I thought I knew a lot until I came here. (Nonetheless, I'm glad I found this site. It's been such a comfort to finally connect with others who have my issues or similar ones.) Are there any books or text books that you could recommend that could help me learn more about all of this?
> >
>
> A really good book is David Healy's "The Antidepressant Era". he's got a new one called "Let Them Eat Prozac" that is about the SSRI-suicide link. The first one is out in paperback. It's a brilliant study of how the concept 'antidepressant' has evolved.
> And he has really good taste in poetry (check out to epigraphs to any of his books :)).

Thanks! I've added it to my list.

> > > I'm currently taking 100 mg Provigil. I would like to take more, but need to get the s/e ironed out (still wary of insomnia, and Provigil seems to reverse nortriptyline-induced analgesia, bringing back the abdominal pain that miraculously disappeared when i started nortrip).
> >
> > How frustrating about the abdominal pain coming back. It seems we're always trying to hit a moving target.
>
> yes, the target moves more the older we get. I can put up with side effects- I'm just worried all these drugs are destroying my intestines or something. If I go back to the gastroenterologist I know what he'll tell me. That I'm on too many meds :) I would like to be on the minimum possible, but I don't see how else I can control my symptoms.

You gotta do whacha you gotta do - otherwise you woudn't be functioning. Unfortunately your gastroenterologist is only concerned with your stomach.


> > > How soon do you think you'll be starting Cymbalta?
> >
> > I've just recently decided to move it up on my list of things to try. The 2 things that I was planning on trying soon (not together) were SJW and selegiline. For several reasons, they're both off of the list now - though i have to look into one more thing about SJW which could put it back on the list. If not, then I'll probaby call my doctor (who I haven't seen in quite a while) and make an appointment to get Cymbalta. I also want to see what a few of the others' experiences are with it first as I'm quite strapped financially right now and that would be a large expense. It would be taken as a gamble though if I thought it could get me functional again fairly soon.
>
> That would definitely be worth it! The preliminary reports, from people here trying it, are encouraging. maybe you could get free meds from one of the programs that offer this? I know someone who gets Lexapro for free, although I think Cymbalta is going to prove far superior to Lexapro in terms of actually getting people better. what is it about SJW that you're investigating?

The preliminary reports on Cymbalta are that people seem to be tolerating it well overall. The jury is still out on its efficacy.

My hedging on SJW relates to a post I read on the alternative board that said SJW may lower estrogen levels (which I definitely don't want to happen). So I'll look into that more. I think SJW is too serotonergic for me anyway. I was just thinking of it as a sort of stop-gap measure for now.

-K

 

Re: textbook zeugma

Posted by KaraS on August 31, 2004, at 23:46:16

In reply to textbook, posted by zeugma on August 31, 2004, at 6:59:38

> the name of the textbook is "Synaptic Self".

Thanks again z!

 

Zeugma

Posted by dazedandconfused on September 1, 2004, at 9:25:19

In reply to Re: textbook zeugma, posted by KaraS on August 31, 2004, at 23:46:16

Zeugma,
Have been following your dialogue w/ Kara and want to say I completely relate...to everything! Reason for my post is you mention a feeling of letdown after finishing something, completing a goal. This is a classic ADD symptom and is mentioned in Driven to Distraction in the list of symptoms (he has a list of 50 or 100 symptoms). I don't have ready access to the book right now, but you should look into it. If you are seeing an ADD professional, they should really be aware that this is a symptom. Not unusual at all.

take care...enjoy reading your knowledgeable posts,
dazed

 

Re: Zeugma dazedandconfused

Posted by zeugma on September 1, 2004, at 19:11:43

In reply to Zeugma, posted by dazedandconfused on September 1, 2004, at 9:25:19

thank you so much for the comments and tip... unfortunately i am currently in the condition suggested by your screen name, having sat through hours of boring seminars and then undergone a terrible Provigil crash... what have you found helpful for this dysphoria? It seems to be a form of drawn-out self-torture!

-z

 

Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS

Posted by zeugma on September 1, 2004, at 19:41:14

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? zeugma, posted by KaraS on August 31, 2004, at 23:42:45

> And I am highly 'rejection sensitive' as well. Getting fired was no fun, besides the practical issues of having no money. The shocking thing is that provigil is actually helping with this. It's why I want to give it a trial up to 200 mg despite the side effects (and you're right, it's a moving target).

I wonder why that would be. Isn't rejection sensitivity tied more to serotonin?>>

For sure. Provigil may have serotonergetic effects as zana described in the provigil thread above, albeit not entirely pleasant ones (serotonin release followed by depletion?). In any case I spoke too soon, the past two days my 'rejection sensitivity' has been back, although not in full force (for which I'm thankful- less thankful about the midafternoon sweating and crash).

It seems we have a similar dilemma. Rejection sensitivity responds preferentially to SSRI's, and yet you describe SJW as too 'serotonergetic' for you (besides its negative effects on estrogen). I have not found SSRI's to be tolerable for the most part. I think Paxil would work best for me, as it would be least likely to induce appetite loss and insomnia, but my pdoc refused to let me try it as it would not go well with nortriptyline. Prozac caused nausea and sleeplessness, a thousand times worse than Provigil, and Zoloft was so unutterably bad that I swore off AD's for a decade. I'm not sure what happened; it may have been an allergic reaction, but my pdoc at the time was terrible and insisted that Zoloft had no s/e. It came at the end of a long series of medication trials including various stims and AD's, and soured me on meds for a long time.

Could you say a little more about adrenal fatigue? Symptoms, treatment, etc.?

 

Re: 2nd Q on paradoxical stim. response - z, anybody? zeugma

Posted by KaraS on September 1, 2004, at 20:56:02

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS, posted by zeugma on September 1, 2004, at 19:41:14

> > And I am highly 'rejection sensitive' as well. Getting fired was no fun, besides the practical issues of having no money. The shocking thing is that provigil is actually helping with this. It's why I want to give it a trial up to 200 mg despite the side effects (and you're right, it's a moving target).
>
> I wonder why that would be. Isn't rejection sensitivity tied more to serotonin?>>
>
> For sure. Provigil may have serotonergetic effects as zana described in the provigil thread above, albeit not entirely pleasant ones (serotonin release followed by depletion?). In any case I spoke too soon, the past two days my 'rejection sensitivity' has been back, although not in full force (for which I'm thankful- less thankful about the midafternoon sweating and crash).
>
> It seems we have a similar dilemma. Rejection sensitivity responds preferentially to SSRI's, and yet you describe SJW as too 'serotonergetic' for you (besides its negative effects on estrogen). I have not found SSRI's to be tolerable for the most part. I think Paxil would work best for me, as it would be least likely to induce appetite loss and insomnia, but my pdoc refused to let me try it as it would not go well with nortriptyline. Prozac caused nausea and sleeplessness, a thousand times worse than Provigil, and Zoloft was so unutterably bad that I swore off AD's for a decade. I'm not sure what happened; it may have been an allergic reaction, but my pdoc at the time was terrible and insisted that Zoloft had no s/e. It came at the end of a long series of medication trials including various stims and AD's, and soured me on meds for a long time.

It really makes me angry when pdoc's make blanket statements like that which don't take into account that we are all unique individuals. Any number of factors, including excipients, could cause idiosyncratic reactions. I had a very strange reaction to Wellbutrin. It made me feel like I couldn't breathe - like it was an effort I was always aware of. It was very wierd. My pdoc insisted it was all in my head. Now I've tried many medications and I've never had any kind of wierd reaction like that so chances are it wasn't all in my head. But we have to humor them if we want to keep those scripts coming!


> Could you say a little more about adrenal fatigue? Symptoms, treatment, etc.?

It might be best if I send you the links below instead. They're written for laymen so it may not go into the kind of detail you might be interested in but it's a good starting place. I decided that this condition may pertain to me after Larry Hoover said that my symptoms sounded like adrenal fatigue to him. Then Simus (who doesn't ever come to this side of the boards) chimed in that those were her symptoms too and she was being treated for adrenal fatigue. The treatment involves supplements, diet and lifestyle changes. (One of the main things is no use of stimulants because they are taxing to the adrenal system. For someone like you with ADD, that is probably not practical. On the other hand, for those who react to stimulants paradoxically, I would think that this ban might not apply.)

Anyway, here a couple of links. (The book "Adrenal Fatigue" by James L. Wilson is much better than these articles if you want to look into it more.) One of these links says that it's a condition more common in women though that's the only place I've seen that stated. This first article has a good list of symptoms. Neither of these has great info on treatment however.

http://thyroid.about.com/cs/endocrinology/a/adrenalfatigue.htm


http://www.medical-library.net/sites/framer.html?/sites/_general_discussion_of_adrenal_fatigue.html


Kara

 

Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS

Posted by zeugma on September 2, 2004, at 16:48:17

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? zeugma, posted by KaraS on September 1, 2004, at 20:56:02

thanks for the info on AF. have you implemented any of these strategies? with any success?

-z

 

Re: 2nd Q on paradoxical stim. response - z, anybody?

Posted by KaraS on September 2, 2004, at 23:36:59

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS, posted by zeugma on September 2, 2004, at 16:48:17

> thanks for the info on AF. have you implemented any of these strategies? with any success?
>
> -z

I've only made a few changes so far. I've cut down on coffee, increased my magnesium intake, am exercising a bit and am keeping more regular hours which has made a difference. I'm still in the planning stage in terms of the supplements and the full program I want to implememt. I was taking maca (an adaptogen) for female hormonal issues a while back and felt much better in general. I didn't realize at the time that it was probably helping with the adrenal problem.

I'm now thinking about the antidepressants Cymbalta (which I mentioned earlier) or Marplan rather than selegiline as I'm now looking to try something more neutral rather than stimulating (even though part of me really wants that stimulation). We'll see. The changes I've made have improved my concentration but I may have to address that further in the future. I'll just have to see how it all pans out.

Simus has been following some of the treatment recommendations. She has said that she feels a lot better. Plus she has recently gone to a holistic doctor to get some tests done and more recommendations for treatment. I think it's a gradual healing though - not the kind of thing that changes overnight.

Do you think it might apply to you or not? I think you probably have a gut sense from reading the info of whether or not the condition applies. Or are you skeptical about the whole concept?

-K

 

Re: 2nd Q on paradoxical stim. response - z, anybody? KaraS

Posted by zeugma on September 3, 2004, at 9:10:24

In reply to Re: 2nd Q on paradoxical stim. response - z, anybody?, posted by KaraS on September 2, 2004, at 23:36:59

> > thanks for the info on AF. have you implemented any of these strategies? with any success?
> >
> > -z
>
> I've only made a few changes so far. I've cut down on coffee, increased my magnesium intake, am exercising a bit and am keeping more regular hours which has made a difference. I'm still in the planning stage in terms of the supplements and the full program I want to implememt. I was taking maca (an adaptogen) for female hormonal issues a while back and felt much better in general. I didn't realize at the time that it was probably helping with the adrenal problem.
>
> I'm now thinking about the antidepressants Cymbalta (which I mentioned earlier) or Marplan rather than selegiline as I'm now looking to try something more neutral rather than stimulating (even though part of me really wants that stimulation). We'll see. The changes I've made have improved my concentration but I may have to address that further in the future. I'll just have to see how it all pans out.
>
> Simus has been following some of the treatment recommendations. She has said that she feels a lot better. Plus she has recently gone to a holistic doctor to get some tests done and more recommendations for treatment. I think it's a gradual healing though - not the kind of thing that changes overnight.
>
> Do you think it might apply to you or not? I think you probably have a gut sense from reading the info of whether or not the condition applies. Or are you skeptical about the whole concept?
>
> -K
>
>

no, not skeptical at all. i actually know a lot less than you think.

also, for me prescription meds only bring gradual relief, except for klonopin, which has the great merit of not inducing tolerance, and ritalin, which does... real change takes a lot of time.

is it that you're worried about depleting your adrenal glands by taking a stimulating AD, about inducing insomnia, or having a paradoxical reaction? or some combo of the above?

i wish i could cut down on coffee. my caffeine intake is slowly creeping back up as tolerance is developing to the provigil/ritalin. i don't mind using caffeine, as long as i don't need two cups an hour.

i should say that my thyroid has long come under suspicion, as i'm extremely thin and nervous, was hyperkinetic as a child. i was tested at 17, and periodically thereafter, most recently a year ago as part of a thorough checkup. it's always been in the normal range.

i may have some degree of AF, but if so it's secondary to a lot of other problems. i have to pick my battles, when it comes to these things. i'm eating as well as i can, exercising and sleeping at night, plus taking some supplements per my pdoc's instructions. it's a long, long road.

-z


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