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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk on November 6, 2006, at 13:52:40
In reply to more on buprenorphine tolerance, posted by pseudoname on November 6, 2006, at 12:17:22
Hi PN
Now you're on a higher dose of bupe, and are feeling better............what are your symptoms? ie. which symptoms does bupe leave untreated?
Ed
Posted by pseudoname on November 7, 2006, at 9:43:03
In reply to Re: more on buprenorphine tolerance » pseudoname, posted by ed_uk on November 6, 2006, at 13:52:40
Thanks for the question, Edski.
> what are your symptoms? ie. which symptoms does bupe leave untreated?
I don't do things, or *want* to do them. I don't read books, learn about new things, shower, clean my house, do bookkeeping, spend time with people, enjoy food, etc. Even things that are easy & presumptively pleasurable I have no interest in doing, and I don't enjoy them when I do force myself to do them. Even my fantasies end in indifference. Shall we call that *anhedonia*?
I also have some huge neurotic fears, obsessions, and intrusive thoughts centered around What Other People Think Of Me (chiefly that everyone hates my guts or finds me ridiculous & undeserving), but I suspect that if the anhedonia were cleared up, I could tackle those obsessive thoughts behaviorally / therapeutically / mindfully.
ECT might still help with the anhedonia, might it not? Or perhaps Provigil? Do you think an MAOI might have a different effect for me when I'm on buprenorphine than they did before? I got no response from several MAOI trials 10+ years ago. Don't opioids & MAOIs have an area of intersection in the brain?
Posted by Declan on November 7, 2006, at 11:18:37
In reply to good question » ed_uk, posted by pseudoname on November 7, 2006, at 9:43:03
Hi PN
Wouldn't it be more likely for ECT to help with intrusive thought processes than anhedonia? I can't see how ECT would give you any get up and go. Which brings stimulants to mind. But if you take all that stuff you can end up simply feeling unwell, on top of whatever else you have.
Declan
Posted by ed_uk on November 7, 2006, at 14:34:20
In reply to good question » ed_uk, posted by pseudoname on November 7, 2006, at 9:43:03
Hi PN
Which tricyclic antidepressants have you tried? Perhaps one of the non-sedating tricyclics might help your anhedonia.
Ed
Posted by pseudoname on November 8, 2006, at 11:15:45
In reply to Re: good question, posted by Declan on November 7, 2006, at 11:18:37
Hi, Dek.
> Wouldn't it be more likely for ECT to help with intrusive thought processes than anhedonia?
My understanding from the ECT promotional literature is that it does NOT help with intrusive thoughts or schizophrenic symptoms or mania but does help with more classic depressive symptoms (when it helps at all).
> Which brings stimulants to mind. But if you take all that stuff you can end up simply feeling unwell, on top of whatever else you have.
Yeah. Does that happen even with Provigil? Does anyone know? I.e., does Provigil eventually result in tolerance and after-crash?
Then again, I can't see even my fruitcake pdoc prescribing BOTH an opioid and Provigil at the same time.
Posted by pseudoname on November 8, 2006, at 11:18:56
In reply to Re: good question ? pseudoname, posted by ed_uk on November 7, 2006, at 14:34:20
> Which tricyclic antidepressants have you tried?
I believe I've tried 3, but I don't have my list with me, so I can't be specific. You think a different one might be worth another shot, eh? I'll speak to my pdoc. Thanks for the suggestion.
Posted by ed_uk on November 8, 2006, at 16:27:51
In reply to ECT and intrusive thoughts » Declan, posted by pseudoname on November 8, 2006, at 11:15:45
>Then again, I can't see even my fruitcake pdoc prescribing BOTH an opioid and Provigil at the same time.
Provigil is not a euphoric drug. It's potential for abuse and dependence appears to be fairly minimal. In most countries, Provigil is not subject to any controlled drugs legislation. I think it's Sch IV in the US though.
Ed
Posted by ed_uk on November 8, 2006, at 16:30:35
In reply to tricyclics » ed_uk, posted by pseudoname on November 8, 2006, at 11:18:56
Hi PN
>You think a different one might be worth another shot, eh?
Yes, but not a sedating TCA. You could consider desipramine or nortriptyline. Imipramine might be useful, especially if nort and desip don't help.
Ed x
Posted by Quintal on November 11, 2006, at 18:17:50
In reply to good question » ed_uk, posted by pseudoname on November 7, 2006, at 9:43:03
> Thanks for the question, Edski.
>
> > what are your symptoms? ie. which symptoms does bupe leave untreated?
>
> I don't do things, or *want* to do them. I don't read books, learn about new things, shower, clean my house, do bookkeeping, spend time with people, enjoy food, etc. Even things that are easy & presumptively pleasurable I have no interest in doing, and I don't enjoy them when I do force myself to do them. Even my fantasies end in indifference. Shall we call that *anhedonia*?
>
> I also have some huge neurotic fears, obsessions, and intrusive thoughts centered around What Other People Think Of Me (chiefly that everyone hates my guts or finds me ridiculous & undeserving), but I suspect that if the anhedonia were cleared up, I could tackle those obsessive thoughts behaviorally / therapeutically / mindfully.
>
Pseudoname, have you tried low dose amisulpride (50mg region) for your dysphoria? I have found it's the only med that really helps me with this problem. It has very few side effects at this dose, perhaps a bit of insomnia, otherwise it works brilliantly at helping me actually enjoy life.I imagine amisulpride plus an MAOI like Nardil might be very effctive as amisulpride is mildly stimulating due it its dopamine agonist action at low doses and may help clear grogginess/brain fog caused by Nardil?
Personally I find the effect of low dose amisulpride similar to the effect of Parnate + Klonopin in terms of energy boost and anxiety relief.
Posted by pseudoname on November 14, 2006, at 13:25:13
In reply to Re: good question, posted by Quintal on November 11, 2006, at 18:17:50
Hi, Quintal. Nice to meet you.
> Pseudoname, have you tried low dose amisulpride (50mg region) for your dysphoria?
I have not tried amisulpride/Solian®. I live in the U.S., and as far as I understand, it's not available here at all. Where do you live or how do you get it? (In general terms I mean, not violating Bob's rules….)
> Personally I find the effect of low dose amisulpride similar to the effect of Parnate + Klonopin
Maybe I should try Parnate + Klonopin, then, eh? ECT terrifies me, and I don't know if I can manage it logistically. My life terrifies me. Maybe I should try Klonopin by itself, too.
Posted by Quintal on November 14, 2006, at 16:19:47
In reply to amisulpride (Solian) » Quintal, posted by pseudoname on November 14, 2006, at 13:25:13
> Hi, Quintal. Nice to meet you.
>
> > Pseudoname, have you tried low dose amisulpride (50mg region) for your dysphoria?
>
> I have not tried amisulpride/Solian®. I live in the U.S., and as far as I understand, it's not available here at all. Where do you live or how do you get it? (In general terms I mean, not violating Bob's rules….)
>
> > Personally I find the effect of low dose amisulpride similar to the effect of Parnate + Klonopin
>
> Maybe I should try Parnate + Klonopin, then, eh? ECT terrifies me, and I don't know if I can manage it logistically. My life terrifies me. Maybe I should try Klonopin by itself, too.
--------------------------------------------------
Hi Pseudoname. I live in the UK where I used to get amisulpride free on prescription. I was going to suggest you try sulpiride as an alternative but a web search revealed that neither of them are approved by the FDA for use in the US.
I'm sure I've heard of people using amisulpride in America though. In fact I saw a thread on this topic a few days ago. There are legal ways of obtaining amisulpride in the US as it is not an illicit drug as such, just has no current medical licence. You may be able to import it if you can convince your pdoc it is likely to be sufficiently effective for your problems. Amisulpride was found to be more effective in treating dysthymia and depression than Prozac in one study, I'm sure there are others: http://en.wikipedia.org/wiki/Amisulpride
I would be surprised if Parnate + amisulpride + buprenorphine did not lift your dysthymia. Have you considered augmenting an MAOI and/or your buprenorphine with lamotrigine (Lamictal)? Lamotrigine also seems effective in preventing tolerance/sustaining the effects etc of opiates and possibly augmenting their effect, as well as being an effective antidepressant and mood stabilizer in itself. Here is one study I found that demonstrates this effect, but there are others that are more convincing: http://ajp.psychiatryonline.org/cgi/content/full/156/12/2017
I recall the legendary Elizabeth of buprenorphine solved her dysthymia problem by adding a pinch of lithium to her MAOI. Perhaps lamotrigine would have fewer side effects though?
Klonopin helps with jitteriness and insomnia caused by Parnate and obviously soothes any residual anxiety. I found that Parnate antagonised the sedative effect of Klonopin during the day (although it was still effective for anxiety), but sedation recurred at night when the stimulant effect of Parnate wore off, which was good as it helped me sleep soundly without additional meds.
I’m getting tired of playing the medication game myself as nothing worked for very long, either that or I abused it (Klonopin) and was forced to withdraw. As an alternative to ECT / psychosurgery / suicide I am going out on a limb and venturing to Peru to participate in an Ayahuasca healing ceremony. I’m terrified of Ayahuasca, and being a social phobe, going to Peru without my comforting meds is even more terrifying than the Aya itself. It is going to be the biggest challenge of my life but I see no meaning or direction in the way I’m living right now.
Have you considered something like this pseudoname? It may be even more difficult to manage logistically, but it may be an greater mental/spiritual shock than ECT, and I suspect it would give you much more insight and lasting benefit (and perhaps even some cognitive enhancement?) than ECT.
Just a thought.
Posted by Quintal on November 14, 2006, at 17:07:11
In reply to Re: tricyclics  » pseudoname, posted by ed_uk on November 8, 2006, at 16:30:35
> Hi PN
>
> >You think a different one might be worth another shot, eh?
>
> Yes, but not a sedating TCA. You could consider desipramine or nortriptyline. Imipramine might be useful, especially if nort and desip don't help.
>
> Ed xHave you tried trimipramine pseudoname? After reviewing some of the earlier posts on this thread I noticed a question regarding tricyclics and this reminded me that trimipramine also has some D2 receptor agonist/antagonist effects like amisulpride.
Trimipramine also has beneficial effects on sleep architecture, promoting REM sleep where most ADs suppress it. Trimipramine also soothes mild anxiety. Here is a link that has more info: http://en.wikipedia.org/wiki/Trimipramine
It is a sedating tricyclic however, but some people find tricyclics very effective for these problems at sub theraputic doses.
I hope posting of external links is allowed here (I'm new) :-)
Posted by pseudoname on November 15, 2006, at 12:39:16
In reply to Trimipramine, posted by Quintal on November 14, 2006, at 17:07:11
> Have you tried trimipramine pseudoname?
I have not. Anxiolytic properties are something I could probably do well with, however. Another idea; thanks.
> I hope posting of external links is allowed here (I'm new) :-)
External links are fine as long as the linked page itself is civil by Babble standards: no F-words, for example, no put-downs, no political insults, no obscenities, no deliberate misinformation, etc. Wiki medication articles are generally fine.
Posted by ed_uk on November 15, 2006, at 15:40:40
In reply to Trimipramine, posted by Quintal on November 14, 2006, at 17:07:11
Hi Q
>I hope posting of external links is allowed here (I'm new) :-)
Welcome to babble! I was actually wondering whether you used to post a few years ago under a different name!
Ed
Posted by Quintal on November 15, 2006, at 17:33:54
In reply to Re: Trimipramine » Quintal, posted by ed_uk on November 15, 2006, at 15:40:40
> Hi Q
>
> >I hope posting of external links is allowed here (I'm new) :-)
>
> Welcome to babble! I was actually wondering whether you used to post a few years ago under a different name!
>
> EdHi Ed,
I once posted a reply to a query about moclobemide a few years ago and asked a question about the Marplan I was taking at the time. I don't think you would have remembered that though? I forgot my password when I came to log in again so I set up a new account. Who did you think I used to post as?
Q
Posted by ed_uk on November 16, 2006, at 12:51:55
In reply to Re: Trimipramine, posted by Quintal on November 15, 2006, at 17:33:54
Hi Q
>Who did you think I used to post as?
No one specific, you just 'sounded' like an 'old timer' somehow! :)
Ed
Posted by pseudoname on November 16, 2006, at 17:12:13
In reply to considering ECT, posted by pseudoname on November 2, 2006, at 11:39:50
I saw an ECT pdoc last night. If my insurance okays the procedure (which costs $5,000-$9,000 EACH TIME), I guess the hospital will call me when they get a bed available. Then I go in for 2 days of tests and two treatments. Then I can come home (probably for Thanksgiving) and continue the rest of the treatments as an outpatient -- thus saving my insurance company $1,300 a day they charge for an inpatient bed.
Based on blueberry's experience, I insisted on spreading the treatments out. The doctor insisted that the first two weeks, however, have to have at least 2 treatments in each week. Then I can come once a week if that's what I want.
This whole thing is scaring me spitless (dry mouth). I'm afraid that after all this expense and effort, I won't be any better. After 23 years of severe depression, why would I expect to be better? I don't. Oh well.
Anyway, my insurance company may refuse to go along. It's a huge expense.
Posted by Quintal on November 17, 2006, at 10:10:13
In reply to still considering ECT, posted by pseudoname on November 16, 2006, at 17:12:13
Looks like lamotrigine is a strong contender then pseudoname? Do you see the buprenorphine pdoc before you commit to the next ECT pdoc appointment? You guys are really lucky to have access to so many professionals!
>It sounds like you're willing to do whatever it may take. FOR MYSELF, a brew that would equal the insight I got out of 4 years of psychoanalysis would just make me consider 4 years of psychoanalysis largely a waste of my time.
Psychotherapy was largely a waste of time for me too. I was rejected at interview stage for CBT also, because I was too unstable. Counselling did help a bit I must admit, but I think a lot of that boils down to just having someone you can talk openly with when you're feeling lonely and afraid. I suspect the outcome depends greatly on the level of trust between therapist and client so I can see how it could fail completely if that does not develop.
>If my insurance okays the procedure (which costs $5,000-$9,000 EACH TIME)
Ouch!!! I suppose they have anaesthetist's fees etc to consider but that still seems pretty steep for what you're getting out of it.
Would it not drain your finances and brain power less to try a dopamine agonist like cabergoline? There was a thread here a few days ago on that topic, so may be a possible alternative to amisulpride since it is freely available in the US?
Q
Posted by pseudoname on November 17, 2006, at 14:04:26
In reply to Re: still considering ECT » pseudoname, posted by Quintal on November 17, 2006, at 10:10:13
> Looks like lamotrigine is a strong contender then pseudoname?
Yeah, even if I do get ECT. My insurance company hasn't okayed the ECT, so I'm really in limbo for the moment -- as is my extended family, who must take time from work to get me to & from the hospital.
:(I'm about to make an appointment with my regular doc, which will be for a time after the ECT, *if* I get the ECT.
> You guys are really lucky to have access to so many professionals!
It is easy to take things for granted. Thanks for reminding of that good side of U.S. health care: broad choice, if you can afford to pay for it.
> I was rejected at interview stage for CBT also, because I was too unstable.
Very interesting. I think most of the CBT stuff can be done on your own, with a good book (like "Feeling Good").
> ...try a dopamine agonist like cabergoline?
Can you say more about cabergoline? You've used it? But it didn't help enough? That's the usual way. I looked just now but I don't find a thread for it on the main board or on Alternative. I'll look on Wiki. ;-)
Posted by pseudoname on November 17, 2006, at 14:28:34
In reply to still considering ECT, posted by pseudoname on November 16, 2006, at 17:12:13
I had a dream last night about ECT.
I was in Florida, at the condo of some older, possibly lecherous, man. He was showing me things about his history collections. We went into the big parking garage. A lightning storm suddenly appeared. The sky was continually lit with lightning for a minute or so and the noise from the thunder was deafening. We could smell ozone in the air, and it was terrifying. We could get easily hit where we were standing. Would we even be safe if we got inside??
The man said, "We haven't had a storm like this since the Reagan years." As in so many dreams, I was unable to move, so I couldn't run indoors. I woke with my heart pounding so hard I thought it would come out of my chest. I was covered in sweat and it took quite a few minutes before I was able to calm down. This is what I get for making an ECT appointment!
Also, when I awoke, the radio beside my bed was on and airing a news report with someone in Florida talking about "the Reagan years".
Posted by Quintal on November 17, 2006, at 14:32:12
In reply to cabergoline? » Quintal, posted by pseudoname on November 17, 2006, at 14:04:26
Here is the thread I was referring to: http://www.dr-bob.org/babble/20061110/msgs/703230.html
I bought a book called 'Overcoming Social Anxiety and Shyness' by Gillian Butler quite some time ago in the hope I would be able to cure myself with the power of thought alone, but no. I was already aware of the workings of most of my inner thought processes, hadn't actually drawn them out on paper in little logic diagrams to be fair to the CBTists. Even so, that didn't help me change the way I thought even when I actually got round to doing it.
Putting it loosely, Cabergoline is a D2 & D3 agonist licensed for the treatment of Parkinson's disease. I'm suggesting it because it appears to have a similar action to low dose amisulpride, which is often helpful for social anxiety and dysphoria but is not available in the US. Cabergoline is widely available in the US as far as I understand and may well be a good addition to lamotrigine and buprenorphine to treat your dysphoria/dysthimia?
Q
Posted by pseudoname on November 17, 2006, at 14:43:46
In reply to Re: cabergoline? » pseudoname, posted by Quintal on November 17, 2006, at 14:32:12
Hey, Q. Thanks for the link to that thread. I will mention Dostinex® to my pdoc -- and also maybe to the ECT doc, who seems to have a good, aggressive attitude toward meds.
> Even so, that didn't help me change the way I thought even when I actually got round to doing it.
I sometimes (sometimes) find the acceptance techniques in "Acceptance and Commitment Therapy" very liberating. There are a few threads (sorry, no links) about it here & there and a couple web sites.
Posted by Quintal on November 17, 2006, at 14:51:21
In reply to ECT dream (nightmare), posted by pseudoname on November 17, 2006, at 14:28:34
You seem to be blessed (?) with very vivid dreams pseudoname. Do you think the radio may have had an influence on the course of your dream? I have had this experience myself of outside noises being integrated with the dream as if I'm slowly starting to wake up and my brain is trying to make sense of the information it's getting from my senses.
You seem to be dreading the ECT?
Posted by pseudoname on November 18, 2006, at 11:32:15
In reply to Re: ECT dream (nightmare) » pseudoname, posted by Quintal on November 17, 2006, at 14:51:21
> You seem to be blessed (?) with very vivid dreams
I guess that is kinda neat, even when they're scary.
> Do you think the radio may have had an influence on the course of your dream?
Oh yeah. Since 9/11, I've been in the habit of leaving the radio on the BBC news all night. It helps me sleep. In the mornings, I often have little dreams about what I'm barely hearing in the background. Sometimes I'll have a dream about something and then later in the day I'll hear or read news about the exact same thing. For I moment I'll be astonished until I realize that my dreams were influenced by a news report I heard during the night.
> You seem to be dreading the ECT?
I was. Less so now. My insurance company is dragging its feet, so I may not get ECT anyway.
Posted by Dr. Bob on November 18, 2006, at 14:33:05
In reply to Amisulpride and Ayahuasca, posted by Quintal on November 14, 2006, at 16:19:47
> As an alternative to ECT / psychosurgery / suicide I am going out on a limb and venturing to Peru to participate in an Ayahuasca healing ceremony.
Sorry to interrupt, but I'd like to redirect follow-ups regarding Ayahuasca to Psycho-Babble Alternative. Here's a link:
http://www.dr-bob.org/babble/alter/20061118/msgs/704914.html
Thanks,
Bob
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