![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 28. Go back in thread:
Posted by JadeKelly on November 28, 2008, at 16:37:38
In reply to Different treatment for emotional numbness???, posted by X_ander on November 27, 2008, at 20:54:27
Hi X_ander,
That's pretty interesting stuff for me. Don't think I have PTSD, but certainly could have the biological changes you're referring to. I'm gonna look into that too. Keep us posted!
PS-I posted a good response to you, another thread, went back and it wasn't there! I must have forgotten to hit submit. I'll find it now and re-post, sorry bout that.
~Jade
Posted by fayeroe on November 29, 2008, at 15:19:29
In reply to Re: Different treatment for emotional numbness???, posted by bleauberry on November 28, 2008, at 9:07:33
> Based on my own experience I think there could be some truth to the opioid connection. I was on LDN (low dose Naltrexone) for only a short time and will probably revisit it soon. During that short time, I noticed more interest in things I was doing, more especially with things that I try to enjoy and I know I do enjoy (except I don't feel the joy).
>>>Bleauberry, you're the only person that I've found that refers to the "joy" of life. How long has it been since you've felt joy? That is the one thing missing from my life now. Thanks for including "joy" in this post.I am going to ask my doctor about this med.<<<<<Such as guitar playing. I played a ton of guitar on LDN and was "into it".
>>>I tried playing the piano last week and felt nothing. I play by ear and was dismayed concerning how long it took me to remember some tunes. When I did remember them, I didn't feel anything. I am working really hard now to dig out better feelings concerning my music.<<<<
>
> It wasn't a miraculous awakening kind of thing, but rather a situation where if you force yourself to start doing something, in a little while you are actually enjoying it. This was from just 1.5mg taken at 9pm nightly.
>
> While LDN supposedly only blocks opioid receptors during the blood level spike a few hours after dosing, my own feeling was that it blocked them about 16 hours.>>>Wow!<<<
>
> There is the possibility also that opioid antagonists have a direct or downstream indirect effect of stimulating dopamine function. It just instinctively felt that way to me.
Posted by JadeKelly on December 5, 2008, at 20:58:44
In reply to Different treatment for emotional numbness???, posted by X_ander on November 27, 2008, at 20:54:27
> Hi everyone
>
> In my attempt to find an answer to my own issues of anhedonia and emotional numbness/apathy, I was scouring the web and found a theory that is completely different to that involving dopamine hypofunction.
>
> Instead this doctor posutlated in a patent and a couple journal articles that the emotional numbness was induced by the body's response to severe stress as in PTSD...that this response involved the body's endogenous opiates..that is endorphins..over activity of endorphins, as the body's defense mechanism against very painful and stressful situations.
>
> His solution...opiate antagonists. Naltrexone, thebaine and others...he goes on to talk about good reponses with war veterans etc...and that it may not be exclusive to PTSD, sometimes depression and other disorders..
>
> I'd never heard of it, but maybe some of you have?? Anyone try it?
>
> google: "treatment for emotional numbness" it'll be a free online patent thing..
>
> Just searching for answers like the rest of us I suppose.Hi X_ander,
Don't know if you're still watching this thread, but was wondering if in your search, you have found anything new or interesting. I'd really like to follow up on this topic and will share same if I find anything.
~Jade
Posted by X_ander on March 10, 2009, at 10:48:15
In reply to Re: Different treatment for emotional numbness??? » X_ander, posted by JadeKelly on December 5, 2008, at 20:58:44
hey everyone,
just thought I'd see if anyone has had any improvement in their symptoms of emotional numbness??
Anyone had it and found a med regime that overcame it?
This symptom is driving me crazy (yes i'm aware of the irony on these boards sigh), so yeah anyone who has done it give us a yell...!
Thanks to all, X_ander.
Posted by yxibow on March 10, 2009, at 21:16:14
In reply to Treatment for emotional numbness???, posted by X_ander on March 10, 2009, at 10:48:15
> hey everyone,
>
> just thought I'd see if anyone has had any improvement in their symptoms of emotional numbness??
>
> Anyone had it and found a med regime that overcame it?
>
> This symptom is driving me crazy (yes i'm aware of the irony on these boards sigh), so yeah anyone who has done it give us a yell...!
>
> Thanks to all, X_ander.
Apathy sounds like a classic symptom of depression.. the previous idea posted of adding opiates to a mixture would seem to create initial elation, followed by habituation, and rehab, not to be too crass.A stimulant like Strattera might be of better use I would think, but I can't say for sure
-- Jay
Posted by X_ander on March 10, 2009, at 23:55:22
In reply to Re: Treatment for emotional numbness??? » X_ander, posted by yxibow on March 10, 2009, at 21:16:14
Hi Jay,
yep I'm trying the stimulant path now but it seems to be losing it's effect after only a week...I'm taking ritalin 30mg per day..works wonders in the first few days, now I hardly notice it.
As regards the opiates...that was actually the use of opiate "antagonists"...essentially the opposite of opiates. Opiate antagonists lower the activity/sensitivity of the opioid receptors. The theory is that too much endorphin production (the body's natural opiates), is the cause of the numbing. Lowering endorphin activity with the antagonist naltrexone would in theory, ameliorate that situation, returning normal feelings and emotions.
So yeah again, anyone overcome emotional numbing?
If you have what meds did you use?
And how long did it take to start feeling again?
(I've found that traditional antidepressants, and the atypical anti-psychotics I've tried didn't do much for this symptom).
All the best, X_ander.
Posted by JadeKelly on March 14, 2009, at 23:06:49
In reply to Re: Treatment for emotional numbness???, posted by X_ander on March 10, 2009, at 23:55:22
Hi X_ander,
I didn't have time to read old posts if there are any but I notice that this one is months old. This concerns me as to your true Dx. Do you know what it is? Did you mention PTSD? Have you had problems with cognitive ability, memory, inability to express yourself, and, most importantly, any severe nightmares, flashbacks or panic attacks? Anything traumatic happen to you in the last couple/few years?
In addition, surrounding this period of numbness, did you suffer from MDD?
My numbness lasted for a long time. Other not so fun things came and went as well. Thats why I ask these questions. If you'd rather, feel free to babblemail me.
I'm in full remission (after hell)
80mg Parnate
60mg Ritalin
1.5mg KlonopinYou need to see an experienced PDoc to pull this off. I take my BP regularly (normal), I see him every 2 weeks, and he said to treat me I had to be in therapy which I didn't like at first, now I don't know what I was thinking to rule it out. Its all good and I swear to God I am happy for the first time in 3-4 years.
Let me know where you're at...
~Jade
Posted by X_ander on March 15, 2009, at 3:35:20
In reply to Re: Treatment for emotional numbness??? » X_ander, posted by JadeKelly on March 14, 2009, at 23:06:49
Hi Jade, thanks for your post, appreciate it.
Ok, well I'm officially diagnosed as MDD.
My symptoms are: emotional/reactive numbness, detachment, insomnia (off and on), and it's more that I get depressed ABOUT the detachment and lack of emotion, rather than feeling sad about something in particular. And I think that's it, no other symptoms.
I've had a pdoc at one time say I had prodromal psychosis. State before schizophrenia essentially. And I rejected it. I've never had delusions, heard voices, hallucinated. Never used anything not prescribed. I uh, yeah i'm just at a loss. In reading up, prodromal psychosis symptoms are pretty much what I have. But I have no family history of it. I'm 24 btw, male... if that's relevant.
But I haven't responded to anything. I was put on anti-psychotics for 2 weeks...didn't change anything (abilify and zeldox)..maybe didn't stay on them long enough?? I dunno, they aren't really supposed to help the negative symptoms of schizophrenia anyway, which are pretty much just the prodromal symptoms.
So I guess I'm wondering if i'm gonna become psychotic. Wondering if it's just a horrible type of depression. Wondering which way to take it. I really just want to feel again. That is it. I don't care about being down really, I just want to feel and react to the world around me.
I've never been diagnosed PTSD, never had any incredibly traumatic event occur. I just looked it up because of the whole numbness side of things. Looking everywhere for clues, answers.
I'm taking ritalin at the moment, for anhedonia. Finally convinced my doc to let me try it. It seems like it works some of the time. Like for 20mins couple times a week maybe where I feel more excitement for things, it's weird, definitely the ritalin, but then it goes away. And increasing the dose only seems to make me zone out...become sort of like a robot.
Tried, cymbalta, bupropion, lexapro, luvox, moclobemide, abilify, ritalin, mirtazapine.
Yes at a loss...I'm so so so tired...of not feeling. There seems very little around about treating this specific symptom. I've pretty much scoured the forums here for answers. So yeah..um help..?
Glad to here you're in complete remission, that is unbelievably wonderful. Congratulations.
Xander.
Posted by JadeKelly on March 15, 2009, at 18:46:52
In reply to Re: Treatment for emotional numbness???, posted by X_ander on March 15, 2009, at 3:35:20
Hi again,
The only relevance in your age is that it is the likely time for those types of illnesses to present. That may be why they (Docs) are inclined to think you are headed for something other than MDD. I don't. I think that while you want to feel again, your brain is saying you can't handle the pain of your MDD right now. You and I are different in that I so fully felt my depression for a time prior to the long period of numbness that I actually welcomed it and at first was afraid when it started to fade.
I think the Dx of MDD is accurate, and I'm not a PDoc but I think you know what worked for me. I just posted a couple threads you may want to look at. You can't keep on like this and I think its time to stop with all these meds and get a serious PDoc and a serious med(s) that will bring you out of this. I'm not talking about antipsych's either. IMHO, thats the LAST thing you need. Your trying to wake up, not go into a coma. A strong opinion but I feel for you as I was there.
~Jade
Posted by Phillipa on March 15, 2009, at 18:52:41
In reply to Re: Treatment for emotional numbness??? » X_ander, posted by JadeKelly on March 15, 2009, at 18:46:52
X and under going off prescribe anti-psychotics could lead to full blown psychosis or a manic episode. And your age is prime for scihizo. What is your routine like, are you isolative, feel safe in the house. All signs of a schizo type disoder. I'd discuss fully with your current pdoc as he knows you. You also could get a second oppinion. So what are the symtoms other than numbness? Love Phillipa
Posted by desolationrower on March 15, 2009, at 23:39:36
In reply to Re: Treatment for emotional numbness??? » X_ander, posted by JadeKelly on March 15, 2009, at 18:46:52
yeah no antipsychotics, try a nri and/or maoi
-d/r
Posted by X_ander on March 16, 2009, at 5:54:06
In reply to Re: Treatment for emotional numbness??? » X_ander, posted by JadeKelly on March 15, 2009, at 18:46:52
Hey again everyone,
Hi Phillipa, I'm not on antipsychotics, I haven't been for 5 months. Even then it was only for 2 weeks. I got a second opinion in hospital and they said MDD. Before that I felt like this and wasn't on antipsychotics. Anti-psychotics wouldn't help with what I have anyway, they'd be a prophylactic to curb off some possible thing in the future. In which case (some kind of future psychosis) all would be lost. There are no treatments for negative symptoms. There just aren't. Atypicals don't touch them. It would be over.
I know i'm right in that stupid age bracket to develop that stuff. I guess it's either MDD for me or there's no shot at getting out you know? I'm repeating myself now..sigh...my apologies.
Um I go out...I'm just bored when I'm out. I don't see the point. As a result my routine is screwed up. I work 10hrs a week and struggle massively with that. University is impossible cos I have no motivation at all to study, no reward, curiosity. Just flat flat flat. I don't have anxiety or paranoia. In fact I'm a singer in a band so I'm pretty sure I'm not isolated or afraid of being seen by people...but I don't get any enjoyment from interacting with people like I used to. So it's all effort, no reward. In that sense, I'm likely to stay home more often cos there's just nothing I get from being out, except to keep up appearances. It's just so so so tiring. Pretending.
There are no other symptoms besides numbness, detachment, boredom etc. Disorganisation is part of it too. Insomnia from time to time.
Also, I did an rEEG test a while back. It's supposed to tell you what meds you'll respond to. I'm not sure how much faith I have in it. But it said bupropion, venlafaxine are the ones i'd respond to. Tried bupropion, nothing. And that I'd be unresponsive to MAOIs, stimulants, lamictal, lithium, neurontin. Semi-responsive to SSRIs and TCAs. Anti-psychotics weren't on the list hypothetical list it had to choose from.
Not sure if you guys think those things are reliable at all. But yeah I thought I'd mention it.
I'd have thought MAOI too but the test says otherwise. Antipsychotics won't help with it...anhedonia and dopamine receptor antagonism in the mesolimbic region are like partners in crime.
I've been like this for almost 2 years. No change, no worsening, no improvement either.
I think I've answered most things there..happy to answer others. Thoughts on the above??
Cheers to all, Xander.
Posted by JadeKelly on March 16, 2009, at 15:42:26
In reply to Re: Treatment for emotional numbness???, posted by X_ander on March 16, 2009, at 5:54:06
Hello X_ander,
My final ideas:
Forget about the age bracket thing, you're on the outside of that anyway. Were all in an age bracket for something. You are not psychotic and your not headed that way either. Btw-I used to repeat myself too, my cognitive abilities were way off, still working on that. If you are repeating, forgetful, cognitively "slower", YOU feel slow, these are all classic symtoms of MDD. In addition, I've read there can be ZERO reason for a person to become MDD. In other words, I had significant traumas in my life that I couldn't deal with. I also have some history in my family. I was at great risk. You may have nothing, or somthing like a breakup or a move could have triggered it. You and I would be treated as both having MDD. Doesn't much matter why.In addition, I reread some posts and it seems you do have some experience with ritalin. Something else I became aware of, if dopamine is your problem, and you respond partially to ritalin and/or you've tried desipramine-Tca , and responded even partialy to that, it is likely you will respond to Parnate. Its good you don't have social phobia, I don't either but I've heard people say Parnate alone is not a great SA med.
>
> Also, I did an rEEG test a while back.**(Do you mean an EEG test? by a neurologist?)** It's supposed to tell you what meds you'll respond to. I'm not sure how much faith I have in it. But it said bupropion, venlafaxine are the ones i'd respond to. Tried bupropion, nothing. And that I'd be unresponsive to MAOIs, stimulants, lamictal, lithium, neurontin. Semi-responsive to SSRIs and TCAs. Anti-psychotics weren't on the list hypothetical list it had to choose from.But you were/are semi responsive to ritalin (stim) and I'd be interested to know if you would be partially responsive to desipramine. Not as a one and only med to remedy your depression, but to see how you'd react. I've never taken it so I don't know how long, s/e's, etc.
I have ZERO faith in the test telling you if, and how badly, you are depressed, nor what meds will work. I have faith in EEG's for my son, he has Epilepsy. If that test was really telling you anything, it was ruling out things like Epilepsy, not diagnosing you. Unless they found something of significant medical value, forget it. Sorry.
>
> Not sure if you guys think those things are reliable at all. But yeah I thought I'd mention it.X, who prescribed that test? If they were REALLY testing, they would have used a pet scan or something. Not an EEG. Whole thing sounds fishy.
I have no idea how they can come up with a list like that. If they were saying, okay, you always respond to SSRI's well, then maybe a list to pick from makes sense. The way I see it, that list leaves all doors OPEN as far as neuros, except rules out the anti psych's which I totally agree with.
>
> I'd have thought MAOI too but the test says otherwise. Antipsychotics won't help with it...anhedonia and dopamine receptor antagonism in the mesolimbic region are like partners in crime.Forget that test. Forget antipsychs please. I've seen them in action and you simply are not a cadidate, your the opposite of a candidate, unless there are things we don't know. Remember, everything you say here is all we have to go on.
X_ander, I believe you are suffering from MDD. I think its been too long and you need to get back to your life. I'll tell you what I would do if I was in your place, to bring you out of depression, and soon. When I was with my first PDoc, he would leave me at low levels of Parnate for too long. I was on 30mg for 6 weeks with no to little response. Finally I got up to 40mg or 50mg, it was around Christmas time, and I was responding but not enough and I was dead tired ALL the time. My PDoc wouldnt augment so I went to my GP and got one month supply of ritalin with the stipulation that I had to find a PDoc who used that combination, fast. I would not get a refill. The first day I took 1 pill, 5mg, nothing. The second day, I took 5mg again in the morning. Later that day, I was suddenly in complete remission. 100%. I figured the Parnate had finally kicked in all the way. I had energy galore, I was myself again. It lasted 10 days then left. I never credited the ritalin, and I was scared to take more than 5mg. I got rid of them.
I then found a new PDoc that specializes in MAOI's and is comfortable and experienced in using them with augments. GET ONE. I asked him how I got that ten days and he said the ritalin. What? lol. He rapidly titrated the ritalin and the Parnate to adequate doses, and voila, couple weeks later 100% remission. They work synergistically in amazing ways from what I've experienced. Dopamine ;-)
> I've been like this for almost 2 years. No change, no worsening, no improvement either.Not acceptable! My new Doc was appalled when he heard how long I was in deep depression. If for some reason you can't take the Parnate and Ritalin, or don't want to, my next geuss, and thats what it is, would be Desipramine, augmented with Ritalin if thats not contraindicated. 30mg of Ritalin all a once is a different effect than say, 5mg, 3-4 times a day, spread apart. Don't know what dose would work best with Desaprimine.
Finally, whatever you do, the most important thing I learned through all of this is to get the BEST possible PDoc you can. Sell your car, lol. Look at how much $$ is wasted on all these trials. My PDoc, given an exact history (meds and reactions too) would have most patients symptom free, or close to it, in a very short time. You have to do exactly as he says tho. Fine by me.It will be the best investment you will ever make. This is my first episode as I think it is yours. We are now at around 50% risk of a second, and then it gets higher. I don't know about you, but I want to be ready if it hits again. GO NOW, RUN DON'T WALK, find the BEST Pdoc you can. Whatever the cost. Use a credit card if you have to. Your worth it.
>Cheers to all, Xander.Cheers to you as well ;-)
~Jade **Sorry so long, I wish I had gotten this message when I came here. While I got lots of help, this would have saved me so much aggravation and time I can't get back-hope it helps you**
>
Posted by Phillipa on March 16, 2009, at 19:46:12
In reply to Re: Treatment for emotional numbness???, posted by JadeKelly on March 16, 2009, at 15:42:26
rEEG isn't an EEG it's a new form of testing. Google it. Phillipa
Posted by Phillipa on March 16, 2009, at 19:54:45
In reply to Re: Treatment for emotional numbness??? » JadeKelly, posted by Phillipa on March 16, 2009, at 19:46:12
A bit of rEEG history. Phillipa
REEGTHE NEW IMAGE OF DIAGNOSTIC ACCURACY
SAN DIEGO"Various uses of quantitative EEG are emerging as possible ways to predict positive and adverse psychotropic medication responses," reported Daniel A. Hoffman, MD, and while no one is ready to toss out the DSM-IV just yet, there is now increased evidence that the use of referenced EEG (rEEG) can sometimes do better than clinical diagnostic techniques in determining which psychotropic drugs will help an individual patient or in predicting whether a particular patient will do better without any medication at all.According to Mark Schiller, MD, rEEG is a patented system that uses EEG and quantitative EEG (QEEG) to characterize features of brain function underlying a broad range of psychiatric syndromes. In the procedure, a patients EEG data are compared against a large, clinical outcome database of heterogeneous EEG/QEEG results and diverse medication responses. The patients EEG data are then mathematically classified and correlated with neuroactive medications likely to improve brain function in that particular case. The growing EEG/QEEG database currently includes children from age 6 to adults age 90 and covers a broad range of DSM diagnoses.
In a previous multisite study presented by Drs. Hoffman and Schiller and colleagues at the 158th Annual Meeting of the American Psychiatric Association, 77% of 247 patients with treatment-refractory psychiatric disorders who underwent rEEG received subsequent medication changes as a result of information obtained through that testing. These medication changes were ones "that the psychiatrist would never have chosen without the aid of the rEEG," Dr. Hoffman said.
BIOMARKER BASIS
"rEEG is surfacing as a way to provide psychiatrists with a set of clinically useful biomarkers to guide physicians pharmacotherapeutic choices," Dr. Hoffman said. Based on the number of such biomarkers, physicians can then determine how likely a patient is to respond to a particular type of medication, he explained. In cases where the rEEG report comes back showing a low biomarker prevalence, Dr. Hoffman has found, many of these patients feel better without any medications, during follow-up that so far has lasted two to nine months.
"Whether some of them will need medications later has yet to be determined, but in all cases, if they should, the rEEG report suggests that from a physiological perspective, they had not been on the right psychotropics to date and that implementing the correct medications should make a significant difference."
CASE IN POINT
In an update at the 17th Annual Meeting of the American Neuropsychiatric Association, Dr. Hoffman described the difference that rEEG made in the cases of three patients at the Neuro-Therapy Clinic in Englewood, Colorado.
The first was a 33-year-old woman who came in with her husband; both expressed discouragement and doubt that they would ever be able to live a normal life because of her depression and anxiety. At the time of her visit, the patient had tried 22 psychotropic medications. "Despite the challenging medication discontinuation tapering for the rEEG testing, the patient was feeling so well without medication that to date, she has decided to only use trazodone for sleep," Dr. Hoffman reported. Her scores on the Beck Anxiety and Beck Depression scales both decreased significantly at follow-up.
There was also a 29-year-old woman with bipolar disorder. She was taking six psychotropic drugs "yet still felt suicidal, labile, sleep deprived, and exhausted," Dr. Hoffman said. Following rEEG, which showed low biomarker prevalence, she went off all medications and said she felt "wonderful." At two-month follow-up, she remained symptom-free and medication-free.
The third case was a 15-year-old male who had been diagnosed with oppositional defiant disorder and ADHD and had been on dextroamphetamine for five years. His medication was tapered off prior to the rEEG evaluation, and he remained medication-free thereafter; his parents reported that his behavior was back to where it had been before he took the stimulant drug.
REASONS FOR rEEG
Other reasons to consider the use of rEEG include the likelihood of increased remission rates as well as lower health care costs, according to Dr. Hoffman. He added that in reviewing his cases in which rEEG was used, he found that fewer medications were needed, medication compliance increased, and patients recovered more quickly.
"By targeting the medication response with objective evidence, the previously reluctant practitioner might now choose to use a medication with a higher side-effect profile. Having a neurophysiologic basis for that decision increases the comfort level and likelihood of the prescriber using these medications with greater confidence and increased success," he said. "Certainly, more controlled research seems warranted to pursue rEEGs place in modern psychiatry."
Posted by JadeKelly on March 16, 2009, at 20:10:58
In reply to Re: Treatment for emotional numbness???, posted by Phillipa on March 16, 2009, at 19:54:45
Phillipa,
Actually it IS an EEG, the r in front of it just refers to what they do to the results afterward. For too many reasons to go into now, I find that test to be useless in this case, and stand by every thing I wrote to X. Should he want further discussion on the topic, I'm sure he'll ask me.
Thanks, I've read that "article" before. It doesn't say anything of substance IMO.
~Jade
Posted by Phillipa on March 16, 2009, at 21:11:25
In reply to Re: Treatment for emotional numbness??? » Phillipa, posted by JadeKelly on March 16, 2009, at 20:10:58
I"d just think the poster's pdoc would know more ya know? Phillipa
Posted by JadeKelly on March 16, 2009, at 22:11:07
In reply to Re: Treatment for emotional numbness??? » JadeKelly, posted by Phillipa on March 16, 2009, at 21:11:25
> I"d just think the poster's pdoc would know more ya know? Phillipa
Phillipa, I feel that this is an inappropriate place to debate the merits of this "test". I have a right to my opinion of it and its usefulness here, and I'm sure you respect that as I will respect your right to your opinion.
Thank You, Jade
Posted by metric on March 17, 2009, at 15:14:15
In reply to Re: Treatment for emotional numbness???, posted by JadeKelly on March 16, 2009, at 15:42:26
> Hello X_ander,
> Finally, whatever you do, the most important thing I learned through all of this is to get the BEST possible PDoc you can. Sell your car, lol. Look at how much $$ is wasted on all these trials. My PDoc, given an exact history (meds and reactions too) would have most patients symptom free, or close to it, in a very short time. You have to do exactly as he says tho. Fine by me.It will be the best investment you will ever make. This is my first episode as I think it is yours. We are now at around 50% risk of a second, and then it gets higher. I don't know about you, but I want to be ready if it hits again. GO NOW, RUN DON'T WALK, find the BEST Pdoc you can. Whatever the cost. Use a credit card if you have to. Your worth it.
>
>But then when the drugs stop working -- as they eventually do -- he'll be miserable *and* debt-ridden.
Posted by metric on March 17, 2009, at 15:55:33
In reply to Re: Treatment for emotional numbness???, posted by X_ander on March 10, 2009, at 23:55:22
> Hi Jay,
>
> yep I'm trying the stimulant path now but it seems to be losing it's effect after only a week...I'm taking ritalin 30mg per day..works wonders in the first few days, now I hardly notice it.
>Have yout tried low-dose selegiline? Start very low, 2.5 - 5 mg in the morning and work your way up to 10 mg (preferably in divided doses with meals, but don't take it much after noon, especially if you already have problems with insomnia). It might make you feel a bit neverous/agitated at first, but this should quickly dissipate. Give yourself at least 2 weeks to adjust to a given dose.
Selegiline is rarely sufficient by itself, especially at these doses. What it will do is potentiate the action of stimulants.
Methylphenidate (Ritalin) sucks. Ask your doc for DextroStat (d-amphetamine). If he tries to push Adderall instead, tell him that the presense of racemic amphetamine salts in Adderall makes it more cardiotoxic than pure d-amphetamine and confers no therapeutic advantage (tell him to consult Goodman & Gilman's text -- the most authoritative medical reference on pharmacology -- if he denies this. Start with *small* doses and use the minimal effective dose. Don't take more than 40 mg/day.
You should frequently monitor your blood pressure during this process (this is very important!). Do *not* attempt this combination if you have severe anxiety or are emotionally unstable. You may need a sleeping pill at night, especially at first.
> As regards the opiates...that was actually the use of opiate "antagonists"...essentially the opposite of opiates. Opiate antagonists lower the activity/sensitivity of the opioid receptors. The theory is that too much endorphin production (the body's natural opiates), is the cause of the numbing. Lowering endorphin activity with the antagonist naltrexone would in theory, ameliorate that situation, returning normal feelings and emotions.
>
> So yeah again, anyone overcome emotional numbing?
>
> If you have what meds did you use?
>
> And how long did it take to start feeling again?
>
> (I've found that traditional antidepressants, and the atypical anti-psychotics I've tried didn't do much for this symptom).
>
> All the best, X_ander.
>
>
Posted by JadeKelly on March 17, 2009, at 16:24:57
In reply to Re: Treatment for emotional numbness???, posted by metric on March 17, 2009, at 15:14:15
> > Hello X_ander,
>
>
> > Finally, whatever you do, the most important thing I learned through all of this is to get the BEST possible PDoc you can. Sell your car, lol. Look at how much $$ is wasted on all these trials. My PDoc, given an exact history (meds and reactions too) would have most patients symptom free, or close to it, in a very short time. You have to do exactly as he says tho. Fine by me.It will be the best investment you will ever make. This is my first episode as I think it is yours. We are now at around 50% risk of a second, and then it gets higher. I don't know about you, but I want to be ready if it hits again. GO NOW, RUN DON'T WALK, find the BEST Pdoc you can. Whatever the cost. Use a credit card if you have to. Your worth it.
> >
> >
>
> But then when the drugs stop working -- as they eventually do -- he'll be miserable *and* debt-ridden.
>
Hello metric,Well, I hear what your saying and thats certainly a view worth looking at. I geuss you (anyone) would have to ask is this the difference between working/$$ and being not productive, even if only for a year or two. Is the Depressive incindent a one time thing or have there been others, or is it chronic?
My MDD episode was the result of an evnt in my personal life that I couldn't bare. I would have given away everything I own AND gone into debt to get some relief. I don't expect to have another one.
If we really wanted to debate this, I think I could make a really good case relative to the cost of not getting well. To name just a few: In X's case, possible waste of tuition, spending the same amount of money on low quality care, he has already wasted a lot of money on trials of meds that didnt work, lost wages, etc.
In my case my depression, and wasted time with a PDoc that was not effective, cost me, among other things, huge sums of money as a result of wasted fees ($90 per 15min session) lost wages, I know most people spend unbelievable amounts of money on trialing meds, lost productivity, forgetfulness alone has cost me probably $1000-2000 in late fees on bills, and other household pymts. In my fog I backed one of our cars into our truck. That raised my insurance. I could go on and on here.
Depression is expensive.
Mental Illness is expensive.
Mediocre care is expensive.
Excellent care is expensive.In thinking further about this, I most definately stand by what I stated.
What I'm curious about now is, what is your premise for believing that there is a solution that will not be costly? Even if its to do nothing? Also, I'm just wondering if you have had a med or med(s) that worked, for how long, and what they were? Thanks-
~Jade
Posted by X_ander on March 19, 2009, at 11:10:14
In reply to Re: Treatment for emotional numbness??? » metric, posted by JadeKelly on March 17, 2009, at 16:24:57
Wow, firstly Jade, thanks so very much for obviously caring and posting with emotion like you do. Having emotions back is definitely empowering you. It can be the difference in a lot of ways especially because in the state I'm in, I'm almost necessarily vague and indecisive...the numbing makes it hard to know what's good and bad essentially, what you like and dislike.
I agree with pretty much everything you have said.
On money I agree. Depression is expensive. You lose your life whilst being alive...depending on severity. So money mext to mental health is a distant second.
My only real worry is how do you find that kind of fantastic, knowledgable, innovative, creative but still abundantly competent and careful Pdoc. I mean it's not like they have next to their names in the phonebook, "specializes in MAOIs and augmented medications"...or something similar you know...? I've seen 4 pdocs and a clinical psychologist. All as conservative as the last.
So yes, finding that kind of pdoc who is willing to listen and understand the difference between symptoms which respond to SSRIs and those which require dopaminergic meds is paramount, but not all that straightforward.
Whe you were looking for your Pdoc, was it literally just picking up the phonebook, randomly choosing a doc in you area and trying for a month? Or were you able to find out somehow what they were like before meeting them?
Yeah look rEEG is a bit of a grey area I think. It has to be, because I respond at least partially to ritalin, esp with black coffee actually. So I'd imagine carefully augmenting parnate or selegiline would have better results than caffeine. It's just that most pdocs would recoil in horror at the thought of that combination.
Thanks everyone for contributing. Really.
Xander.
Posted by Sigismund on March 19, 2009, at 17:11:36
In reply to Re: Treatment for emotional numbness???, posted by X_ander on March 19, 2009, at 11:10:14
>My only real worry is how do you find that kind of fantastic, knowledgable, innovative, creative but still abundantly competent and careful Pdoc. I mean it's not like they have next to their names in the phonebook, "specializes in MAOIs and augmented medications"...or something similar you know...? I've seen 4 pdocs and a clinical psychologist. All as conservative as the last.
It is easy for me now to do this, whether because of where I live or something else, I don't know. Getting older helps as well. Look for sceptics. Doctors out on a limb, out on their own, or highly educated.
But it will be difficult to find a psych dr in Australia who augments Parnate with amphetamine or Ritalin unless you also fall within the criteria for ADHD.
Posted by JadeKelly on March 19, 2009, at 21:25:21
In reply to Re: Treatment for emotional numbness???, posted by X_ander on March 19, 2009, at 11:10:14
> Wow, firstly Jade, thanks so very much for obviously caring and posting with emotion like you do. Having emotions back is definitely empowering you. It can be the difference in a lot of ways especially because in the state I'm in, I'm almost necessarily vague and indecisive...the numbing makes it hard to know what's good and bad essentially, what you like and dislike.
>
> I agree with pretty much everything you have said.
>
> On money I agree. Depression is expensive. You lose your life whilst being alive...depending on severity. So money mext to mental health is a distant second.
>
> My only real worry is how do you find that kind of fantastic, knowledgable, innovative, creative but still abundantly competent and careful Pdoc. I mean it's not like they have next to their names in the phonebook, "specializes in MAOIs and augmented medications"...or something similar you know...? I've seen 4 pdocs and a clinical psychologist. All as conservative as the last.
>
> So yes, finding that kind of pdoc who is willing to listen and understand the difference between symptoms which respond to SSRIs and those which require dopaminergic meds is paramount, but not all that straightforward.
>
> Whe you were looking for your Pdoc, was it literally just picking up the phonebook, randomly choosing a doc in you area and trying for a month? Or were you able to find out somehow what they were like before meeting them?
>
> Yeah look rEEG is a bit of a grey area I think. It has to be, because I respond at least partially to ritalin, esp with black coffee actually. So I'd imagine carefully augmenting parnate or selegiline would have better results than caffeine. It's just that most pdocs would recoil in horror at the thought of that combination.
>
> Thanks everyone for contributing. Really.
>
> Xander.Hi Xander ;-)
Thanks for noticing my improved state!! Still working on clarity, short term memory, and cognitive ability (quickness). I feel especially emotional about you getting help because essentially I was where you are and it really pisses me off how much time I wasted in the hands of a PDoc that was ineffective and didn't care.
So, this is IMPORTANT: DO NOT stop taking ritalin. In fact, if it was me, I would tell my PDoc how much its working in all areas other than your depression. Your going to end up needing around 60mg a day at some point to knock out this depression. Now I would have cringed at that before, but you don't feel it. It potentiates the Parnate. Please trust me on this. The reason: When you go to your new PDoc, it would be very unlikely that he would take you off a med that is helping.
Also, make a list of all the meds you have taken. If ssri's never did much for you tell him you can't take them. I'm assuming your current PDoc will not add Parnate? Even if its a small amount, take it. This way you are established on the two meds, and the new PDoc is simply going to raise them to the point that you are in remission. A little tricky I know, but desperate times call for desperate measures.
Okay, about finding the PDoc. I posted this somewhere else, but just as quick to retype I geuss! First I googled something like: Maoi's, stims, desipramine, PDocs. You may have to mix it up a bit but I came up with an article written by my PDoc 10 years ago, and it was essentially what he was lecturing about at various Hospitals, Psychiatric facilities, and the like. My next move was to check with a top notch teaching Hospital in my area, geuss where the lecturer practiced, this same hospital. Actually, he's a professor there now and has private practice in one of their buildings.
Scott told me this about finding a PDoc: "the litmus test is do they prescibe Parnate with augments desipramine and stims", I believe thats how it went. My Doc prescribes all three. Now don't get me wrong, he's not a pushover, you have to do what he says, but it seems unacceptable to him that ANY patient of his was going to be depressed. I liked that attitude.
So, did someone say you live in Australia? I don't know the system there, but remember, difficulty in finding that PDoc is not the same as impossible. I believe you can pull this off. When you find a candidate, call the office and ask the receptionist if he is experienced with MAOI's, and does he prescribe those augments with it. My receptionist was quick to say yes. If Receptionist won't tell you, leave urgent message for PDoc and ask directly. You have a right to know whether he is experienced with certain meds, especially if you are on one/both.
So, with current PDoc, stay on ritalin, ask for Parnate, he may do it if doses are low. Next search for experienced MAOI PDoc's on line (articles, lectures, anything) and at the BEST hospital(s) in your area. When you find someone, call and see if its a match. Don't go for a consultation until you KNOW he is experienced using MAOI's and prescribes the combo you're looking for. Be prepared, the initial consultation is costly.
Good Luck Xander! Feel free to post or babblemail any questions. If you want to tell me where you live and what good to excellent hospitals are close, I can try to do a similar search if you like. Also, I'm gonna try to find that article that got me started.
~Jade
Posted by X_ander on March 24, 2009, at 11:15:27
In reply to Re: Treatment for emotional numbness??? » X_ander, posted by JadeKelly on March 19, 2009, at 21:25:21
Seeing my pdoc in a few hours...will find out more then. I dunno about ritalin, it's like it works for me for a couple hours one day, then the next it's just physical jitters or something. I dunno what i'm getting. It's like it's teasing me...Tolerance??
So I dunno what to say tomorrow. Truth is ritalin has the ability to help more than the other meds I have tried...but it does it only some of the time. Usually after I've taken a break from it to see what i'm like without it....which makes me think I'm developing a tolerance over a few days. Or maybe it's tolerance to the caffeine I augment with, I usually break from that too.
Ritalin without caffeine doesn't lift me too much. It kind of zones me out...which is weird for a stimulant I would have thought.
As for MAOI augmentation. I'd love to find a doc like yours Jade, Australia is like where all the conservative psychs chose to live. To have a pro-active pdoc who just has that no way my patient is gonna be depressed attitude would be such a weight off my shoulders.
My current doc has often accused me of subconsciously benefiting from the depression, hence why I don't come out of it. The secondary benefits theory it was called. I mean f*#k what do you say to that. It's subconscious so there's no "conscious" argument to it. All I say is it's completely, absolutely, without exception, wrong. But my pdoc is stubborn. So when it comes down to it, I don't feel I can trust the docs in my country to do the job. Which is why I'm here most of the time!! I have thought about going to the US...but yeah that would be a big move for no guaranteed return. But like you say, everything is risky (well expensive as you actually put it..but same thing)...ugh I dunno what to do.
I tell the truth, probably takes me off it, as didn't want me on it to begin with. It was just cos I wouldn't let up about it, like saying fine take it, but it's not gonna work, you watch. And the pdoc would be right...it's not working, but it shows that it can work..when it wants to..and then stops to give me a bunch of extra depression and "physical" anxiety (jitters heartrate etc.) upon the come down.
I just don't know. I know you can't make decisions for me, and without a pdoc as described earlier I don't have the confidence to go about it on my own (MAOI augmentation etc..). Anyway I'm just venting/letting you know where things are. Your thoughts are most welcome.
luv to all Xander.
This is the end of the thread.
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