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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 53. Go back in thread:
Posted by Lamdage22 on April 8, 2018, at 1:34:42
In reply to Re: Why is alcohol the only thing that helps me?, posted by linkadge on April 7, 2018, at 13:59:25
but you cant drive on medical marihuana right?
Posted by Lamdage22 on April 8, 2018, at 1:39:53
In reply to Re: Why is alcohol the only thing that helps me?, posted by Lamdage22 on April 8, 2018, at 1:34:42
for me thc and cbd is poison
Posted by beckett2 on April 8, 2018, at 1:58:49
In reply to Re: Why is alcohol the only thing that helps me? » Prefect, posted by linkadge on April 7, 2018, at 13:56:24
>
> I read one study in which the AD effect of ketamine was associated with a rapid activation of the reward pathways in the brain. It seemed to work in mice to quickly normalize activity in this region (in patients where there was underactivity).
>
> I'm not advocating using any drug willy-nilly to feel good (as there can be pitfalls). I just know from my own case, that when I get really depressed I don't feel anything and don't want to do anything. SSRIs don't seem to help this (or even make it worse).This is true, isn't it? I know this has been discussed-- the ssri's and the lot flatten feelings, but I just got the lightbulb moment. So a damn ssri won't treat exactly what I'd like it to treat. Quite ridiculous really. But what else to take?
I'm glad to hear about your success with CBD. And that you discontinued Effexor just like that.
Drat this whole illness.
>
> Linkadge
>
>
>
>
Posted by beckett2 on April 8, 2018, at 2:04:48
In reply to Why is alcohol the only thing that helps me?, posted by Prefect on April 6, 2018, at 14:34:51
> I suffer from severe anxiety, inner tension, tremors, cognitive deficit, derealization, etc
>
> One double shot of whiskey gives me more relief than 1 mg of clonazepam. I am able to think, I become more motivated, relaxed, and my inner tension and tremors stop.
>
> What is the mechanism behind this? It can't just be GABA and NMDA antagonism otherwise clonazepam would work too. It's got to be something else alcohol does that I need to find a medication that can do the same, otherwise I'm on the path to alcoholism.
>
> And no, my symptoms are not from alcohol withdrawal, I had them for a year before I accidentally discovered alcohol practically makes me NORMAL for a few hours.The various benzos are different in effect-- couldn't tell you why, but I've only liked two and the rest made me feel like rubbish. Clonazapam I did not like, and I'd rather a shot of whiskey that it.
I suppose if you don't overdo or feel worse later or in the long run, lots of people find whiskey works fine.
Posted by linkadge on April 8, 2018, at 12:07:17
In reply to Re: Why is alcohol the only thing that helps me?, posted by Lamdage22 on April 8, 2018, at 1:34:42
>but you cant drive on medical marihuana right?
My doctor told me I could drive, but just to wait a few hours. Marijuanna will be legalized in Canada soon. There is likely emerging legislation on what thresholds constitute impairment. You obviously cannot be impaired while driving.
Linkadge
Posted by linkadge on April 8, 2018, at 12:10:14
In reply to Re: Why is alcohol the only thing that helps me? » linkadge, posted by beckett2 on April 8, 2018, at 1:58:49
In theory, SSRIs are supposed to treat depression (a core symptom of which is anhedonia).
In practice, I don't know how well they work on that symptom.
There is some evidence too that SSRIs may work better in women (not conclusive, but emerging evidence).
The article I read suggested that women were 2x as likely to achieve remission on an SSRI then men.
Linkadge
Posted by beckett2 on April 8, 2018, at 15:52:05
In reply to Re: Why is alcohol the only thing that helps me? » beckett2, posted by linkadge on April 8, 2018, at 12:10:14
> In theory, SSRIs are supposed to treat depression (a core symptom of which is anhedonia).
>
> In practice, I don't know how well they work on that symptom.
>
> There is some evidence too that SSRIs may work better in women (not conclusive, but emerging evidence).
>
> The article I read suggested that women were 2x as likely to achieve remission on an SSRI then men.
>
> Linkadge
>
>Would you consider lack of motivation an expression of anhedonia?
Posted by linkadge on April 8, 2018, at 17:20:46
In reply to Re: Why is alcohol the only thing that helps me? » linkadge, posted by beckett2 on April 8, 2018, at 15:52:05
>Would you consider lack of motivation an >expression of anhedonia?
Absolutely.
We do things that we enjoy doing. If we enjoy doing it, we want to repeat it. When we stop enjoying things (or everything) we stop doing things.
Its a learned response.
Lack of motivation (for me) has slowly crept up as I stopped enjoying doing the things I once did. If the action stops providing pleasure, we stop doing it.
Linkadge
Posted by beckett2 on April 8, 2018, at 17:51:47
In reply to Re: Why is alcohol the only thing that helps me? » beckett2, posted by linkadge on April 8, 2018, at 17:20:46
> >Would you consider lack of motivation an >expression of anhedonia?
>
> Absolutely.
>
> We do things that we enjoy doing. If we enjoy doing it, we want to repeat it. When we stop enjoying things (or everything) we stop doing things.
>
> Its a learned response.
>
> Lack of motivation (for me) has slowly crept up as I stopped enjoying doing the things I once did. If the action stops providing pleasure, we stop doing it.
>
> Linkadge
>
>
>
>Do you think MMJ might help you with that? Maybe it's something else you're seeking, too.
Posted by Prefect on April 9, 2018, at 11:55:47
In reply to Re: Why is alcohol the only thing that helps me? » linkadge, posted by beckett2 on April 8, 2018, at 17:51:47
My concern is that it's come to the point I have to drink a whole bottle of whiskey a day in order to function. The more I drink I have to consume more and more since the alcohol is likely desensitizing my GABA receptors and causes a rebound effect where I feel withdrawal and likely suffer from rebound glutamate excitotoxicity when I don't drink.
I need to find an alternative. I'm considering weening off using clonazepam, get off the zoloft, and start taking Fluvoxamine at nights and abilify in the morning to see of it helps.
Posted by bleauberry on April 9, 2018, at 13:14:20
In reply to Why is alcohol the only thing that helps me?, posted by Prefect on April 6, 2018, at 14:34:51
My first gut instinct guess is that alcohol is stimulating the release of dopamine which might be your weak link, and that the way it stimulates dopamine is different than any of the psych meds.
I experienced the exact same things you described and the medication that fixed it all like magic was the medication I thought would make it all much worse - Ritalin!
It could be that dopamine is the weak link. As the adrenal glands try to compensate for that, they pump out the best substitutes they have, which are adrenalin-like. And thus your symptoms. When dopamine is normalized, those symptoms go away.
Your story and mine are identical except for 2 things. Ritalin for me instead of alcohol. And a diagnosis of Lyme as well. Your symptoms are 100% consistent with an unsuspected, stealth, misdiagnosed or undiagnosed, tick born disease. Either Borellia or Bartonella - both are bacterias from ticks - present a symptom profile that looks exactly like what you described.
Alcohol likely makes your problems and your life worse in the long run. It is generally destructive to many people. I would try experimenting with other things that hit dopamine.
And consider going a step further than merely treating the symptoms - set your sites on figuring why it is all happening in the first place - there is a reason - and in my experience it is not often the mystery we think it is - not often the complicated unsolvable puzzle that we think it is.
imo
> I suffer from severe anxiety, inner tension, tremors, cognitive deficit, derealization, etc
>
> One double shot of whiskey gives me more relief than 1 mg of clonazepam. I am able to think, I become more motivated, relaxed, and my inner tension and tremors stop.
>
> What is the mechanism behind this? It can't just be GABA and NMDA antagonism otherwise clonazepam would work too. It's got to be something else alcohol does that I need to find a medication that can do the same, otherwise I'm on the path to alcoholism.
>
> And no, my symptoms are not from alcohol withdrawal, I had them for a year before I accidentally discovered alcohol practically makes me NORMAL for a few hours.
Posted by SLS on April 9, 2018, at 15:03:13
In reply to Re: Why is alcohol the only thing that helps me?, posted by Prefect on April 9, 2018, at 11:55:47
> My concern is that it's come to the point I have to drink a whole bottle of whiskey a day in order to function. The more I drink I have to consume more and more since the alcohol is likely desensitizing my GABA receptors and causes a rebound effect where I feel withdrawal and likely suffer from rebound glutamate excitotoxicity when I don't drink.
>
> I need to find an alternative. I'm considering weening off using clonazepam, get off the zoloft, and start taking Fluvoxamine at nights and abilify in the morning to see of it helps.Why are you discontinuing Zoloft and starting fluvoxamine?
Have you tried:
Lamictal
Trileptal
Tegretol
N-acetylcysteine (NAC)Lamictal might increase dopamine (secondary to glutamate release inhibition). Tileptal and Tegretol can reduce glutamate and exitotoxicity. Tegretol can be sedating, which might be good in your case. NAC modulates glutamatergic activity and can increase dopamine, but often takes several months to take effect. Perhaps reducing inflammation is involved. I really don't know. Andrew Nierenberg suggested combining Lamictal with NAC.
Some people do well on a combination of Abilify, Lamictal, and Wellbutrin for severe depression. If you react poorly to Wellbutrin because of anxiety, aggitation, or dysphoria, nortriptyline or a SRI might make a good substitute.
- Scott
Posted by linkadge on April 9, 2018, at 17:01:15
In reply to Re: Why is alcohol the only thing that helps me?, posted by Prefect on April 9, 2018, at 11:55:47
Have you tried other anticonvulsants / mood stabilizers.
Topomax? Lamotrigine? Pregabalin?
Linkadge
Posted by Phillipa on April 9, 2018, at 17:19:06
In reply to Re: Why is alcohol the only thing that helps me?, posted by Prefect on April 9, 2018, at 11:55:47
Chloral hydrate is what stopped me from drinking the 4-5 beers a night. It does sound like you are building up a huge tolerance to alcohol. Can you stop drinking? If not than see an addiction specialist. Inpatient with valium and slowly weaning down. Phillipa
Posted by beckett2 on April 9, 2018, at 18:33:27
In reply to Re: Why is alcohol the only thing that helps me?, posted by Prefect on April 9, 2018, at 11:55:47
Lyrica has been helpful. I took Xanax for many years, and I just needed something after I detoxed. It's a thought. The effect is pro social and allows me some relaxation and enjoyment. (Just can't drive for the day after a certain amount.) Life is tough on the inside for some of us :/
Posted by Prefect on April 9, 2018, at 19:49:36
In reply to Re: Why is alcohol the only thing that helps me? » Prefect, posted by SLS on April 9, 2018, at 15:03:13
I'm discontinuing zoloft because it's not not working. I've been on it for almost a year at 150mg per day and it's not helping. I've also read zoloft and lamictal are a toxic combination. I want to taper of and either try prozac with lamital or luvox with abilify.
Posted by Prefect on April 9, 2018, at 20:13:00
In reply to Re: Why is alcohol the only thing that helps me? » Prefect, posted by bleauberry on April 9, 2018, at 13:14:20
I'm not sure I understand this lyme angle. I've been suffering from various form of this for 20 years. My understanding is antibiotics onlt work for lyme in the first 6 months of infection. You're proposing I go on antibiotics for a possible lyme infection after 20 years? Would it even work now?!
Posted by Prefect on April 9, 2018, at 20:23:56
In reply to Re: Why is alcohol the only thing that helps me? » Prefect, posted by SLS on April 9, 2018, at 15:03:13
I should add when I started luvox 20 years ago I had more positive results from 25 mg per night than I'm getting from 150 mg of zoloft a day. I suspect the sigma 1 agonism of luvox might be my therapeutic answer rather than just more serotonin. Zoloft is in fact a sigma 1 antagonist.
Posted by SLS on April 9, 2018, at 21:04:57
In reply to Re: Why is alcohol the only thing that helps me? » SLS, posted by Prefect on April 9, 2018, at 19:49:36
> I'm discontinuing zoloft because it's not not working. I've been on it for almost a year at 150mg per day and it's not helping. I've also read zoloft and lamictal are a toxic combination.
I didn't know that. In what way are they toxic?
> I want to taper of and either try prozac with lamital or luvox with abilify.
Will you add Lamictal if you go with Abilify and Luvox? I should think that the three drugs would go together well. What do you think?
- Scott
Posted by Prefect on April 9, 2018, at 21:16:47
In reply to Re: Why is alcohol the only thing that helps me? » Prefect, posted by SLS on April 9, 2018, at 21:04:57
Aparently one severly interferences with clearance of the other:
https://www.ncbi.nlm.nih.gov/pubmed/9627209
But I've read positive literature about prozac/lamictal combo for depersonizaltion disorder.
Why do you feel lamictal would be a good add on to luvox+abilify?
Posted by SLS on April 9, 2018, at 22:43:48
In reply to Re: Why is alcohol the only thing that helps me? » SLS, posted by Prefect on April 9, 2018, at 21:16:47
> Aparently one severly interferences with clearance of the other:
>
> https://www.ncbi.nlm.nih.gov/pubmed/9627209
>
> But I've read positive literature about prozac/lamictal combo for depersonizaltion disorder.
>
> Why do you feel lamictal would be a good add on to luvox+abilify?I have seen Abilify + Lamictal work well for a woman with severe depression. These drugs are also critical for my feeling better (not remission yet). In my opinion, both drugs are pro-dopaminergic, albeit via different mechanisms. Abilify often acts to make SSRIs work better, so perhaps the three drugs together will help you. Lamictal is metabolized by glucuronidation, not by CYP450 enzymes, so I don't see any problems with pharmacokinetics. You might want to start Abilify at 2.0-5.0 mg/day. It is metabolized by CYP450 3A4 and 2D6. Luvox might increase blood levels of Abilify. I'm not sure. For me, 15 mg/day of Abilify is optimal, but I have bipolar depression. I had severe depersonalization and derealization earlier in the course of my illness. If depersonalization is a feature of your condition, you might need to titrate the Abilify upwards. There are reports of Abilify helping:
https://www.ncbi.nlm.nih.gov/pubmed/24992087
Keep bothering Linkadge. He knows his stuff and thinks outside the box. I'm sure he can help you.
- Scott
Posted by Prefect on April 10, 2018, at 11:07:07
In reply to Re: Why is alcohol the only thing that helps me?, posted by SLS on April 9, 2018, at 22:43:48
I'll be taking Luvox at night. Would I take Lamictal at nigh too? I suspect it's somewhat sedating.
Posted by Prefect on April 10, 2018, at 11:18:47
In reply to Re: Why is alcohol the only thing that helps me? » Prefect, posted by bleauberry on April 9, 2018, at 13:14:20
BTW I should mention I've tested positive for Bartonella not even through a specialized testing lab but a public health lab.
You mention Ritalin, would low dose abilify not rebalance dopamine levels as well? It's a D1 agonist.
Posted by Prefect on April 10, 2018, at 12:21:03
In reply to Re: Why is alcohol the only thing that helps me? » Prefect, posted by bleauberry on April 9, 2018, at 13:14:20
Also I have a lot of inner tension, tachycardia, and sensory agitation. Would Ritalin not make this worse, because it's also a norepinephrine reuptake inhibitor. I went on Fetzima last year for a weak and it turned me into a basketcase.
Posted by linkadge on April 10, 2018, at 16:50:42
In reply to Re: Why is alcohol the only thing that helps me? » bleauberry, posted by Prefect on April 9, 2018, at 20:13:00
There are a few new studies linking overuse of antibiotics to an increased risk of future heart disease.
Of course, if you need them, use them. The notion, however, that people should be on a steady stream of antibioticis is perhaps a bit unwise.
Linkadge
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