Shown: posts 14 to 38 of 54. Go back in thread:
Posted by SLS on September 14, 2021, at 21:11:05
In reply to Re: Why do meds constantly stop working for me?, posted by rose45 on September 14, 2021, at 17:32:09
> All the links to sulpride that I have found mention its augmentation use for schizophrenia. Not one article for its use in augmentation of anti depressants, or maois in particular.
Darn. I meant amisulpride as opposed to sulpiride. Sorry.
They are similar in that they are both selective for dopamine presynaptic autoreceptors. Those are the receptors on the first neuron at the synapse. When they "see" too much dopamine, they turn off the manufacture and release of dopamine. So, when an antagonist makes the first neuron "blind" to the excess dopamine, it continues to release it anyway. These presynaptic autoreceptors are "stickier" (higher binding affinity) than are the postsynaptic receptors on the second neuron. At low dosages, the presynaptic binding predominates, so dopamine release is increased without the postsynaptic receptors being antagonized (blocked). The postsynaptic neuron can still see dopamine and can be stimulated by it.
Anyway, like I said, amisulpride was of great interest on Psycho-Babble perhaps 20 years ago. I think there are several papers on amisulpride being a good treatment for dysthymia. Zyprexa is an entirely different beast, and I don't know how it augments MAOIs pharmacologically. 5-HT2a/c antagonism maybe? I'm sure someone will know. Zyprexa is what's called an inverse-agonist at those receptors. Basically, this means that it actually suppresses activity even more that a pure antagonist does. It's sort of like a super-antagonist.
- Scott
Posted by rose45 on September 20, 2021, at 9:01:15
In reply to Re: Why do meds constantly stop working for me? » rose45, posted by SLS on September 14, 2021, at 21:11:05
Scott, To my amazement the NHS has just approved marplan for me. Its hard to believe, because they just dont normally prescribe it.
The problem is they will insist on a long drawn out reduction of the parnate which I am on, and a 2 week wash out.I am dreading it, as I have been on parnate for 8 years or so.
I seem to remember that you had a post where you substituted one maoi for another without the washout and landed up in hospital? Is that correct? Or maybe it was someone else?
Posted by SLS on September 20, 2021, at 9:37:27
In reply to Re: Why do meds constantly stop working for me?, posted by rose45 on September 20, 2021, at 9:01:15
Hi, Rose.
> Scott, To my amazement the NHS has just approved marplan for me. Its hard to believe, because they just dont normally prescribe it.
>
> The problem is they will insist on a long drawn out reduction of the parnate which I am on, and a 2 week wash out.I am dreading it, as I have been on parnate for 8 years or so.
>
> I seem to remember that you had a post where you substituted one maoi for another without the washout and landed up in hospital? Is that correct? Or maybe it was someone else?
Yes. My doctor thought it could be done. When I switched from Nardil to Parnate within a day, I became delirious and who knows what else. In the ambulance, I got pricked in the penis with a catheter for urine. My senses were generally numb, but I sure as heck felt that!
I don't have the time to look back, but have you tried Nardil yet?1. What was your highest dosage?
2. How long were you on the highest dosage for?
3. Did it help with depression? In what wasys were you improved?
4. What were your side effects?
* 5. What other drugs did you combine it with?
- Scott
Posted by rose45 on September 20, 2021, at 11:19:06
In reply to Re: Why do meds constantly stop working for me? » rose45, posted by SLS on September 20, 2021, at 9:37:27
Hi Scott,
I was on Nardil for 15 years and then it totally stopped working and anxiety came back in full force.
I would take it up to 60 mg which was pretty unbearable with side effects, but as soon as it worked, I stayed on it for 2 or 3 weeks, and then went down to 45mg and that was my maintenance dose.
This was the classical way of titrating up at the maudsley hospital where i was an inpatient.I did feel very happy on it, but later realised it was making me manic.... i started gambling, spending money etc. which i had never done before. I told the doctors but being uk and conservative, they said it was better to stay on one med, than add lithium, as i had suggested to them.
It had loads of side effects, putting on weight, constipation being the main ones. I far preferred parnate.
Strangely, I was able to sleep on nardil, though I had suffered from insomnia for most of my life.
I never combined it with other drugs. In the UK they dont like doing that, as they do in the usa. But it worked fine on its own for the 15 years i was on it.
When it stopped working, i tried to increase but it didnt make any difference. Psychs added seroquel and I suffered terribly as they increased the seroquel for 6 months. Finally they agreed to switch to parnate, and parnate was almost side effect free, except for the insomnia
I hope that answers your questions. Here in the UK, they simply dont believe in taking several meds at the same time. You re much more fortunate in the USA.
Posted by SLS on September 20, 2021, at 21:52:38
In reply to Re: Why do meds constantly stop working for me?, posted by rose45 on September 20, 2021, at 11:19:06
Hi, Rose
> I hope that answers your questions. Here in the UK, they simply dont believe in taking several meds at the same time. You re much more fortunate in the USA.
The NHS is so backwards. According to the most recent diagnositic criteria in the DSM 5, you fit the description of Bipolar Disorder (Depressive subtype) with Drug-Induced-Mania as a qualifier. From now on, I would use treatment strategies found to be effective in that Bipolar subtype. I think lamotrigine is a candidate as an augmenter. I think Undopaminergic could provide some information about this. In my personal experience and from what the medical literature yields, the range of dosages of Nardil are usually between 60-90 mg/day.
What about France?
- Scott
Posted by undopaminergic on September 21, 2021, at 0:19:54
In reply to Re: Why do meds constantly stop working for me? » rose45, posted by SLS on September 20, 2021, at 21:52:38
> I think lamotrigine is a candidate as an augmenter. I think Undopaminergic could provide some information about this.
>I'm sorry that I'm not any kind of expert on lamotrigine. Indeed it sounds to me that you might know better, as you have suggested a minimum dose (whereas I wouldn't know).
-undopaminergic
Posted by rose45 on September 21, 2021, at 6:54:40
In reply to Re: Why do meds constantly stop working for me? » rose45, posted by SLS on September 20, 2021, at 21:52:38
Scott, I think we have crossed wires.
My earlier message was to say that to my great surprise, the NHS here in UK have agreed to put me on Marplan.
I did not think they would agree to it as it is very expensive, and the alternatives they gave me were lithium or ECT, neither of which I was keen on.
Im not too sure why you asked about Nardil. Since it stopped working some years ago, and since Parnate also stopped working, it seemed to make sense to try Marplan, which is the only maoi I have never taken, even though people seem to think that it is weaker than the other maois.
I may well keep Lamotrigine going in the background, if the psychs agree.
France is a different country and I dont live there.
Posted by rose45 on September 22, 2021, at 7:50:48
In reply to Re: Why do meds constantly stop working for me? » rose45, posted by SLS on September 20, 2021, at 21:52:38
Scott,
I really do appreciate the time you have given to answering my posts, and opening my eyes to the fact that I am a sub-type of bipolar, and should carry on with the lamotrigine in the background.
You do not say anything about marplan, which, as I mentioned in my previous post, has just been approved for me by the NHS? Is that because you do not think that marplan would be an ideal solution, along with the lamotrigine?
Posted by SLS on September 23, 2021, at 7:52:03
In reply to Re: Why do meds constantly stop working for me? » SLS, posted by undopaminergic on September 21, 2021, at 0:19:54
> > I think lamotrigine is a candidate as an augmenter. I think Undopaminergic could provide some information about this.
> >
>
> I'm sorry that I'm not any kind of expert on lamotrigine. Indeed it sounds to me that you might know better, as you have suggested a minimum dose (whereas I wouldn't know).
>
> -undopaminergic
>
You are indeed a gentleman.:)
- Scott
Posted by SLS on September 23, 2021, at 8:13:59
In reply to Re: Why do meds constantly stop working for me?, posted by rose45 on September 21, 2021, at 6:54:40
Hi, Rose.
I would not consider my memory competent enough to remember all of your posts. I'm also too lazy to look back. So, please don't be insulted or frustrated by my lack of recall.
I mentioned Nardil *again* because if you haven't combined it with a tricyclic, some other antidepressant or augmenting drug, or a "mood stabilizer", you are far from done searching for an effective treatment for your depression. I mentioned lamotrigine specifically, as I am 100% sure that it works for me and is necessary for me to achieve remission. Lamotrigine is FDA approved to treat bipolar depression. So, I would suggest that lamotrigine, at as high a dosage as you can tolerate up to 300 mg/day (when given time for side-effects to wane) is worth keeping onboard indefinitely, just in case you respond to any treatment that requires its presence as an augmenter.
Are you bipolar? I think you should review the DSM 5 manual to investigate this question. You *must* read the list of "qualifiers" that are listed for bipolar disorder. You do indeed qualify. So, as I suggested, you might do better to use the DSM 5 diagnostic criteria and adjust your treatment plan accordingly. Your future choices of drug treatments might be greatly expanded using lists of treatment regimes recommended for bipolar depression.
That's just my opinion. I recommend that you do the reading I suggested in order to come to your own opinion.
Good luck.
- Scott
Posted by rose45 on September 23, 2021, at 17:57:13
In reply to Re: Why do meds constantly stop working for me? » rose45, posted by SLS on September 23, 2021, at 8:13:59
Not too sure where I can get an online copy of the DSM 5 Manual,is there one?
I have been reading the following website https://psycheducation.org/ by Jim Phelps which is very enlightening on the subject of the different types of bipolar.
Re. Lamotrigine, it worked well at 200mg for 3 months and then pooped out. So although Im still taking it, it is no longer working....it may well be that it is a generic which does not work like the original lamictal, but I have no choice re. which version I am given by the pharmacy unfortunately.
Posted by SLS on September 23, 2021, at 23:52:25
In reply to Re: Why do meds constantly stop working for me?, posted by rose45 on September 23, 2021, at 17:57:13
> Re. Lamotrigine, it worked well at 200mg for 3 months and then pooped out. So although Im still taking it, it is no longer working....it may well be that it is a generic which does not work like the original lamictal, but I have no choice re. which version I am given by the pharmacy unfortunately.
Rose:*** lamotrigine = 3OO mg/day!!! ***
What prevented you from continuing the titration of the lamotrigine dosage beyond 200 mg/day?
If you tried 300 mg/day, what happened? How many weeks did you allow for it to work?
- Scott
Posted by SLS on September 24, 2021, at 0:13:47
In reply to Re: Why do meds constantly stop working for me?, posted by rose45 on September 22, 2021, at 7:50:48
Hi, UD
Regarding Marplan, it is the only MAOI for which a small subset of people who fail to respond to both Parnate and Nardil that will respond well to Marplan. This seems to be a rather uncommon breed. I would place the efficacy of these drugs in order as:
1. Nardil
2. Parnate
3. Marplan
4. Selegiline (EMSAM)
6. Moclobemide / RIMA
After my first two doses of Marplan, I experienced a noticeable improvement. However, within a week, things turned foul. I felt significantly worse with continued dosing. I stopped taking it, and I recovered a level of depression that approximated my usual baseline depression.Strangely enough, before pooping out on me, Marplan actually felt like some sort of hybrid between Parnate and Nardil.
UD: I find that your thoughts contain what one might consider esoteric information from which you construct creative and plausible arguments and explanations.Just don't turn around. You might see smoke.
- Scott.
Posted by undopaminergic on September 24, 2021, at 3:24:08
In reply to Re: Why do meds constantly stop working for me? » rose45, posted by SLS on September 24, 2021, at 0:13:47
>
> UD: I find that your thoughts contain what one might consider esoteric information from which you construct creative and plausible arguments and explanations.
>Interesting observation. Do you have examples?
> Just don't turn around. You might see smoke.
Can you clarify that?
-undopaminergic
Posted by rose45 on September 24, 2021, at 5:49:11
In reply to Re: Why do meds constantly stop working for me? » rose45, posted by SLS on September 23, 2021, at 23:52:25
Lamotrigine started to work at 100 mg, but I titrated up to 200mg. There was not much difference between 100 and 200 mg, but I did not feel myself, until I added 2.5mg olanzapine. I then felt I was in remission, although the unpleasant cognitive side effects of loss of memory, nightmares and loss of hair were still there. I felt in remission for 3 months,and then it slowly stopped working.I increased the dose of lamotrigine, but it made no difference. Hence the title of this thread - nardil, parnate and lamotrigine have all stopped working for me.
That is why I want to try marplan, as it is the only maoi which I have not yet tried Both Nardil and Parnate stopped working. I will keep taking Lamotrigine, as you suggest, but will it make much difference if it is not working? At this point, I doubt that increasing it any more will make much difference, and the memory loss and hair loss are really upsetting me.
Posted by SLS on September 24, 2021, at 14:39:31
In reply to Re: Why do meds constantly stop working for me? » SLS, posted by undopaminergic on September 24, 2021, at 3:24:08
> >
> > UD: I find that your thoughts contain what one might consider esoteric information from which you construct creative and plausible arguments and explanations.
> >
>
> Interesting observation. Do you have examples?
"esoteric" (Merriam-Webster): Requiring or exhibiting knowledge that is restricted to a small group."Examples? 99.9% of your posts. I'm joking, of course, but it's not far from the truth. :-)
> > Just don't turn around. You might see smoke.
> Can you clarify that?
It's an allusion to someone "blowing smoke up your *ss".
- Scott
Posted by SLS on September 24, 2021, at 15:11:14
In reply to Re: Why do meds constantly stop working for me?, posted by rose45 on September 24, 2021, at 5:49:11
> Lamotrigine started to work at 100 mg, but I titrated up to 200mg. There was not much difference between 100 and 200 mg, but I did not feel myself, until I added 2.5mg olanzapine. I then felt I was in remission, although the unpleasant cognitive side effects of loss of memory, nightmares and loss of hair were still there. I felt in remission for 3 months,and then it slowly stopped working.I increased the dose of lamotrigine, but it made no difference. Hence the title of this thread - nardil, parnate and lamotrigine have all stopped working for me.
>
> That is why I want to try marplan, as it is the only maoi which I have not yet tried Both Nardil and Parnate stopped working. I will keep taking Lamotrigine, as you suggest, but will it make much difference if it is not working? At this point, I doubt that increasing it any more will make much difference, and the memory loss and hair loss are really upsetting me.I would be upset, too. I would not want to see you suffer such upsetting side effects from lamotrigine if you can find remission without it.
For me, the difference between 200 mg/day and 300 mg/day is the difference between my successfully designing and building a couch by reading a book versus being able to only vegetate on one, staring into space.
That was a very silly simile, but it is absolutely accurate.
For me, the difference between 200 mg/day and 300 mg/day of lamotrigine is the difference between agony and remission.
Mine is just one anecdote. It is impossible to know that it would also be crucial to an effective treatment for you. I found Zyprexa to have:
1. Anti-manic properties - including manic psychosis.
2. Antidepressant properties.
3. The ability to think more clearly.If there is any drug worse than Zyprexa (olanzapine) for producing weight gain, it would be clozapine (Clozaril), the original atypical antipsychotic. I think the two drugs are chemically related, but I'm not sure.
I'm curious where your decision-making process is headed.
As always, good luck. You are in my thoughts.
- Scott
Posted by undopaminergic on September 25, 2021, at 0:44:15
In reply to Re: Why do meds constantly stop working for me? » undopaminergic, posted by SLS on September 24, 2021, at 14:39:31
> > >
> > > UD: I find that your thoughts contain what one might consider esoteric information from which you construct creative and plausible arguments and explanations.
> > >
> >
> > Interesting observation. Do you have examples?
>
>
> "esoteric" (Merriam-Webster): Requiring or exhibiting knowledge that is restricted to a small group."
>Yes, I know what it means.
> Examples? 99.9% of your posts. I'm joking, of course, but it's not far from the truth. :-)
>OK, but what (for example) is esoteric of what I post?
> > > Just don't turn around. You might see smoke.
>
> > Can you clarify that?
>
>
> It's an allusion to someone "blowing smoke up your *ss".Who would be doing the blowing?
-undopaminergic
Posted by undopaminergic on September 25, 2021, at 0:55:27
In reply to Re: Why do meds constantly stop working for me? » rose45, posted by SLS on September 24, 2021, at 15:11:14
>
> If there is any drug worse than Zyprexa (olanzapine) for producing weight gain, it would be clozapine (Clozaril), the original atypical antipsychotic.
>Olanzapine (Zyprexa) is a little worse according to what I've read, at least as far as diabetes risk is concerned.
> I think the two drugs are chemically related, but I'm not sure.
>They both have the three rings like TCAs, and one additional, piperazine, ring, making them tetracyclic.
-undopaminergic
Posted by SLS on September 25, 2021, at 6:22:26
In reply to Re: Why do meds constantly stop working for me?, posted by undopaminergic on September 25, 2021, at 0:44:15
Dear UD
I can see how someone could look upon the word "esoteric" and perceive a negative connotation. Most of the people who had posted on Psycho-Babble before Lou Pilder managed to disrupt the board possessed esoteric knowledge that I still judge to be absent in every clinician who treated me. That makes your knowledge and understanding esoteric. The audience that you direct your knowledge and understanding to is very small indeed - thus, "esoteric".
> > It's an allusion to someone "blowing smoke up your *ss".> Who would be doing the blowing?
Me, of course!
Sincerely,
Scott
* P.S. - That should be enough flattery for you to get by today. If not, you'll have to wait until tomorrow.<smile>
Posted by SLS on September 25, 2021, at 7:19:24
In reply to Re: Why do meds constantly stop working for me? » SLS, posted by undopaminergic on September 25, 2021, at 0:55:27
> >
> > If there is any drug worse than Zyprexa (olanzapine) for producing weight gain, it would be clozapine (Clozaril), the original atypical antipsychotic.
> >
>
> Olanzapine (Zyprexa) is a little worse according to what I've read, at least as far as diabetes risk is concerned.
I didn't know that, but I very much trust your esoteric knowledge. <wink> Thank you.
> > I think the two drugs are chemically related, but I'm not sure.
> >
>
> They both have the three rings like TCAs, and one additional, piperazine, ring, making them tetracyclic.
Remember, adding a single chlorine atom turns imipramine into clomipramine (Anafranil). Sometimes, a very small change in chemical structure can make a huge difference in pharmacodynamic and clinical activity. Tramadol (Ultram) is labelled an "opioid". However, it does other things pharmacologically. Tramadol is a derivative on venlafaxine (Effexor), yet possesses some, but insufficient, antidepressant activity to be given an indication by the FDA to treat MDD or BD.Tramadol is a only weak agonist at the opioid receptor compared to all other opioid analgesics. I didn't want to hit my mother's doctor with "esoteric" facts, but, like venlafaxine, tramadol is an SNRI if you discount its opioid receptor agonism. Of course, we can't, but it is conceivable to me that the inhibition of both the serotonin and norepinephrine transporters (reuptake inhibition) works synergistically with opioid agonism to produce a stronger analgesic. Duloxetine (Cymbalta), another SNRI, was touted as being particularly capable of reducing the sensation of pain (nociception) when it is used to treat depression. In fact, this property was the focus of mass-media advertisements by Johnson & Johnson.
The following is one of my many rants:
I have yet to hear of a single case of someone becoming physiologically dependent on tramadol. My guess is that if there are, they must be very few in number. I have not seen an avalanche of medical literature reporting such sequlae with tramadol. The point is that the clinicians who prescribe tramadol think of it as an addictive opioid to be avoided if possible. And then, they are very reluctant to prescribe it as a long-term treatment as an analgesic. Many people get significantly greater pain relief from tramadol than they get from ibuprofen or naproxen monotherapy. I'm thinking that the weak opioid activity of tramadol is amplified by the extant reuptake inhibition of norepinephrine and serotonin (SNRI), leaving tramadol much less liable to produce opioid dependence and an opioid discontinuation withdrawal syndrome.
Tramadol is not one of the "evil" opioids that are invaluable, but now avoided because members of the public at large use it recreationally. Excuse me. F*ck the law-breaking, hedononistic members of the public who abuse this drug illegally, and therefore make opioids out to be in alliance with the Devil. Meanwhile, people in severe, and often chronic intractable pain can't find a doctor who is willing to mitigate their suffering. You can't blame doctors, though. Some legally prescribed opioids are extremely problematic when it comes to physiological dependence and severe withdrawal symptoms. Not everyone experiences euphoria, gets "high", when taking an opioid. I don't have any statistics to produce, but my guess is that a sizeable percentage, likely the majority, do not receive a euphoric effect from Percocet. Those who do are screwed, though.
Fentanyl is often the only substance that has the ability to relieve cancer patients of the severe pain they experience. To my knowledge, Fentanyl is the most powerful opioid analgesic in the world. Now, everyone is screwed. Damned public.
By the way, there is a new product that combines ibuprofen with acetaminophen (in one pill). Of course, it is much cheaper to buy the two generic products separately. It works stunningly well for my mother, for whom tramadol isn't always sufficient.
- Scott
Posted by undopaminergic on September 25, 2021, at 10:50:19
In reply to Re: Why do meds constantly stop working for me? » undopaminergic, posted by SLS on September 25, 2021, at 7:19:24
> > >
> > > If there is any drug worse than Zyprexa (olanzapine) for producing weight gain, it would be clozapine (Clozaril), the original atypical antipsychotic.
> > >
> >
> > Olanzapine (Zyprexa) is a little worse according to what I've read, at least as far as diabetes risk is concerned.
>
>
> I didn't know that, but I very much trust your esoteric knowledge. <wink> Thank you.
>I'm exceptional enough to have lost weight on clozapine. That is quite esoteric knowledge.
> > > I think the two drugs are chemically related, but I'm not sure.
> > >
> >
> > They both have the three rings like TCAs, and one additional, piperazine, ring, making them tetracyclic.
>
>
> Remember, adding a single chlorine atom turns imipramine into clomipramine (Anafranil). Sometimes, a very small change in chemical structure can make a huge difference in pharmacodynamic and clinical activity.
>Of course.
> Tramadol (Ultram) is labelled an "opioid". However, it does other things pharmacologically. Tramadol is a derivative on venlafaxine (Effexor), yet possesses some, but insufficient, antidepressant activity to be given an indication by the FDA to treat MDD or BD.
>The opioid effect is also an antidepressant action, although perhaps only in the short term due to tolerance.
> Tramadol is a only weak agonist at the opioid receptor compared to all other opioid analgesics. I didn't want to hit my mother's doctor with "esoteric" facts, but, like venlafaxine, tramadol is an SNRI if you discount its opioid receptor agonism. Of course, we can't, but it is conceivable to me that the inhibition of both the serotonin and norepinephrine transporters (reuptake inhibition) works synergistically with opioid agonism to produce a stronger analgesic.
>Yes, or a stronger antidepressant effect.
> Duloxetine (Cymbalta), another SNRI, was touted as being particularly capable of reducing the sensation of pain (nociception) when it is used to treat depression. In fact, this property was the focus of mass-media advertisements by Johnson & Johnson.
>It seems that a number of drugs not traditionally regarded as analgesics can be useful in the treatment of pain, sometimes alone and sometimes in combination with some other class of drug.
> Many people get significantly greater pain relief from tramadol than they get from ibuprofen or naproxen monotherapy.
>And NSAIDs (such as ibuprofen) can produce gastrointestinal ulcers.
> Tramadol is not one of the "evil" opioids that are invaluable, but now avoided because members of the public at large use it recreationally. Excuse me. F*ck the law-breaking, hedononistic members of the public who abuse this drug illegally, and therefore make opioids out to be in alliance with the Devil. Meanwhile, people in severe, and often chronic intractable pain can't find a doctor who is willing to mitigate their suffering.
>Right. It's like with the MAOIs (ie. doctors are afraid to prescribe them).
> You can't blame doctors, though. Some legally prescribed opioids are extremely problematic when it comes to physiological dependence and severe withdrawal symptoms. Not everyone experiences euphoria, gets "high", when taking an opioid. I don't have any statistics to produce, but my guess is that a sizeable percentage, likely the majority, do not receive a euphoric effect from Percocet. Those who do are screwed, though.
>Euphoria, or more specifically a powerful rush, is more likely with intravenous use, and also depends on dose. And at first there are side effects like nausea and sleepiness that may outweigh any pleasant effects.
> Fentanyl is often the only substance that has the ability to relieve cancer patients of the severe pain they experience. To my knowledge, Fentanyl is the most powerful opioid analgesic in the world. Now, everyone is screwed. Damned public.
>If you mean potency per unit of weight, I think etorphine is the most powerful.
-undopaminergic
Posted by undopaminergic on September 25, 2021, at 11:50:50
In reply to Re: Why do meds constantly stop working for me? » undopaminergic, posted by SLS on September 25, 2021, at 6:22:26
> Dear UD
Dear SLS
> I can see how someone could look upon the word "esoteric" and perceive a negative connotation.
>I'd say I have mixed feelings about it. It is an honour to be in the know about things few know anything about. On the other hand, if you mean the knowledge is of interest (or use) only to a few, it could be regarded as negative.
> Most of the people who had posted on Psycho-Babble before Lou Pilder managed to disrupt the board possessed esoteric knowledge that I still judge to be absent in every clinician who treated me. That makes your knowledge and understanding esoteric. The audience that you direct your knowledge and understanding to is very small indeed - thus, "esoteric".
>What clinicians today, more than ever, lack is first-hand experience with the drugs and treatments they prescribe. First hand knowledge is indeed esoteric.
> Sincerely,
> ScottYours truly,
Undopaminergic
Posted by SLS on September 25, 2021, at 13:49:15
In reply to Re: Why do meds constantly stop working for me? » SLS, posted by undopaminergic on September 25, 2021, at 10:50:19
> > Fentanyl is often the only substance that has the ability to relieve cancer patients of the severe pain they experience. To my knowledge, Fentanyl is the most powerful opioid analgesic in the world. Now, everyone is screwed. Damned public.
> If you mean potency per unit of weight, I think etorphine is the most powerful.
I had never heard of it, but you are right. In the US, etorphine is listed as a Schedule I drug. Fentanyl is listed as a Schedule II drug. So I guess it would be hard to have a doctor prescribe etorphine. Can cancer pain be treated with a Schedule I drug? I know cocaine can be used for topical ophthalmic indications, but it is only Schedule II.
- Scott
Posted by undopaminergic on September 25, 2021, at 14:51:26
In reply to Re: Why do meds constantly stop working for me? » undopaminergic, posted by SLS on September 25, 2021, at 13:49:15
> > > Fentanyl is often the only substance that has the ability to relieve cancer patients of the severe pain they experience. To my knowledge, Fentanyl is the most powerful opioid analgesic in the world. Now, everyone is screwed. Damned public.
>
> > If you mean potency per unit of weight, I think etorphine is the most powerful.
>
> I had never heard of it, but you are right. In the US, etorphine is listed as a Schedule I drug. Fentanyl is listed as a Schedule II drug. So I guess it would be hard to have a doctor prescribe etorphine. Can cancer pain be treated with a Schedule I drug? I know cocaine can be used for topical ophthalmic indications, but it is only Schedule II.
>It is mainly used as a tranquiliser for large animals, such as elephants.
-undopaminergic
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