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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Francesco on September 5, 2003, at 16:14:07
I red a lot of posts about it and many users seemed enthusiastic. I discovered with some surprise that I have SAM-E at home (the name is SAMYR 400)'cause a doctor prescribed it to me to help me to recover from Paxil withdrawal (I recovered but my starting point was too bad to know if sam-e is a good antidepressant ...)
Tomorrow I'll start but I have two doubts:
A lot of people talk about a 200mg dosage but in the box there is written 2/3 capsules per day, which it means 800-1200 mg per day. Why ? In the box there is written also that it's better to start with injections and then take pills (?!). I can remember that even my doctor suggested injections. Which is the reason ? (I have both, the pills and the injections). Sorry for my awful english. I'm currently on 20mg of Prozac and I'm really really apathetic and slow. I have to something, can't wait anymore.
Posted by DSCH on September 6, 2003, at 16:36:53
In reply to two questions about SAM-E, posted by Francesco on September 5, 2003, at 16:14:07
I would be careful, Francesco... if you are not an under-methylated person SAMe might have bad side effects or you just might blow cash for pills that do nothing. Remember Prozac takes its time both coming and going, unlike Paxil (hence withdrawl is more severe with Paxil).
Posted by Francesco on September 6, 2003, at 18:22:41
In reply to Re: two questions about SAM-E » Francesco , posted by DSCH on September 6, 2003, at 16:36:53
Hi DSCH, nice to see you again : )
I'm not sure if I understood what you said.
Ok, I didn't : )
What side-effects of SAM-E you're talking about ?
Do you think I'll have problems quitting Prozac 20mg after only ten days ?This is my first day without it and I had no problem ... of course I feel a lot better ... I know I didn't give it a decent trial but I felt autistic while on it ... blurred speeching, my parents were aliens, terrified by the perspective of talking to someone because I knew I had nothing to say ... today I'm not *happy* but a couple of times I smiled ... and that's what I expected ... normal emotions, while before everything was millions miles away from me ... I know I'm still under the Prozac but skipping one dose has helped somewhat ... and tomorrow I'll go out and see some friends which was absolutely out of question until yesterday ... oh, will I become a testimonial for Breggin and fellows ? ;-)
I would like not to take this stuff anymore. ADHD is far from better (I can enjoy life sometimes at least ! ... I can have sex ! I can taste food !).
Did your experiments with supplements had complete success ? What I'm trying to say is ... the effect you had on stims were comparable with the effect you're having now ?
I've read a very kind post of yours in which you suggested to try everything else before trying stims. But I think that before or after in my life I'll have to try them to see what happens. In many articles I've read they're considered first line treatment in ADHD ... I know about tolerance and dependance and so on ... but reading the posts this doesn't seem to happens *always*. So they're worth of a trial in my opinion ... I went paranoid and didn't sleep for 11 days after one of my cold turkey Anafranil withdrawal ... I think nothing can be worse : )
Moreover it seems to me that every non-stim med that could be useful for ADHD can lead to sexual disfunctions (with the exception of Wellbutrin that didn't work)... I don't think that the problem is limited in non experiencing a pleasure you experienced before ... I think it affects your *whole life*, the way you look at things, your being 'sexy' and chatty and interested in things ...
Ok, I've talked too much and maybe I got a bit hypo ;-) I'm very interested in your -suplements experience-. Amen suggests a lot of things but my problems about this issue are:
1) are they very very expensive ? I mean ... how much do you spend every month for them ?
2) how can you know it's not placebo effect ? I mean, I know ADHD is supposed to be a neurogical disorder but once a month I *can* concentrate ... I'm afraid that If I'll take this stuff I could convince myself that they are working even if they are doing anything
3) how long did you have to wait for considerable effects ?sorry for all these questions ... do I bore you too much if I'm asking you one more thing ? : )
Let's say my problem is bipolar II and not ADHD.
How can I know it for sure ? I've read both the profiles but ADHD seems to fit me more ... but is there some clear discriminating criterion ? Ok, I had some *hypomaniac* period but what does it mean ? I had a wonderful relationship and I had stopped my med for the first time after a long period ... so maybe I was just happy : /Thanks and best wishes. (OH ! I wrote a poem !)
Posted by DSCH on September 6, 2003, at 19:22:48
In reply to Re: two questions about SAM-E » DSCH, posted by Francesco on September 6, 2003, at 18:22:41
Just from reading your posts I get the impression you are somewhat bipolar. Of course you have been on and off medication quite a bit. If this is indeed the case though stims would likely send you into strong hypomania. SAMe could do this too. Overall, your being extroverted/ADHD/bipolar(?) off meds makes me think you are not under-methylated and thus not the best candidate for a good response to SAMe.
If you are indeed bipolar and try lithium but find it dampens your mental functioning too much, your best bet after that would be a anticonvulsant.
As far as supplements go you should be able to find grape seed extract OPCs from France that are not too expensive. The Pycnogenol (martime pine bark extract) from France is a bit more pricey. Phenylalanine and tyrosine should be cheap.
Posted by francesco on September 6, 2003, at 20:01:21
In reply to Re: two questions about SAM-E » Francesco , posted by DSCH on September 6, 2003, at 19:22:48
About the Bipolar Issue. I've thought about it. But there are more things that doesn't convince me. First of all as you said I've been on and off meds. I got hypomaniac for the first time for a consistent period of time the last time I stopped Anafranil. But this could mean nothing I think, just a withdrawal reaction (no side effects anymore plus antidepressive effects still lasting). The second think is that even if I'm sometimes hypomaniac my cicles are very short ... I can go up and down many times in a day but it depends strongly on what happens to me. Anyway, I'll try to read more on the subject because it intrigues me very much. I must I have somewhere that Bipolar II get irritable while on Antidepressants. And that's what happens to me. So I have to continue searching and learning.
Do you think that lithium (or similar) could take care also of my attention-problems ? Is the treatment for Bipolar II similar to that of Bipolar I ? (lithium and so on ?)
Posted by DSCH on September 6, 2003, at 20:37:50
In reply to Re: two questions about SAM-E » DSCH, posted by francesco on September 6, 2003, at 20:01:21
Bipolarity swinging around quickly is called 'rapid cycling'. I'm not sure how reactive it can be or wether it usually is entirely independent of outer stimuli.
If all the neural activity of the alternating hypomania/depression is swamping your ability to concentrate rather than it being an inherent issue with your pre-frontal cortex than, yeah, lithium or an anticonvulsant could help you concentrate. (note the 'ifs' and 'coulds')
But, again, I am not a degreed medical or psych professional, get a professional opinion (or as far as you can get one in Italy). ;-) I'm also just sitting behind a computer thousands of miles away from you too. In fact, let me recommend that you put as much effort as you can into finding the best pdoc (or a psychologist with a neurological rather than a Freudian/Jungian/Adlerian bent).
If I ever come to Italy and you're doing OK would you be willing to show me around and help me avoid the tourist traps? :-) I'd like to see the country one day.
Posted by francesco on September 7, 2003, at 7:30:59
In reply to Re: two questions about SAM-E, posted by DSCH on September 6, 2003, at 20:37:50
I'll try to do the best I can to find a good p-doc even if I'm not sure how to do (I think trials and errors could be the only method !).
The last one I went to was very very famous, wrote a lot of articles and so on, but we talked only for twenty minutes (!) and he gave me Parmodanil. Maybe he suspected some psychotic features (remember the anti-psychotic add-on ?), maybe he just chose MAOIs because I wasn't satisfied with SSRIs and TCAs, and Parmodalin was the only available. Who knows ? I sometimes think to have some borderline-features, but some other times I think that all these criteria are too vague to say without doubt: yeah, I am that one !
(with the exception of ADHD ... I'm that one ;-)
I don't even know if bipolar II here is a possible diagnosis ...Anyway, thanks very much for the explainations and the support ... I needed it very very much !
And of course you'll be welcome in Italy : )
I hope not to be in the antisocial phase for that time ;-)
Posted by Francesco on September 7, 2003, at 8:53:37
In reply to Re: two questions about SAM-E » DSCH, posted by francesco on September 7, 2003, at 7:30:59
I've found an excellent post about ADHD/BP II differences (http://www.dr-bob.org/babble/20020103/msgs/89263.html). After reading it I have no more doubt that I have ADHD and not BP II. Oh ... why did I post this ? to keep you informed : )
Posted by DSCH on September 9, 2003, at 12:37:53
In reply to Re: two questions about SAM-E » DSCH, posted by francesco on September 7, 2003, at 7:30:59
> I'll try to do the best I can to find a good p-doc even if I'm not sure how to do (I think trials and errors could be the only method !).
>
> The last one I went to was very very famous, wrote a lot of articles and so on, but we talked only for twenty minutes (!) and he gave me Parmodanil. Maybe he suspected some psychotic features (remember the anti-psychotic add-on ?), maybe he just chose MAOIs because I wasn't satisfied with SSRIs and TCAs, and Parmodalin was the only available. Who knows ? I sometimes think to have some borderline-features, but some other times I think that all these criteria are too vague to say without doubt: yeah, I am that one !
> (with the exception of ADHD ... I'm that one ;-)
> I don't even know if bipolar II here is a possible diagnosis ...
>
> Anyway, thanks very much for the explainations and the support ... I needed it very very much !
> And of course you'll be welcome in Italy : )
> I hope not to be in the antisocial phase for that time ;-)Are you going to try out the Parmodanil? I need to look that one up. LOL
I won't be in world travel mode for quite a while yet. Hopefully you'll be going much better by that time. :-)
Posted by DSCH on September 9, 2003, at 12:47:31
In reply to Re: two questions about SAM-E » francesco, posted by Francesco on September 7, 2003, at 8:53:37
> I've found an excellent post about ADHD/BP II differences (http://www.dr-bob.org/babble/20020103/msgs/89263.html). After reading it I have no more doubt that I have ADHD and not BP II. Oh ... why did I post this ? to keep you informed : )
Thank you for bringing this to my attention, Francesco. "ADHD Shutdown" sounds suscpiciously like my most of my life from 1999 to 2003.
Posted by Francesco on September 9, 2003, at 14:31:32
In reply to BPII vs. ADHD/and both » Francesco , posted by DSCH on September 9, 2003, at 12:47:31
So, when you'll come to Italy I'll withdraw my eventual Anafranil ... I feel usually hypomaniac after withdrawal but it doesn't last long so I hope you will not stay too much ! ;-) (is this social babbling ? ;-)
Posted by DSCH on September 13, 2003, at 20:35:02
In reply to Re: BPII vs. ADHD/and both » DSCH, posted by Francesco on September 9, 2003, at 14:31:32
Francesco: you've been posting more on the helpful side than the soliciting side lately and your expressiveness in English has improved noticeably. What's been going on with you lately?
Posted by francesco on September 14, 2003, at 6:38:44
In reply to Update time :-) » Francesco , posted by DSCH on September 13, 2003, at 20:35:02
My last "trips": yesterday I started Anafranil again ... concentration and impulse-control improved without excessive sedation (much better than Prozac). Yesterday afternoon called me a pediatrist (!) to whom I had written an e-mail and he asked me if I wanted to be tested for adult ADHD ... He visited me this morning (sunday !) ... I don't know what he thinks about me but HE is very very AHDH (he takes Ritalin but I don't think it helps him) ... This guy imports Ritalin in Italy from Switzerland, he's a kind of pusher (I don't know how legally it is ... anyway he doesn't prescribe it ... he sends people to a psychiatrist for further consultation). He cures something like 170 children ... of course he has been attacked by media (here the Ritalin controversy is very harsh) and of course he told me about HIS story life for something like three hours. Anyway I'll have to wait some week to talk with Prof. Tondo, a famous psychiatrist who has studied at Harvard and so on (translation: who I will give to a bunch of money). Anafranil is helping somehow therefore it won't be terrible to wait ... Yeah, my English improved and my Italian too ... now I can think before speaking and this helps a lot ... Incidentally, yesterday I red some post about Ritalin that described some effects similar to my Anafranil-induced social phobia ... "The only problem is Ritalin makes me act kind of weird- shy, introverted, & too conscious of people looking at me" and so on.
For what I've read the only stim that shouldn't have this effect for sure is Dextro-something but my pediatrist-pusher manages to get only Ritalin.
These are my news : ) How are you ?
Posted by DSCH on September 14, 2003, at 9:21:10
In reply to Re: Update time :-) » DSCH, posted by francesco on September 14, 2003, at 6:38:44
I would be somewhat wary of this pediatric psychiatrist fellow.
That's interesting that there is this parallel between your experience with Anafranil and other people's experiences with Ritalin re: improved focus but at the cost of introversion/mild social phobia. One of the ADHDers (Ame Sans Vie? 3 Beer Effect?) prefers Adderall or Dexedrine to Ritalin because the various amphetamine salts improved focus without the "enforced" introversion of Ritalin. Of course there are others who prefer Ritalin.
I'm doing pretty good. I felt some loss of focus coming back a few days ago, but I think that was because I had stopped drinking protein powder mixed with water. I started taking DLPA capsules again and I "came back". :-)
Re: Ritalin controversy. There is controversy in America about this as well. I wrote this post not long back in response to a forum "dust up" over a mothers' concerns regarding Concerta (OROS extended-release methylphenidate)...
http://www.dr-bob.org/babble/20030812/msgs/251620.html
Posted by francesco on September 14, 2003, at 17:23:38
In reply to Re: Update time :-) (Redirect Dr. Bob? Meds!), posted by DSCH on September 14, 2003, at 9:21:10
HI DSCH, nice to hear you again ... yes, the parallel is interesting ... some of the posters wrote something that sounded like: "When I was ADHD I was used to said the first thing that came into mind and people laughed ... Now I think before speaking and people don't laugh anymore" ... I really sympatize with this ... One of the problem of ADHD is in my opinion that you don't aware of what you're doing or thinking ... When I'm on Anafranil I'm TOO aware ... that's great if have to study for ex. because I can notice that I'm beginning daydreaming and I can go back and concentrate ... but it's not great if you have to talk to people because "I can hear myself saying what I'm saying" ... Maybe when you have more self-control you are less spontaneuos and viceversa ... Anyway I hope Ritalin will work for me (if the psychiatrist will allow me to take it) and however after I re-started taking Anafranil the worst has passed ... Now I know how to spend my time (reading and studying and so on) and so I won't care if for the next month or so, waiting for the appointment, I'll be a little bit social phobic (hope I won't care). After all these trials I can say that I'm one of those persons who do better on TCAs than SSRIs (I have some feelings dumbness on TCAs but it's nothing compared to SSRI's one).
I'm glad you're doing fine. Did you have problems with stims ? I know supplements are working for you but what's was your experience with stimulants ? (Ok, we'll see each other in the other babble, we're going to be redirected ...)
Ehm ... What about St. John's Wort and SAM-E ? ;-)
Posted by DSCH on September 14, 2003, at 19:12:49
In reply to Re: Update time :-) (Redirect Dr. Bob? Meds!) » DSCH, posted by francesco on September 14, 2003, at 17:23:38
Sounds like the anafranil is doing its thing again for you. Congratulations, you have your pre-frontal cortex back online and can actually exert some centralized control over your thinking process! If I were you, I would consider staying on anafranil for the time being, unless you find a compelling argument for a new medication trial. You appear to be tolerating anafranil well and you're just missing your extravert, life-of-the-party spontaneity. And anafranil doesn't take you in the legal red tape areas that the stimulants do.
This gets into the tricky territory of the "true" nature of your personality. I know this, as I have felt how "blocks" of my personality have shifted relative to each other.
I do not discount the notion of will and neuroplasticity being able to change things. Having your pfc back is priceless, as it is here that many things that we associate the concept of "will" get done. With that will you can start to excercise what you consider to be your weaker functions so that they gradually get stronger. I think it might be possible for you to become more comfortable in social settings through practice. Many successful social people I am sure are just as aware of their mental process working during conversation as you are now, they are just comfortable with it. :-)
Just to clarify, is it really 'social phobia' or are you just uncomfortable with social situations now that you have focus rather than the 'party-time' free association loose tongue thing going on? ;-)
Posted by francesco on September 15, 2003, at 2:49:59
In reply to Re: Update time :-) (Redirect Dr. Bob? Meds!) » francesco, posted by DSCH on September 14, 2003, at 19:12:49
I'll try to explain the "Social Phobia" thing the best I can. Anafranil makes me too assertive and oppositive ... I tend to disagree with people whatever they say and to defend my positions in a very rude manner ... I tend to adfirm rather than asking ... I tend to be sarchastic and offensive ... Yesterday afternoon for example I played a very bad joke about the death of a granmother's friend ... I found it funny but nobody had the same 'experience' ... That's the reason why I tend to develop SP syntoms and to alleviate them using alcohol and benzos ... When I'm on Anafranil I sometimes speak like a cocain abuser ... For ex. some month ago I went to Parma to talk to my tutor (PHD). He's a very rude person and I'm usally 'afraid' of him ... But I had taken some Anafranil the days before ... I shouted to him than I was not going to go to Parma anymore and I talked for something like 20 minutes without caring for any feedback ... I didn't say anything I didn't think and he problably deserved it but ... you know ... it's not the kind of things that people like in a person (me included) ... the same happened with my ex-girfriend some time ago ... I said very very unpleasant things to her after an Anafranil trial without allowing her to talk or being able to stop myself even if I was clearly exaggerating ... if I quit the med for some days I can see what has happened but during the time I'm on it I feel I'M RIGHT. I don't know if my reaction to this med can mean that I'm bi-polar or if it's dued to an excess of serotonin (!) ... but I know for sure I can't take Anafranil for long periods of time and caring for people at the same time ... I don't know if the psychiatrist will understand this point or if something like stimulants can help better ... But I feel like I have the duty to try ... Yesterday, incidentally I was very rude (via mail) with the psychiatrist too ! (it's lithium time ;-)
Stay well and let me know what you think about it : )
Posted by DSCH on September 15, 2003, at 8:23:56
In reply to Re: Update time :-) (Redirect Dr. Bob? Meds!) » DSCH, posted by francesco on September 15, 2003, at 2:49:59
OK, that sounds more serious than was my original impression. Sounds like a focused form of impulsiveness to me (somewhat paradoxical), and increased agression, lowered empathy. Not really OCD or SP or BP. More like one of the personality/mood disorders... like oppositional/defiant (ODD)? (Euro description: http://www.mentalhealth.com/icd/p22-ch05.html )
The thing that strikes me about clomipramine (Anafranil) is its strong serotonin reuptake inhibition and its antagonism for NE-alpha receptors. To me, having NE reuptake inhibition and then antagonizing some of the NE receptors sounds like "one step forward, one step back" but I am not familar with the actions of each NE receptor type (some could be down-regulators).
I would think that of the other "+++ meds" for ADHD from the Italian viewpoint, the TCs imipramine and nortriptyline would do for you much as clomipramine, a TC itself, has done. Guanfacine I don't know anything about. Clonidine, which SLS lists as a NE-alpha2 agonist sounds like it might be helpful in your case.
Posted by DSCH on September 15, 2003, at 8:34:27
In reply to Re: Update time :-) (Redirect Dr. Bob? Meds!) » DSCH, posted by francesco on September 15, 2003, at 2:49:59
What is the longest stretch of time you have used Anafranil, Francesco? Did this ODD thing give signs of tapering off? Keep in mind that side effects can fade with time.
Posted by Francesco on September 15, 2003, at 9:10:05
In reply to Non-stimulant, Non-tricyclic for ADHD? » francesco, posted by DSCH on September 15, 2003, at 8:23:56
Thank you for your kind reply. Yeah, it seems something like ODD.
"having NE reuptake inhibition and then antagonizing some of the NE receptors" ... Why does Anafranil has both properties ?
Could you explain to me what is the half-life of the meds ? For ex. Imipramine 19 hrs, (8-20 hrs).
Why three numbers ?
Does it mean that if I take Imipramine after 20 hours there won't be any trace of the med in my body ? (Clomipramine 19-37 hrs)
mumble mumble ... does it mean that I could take Imipramine only when I need it for daily use ? Interesting issue ... since here Tofranil is considered the best TCA for ADHD ... It's less serotoniergic and more NEergic ... seems interesting : ) (I'll ask about Clonidine ... I think Guanfacine is a med of the same class)P.S. I red before posting your new post ... I usually stayed on it for ten-eleven months then stop it on summer than re-take it. And I did this for 5-6 years. Maybe some anxiety can taper off in the long term but the social avoidance usually lasts ... Besides the "ODD problem" I don't enjoy very much staying with people when I'm on it ... I easily get bored and want to go back home and reading my books ... Furthermore and unluckly sexual disinterest and weight gain doesn't taper off : ) (I know, it would be the same for Tofranil : /)
Posted by Dr. Bob on September 15, 2003, at 20:14:57
In reply to Re: Non-stimulant, Non-tricyclic for ADHD? » DSCH, posted by Francesco on September 15, 2003, at 9:10:05
> Thank you for your kind reply. Yeah, it seems something like ODD.
> "having NE reuptake inhibition and then antagonizing some of the NE receptors" ... Why does Anafranil has both properties ?
> Could you explain to me what is the half-life of the meds ? For ex. Imipramine 19 hrs, (8-20 hrs).
> Why three numbers ?Yes, I guess I should redirect this to Psycho-Babble, since it's no longer about an alternative treatment. Here's a link:
http://www.dr-bob.org/babble/20030912/msgs/260422.html
Thanks,
Bob
Posted by Wolf Dreamer on September 30, 2003, at 15:30:43
In reply to two questions about SAM-E, posted by Francesco on September 5, 2003, at 16:14:07
I didn't bother reading all the messages, I just wanted to say that I used Sam-e for more than 7 weeks and it did nothing for me. Various women in my family claims it helped them though. So maybe its just a chick thing. Anyone who used it should post their gender, and we can see if, like flakseed oil, women are able to process it into something useful while men can not.
This is the end of the thread.
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