![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 96 to 120 of 434. Go back in thread:
Posted by Elizabeth on July 26, 2001, at 22:36:23
In reply to Re: Nardil vs. Parnate, posted by lawrence s. on July 24, 2001, at 1:29:58
> Parnate seemed better geared for deppresion. Also seemed to react to amines much more than Nardil. Hope this helps.
That's true: Parnate potentiates vasoconstricting biogenic amines more than Nardil does at equivalent doses.
-e
Posted by Elizabeth on July 26, 2001, at 22:59:22
In reply to Re: Handholding Shelli » shelliR, posted by Lorraine on July 26, 2001, at 18:45:59
> (Lord, can you see where I am in this depression? Slipping down--I become all soppy even though the sentiment is true. I tear up with gratitude--which I guess is one of the good things--that I can still feel "touched".)
I think that, relatively speaking, that's a good sign. To me it indicates a reactive mood, and the possibility that you have the potential to be cheered up temporarily.
Interesting about panic and hypothyroidism. All my TSH tests have been pretty normal, and T3/4 augmentation is something I've never tried.
> Well, I know what you mean about "finally"--it's like waiting for the other shoe to drop, isn't it and for me at least was such a physical feeling-a prenumbra?
Buprenorphine seems to make my periods irregular. I've been wondering about the mechanism there.
> The feeling of being "high" is very unsettling to me as well. You've been on this med long enough that you would think that side effect would have evaporated if that's what its intent was. That's unfortunate.
You know, any effective antidepressant has the potential to trigger mania. When I started taking buprenorphine, it seemed to cause activation, psychomotor agitation, etc., rather than the calming effect that opioids seem to have on a lot of people.
> The lack of a scientific basis makes me uneasy too.
We work with the information we have, and count on the research folks to accumulate more information. I don't think that we should feel we have to wait for more research to be done before we can be comfortable treating mood & anxiety disorders.
> Though my hunch is that nobody really knows what they are doing with these meds--it's all trial and error with a bit of hunch thrown into it. (elizabeth would disagree I think.)
Only partially. I think that lately, research has focussed mainly on biology, and the empirical-descriptive school of thought has become passe'. This is unfortunate in a way, because despite technological and scientific advances, psychiatrists still mainly have to go on the clinical presentation.
> Yeah, but, don't you think that first you manage the depression, then you worry about simplifying?
I agree here.
> That's unfortunate that you can't take this pill when you are on an MAO.
It must be one of the -triptans (e.g., Imitrex).
> An there is no substitute?
No, the triptans are all serotonin agonists.
> Well, we decided to go with parnate. My guy is an odd duck--he bases everything pretty much on your QEEG. So when I say, Nardil is associated with weight gain and sexual dysfunction, he says "I've never had anyone with your QEEG gain weight or have sexual dsyfunction on Nardil".
That is so wacky! There's a doctor here who's known for similar approaches (using EEGs and functional imaging to treat depression, mania, fibromyalgia, CFS, etc., and believing that these conditions are very often caused by seizure disorders). Some people seem to respect him quite a bit, while others think he's loopy. I'm not sure what to think (although I have met him and he does seem like a bit of a flake).
> The problem is I only half (or less than half) believe in his methodology--so I believe the weight gain has to do with histamine receptors and so forth.
It's not clear how Nardil would affect that. I think it could be related to serotonin and happens at the level of the hypothalamus. The effects of Nardil on insulin sensitivity probably play a role.
> Anyway, I'm officially off selegiline and start a very low dose (5mg) of Parnate in 3 days--which I know is a short wash-out period, but he bases these things of my QEEG (and, of course, I'll be very careful to look for problems).
Ask the pharmacist if it's okay to cut Parnate pills in half.
> I think that I remember reading that Tegretal has a very high rate of success with depressed people who have temporal lobe epilepsy. Another option, anyway.
Consider Trileptal (oxcarbazepine), Tegretol's newer, gentler cousin.
> I went to my first DMDA meeting on Tuesday. I went with Neal, another psychobabbler who happens to live in Los Angeles. It was helpful to me to see how others cope. I may go back. I'm still thinking it through.
That's great to hear. I hope you can continue going; support groups can be of help in a number of ways.
-elizabeth
Posted by Cindylou on July 27, 2001, at 7:14:06
In reply to Re: Handholding Shelli » shelliR, posted by Lorraine on July 26, 2001, at 18:45:59
Hi,
I don't mean to sidetrack this thread, but was wondering what a DMDA meeting was -- I've been looking for a depression support group -- Sorry for my ignorance! But appreciate your reply,
-cindy
> I went to my first DMDA meeting on Tuesday. I went with Neal, another psychobabbler who happens to live in Los Angeles. It was helpful to me to see how others cope. I may go back. I'm still thinking it through.
>
> All my best to you Shelli. You are a jewel, truly.
> >
> > Shelli
Posted by shelliR on July 27, 2001, at 9:07:19
In reply to Re: Handholding Shelli - DMDA?, posted by Cindylou on July 27, 2001, at 7:14:06
> Hi,
> I don't mean to sidetrack this thread, but was wondering what a DMDA meeting was -- I've been looking for a depression support group -- Sorry for my ignorance! But appreciate your reply,
> -cindy
>
>
> > I went to my first DMDA meeting on Tuesday. I went with Neal, another psychobabbler who happens to live in Los Angeles. It was helpful to me to see how others cope. I may go back. I'm still thinking it through.
> >
> > All my best to you Shelli. You are a jewel, truly.
> > >
> > > ShelliHi Cindylou. Sorry, these messages tend to get all mixed up because older messages are quoted in them. Anyway, it is Lorraine that went to a DMDA meeting, but somehow my signoff got in there, and it appears that I'm telling myself I am a jewel! I think that Lorraine did talk about this on the social babble board; you might try seeing if you can find it there, or posting to her over there about it (non-med issue!). Shelli
Posted by Lorraine on July 27, 2001, at 10:02:38
In reply to Re: Nardil vs. Parnate » lawrence s., posted by Elizabeth on July 26, 2001, at 22:36:23
> > Parnate seemed better geared for deppresion. Also seemed to react to amines much more than Nardil. Hope this helps.
>
> That's true: Parnate potentiates vasoconstricting biogenic amines more than Nardil does at equivalent doses.elizabeth--what does that mean "vasoconsticting"--constriction of the veins--but what is the importance of this or the importance of reacting to "amines". Does this just mean that it is more difficult to guage individual reaction because the method of action is less clear?
>
> -e
Posted by Lorraine on July 27, 2001, at 10:09:38
In reply to Re: Handholding Shelli - DMDA?, posted by Cindylou on July 27, 2001, at 7:14:06
> > >I don't mean to sidetrack this thread, but was wondering what a DMDA meeting was -- I've been looking for a depression support group -- Sorry for my ignorance! But appreciate your reply,
> -cindycindy: DMDA stands for Depression and Manic Depression support group. There is a whole thread on this over at psychobabble social. I did a lot of research on all the different groups available so you might want to check it out. Me and Phil each are checking out a group this week and reporting back on our findings.
>
Posted by Lorraine on July 27, 2001, at 10:36:23
In reply to Re: hand holding » Lorraine, posted by Elizabeth on July 26, 2001, at 22:34:55
Hooray! You're back. Welcome.
> > >You know, a lot of brash insensitive intern types--which at teaching hospitals sometimes you get.
>
> > > They're like that because they don't have the self-confidence to just chill.It's the same with lawyers, actually. The "chill" part takes a long time to achieve for many.
> > > Anyway, the effect you described sounds like the way people sometimes describe ketamine anaesthesia, which was why I asked.
I'm wondering if ketamine also makes you vaguely paranoid? Because even though I don't doubt the reality, I had a very heightened sense of fear. I remember coming out of wisdom teeth surgery and believing that I was in a mental ward or prison of some sort and had to act a certain way to get released--the anesthesia's effect I'm sure.
> > > Not feeling like it's okay to trust your own perceptions is one of the many negative consequences of being mentally ill, I think.Well, now, that's an interesting way of looking at it. I didn't at the time think I was mentally ill (this was maybe 20 years before I was diagnosed). I knew that I had more than my fair share of "past" issues to resolve in talk therapy as a result of family dynamics that "discounted" pain and moved on.
> > > I wouldn't allow it to happen. I'd make him get out the PDR and look at the recommended dosing schedule; if necessary, I'd find a standard, reputable textbook and read the passage about the distribution and clinical duration of action of diazepam.Now you've motivated me to buy the PDR. I do find myself educating him from time to time. But, I find I do this with all doctors (and architects and landscapers and consultants generally). It doesn't bother me much because I am willing to look things up myself and am grateful when someone like you steer me in the right direction. It bothers me greatly though when I see someone who just blindly accepts their doctors word as gospel.
> > > That sounds like what happened when I tried taking Cylert with Nardil: the psychiatrist at the medical centre at my school insisted that my compulsive scratching and skin-picking was due to "anxiety;" when I spoke to my own doctor, he said that was a common side effect of stimulants, especially in overdose (MAOIs can be expected to potentiate psychomotor stimulants).
Course, it gets a bit humorous when you add a drug and a side effect occurs and their response is that it's not a side effect, but something else larger and unrelated--"anxiety" in your case. You have to chuckle sometimes when the obvious is dismissed for something less likely. This has to be a "frame of reference" issue--ie that's not what I expected, therefore it is not.
> > > I would expect benzodiazepines or perhaps Neurontin to be helpful for this sort of anxiety.Well, I'm not happy with the concept of benzos as a long term solution to what appears to be an on-going problem. But, I may not get to "choose". I did try the Valium and found it increased my depression and, at the dose I was on (1-2mg) did not completely wipe out the panic. Increasing the dose, increased the depression. My pdoc prescribed Ativan for me to try next. But I will start on the Parnate with just the Neurontin and see how it goes.
> > >I mentioned that I experienced something similar upon discontinuing Parnate; the Klonopin came in very handy.
Yeah, sounds like "rebound" anxiety? I did decide that I need a benzo in my emergency kit generally. So finding one that I am comfortable with is important.
> > >Benzodiazepines seem to make the most sense, though. MAOIs could be helpful also (thinking back, again, to my Parnate withdrawal experience).Your Parnate withdrawal makes me a bit hopeful.
> > > 300 mg is the target dose, and I'm already there. Because of some weird reactions I've had in the past (intolerance of low doses of other TCAs, several episodes of the "serotonin syndrome" with very little cause (e.g., during Effexor monotherapy)), I had blood drawn for a serum level test today.Sounds like you need to be very careful. Your theraputic dose range is quite narrow?
> > > What type of a washout period would you expect me to have going from selegiline to Parnate? Can it be done in less than a week if you monitor your blood pressure?
I'm lucky. It's 3 days.
Welcome home. Hope the desipramine holds.
Lorraine
Posted by Lorraine on July 27, 2001, at 11:19:35
In reply to Re: Handholding » Lorraine, posted by Elizabeth on July 26, 2001, at 22:59:22
[re: can still be touched]
> I think that, relatively speaking, that's a good sign. To me it indicates a reactive mood, and the possibility that you have the potential to be cheered up temporarily.And so I was last night by my wonderful husband. Stahl talks about the "end-stage" of depressive illness as one where the lows are so low but the ability to "feel" generally has been severely blunted. That scared the putty out of me. At least now I can see the rose, smell it and delight in it.
> > > Interesting about panic and hypothyroidism. All my TSH tests have been pretty normal, and T3/4 augmentation is something I've never tried.It might be worth a try. Also, the notion of "estrogen dominance" causing panic symptoms is interesting. Apparently, estrogen dominance is not just a problem associated with menopause, but can be a woman's normal state throughout her lifetime. Another avenue to explore.
> > > Buprenorphine seems to make my periods irregular. I've been wondering about the mechanism there.
Isn't that odd? When I had endometriosis and would have great pain on starting my period, I was given a drug that is now sold over the counter (maybe it's advil?). Anyway, the trick was to catch the very wisp of the beginning of my period and take the pill at that time. If I was successful, then my period would start and I would not be in pain. But if I missed the very very beginning, what happened was my period would be delayed. I explained this to my doctor, who dismissed it out of hand. Point is there was something operating there that might be similar to your situation.
> > > You know, any effective antidepressant has the potential to trigger mania. When I started taking buprenorphine, it seemed to cause activation, psychomotor agitation, etc., rather than the calming effect that opioids seem to have on a lot of people.
Really? I have adverse reactions to drugs at times, like getting wired from decongestants. But is agitation and activation considered mania? I once (for a couple of days in the weeks just before the last stock market crash), had incredibly racing thoughts, could hardly contain my excitement and so forth, but was still able to sleep. From my reading of the DSM categories, that would not qualify as mania--although I was euphoric and felt a bit invincible.
> > > We work with the information we have, and count on the research folks to accumulate more information. I don't think that we should feel we have to wait for more research to be done before we can be comfortable treating mood & anxiety disorders.Absolutely. We just need to recognize the limitations. Sort of like when I read a fairly compelling article on Darwinism and viral evolution which proposed that many of our chronic illness may ultimately be linked to viral conditions where the viruses have adapted so that they are much more difficult to detect. They started with the ulcer situation--where they first said diet and environment were the underlying causes and ultimately determined that it was a bacteria that was responsible for the condition--and moved on to heart disease, diabetes, depression and OCD. All speculative at this point, but it does sort of blow the lid off of current thinking. And I wouldn't be surprised... But does that change how we need to approach treating these conditions now? Probably not. (except maybe Amantadine should be tried as a low odds possibility).
> > > Only partially. I think that lately, research has focussed mainly on biology, and the empirical-descriptive school of thought has become passe'. This is unfortunate in a way, because despite technological and scientific advances, psychiatrists still mainly have to go on the clinical presentation.
The problem is that we have an entire conceptual framework that is premised on presentation rather than on physiology. I think the old system just has to be gutted. I think it gets in the way of determining what works and doesn't work because we test drugs on "depressed" people. Well, if the category "depressed" is not meaningful--that is if in fact very different physiological processes are occurring in different people with depression--then we are barking up the wrong tree. It may be that the med that is tested as effective in reducing symptoms by 50% in 51% of the subjects is actually 85% effective in 90% of the subjects with a specified physiology and that is the direction we need to be heading in in terms of research. So to the extent that the old paradigm henders rather than helps progress, it should be rethought and possibly abandoned. That doctors have been taught an incorrect frame of reference just makes the process of transition that much harder. It's like a legacy computer system at an old corporation--much easier to throw the whole thing out than to try to change it bit by bit.
> > > Well, we decided to go with parnate. My guy is an odd duck--he bases everything pretty much on your QEEG. So when I say, Nardil is associated with weight gain and sexual dysfunction, he says "I've never had anyone with your QEEG gain weight or have sexual dsyfunction on Nardil".
> > >That is so wacky!Yeah, I agree it sounds wacky. If I really believed that there was another paradigm that offered a better result I would be concerned. But as it stands now, I don't think that the treatment I am receiving suffers. I am after all progressing on to MAOs just when you would think that I would. And, he would be quick to point out, that at least his approach is rooted in physiology--there is some measure of physical activity that is used to determine treatment. Just so you know he's not completely out there--what he does is run a QEEG and then perform a covariance analysis of your data against a data base of 8000 other people in terms of what meds were effective for them. He then prescribes based on that. His believes that my QEEG indicates that a combination of stimulants (he includes MAOs here) and anticonvulsants should work.
> > >There's a doctor here who's known for similar approaches (using EEGs and functional imaging to treat depression, mania, fibromyalgia, CFS, etc., and believing that these conditions are very often caused by seizure disorders). Some people seem to respect him quite a bit, while others think he's loopy. I'm not sure what to think (although I have met him and he does seem like a bit of a flake).
It's really too early in any of these approaches to determine whether they will ultimately prove to be worthwhile.
> > > It's not clear how Nardil would affect that. I think it could be related to serotonin and happens at the level of the hypothalamus. The effects of Nardil on insulin sensitivity probably play a role.
Complicated stuff. But if it is "insulin sensitivity" or "insensitivity?", then low carb should help.
> > > Ask the pharmacist if it's okay to cut Parnate pills in half.Very good question. I will do that.
> > > I think that I remember reading that Tegretal has a very high rate of success with depressed people who have temporal lobe epilepsy. Another option, anyway.
>
> Consider Trileptal (oxcarbazepine), Tegretol's newer, gentler cousin.Thanx again. Good suggestion.
> > > That's great to hear. I hope you can continue going; support groups can be of help in a number of ways.
Actually, I think it was your suggestion that I look into DMDA. I think it may be useful as well.
Lorraine
Posted by Cindylou on July 27, 2001, at 13:02:11
In reply to Re: Handholding Shelli - DMDA? » Cindylou, posted by Lorraine on July 27, 2001, at 10:09:38
Thank you so much for your help!
>
> > > >I don't mean to sidetrack this thread, but was wondering what a DMDA meeting was -- I've been looking for a depression support group -- Sorry for my ignorance! But appreciate your reply,
> > -cindy
>
> cindy: DMDA stands for Depression and Manic Depression support group. There is a whole thread on this over at psychobabble social. I did a lot of research on all the different groups available so you might want to check it out. Me and Phil each are checking out a group this week and reporting back on our findings.
> >
Posted by Elizabeth on July 27, 2001, at 16:53:19
In reply to Re: Nardil vs. Parnate, posted by Lorraine on July 27, 2001, at 10:02:38
> > Parnate potentiates vasoconstricting biogenic amines more than Nardil does at equivalent doses.
>
> elizabeth--what does that mean "vasoconsticting"--constriction of the veins--but what is the importance of this or the importance of reacting to "amines".When blood vessels are made narrower, the pressure on them increases. Biogenic amines (things with an amino group -- a nitrogen with hydrogens hanging off of it) often have vasoconstricting effects: they are "sympathomimetic" meaning that they imitate the action of the sympathetic nervous system.
-elizabeth
Posted by Elizabeth on July 27, 2001, at 17:30:25
In reply to Re: hand holding » Elizabeth, posted by Lorraine on July 27, 2001, at 10:36:23
> Hooray! You're back. Welcome.
Thanks :)
> I'm wondering if ketamine also makes you vaguely paranoid?
Dunno, I never tried it and don't know much about it. It's considered a "dissociative" anaesthetic. It acts as an antagonist at NMDA (N-methyl-D-aspartate -- not to be confused with the support group NDMDA < g >) receptors (one type of glutamate receptor). I think that some people have "out of body experiences" (depersonalisation) on it. Anybody know anything about that?
> > > > Not feeling like it's okay to trust your own perceptions is one of the many negative consequences of being mentally ill, I think.
>
> Well, now, that's an interesting way of looking at it. I didn't at the time think I was mentally ill (this was maybe 20 years before I was diagnosed). I knew that I had more than my fair share of "past" issues to resolve in talk therapy as a result of family dynamics that "discounted" pain and moved on.When you have a childhood history of having your feelings invalidated, I'd expect that you would be more sensitive to invalidation as an adult. And if other people view you as "mentally ill" (and therefore, it's often assumed, unable to have any rational perceptions or beliefs!), I can easily see how that would make you feel invalidated. A lot of people who spend time in psych hospitals come out feeling less sure of themselves, IMO because of the way they were treated in the hospital (as being unequal to the staff and not having what they say believed).
> Now you've motivated me to buy the PDR.
Uh-oh! Don't take the long lists of side effects too seriously! (IMO, the PDR is too expensive -- ask your doctor if s/he has any copies left over from recent years that s/he hasn't thrown out; it's updated annually.) The PDR is a good resource, but I'd try rxlist.com before you go out and spend a load of money on the PDR. A lot of monographs, especially for relatively new drugs, can be found on the pharmaceutical companies' web sites, too.
> I do find myself educating him from time to time.
Continuing education, even when it comes from seemingly unlikely sources, is an important part of practising medicine!
> It bothers me greatly though when I see someone who just blindly accepts their doctors word as gospel.
Me too. Doctors tend to know stuff we don't know, but that doesn't mean they're always right. A lot of people appeal to their authority in arguments when they don't understand what's going on (and may have misunderstood the doctor, anyway). This isn't a very good substitute for making a real argument, of course.
> Course, it gets a bit humorous when you add a drug and a side effect occurs and their response is that it's not a side effect, but something else larger and unrelated--"anxiety" in your case.
Exactly: that's one of the ways that doctors, nurses, psychologists, social workers, et al. can make psych patients feel invalidated.
> You have to chuckle sometimes when the obvious is dismissed for something less likely. This has to be a "frame of reference" issue--ie that's not what I expected, therefore it is not.
Huh. Interesting way of looking at it.
> > > > I would expect benzodiazepines or perhaps Neurontin to be helpful for this sort of anxiety.
>
> Well, I'm not happy with the concept of benzos as a long term solution to what appears to be an on-going problem. But, I may not get to "choose". I did try the Valium and found it increased my depression and, at the dose I was on (1-2mg) did not completely wipe out the panic.Xanax might be preferable, although taking that long-term is a PITA. Other high potency benzos (Ativan, Klonopin) might be better too. But see if the Neurontin helps.
> > > >I mentioned that I experienced something similar upon discontinuing Parnate; the Klonopin came in very handy.
>
> Yeah, sounds like "rebound" anxiety?One morning I didn't take my AM dose of Parnate -- I think I had put my medication organiser somewhere other than where it usually goes. I had terrible rebound symptoms: anxiety, agitated depression, extreme mood swings. (A lot like what happened when Nardil pooped out.) After a couple hours of this, it finally occurred to me that I hadn't taken my morning dose; when I did, I rapidly began to feel better. MAOI withdrawal symptoms are *bad*.
> I did decide that I need a benzo in my emergency kit generally.
< g > Yeah, me too. Just having a benzo handy can alleviate a lot of worry.
> Your Parnate withdrawal makes me a bit hopeful.
?
> Sounds like you need to be very careful. Your theraputic dose range is quite narrow?
I don't know. I've been taking it on the assumption that I metabolise it normally. The serum level check is to make sure that that's really true.
> Welcome home. Hope the desipramine holds.
Me too. Thanks.
-e
Posted by Elizabeth on July 27, 2001, at 19:51:20
In reply to Re: Handholding » Elizabeth, posted by Lorraine on July 27, 2001, at 11:19:35
> > I think that, relatively speaking, that's a good sign. To me it indicates a reactive mood, and the possibility that you have the potential to be cheered up temporarily.
>
> And so I was last night by my wonderful husband.Good for him. :-)
> Stahl talks about the "end-stage" of depressive illness as one where the lows are so low but the ability to "feel" generally has been severely blunted.
That's what I experience. I don't think of it as an "end stage," but perhaps it does have something to do with the fact that my depression first manifested when I was quite young. I would like to see more research on childhood-onset depression. I think my depression is probably not similar to most early-onset mood disorders, though.
> > > > Interesting about panic and hypothyroidism. All my TSH tests have been pretty normal, and T3/4 augmentation is something I've never tried.
>
> It might be worth a try.What do you think it might help with besides panic? Have you ever tried it?
> Also, the notion of "estrogen dominance" causing panic symptoms is interesting. Apparently, estrogen dominance is not just a problem associated with menopause, but can be a woman's normal state throughout her lifetime. Another avenue to explore.
That is interesting. Tell me, can you make anything out of my experience with the pill? (fairly sudden relapse of depression while taking Parnate)
> > > > Buprenorphine seems to make my periods irregular. I've been wondering about the mechanism there.
>
> Isn't that odd?Yes. I've heard of female opioid addicts (who, interestingly, are outnumbered 4:1 by male addicts) having irregular periods, but I assumed that was just due to the junkie lifestyle (where self-care tends to take a second chair to obtaining drugs).
> When I had endometriosis and would have great pain on starting my period, I was given a drug that is now sold over the counter (maybe it's advil?).
Ibuprofen and other nonsteroidal anti-inflammatory drugs are definitely effective for menstrual cramps. (I use Relafen -- easier on the stomach.)
> If I was successful, then my period would start and I would not be in pain. But if I missed the very very beginning, what happened was my period would be delayed. I explained this to my doctor, who dismissed it out of hand. Point is there was something operating there that might be similar to your situation.
How do you mean? I'm a little confused.
> > > > You know, any effective antidepressant has the potential to trigger mania. When I started taking buprenorphine, it seemed to cause activation, psychomotor agitation, etc., rather than the calming effect that opioids seem to have on a lot of people.
>
> Really? I have adverse reactions to drugs at times, like getting wired from decongestants.That's not too unusual. Decongestants are basically bad speed. (Ephedrine or "ma huang" is a step down from bad speed: it's bad Sudafed.)
> But is agitation and activation considered mania?
Not necessarily. They're symptoms of mania, though.
> I once (for a couple of days in the weeks just before the last stock market crash), had incredibly racing thoughts, could hardly contain my excitement and so forth, but was still able to sleep. From my reading of the DSM categories, that would not qualify as mania--although I was euphoric and felt a bit invincible.
Hypomania, perhaps?
> > > > We work with the information we have, and count on the research folks to accumulate more information. I don't think that we should feel we have to wait for more research to be done before we can be comfortable treating mood & anxiety disorders.
>
> Absolutely. We just need to recognize the limitations.Yes! I don't think it's a good idea to pretend that we have a decent understanding of the causes of depression, mania, psychosis, anxiety, etc. -- attributing them to a vague "chemical imbalance" (I wince whenever I hear that expression). For now, I think (as I mentioned before) the most reasonable approach to clinical practise is the empirical-descriptive approach (identifying symptom clusters that respond to particular treatments, and using this information to try to predict which treatments will be most likely to work for any particular patient). Our knowledge about the biology is still in its infancy and should be reserved mainly for research at this time.
> The problem is that we have an entire conceptual framework that is premised on presentation rather than on physiology.
That's not what I'm talking about: I just don't think we have enough information about the physiology of these disorders.
> I think the old system just has to be gutted. I think it gets in the way of determining what works and doesn't work because we test drugs on "depressed" people. Well, if the category "depressed" is not meaningful--that is if in fact very different physiological processes are occurring in different people with depression--then we are barking up the wrong tree.
We have to identify symptoms and symptom clusters in order to say which treatments are most effective for what. This is because known physiological markers are not reliable predictors of response, for the most part.
> It may be that the med that is tested as effective in reducing symptoms by 50% in 51% of the subjects is actually 85% effective in 90% of the subjects with a specified physiology and that is the direction we need to be heading in in terms of research.
Yes: in research. At this time, we have no way of
I think more research is needed in regards to the descriptive approach, too. As you say, the categories are very fuzzy, and it would be nice to make them more specific (which is something that we *can* do with current knowledge).
> So to the extent that the old paradigm henders rather than helps progress, it should be rethought and possibly abandoned.
That's where we disagree. I think that we can simultaneously examine psychiatric illness on both levels (behavioural signs and symptoms, and physiologic ones). Both types of information are useful.
I do like the way that your doctor does it, basing treatment decisions on statistics and not simply on his impressions of what works for whom. The guy in my town who's known for using EEGs and functional imaging doesn't seem to be doing it that way; he also makes some assumptions that are based on flawed logic.
The statistical approach can also be applied to descriptive psychiatry, although it hasn't been used nearly enough IMO.
> His believes that my QEEG indicates that a combination of stimulants (he includes MAOs here) and anticonvulsants should work.
I agree with him that MAOIs are a lot like psychostimulants in their effects on people.
> Complicated stuff. But if it is "insulin sensitivity" or "insensitivity?", then low carb should help.
I dunno, thinking about insulin always gets me confused for some reason.
> > > > Ask the pharmacist if it's okay to cut Parnate pills in half.
>
> Very good question. I will do that.They seem to have some coating on them (not a crunchy shell like Nardil -- the M&M of antidepressants), and it might be there for a reason (other than cosmetic reasons, that is).
> Actually, I think it was your suggestion that I look into DMDA.
Yes, it was. I'm glad to hear that your experience was a good one.
-elizabeth
Posted by shelliR on July 27, 2001, at 22:00:10
In reply to Re: I'll hold your hand if you'll hold mine » shelliR, posted by Elizabeth on July 26, 2001, at 22:05:44
Hi Elizabeth
I meant last time that I thought you had missed a msg from me on this board:
www.dr-bob.org/babble/20010720/msgs/71371.html
> > > > > > > You wrote to Lorraine that the despamine was going pretty well.
> Yes. I'm pleasantly surprised.
> > What is your dosage goal ?
> 300 mg/day (which I reached a couple days ago).
> > Does doing "pretty well" mean you are feeling some benefit, or tolerating side effects?
> The former: it seems to be working about as well as Parnate, and there could be further improvement. The side effects are noticeable at this dose (mainly dry mouth), but tolerable. It doesn't seem to work so great for panic, so I've been taking clonazepam (4 mg/day) too. > > > > > > > > > > > > > > > > > > > > > >
That's incredibly excellent. Does it have the same feeling as the parnate, or different? What were your side effects on parnate? Also, how does the despamine compare to your experience on buprenorphine?About withdrawal after missing a dose of parnate:
Did you ever experience that with nardil? My experience with nardil is that it made no difference if I split my dose, or took it all at the same time. Also whether I took in all in the morning, afternoon or before I went to bed. No difference, still the same sleeping problems. How is your sleeping with desparmine?
I'm up with the air about my next step. Yesterday and today I was in a pretty crummy mood, but then I had to remind myself that most people feel down sometimes, not just very depressed people. Like I wasn't as into my work as I am usually, felt it was getting too repetitious. On the other hand, I did not spend the day in bed like I do when I am terribly depressed. Maybe this is what anhedonia feels like; it's something I don't feel too often, sort of a bored, stale feeling inside.
Maybe it's a signal for me to get out and start doing more besides working. I am going to put the decision about parnate on hold to try to see if the estrogen is having any effect. I like to keep my trials relatively clean! The reason I don't think I can do nardil and oxycontin and concerta is that I took a huge fall into darkness the third day I took prozac, oxy and concerta together. It may have been the crash of the speedball you referred to. I could try nardil and concerta together and drop the oxy. The good thing about stimulents and opiates, they work fast and no waiting period, so it's not like making a huge decision to try one over the other.
I'll let Lorraine try parnate first, although if our reactions to opiates are any indication, we don't react similarly to chemicals.
later, Shelli
Posted by shelliR on July 27, 2001, at 23:39:14
In reply to Re: Handholding Shelli » shelliR, posted by Lorraine on July 26, 2001, at 18:45:59
> I'm sure you're right. I don't think I so much worry about her ability to handle things (because she really seems to be an old hand at this). I suppose I wish that I could be more helpful to her. She does a ton of giving on this board. I'd like to be able to reciprocate on some meaningful level.I think for lots of people giving is definitely a part of getting.
>
> By the way, looking back over some old posts, I see that you have been very helpful in responding to my posts. I don't know how to describe it, but when I first went on psychobabble--all the names were a blur. It is only recently that the names have separated for me and I've come to identify posts with names. Anyway, I want to thank you for all the support you have given me in the past when I didn't know who you were. It really did help.I know exactly what you mean. When I first started participating there were only a couple of names that I could pick out. It took me forever to develop an impression of someone as a person. I once talked about it on the board--how it was particularly difficult for me to identify posters who used initials, or symbols (icemaker, etc.).
Taken out of context "I want to thank you for all the support you have given me in the past when I didn't know who you were" sounds very funny. Like I had been sending my posts as a stranger and then we finally met! And in a cyberspace world, we really have. And I'm glad it helped.
>
> (Lord, can you see where I am in this depression? Slipping down--I become all soppy even though the sentiment is true. I tear up with gratitude--which I guess is one of the good things--that I can still feel "touched".)Gratitude is a really good thing in general. I think it is a very spiritual thing, to be grateful. I see it as a humble experience because the things that I feel graditude about are gifts; I have not directly caused them, nor can I take credit for them. Like I think if you are very good at something, it is okay to acknowlege it, because a talent is a gift, not a product of the ego, although using the gift may be. (sorry, didn't mean to get philosophical on you :-) )
>
>> > > > The only thing about the oxycontin is that I am still on the original dose and the feeling of a little bit of high has never left. It's not a big problem, just better to decide when I want to get high, not start out my day that way.
>
> The feeling of being "high" is very unsettling to me as well. You've been on this med long enough that you would think that side effect would have evaporated if that's what its intent was. That's unfortunate.I sort of knew what I was getting into. My pdoc said I will adjust to it, and I guess I have adjusted, but I suspected it would not go away because it never went away when I was self-medicating with vicidin. But it's only a little high, and sometimes hard to distinguish from being my normal dissociative self.
>> You know they say to do the progesterone on a constant basis as opposed to following the menstrual cycle when you have depression?
No, I didn't know that. I haven't thought too much about the progesterone. I have an appointment with my gyn the second week in August and I'll see if she agrees. She's excellent--really my best doctor. She's just so busy that I have to wait a long time to get an appointment with her.
>>
>
>
> > > > Has your pdoc been encouraging you to take nardil over parnate or vice-versa. Let me know what he said and which you've choosen.
>
> Well, we decided to go with parnate. My guy is an odd duck--he bases everything pretty much on your QEEG. What is a QEEG?
>
> I also asked him if I have temporal lobe epilepsy that didn't manifest itself in physical seizures. He looked at my chart, explained that these things are continuums and then said that I did have temporal lobe epilepsy. Well, one more thing to think about. I think that I remember reading that Tegretal has a very high rate of success with depressed people who have temporal lobe epilepsy. Another option, anyway.A lot of people who were abused in early childhood have temporal lobe epilepsy. I don't really understand about it, but I suppose I will look in up on the internet, since I've been hearing about it for so long without knowing much about it and how exactly it is diagnosed. I know someone who had one doctor give her the diagnosis and the second take it away, so I imagine there is some interpretation involved.
>
> I went to my first DMDA meeting on Tuesday. I went with Neal, another psychobabbler who happens to live in Los Angeles. It was helpful to me to see how others cope. I may go back. I'm still thinking it through.Was it strange to meet another babbler in the real world? I don't know what that would feel like. Dr. Bob was in my area for a conference and meeting with people from the board (I think two people came). I was ambivelent and it turned out I was in the hospital anyway.
>
> All my best to you Shelli. You are a jewel, truly.
blush, blush, and same to you!
Shellip.s., congradulations on picking parnate--I hope it goes well.
Posted by Elizabeth on July 29, 2001, at 14:01:07
In reply to Re: Handholding Shelli » Lorraine, posted by shelliR on July 27, 2001, at 23:39:14
> > I'm sure you're right. I don't think I so much worry about her ability to handle things (because she really seems to be an old hand at this). I suppose I wish that I could be more helpful to her. She does a ton of giving on this board. I'd like to be able to reciprocate on some meaningful level.
>
> I think for lots of people giving is definitely a part of getting.That's precisely right, Shelli.
And to Lorraine: I don't know when you first became depressed or seriously anxious, but I've had problems since childhood (first dx of major depression when I was 14, but my doctor and I felt that I'd probably suffered at least one previous episode, when I was 10-11 and possibly dysthymia long before). I think that early-onset depression has much more profound effects on a person than adult-onset depression has. In a sense, I had an incomplete childhood. Although the effect is qualitatively different from the effects of serious abuse in childhood, the degree of impairment that results is comparable, I think.
> I sort of knew what I was getting into. My pdoc said I will adjust to it, and I guess I have adjusted, but I suspected it would not go away because it never went away when I was self-medicating with vicidin. But it's only a little high, and sometimes hard to distinguish from being my normal dissociative self.
(I hate to correct you again, but it's "Vicodin," as in hydrocOdone. :-) )
I'm not so sure that opioids are a good idea for someone who's had problems with dissociation, although the oxycodone seems to be doing you some good. Believe it or not, I've heard that naltrexone can be very beneficial to people who suffer from dissociation.
> A lot of people who were abused in early childhood have temporal lobe epilepsy. I don't really understand about it, but I suppose I will look in up on the internet, since I've been hearing about it for so long without knowing much about it and how exactly it is diagnosed.
It's a lot fuzzier than I think most people realise. You're right that EEGs are subject to interpretation. It does sort of make sense that people who'd suffered abuse would have hyperactive limbic systems (perhaps including the potential for limbic seizures), though.
-elizabeth
Posted by Elizabeth on July 29, 2001, at 14:04:32
In reply to Re: Give me back my hand- (just kidding) » Elizabeth, posted by shelliR on July 27, 2001, at 22:00:10
> Hi Elizabeth
Hi Shelli.
> I meant last time that I thought you had missed a msg from me on this board:
> www.dr-bob.org/babble/20010720/msgs/71371.htmlYou're right, I did miss it.
You said you have DD-NOS. "NOS" covers a lot of territory -- what does it mean in your case? (if you're comfortable talking about that here)
Most of the doctors I've spoken to in Boston, at least, seem to feel that patients are often convinced (by suggestion) that they have DID by overzealous therapists. A lot of doctors in the Boston area don't consider DID even to be a legitimate dx!
> That's incredibly excellent. Does it have the same feeling as the parnate, or different? What were your side effects on parnate? Also, how does the despamine compare to your experience on buprenorphine?I'm still taking buprenorphine, but at a lower dose than before. I only got up to 100 mg of DMI (which is the very low end of the therapeutic range) about two weeks ago, so there's still a good chance that things will continue improving. At present, it seems to be working about as well as Parnate did, but without the immediate stimulant-like effect (which was sort of a mixed blessing, anyway).
> About withdrawal after missing a dose of parnate:
> Did you ever experience that with nardil?Not that I can recall. The last time I took Nardil was in late 1997, though. I tried taking it in all sorts of dosing schedules (in an attempt to decrease the insomnia) without seeing any difference, like you described. I finally gave up and just started taking the whole dose (75 mg, I think) in the late morning or early afternoon.
> How is your sleeping with desparmine?
Desipramine, you mean? :-) It's weird. Initially my sleep seemed to be improved quite a bit. Now it's less fragmented, but I've started waking up early again, as when I was depressed (although I am feeling significantly better. (The MAOIs did the same thing, only more so -- they decreased my *need* for sleep, as far as I could tell. MAOIs have wild effects on sleep architecture.)
> I'm up with the air about my next step. Yesterday and today I was in a pretty crummy mood, but then I had to remind myself that most people feel down sometimes, not just very depressed people. Like I wasn't as into my work as I am usually, felt it was getting too repetitious. On the other hand, I did not spend the day in bed like I do when I am terribly depressed. Maybe this is what anhedonia feels like; it's something I don't feel too often, sort of a bored, stale feeling inside.
That's one major (and difficult to treat) aspect of my depression: flattened affect. Desipramine has helped -- I have a fuller range of emotions. I'm hoping I may be able to stop taking the buprenorphine altogether (it helps a *lot* with anhedonia and anergia, but desipramine might work there too).
> Maybe it's a signal for me to get out and start doing more besides working. I am going to put the decision about parnate on hold to try to see if the estrogen is having any effect. I like to keep my trials relatively clean!
I think that's a good plan in general, if you can afford to take the extra time.
> The reason I don't think I can do nardil and oxycontin and concerta is that I took a huge fall into darkness the third day I took prozac, oxy and concerta together. It may have been the crash of the speedball you referred to.
I'd attribute that more to the stimulant and perhaps the opioid than to Prozac.
> I could try nardil and concerta together and drop the oxy. The good thing about stimulents and opiates, they work fast and no waiting period, so it's not like making a huge decision to try one over the other.
That's very true. But there is the potential for bad interactions between Nardil and Concerta, whereas oxycodone is probably fine to use with Nardil. (Some of the synthetic opioids, such as Demerol and Ultram, shouldn't be used with MAOIs. Morphine, codeine, hydrocodone, etc. -- the natural and semisynthetic ones -- are fine.)
> I'll let Lorraine try parnate first, although if our reactions to opiates are any indication, we don't react similarly to chemicals.
So, Lorraine is your guinea pig? :-)
-elizabeth
Posted by may_b on July 29, 2001, at 15:20:28
In reply to Re: Give me back my hand- (just kidding) » shelliR, posted by Elizabeth on July 29, 2001, at 14:04:32
Hi Elizabeth
Ever heard of a paradoxical slowing down on Parnate? I am in my first week at 10 mg and feeling unbelievably tired, a bit weak and anhedonic. Getting feedback that I am "subdued" and "slowed down".
Would love to hear any thoughts/observations you might have re this reaction.
Thanks, May_b
Posted by shelliR on July 29, 2001, at 23:51:29
In reply to Re: Give me back my hand- (just kidding) » shelliR, posted by Elizabeth on July 29, 2001, at 14:04:32
Hi Elizabeth
>>
> You said you have DD-NOS. "NOS" covers a lot of territory -- what does it mean in your case? (if you're comfortable talking about that here)It's complicated and it's sounds much more bizarre than it feels, I am so used to it by now. I have different personalities inside; girls clustered around three and eight, related to sexual abuse at those ages. If you heard them you would not think they are me--the three year old especially, not only has the voice of a three year old, but has the verbal patterns of a three year old: repetition, disinterest in answering questions, etc. and chatters on and on. I worked a lot with them in therapy with EMDR and in body therapy, and at this point while still present, they do not dominate my life. I know there is more work to do with one of the 8 year olds., but I don’t think I am quite ready yet. I am co-conscious with them, so I don't have a DID diagnosis.; although really it depends on who does the diagnosing. I do not consider myself to have DID because I do not lose time. Only when I am sound asleep, the kids do have conversations with others that I have no knowledge of until I'm told. But to me that doesn't really count as not co-conscious. A child was the first to wake up after my knee surgery, but I had already given notice to the anesthesiologist that this might happen, and explained how alters come to be. So everyone was sort of pleased when they got to meet one of the kids.
But, also, generally when I say I dissociate, I mean I feel unrelated to my body and spacey, rather than these children are "out".
>
> Most of the doctors I've spoken to in Boston, at least, seem to feel that patients are often convinced (by suggestion) that they have DID by overzealous therapists. A lot of doctors in the Boston area don't consider DID even to be a legitimate dx!
>
That is really sad, because there is absolutely no doubt in my mind that it is real. I have met many multiples in my hospitalizations and I think that it is a rare thing that a therapist convinces a patient that she has DID unless it is a true diagnosis. There are some cases that are called multiple that I would call ddnos. The sad part is that although the prognosis is good for DID, it is a hellish journey. Personalities that one doesn't even know exist, ruin jobs and relationships and definitely put lives at risk. Can you imagine what it feels like to find yourself in LA from Washington with no clue of why you are there? Or to lose a job because a personality inside of you said extremely inappropriate things that you have no idea about. Anyway, I feel a lot of passion about it because people who are multiple have generally experienced a horrific childhood, and then as adults they have still have the coping mechanism that saved them as a child, but now it just screws them up more. So when doctors deny the validity of the diagnosis at all, I see it as another form of abuse for these patients.It is true, however, that at times I can’t deal with the histrionics of some people who are DID and have no friends now with that diagnosis. I had a friend with DID who let her eight year old personality talk at restaurants, and other public places and even had a birthday party for her. I was not at all comfortable with that and walked away from that friendship.
BTW, Dr. James Chu who used to run the dissociative disorders unit at McLean Hospital was promoted to chief of hospital clinical services. He has an excellent reputation in the field of dissociative disorders. I don’t know who the doctors you are talking to in Boston are—because his work is pretty well known and respected, and not just locally. I think that
the doctors you are speaking to, I can only consider to be at best, ignorant in this area, although as I said, I might agree that *some* people are diagnosed with DID, who really have a lesser dissociative disorder .re nardil:
The reason I don't think I can do nardil and oxycontin and concerta is that I took a huge fall into darkness the third day I took prozac, oxy and concerta together. It may have been the crash of the speedball you referred to.
> I'd attribute that more to the stimulant and perhaps the opioid than to Prozac.right, probably the combination of the stimulent with the opiate. It may be revisited. Prozac won't be.
>
> > I could try nardil and concerta together and drop the oxy. The good thing about stimulents and opiates, they work fast and no waiting period, so it's not like making a huge decision to try one over the other.
>
> That's very true. But there is the potential for bad interactions between Nardil and Concerta, whereas oxycodone is probably fine to use with Nardil. (Some of the synthetic opioids, such as Demerol and Ultram, shouldn't be used with MAOIs. Morphine, codeine, hydrocodone, etc. -- the natural and semisynthetic ones -- are fine.)I've never had an interaction with stimulants and nardil before and I've tried most of them.(adderal, ritalin, dexadrine) . So I wouldn't anticipate a reaction. Concerta is the only stimulant which didn't make me feel absolutely awful and I didn’t try it until I had stopped nardil.
> > I'll let Lorraine try parnate first, although if our reactions to opiates are any indication, we don't react similarly to chemicals.
>
> So, Lorraine is your guinea pig? :-)for sure.
>
Shellip.s., do you have a compulsive disorder re spelling :-) If so, I'll drive you nuts. I was most upset to stop taking seglegiline because I had finally learned how to spell it.
Posted by shelliR on July 30, 2001, at 10:51:18
In reply to Re: Handholding (Shelli, Lorraine), posted by Elizabeth on July 29, 2001, at 14:01:07
Hi Elizabeth,
> I'm not so sure that opioids are a good idea for someone who's had problems with dissociation, although the oxycodone seems to be doing you some good. Believe it or not, I've heard that naltrexone can be very beneficial to people who suffer from dissociation.
I actually tried naltrexone for one day. It made me feel awful, like I had taken way too much vicodin, without any of the benefits. The oxycontin is definitely not perfect, but I was fighting for my survival when I was put on it. I mind the bit of "highness" much more in the morning than in the evening, when I don't mind a little buzz, sort of like one glass of wine with dinner. I don't know whether to leave well enough alone, or to broach the subject of buprenorphine with my pdoc. Oxycontin is certainly a lot easier to take and I take it just twice a day. And I do like the high during the overlap of the two doses in the afternoon because it is for only a short time; in fact its a good time for me to do the treadmill--lots of energy. I have tons of work in the next month, and then I go on vacation the first week of september. So I can't afford to feel really bad side effects. I am also thinking about parnate; my "waiting period" after prozac is over next week.
>
Shelli
Posted by may_b on July 30, 2001, at 11:43:53
In reply to re parnate, posted by may_b on July 29, 2001, at 15:20:28
> Hi Elizabeth
>
> Ever heard of a paradoxical slowing down on Parnate? I am in my first week at 10 mg and feeling unbelievably tired, a bit weak and anhedonic. Getting feedback that I am "subdued" and "slowed down".
>
> Would love to hear any thoughts/observations you might have re this reaction.
>
> Thanks, May_b
Posted by Elizabeth on July 30, 2001, at 12:20:17
In reply to re parnate, posted by may_b on July 29, 2001, at 15:20:28
> Hi Elizabeth
Hiya.
> Ever heard of a paradoxical slowing down on Parnate? I am in my first week at 10 mg and feeling unbelievably tired, a bit weak and anhedonic. Getting feedback that I am "subdued" and "slowed down".
Sure. Some people do get groggy on Parnate. It might be due to central activation of NE autoreceptors and/or the orthostatic hypotension that is common with MAOIs. I'm not sure what to suggest. Some people can use stimulants with MAOIs. Provigil is probably safer than amphetamines or Ritalin. If the problem turns out to be related to (low) blood pressure, eating salt tablets and making sure you stay hydrated can help. There's also a steroid (fludrocortisone, brand name Florinef) that can be used for orthostatic hypotension if necessary.
I hope this is at least somewhat helpful. Try to get in touch with the doctor who prescribed the Parnate so you can figure out what to do.
-elizabeth
Posted by Elizabeth on July 30, 2001, at 13:48:54
In reply to Re: Give me back my hand- (just kidding) » Elizabeth, posted by shelliR on July 29, 2001, at 23:51:29
> Hi Elizabeth
Hi Shelli.
> It's complicated and it's sounds much more bizarre than it feels, I am so used to it by now. I have different personalities inside; girls clustered around three and eight, related to sexual abuse at those ages.
Okay; so it's basically a variant on DID. My understanding is that the experience of "multiple personalities" is usually related to childhood abuse. Is that right? Are there other correlates as well?
> If you heard them you would not think they are me--the three year old especially, not only has the voice of a three year old, but has the verbal patterns of a three year old: repetition, disinterest in answering questions, etc. and chatters on and on.
I'm very curious about this sort of thing. I wonder what sort of mechanism could lead to the experience of switching personalities (so to speak).
> I worked a lot with them in therapy with EMDR and in body therapy, and at this point while still present, they do not dominate my life.
Did you find the therapies helpful, and if so, in what ways?
EMDR sounds pretty flakey to me, and the evidence supporting it is very sketchy, but I've encountered a number of people who felt it was helpful for them, enough to make me wonder whether there might be something to it after all.
What is body therapy? That's one I'm not familiar with.
> I am co-conscious with them, so I don't have a DID diagnosis.; although really it depends on who does the diagnosing.
Psych diagnoses frequently do. Can you explain what you mean by "co-conscious?" Does it mean that you actually feel like there are several different personalities in you simultaneously? That's so hard to imagine.
> I do not consider myself to have DID because I do not lose time. Only when I am sound asleep, the kids do have conversations with others that I have no knowledge of until I'm told.
Ever had a sleep or ambulatory EEG?
> But, also, generally when I say I dissociate, I mean I feel unrelated to my body and spacey, rather than these children are "out".
Have you noticed any effect of the medications you're taking on this phenomenon?
I've had several bizarre experiences over the years that I think are related to my sleep disorder, and which are considered "dissociation" in a different (but similar) sense (intrusion of sleep states upon waking states, or vice versa). My sleep has always been odd; I can remember physically acting out dreams as early as age 4, and my parents say that I walked in my sleep intermittently throughout my childhood (for all I know, I still do it).
> That is really sad, because there is absolutely no doubt in my mind that it is real.
I can understand that. I've encountered my share of people who think that depression is just a more extreme version of grief or a bad hair day or who don't understand that ADD is more than just normal childhood behaviour. These things aren't easy to explain to a person who's never experienced them.
> The sad part is that although the prognosis is good for DID, it is a hellish journey. Personalities that one doesn't even know exist, ruin jobs and relationships and definitely put lives at risk. Can you imagine what it feels like to find yourself in LA from Washington with no clue of why you are there?
Yes, actually. As I said, I seem to have had more than my fair share of peculiar experiences, some of which involved memory lapses/lost time.
> Anyway, I feel a lot of passion about it because people who are multiple have generally experienced a horrific childhood, and then as adults they have still have the coping mechanism that saved them as a child, but now it just screws them up more. So when doctors deny the validity of the diagnosis at all, I see it as another form of abuse for these patients.
I can understand that. I've certainly known doctors, psychologists, etc. who seemed to have prejudices that made it difficult for them to listen properly.
> BTW, Dr. James Chu who used to run the dissociative disorders unit at McLean Hospital was promoted to chief of hospital clinical services.I've heard of him, and yes, he does have a good reputation. The dissociative disorders and trauma program at McLean (Proctor House 2; I've known 3 or 4 people who were hospitalised on that unit) is supposed to be good in general. I have only discussed the DID issue with a few professionals, and I'm sure my sample is biased (the psych professionals I know are mostly of the cognitive-behavioural and/or biopsychiatric schools, although the one psychoanalyst I spoke to was fairly skeptical about DID, feeling that the term "multiple personalities" is misleading -- more about that below). The general feeling I've gotten has been that DID is often overdiagnosed at treatment centres where the diagnosis is a fad of sorts, and there are those who don't think that DID exists as a distinct entity at all. Others think that "multiple personalities" are "real" in a sense but shy away from that terminology because, in their opinions, the alters tend to be stereotyped and one-dimensional as distinguished from the "core" personality; they see it as a maladaptive coping mechanism. (I think this is mostly semantic, personally.) I haven't met anyone who denies the existence of dissociative symptoms and their relationship to childhood trauma, but the prevailing view on DID in particular seems to be a skeptical one. Personally, I've never spent time with someone who had experienced alternate personalities, so I reserve judgment on the matter.
> I've never had an interaction with stimulants and nardil before and I've tried most of them.(adderal, ritalin, dexadrine).
Okay, then it's probably a safe bet that Concerta wouldn't be a problem for you.
> p.s., do you have a compulsive disorder re spelling :-)
No, I just like giving people a hard time about it. < g >
> If so, I'll drive you nuts. I was most upset to stop taking seglegiline because I had finally learned how to spell it.
Are you *sure* you learned how to spell it? :-)
-elizabeth
Posted by shelliR on July 30, 2001, at 22:23:16
In reply to Re: Give me back my hand- (just kidding) » shelliR, posted by Elizabeth on July 30, 2001, at 13:48:54
Hi Elizabeth.
>
> Okay; so it's basically a variant on DID. My understanding is that the experience of "multiple personalities" is usually related to childhood abuse. Is that right? Are there other correlates as well?It’s a variant, but a significant variant, much less of a disruption of my life as a adult. And yes, abuse has to occur and the child must have a tendency to dissociate. Obviously all children who are abused do not become multiple, some children become suicidal, others become aggressive, etc. I don't know if this is a fact or not, but it seems from my observations that the abuse had to have been kept a secret; even in the case of siblings both being sexually abused by the same adult, it has generally never been discussed until they were adults with the people that I have come to know.
>
>
> I'm very curious about this sort of thing. I wonder what sort of mechanism could lead to the experience of switching personalities (so to speak).I’m not sure what you mean by "mechanism" but the issue of personalities and switching is
so complicated that I will refer you to Frank W. Putnam's Book " Diagnosis and treatment of multiple personality disorder." Putnam (NIMH) had the strictest definition of MPD before its name change. He was also on the committee for the guide lines for DID for the DSM-IV, although the diagnosis got pretty muddled there because of compromise, I’ve heard. His book is sort of the MPD bible for purists. You might also want to read the book I mentioned before "the Magic Daughter: A Memoir of Living with
Multiple Personality Disorder " by Jane Phillips. She is a university professor, writes anonymously, and I think gives a good idea of how it feels to try to work and be multiple.
> > I worked a lot with them in therapy with EMDR and in body therapy, and at this point while still present, they do not dominate my life.
>
> Did you find the therapies helpful, and if so, in what ways?
>
>EMDR sounds pretty flakey to me, and the evidence supporting it is very sketchy, but I've encountered a number of people who felt it was helpful for them, enough to make me wonder whether there might be something to it after all.I sort of have the same feelings about its scientific reality, but it does seem to help people process through memories much quicker and less painfully than without EMDR. My therapist swears by it and one of my closest friends is a psychologist who also swears by it. I don’t have a definite opinion for me about it; in the work I did early it was useful, but I’m not sure any more useful than other things, like hypnotherapy which I also used during the same time. In some early experiences with EMDR my kids (alters) came out and in coming out and verbalizing helped "them" to share with me what had happened to them (me) at a very early age, and gave me clues how to keep us all feeling safe.
> What is body therapy? That's one I'm not familiar with.Body therapy is the combination of therapy with on-hands massage type work. That I found extremely helpful, both for my depression and for letting my kids act out their experiences in a safe place. It was a place where my "kids" got to feel safe touch. One session after light touch one child just shook and cried on the floor for the entire session and it seemed to work things out for her (us) after that and she started to feel safer. I think a lot of trauma remains locked up in the body and body work can be very useful. The woman I worked with was wonderful and I totally trusted her, so that’s why it worked so well. Body therapy can greatly vary depending on the personality and the training of the therapist. Unfortunately it was not covered under my insurance, so I only went for short periods of time. I am thinking of starting again, to work on the depression in my chest.
> > I am co-conscious with them, so I don't have a DID diagnosis.; although really it depends on who does the diagnosing.
>
> Psych diagnoses frequently do. Can you explain what you mean by "co-conscious?" Does it mean that you actually feel like there are several different personalities in you simultaneously? That's so hard to imagine.Co-conscious means that I always know when my personalities are talking -I can hear them when they are talking and I don’t let them take over my body. If I was not co-conscious I might recede all the way in, and they would take over my personality and I might find things around my house that I had no idea how they got there (like toys or candy). If you’re multiple the first task is to gain co-consciousness, to get control of your life. I never had to do that step, I always had it. And I can talk to all the personalities inside, ask them things, calm them down if they are scared, etc. It’s like talking to kids, only they’re inside. They have names, they have their own preferences about things that may or may not agree with mine and they sometimes disagree with each other. I suppose it’s odd, but it doesn’t seem odd to me. Actually my youngest one, who has recently turned three and a half (a momentous event for a child who had declared she did not want to get any older) has the name Elizabeth. BTW, they get older on their own, they tell me when they have gained a half year or a year and they sound older.
> > I do not consider myself to have DID because I do not lose time. Only when I am sound asleep, the kids do have conversations with others that I have no knowledge of until I'm told.
>
ÿ Ever had a sleep or ambulatory EEG?No, because sleep hasn’t been a problem (except on nardil) and I have no indication that I sleep-walk.
>
> > But, also, generally when I say I dissociate, I mean I feel unrelated to my body and spacey, rather than these children are "out".
>
ÿ Have you noticed any effect of the medications you're taking on this phenomenon?No, I never even deal with it with medications—just the depression and the anxiety. Valium will sometimes ground me when I am very floaty. BTW, I think one of the reasons psychiatrists dismiss DID as a diagnosis is because there is no way to treat the disorder medically. Only the affects of the disorder like anxiety and depression can be helped by meds. At this time in my life, depression is so much more of an issue for me than ddnos. And at this point I'm not sure what the relationship is, although my therapist said she has never treated anyone with alters who did not have severe depression.
>>
> >Others think that "multiple personalities" are "real" in a sense but shy away from that terminology because, in their opinions, the alters tend to be stereotyped and one-dimensional as distinguished from the "core" personality; they see it as a maladaptive coping mechanism. (I think this is mostly semantic, personally.) I haven't met anyone who denies the existence of dissociative symptoms and their relationship to childhood trauma, but the prevailing view on DID in particular seems to be a skeptical one. Personally, I've never spent time with someone who had experienced alternate personalities, so I reserve judgment on the matter.< < <
When alters are one-dimensional they are called ego states, not alters. Like if a part inside is always sad and has no other aspects to it, it is an ego state. And DID *is* a maladaptive coping mechanism for an adult. It was a very useful coping mechanism for a child; it allowed him/her to survive an abusive situation, but a partitioning is not at all helpful to an adult. That’s what the treatment is all about. I don’t believe that the prevailing view is generally skeptical. My therapist (a psychologist) lectures on dissociative disorders , including DID, to medical students at Georgetown and I wouldn’t call Georgetown med school a radical institution. And many psychiatric hospitals are now transferring their dissociative patients to hospitals like Sheppard Pratt, McLean, the PIW dissociative center, and other hospitals with trauma units, because they are recognizing the disorder and know that it requires special skills for treatment.Psychiatrists are not dumb, but many are ignorant and choose to remain so.
>
> > If so, I'll drive you nuts. I was most upset to stop taking seglegiline because I had finally learned how to spell it.
> Are you *sure* you learned how to spell it? :-)
> Well, I don’t take it anymore! When I used to take it then I spelled it selegiline! < g >.More on the topic of medication, the last three days have been pretty awful for me and I am wondering if the estrogen I’m taking is making my depression worse. I wish I had access to the whole study re menopausal depression and estrogen. Actually, my pdoc has a copy of it I think. I’m going to ask him to leave it for me with his receptionist when I see him (maybe Thursday) so I can see if anyone’s depression increased. It’s either that, or the oxycontin is starting to be less effective. Bummer.
Hope you are continuing to do well.
Shelli
Posted by shelliR on July 31, 2001, at 9:23:57
In reply to Re: DID, MDs, DSM, EMDR, etc. » Elizabeth, posted by shelliR on July 30, 2001, at 22:23:16
>
>p.s., I forgot to ask. Do you see your onset of depression at a very early age totally unrelated to emotional experiences. I think that is the impression I get when you post. That the onset was purely physiological and remains so, and it was the depression that had the impact on you emotionally, rather than the reverse.Also , when you went to college at 16, were you placed in any special program, e.g., for gifted highschool children, or were you just in the pack at 16? Because I guess that is a two year earlier start than most--I was 18 when I started college. Were you totally bored in high school or had you been pushed up grades previous to high school, so that you graduated at 16?
Shelli
Posted by Lorraine on July 31, 2001, at 11:03:39
In reply to Re: hand holding » Lorraine, posted by Elizabeth on July 27, 2001, at 17:30:25
elizabeth:
Just got back in town. Today is going to be my first dose of Parnate. The pharmacist said it was ok to split, so here we go.
> > >A lot of people who spend time in psych hospitals come out feeling less sure of themselves, IMO because of the way they were treated in the hospital (as being unequal to the staff and not having what they say believed).
I'm sure that is true. I have found that it is very difficult to hold onto your own sense of reality when you are living in a community that invalidates it--that community would be all-encompassing in a hospital. I have found though that even different jobs can have this "feel", because everyone buys into the "culture" of the job. For instance, in law school a lot of people walk around feeling stupid because the culture is a "let me prove how smart I am by showing how stupid you are" boot camp mentality. That same culture then gets transplanted in the major firms, there is no place for "learning" and you are never forgiven for lacking "experience" or self-confidence--and it is a "confidence game". If you stick with it long enough, as I did, you become the expert and then have to decide whether you will perpetuate that culture with those coming up behind you. I imagine that one way that people who work in mental hospitals make them less threatening is by distancing themselves from the patients so that the patient is "less than"--less than me, less than human in extreme cases, and this is done by discounting what they say and, ultimately who they are. The price of compassion is huge on those who give it. They must remain vulnerable to the pain of others and the possibility that a piece of this pain resides in themselves. So much easier and more efficient to just dismiss what patients have to say. I have never spent time in the hospital for my depression and, from what you are saying, it's clear that for me, it could be a very painful experience given my prior wounds from discounting.
> > >I'd try rxlist.comYes, I use this and drkoop.com drug checker for drug interactions.
> > > You have to chuckle sometimes when the obvious is dismissed for something less likely. This has to be a "frame of reference" issue--ie that's not what I expected, therefore it is not.
>
> Huh. Interesting way of looking at it.I think that people get stuck in their mind set frequently and do not allow new contradictory information in.
> > >Other high potency benzos (Ativan, Klonopin) might be better too. But see if the Neurontin helps.
I've been on the Neurontin long enough (6 mos) to know that it is not the answer to this problem, although it does help smooth things out generally. My pdoc prescribed Ativan for me to try out.
> > > > One morning I didn't take my AM dose of Parnate -- I think I had put my medication organiser somewhere other than where it usually goes. I had terrible rebound symptoms: anxiety, agitated depression, extreme mood swings. (A lot like what happened when Nardil pooped out.) After a couple hours of this, it finally occurred to me that I hadn't taken my morning dose; when I did, I rapidly began to feel better. MAOI withdrawal symptoms are *bad*.I had the same sort of reaction to a missed dose on Effexor and coming off of it was really, really difficult. That was before I was on psychobabble though. Now what they say about Effexor withdrawal is to augment it with a long half-life med like Prozac to ease the transition. I wonder if a similar argument would work with MAOs? Are there some that have a longer half-life? But then there is a wash-out switching from one MAO to another, right?
> > > Your Parnate withdrawal makes me a bit hopeful.
>
> ?I'm assuming that if you felt anxious on withdrawal, that Parnate was medicating the anxiety when you were on it. I'm not sure that this logic holds though.
>
> > Sounds like you need to be very careful. Your theraputic dose range is quite narrow?
>
> I don't know. I've been taking it on the assumption that I metabolise it normally. The serum level check is to make sure that that's really true.Let us know what the serum level check reveals. It could be an important piece of information about your metabolism.
Lorraine
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