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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 191 to 215 of 434. Go back in thread:
Posted by Lorraine on August 8, 2001, at 11:31:37
In reply to Re: Update -- Lorraine and others, posted by Elizabeth on August 7, 2001, at 15:05:26
> I started out on 10 mg q.d. That was fine, but when I started taking 20 mg in a single dose, my blood pressure would shoot up (from low-normal to 180/100 or so) about 1/2 hour after I took the Parnate.
Start low, go slow might be in order sounds like. I'll keep this in mind.
>
> Hmm, the "delete" button on this keyboard doesn't seem to be workingFaulty keyboard, or you spilled water on it? (if so turn it upside down and let it dry out)
> > > That sounds right to me: rejection sensitivity, social or interpersonal anxiety, etc. are all connected to being worried what other people think about you.
Actually, I read an article on the "self-presentational theory of social anxiety"--which predicts that the likelihood and intensity of social anxiety increases as people become more motivated to make a particluar desired impression and less certain that they will do so successfully. Pretty much fit my SA to a tee.
> What's Recovery Inc?It's a support group for people with mental illnesses. I wrote a report in the "social" section of pyschobabble describing it last week.
> > > How far apart are you spacing the doses?8 am and approximately 1pm, but I may move them closer. Woke up at 4 am last night, couldn't get back to sleep easily.
> > > I think it's a good idea to take advantage of times you are doing better. Not only does it utilise time more efficiently, I think it also might help to limit how far you crash when the good time ends.that's the hard part of this illness--riding the waves up and down and mainly trying to stay afloat when things come crashing down.
>
> > Yes, but I don't see your position as "bad" just lower on the list of alternatives than perhaps you have placed it. Jensen says the following: "since the opiates are a brain transmitte, they can fail like anyh other chemical systeim in the grain.
>
> Wow, that really got mangled. :-)Yeah, but look how fast I typed it < vbg >
> > > See my pdoc wouldn't hesitate to prescribe opiates if that was what I needed. He does not believe that people become addicted when you medicate them with the "right" substance.
>
> I think it's possible.It's an interesting idea anyway. He also believes that you won't get side effects if the drug is right for you.
Next post
> > > I'll post the definition of addiction that's given in DSM-IV. (I'm not a big fan of DSM-IV, but in this case I think they got it right, or at least came close. The definition underscores the fact that tolerance and "physical dependence" do not constitute addiction, although they can be signs of a possible addiction.)
Addiction is widely misunderstood.
> > > She thinks if you're with a doctor you do exactly what he/she tells you to do, or you leave and find another doctor.
I suspect this is actually an issue your therapist has with her own relative power visa vie the medical profession and she wants you to know who is "boss"--probably her particular quirk.
> > > I think that you *should* try to decide on a plan with your doctor before implementing it, if possible, but if there's a problem and it can't wait, I don't think that there's anything wrong with taking it into your own hands.
I agree. I usually talk with my pdoc about starting doses, and normal min and max normal doses and then he sets me free to operate in that range, reporting back and getting direction as needed.
> > > I do a lot of nice things for myself and am pretty forgiving of myself. I have to work really hard on not letting people hurt me--really minor things hook right into my depression , and so far I can only deal with that cognitively, since that is my strongest function.
Ditto
not letting other people hurt me
not letting other people determine my worth
not determining my self worth based on what I do
not determining my self worth based on social or professional status
not determining my self worth based on the stock market
not determining my self worth based on what other's think of me
> > >I hope that Parnate continues working in the long term for both of you.Last post
> > > Valium is like that: it works fast because of the way it is distributed. (5-10 mg is nothing. < g >)How is it distributed?
> > >I wouldn't see a psychologist to prescribe medications at all. (My best psychotherapy experiences have been with psychiatrists, not psychologists, social workers, or "counselors.")My experience has been that psychologists are more gifted in talk therapy and psychiatrists or psychopharmacologists are more gifted in meds. By the way, elizabeth, what do you talk about in talk therapy? You sound like your issues are solely medical in nature. Is this right? No split personalities, no alters, no abuse--although I would think you would have social anxiety given the age of onset of your disease. I just saw your response on how you don't find talk therapy useful. I go in spells with it. If I find myself being maladaptive in my responses to something, I go back in. Also---and very interesting to me--one of my most successful bouts with therapy and for my husband as well--was with a social worker, who had developed a cognitive approach to issues. She ran a group like a class, giving homework and so forth. She was very talanted. Before my husband went to her class he believed that the way he did things was "right" and that others who failed to live up to his way of doing things were, well, flawed. Under her guidance, he came to see that his punctuality and exactness were actually driven by anxiety rather than correctness. It kind of destroyed his judgmental bubble. Yeah!!!
> > > > Have you felt anything different yet, since halving your dose? (i.e., not as well?)
> > > Yes; it doesn't seem to be helping as much. I hope that I can find a level that isn't toxic but still works.elizabeth, you can add an MAO to a TCA without a washout is my understanding. This might be the ticket for you.
> > It's actually not much of a hassle getting drugs outside the country.
>
> It is if you want to be completely legitimate about it! I'm really uninterested in buying drugs on the internet "grey market."elizabeth, it's easy to do it legitimately--that's how I did it. You just fax a script to a Canadian pharmacy and they mail you the meds together with a copy of your script (to clear customs)--it takes about 5 days to get your meds.
Lorraine
Posted by shelliR on August 8, 2001, at 11:43:26
In reply to Re: Update » shelliR, posted by Elizabeth on August 8, 2001, at 5:21:49
>
> > Well, I've already become tolerant to oxy in that it's taking 3 a day rather than two to eradicate the depression.
>
> Does that mean that they aren't lasting as long? That can be an early sign of tolerance.
I know I am becoming tolerant because sometimes 10mg is not enough and the depression is breaking through. Still, I don't worry too much about habituation. Life is too short to waste depressed and I have started parnate. Speaking of which,
today is my second day. So far no side effects or AD effects, but I am not expecting the anti-depressant effects to manifest as quickly as they did with Lorraine. That would be a nice surprise, but I am remembering my nardi experience. Still, I have had very good luck with drugs which don't make me feel drugged from the beginning. So I am optimistic and trying to be patient. It is fairly easy with the oxycontin to get me through.
>>
> > Well, they're doing pilot programs where psychologists are doing an extra two or three years post doc and can prescribe meds.
>
> I know, and I think that's a big mistake. There are all sorts of problems that come up: can they prescribe multiple drugs at a time? can they prescribe to medical patients who are already taking lots of other stuff? can they prescribe drugs that aren't considered to be "psychiatric drugs" for off-label uses or for side effects? can they order lab tests? etc. And of course: does a post-doctoral fellowship really prepare them to be able to do these things?Geez, Elizabeth. You sound exactly like a graduate of MIT who wants to go to medical school. :-)
>
> > My therapist will be first in line if it comes to that. And guess what! I would not let her be my medicating psychologist. (surprise, surprise.)
>
> I think I could have guessed that. < g > I wouldn't see a psychologist to prescribe medications at all. (My best
>psychotherapy experiences have been with psychiatrists, not psychologists, social workers, or "counselors.")I did placements on psych units as an undergraduate with the lamest residents. If I had to pick for therapy between psychiatrists vs. psychologists, (not knowing the individual), I'd go for the psychologist any time. They spend much more
of their time learning developmental stages and are better trained to do therapy. Sometimes residents don't even do therapy in their assignments, just basic hospital management of patients. The only counselors I've ever gone to have been body therapists also; one PhD in counseling; the other a MA. I can't understand why anyone would get a PhD in counseling, because that degree is not generally recognized by insurance companies. But it is as difficult, if not more so, to get into a clinical program for psychology,as medical school, because there are very limited spaces per school, like generally 8-12. So it may have been more practical for her to go on in counseling, especially if she was not willing to move (i.e., husband's job, kids in school here).Anyway, it is incredibly hot and I wish we would get one rain day for my flowers. Have you learned to drive yet?
Shelli
Posted by shelliR on August 8, 2001, at 20:28:02
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 8, 2001, at 10:41:34
Hi Lorraine, all
> Shelli--just want to say that it's pretty easy to second guess you therapist decision from the peanut gallary but you are the one who knows her value and limitations and whether she is who you should be seeing right now. You seem to see things clearly and, amazingly, you seem to be able to pull back from her views when they are not useful. Good for you. There is also something for you to learn in her limitations--they force you to protect yourself emotionally in an involved situation. My husband is a general all-round good guy, but he has his limitations like the rest of us mortals. When I was in a toxic work environment that was really destroying me, he failed to see the danger in my continuing to work for an abusive boss--all he could see was the glitter and the gold of this "once in a lifetime" position. At the time, I verified my sense of reality through him--not realizing that he had this fault. One of the lessons I had to learn was to pull back from my enmeshment with him and discern whether his opinion was useful or not. It is a really important lesson and you seem to have a handle on it.
>
> > > > Yes, you are being pushy :-). And that's okay--you care. But I'm pretty clear on this
>I've been thinking about both of your reactions to my therapist and thinking about what I am feeling about therapy in general right now. I am surprised and not surprised that my pdoc is allowing me to increase the oxy. In one sense he had previously said he could not justify raising it, but when I told him how much I was hurting and how much another hospitalization would disrupt my life, I wasn't really surprised that he increased it. Plus a hospitalization wouldn't have helped the pain, just keep me alive until the parnate kicks in, *if* it does. (I am optimistic, still)
It is hard to me to understand how both my last pdoc and my therapist could render such critical judgments about my choices in trying to deal with such horrible pain when they had no solutions. Well, like the saying "unless you have walked in another's shoes." I lost a lot of both my childhood and early adulthood; I'm really not willing to lose more of my life if I have any options. I don't get how they don't get that and I do see it as their problem, not a character flaw of mine.
Once before my therapist and I had a conflict about my life, which didn't involve her either. She expressed her disapproval that I set my business up as a corporation in order not to lose a specific gov't benefit. She said that it was not unlawful, but not in the spirit of the law; I told her that when she showed me her tax returns (and that of her MD husband) we then might approach the topic of the spirit of the law on equal ground!
Anyway, the fact that my therapist is so opinionated is really a pain at times, but she has never "hit" me, as they say "below the belt"; she has never hurt touched any sensitive points (shame issues) with her opinions, or I wouldn't/couldn't tolerate it. And I think I need to learn to accept peoples blind spots; just as I assume they accept mine. Only of course I don't see mine (or don't have any! :-)
btw, did you read any of the thread about attachment? Do you know what I mean now?
Aside from feeling a bit depressed, I am feeling a bit down tonight (two different things for me).
I bought a new treadmill (my other one died over the weekend), so I am up and running (well walking very fast) again which is good. But I don't get an endorphine release high; I can't figure that one out because I walk fast and push myself by setting inclines and I do it for 45 minutes. Any ideas why it's never affected my depression? Mostly the fact that it helps control my weight motivates me to do it.
>>
> > > > I'm not generally interested in support groups, but that does sound interesting.
> Well, I have a strong need for community right now.
Well, I remember you said you missed the community of work. Are you looking for any community, or are you still feeling that you need to be around more people who understand depression? Does a sense of community mean fitting into a group of some sort, e.g. work group, support group, etc. I mean what does that phrase mean for you?
>So you think 10mg of parnate is really making a huge difference?
Also, btw, my gyn doesn't think there is any reliable test for hormone levels, including the saliva test.
> How is Parnate treating you?
No complaints, no ad affects yet.Shelli
Posted by Lorraine on August 8, 2001, at 23:53:50
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 8, 2001, at 20:28:02
Hi Shelli, all
> > > It is hard to me to understand how both my last pdoc and my therapist could render such critical judgments about my choices in trying to deal with such horrible pain when they had no solutions.
It's pretty annoying isn't it--sort of like metting out advice from an ivory tower with nice clean gloves. This is why I'm always a bit in the face about things like length of wash-out periods, drug alternatives during wash-out and length of time before a med becomes effective and influences my mood.
> > >I lost a lot of both my childhood and early adulthood; I'm really not willing to lose more of my life if I have any options.I totally relate to the concept of lost time. The life train leaves the station and you are either on board or marking time by the side of the tracks. My FIL (whom I adore) visits; I am either vitally there or not; if my illness prevents me from being fully present, then that time is irretrievably lost and he is 76 so how many more opportunities are there. Or my child is 11, she will only be 11 once. It's an important age (they all are). I can't afford to miss it. In 7 years, she is out of the house, gone to find her own life, her childhood is gone. Well, here we are Shelli, this ticking clock thing drives me absolutely nut:-(
> > >I told her that when she showed me her tax returns (and that of her MD husband) we then might approach the topic of the spirit of the law on equal ground!I do like this, yes!
> > >And I think I need to learn to accept peoples blind spots; just as I assume they accept mine. Only of course I don't see mine (or don't have any! :-)
Except of course, your therapist< vbg >?
> > > > btw, did you read any of the thread about attachment? Do you know what I mean now?
You shamed me into it. I think I understand. My kids always say "look at this", "watch this, Mommy", "come listen to my new guitar piece, Mom". It's like their life only comes fully alive when I am there to witness it. My husband is the same way. His idea of a great day is to do anything and have me watch him. These is something about this--validate me by letting me be the center of your universe. It is supposed to be (according to my therapist) very important for kids to get their fill of this. The other piece--which I have thought about a lot--is the drive toward symbiosis with another person. Symbiosis, the melding of two into one. I felt it the first time I breast fed my children. I was transported. Also--at least for me--the need to be fully known and loved. I get this stuff in other ways--not with my therapist. You see where the children come in, and symbiosis of sorts with my husband (there is something like patina that comes with time), and being fully known and loved by husband and dear friends. I think I understand what you are talking about. Do I sound on track?
>
> Aside from feeling a bit depressed, I am feeling a bit down tonight (two different things for me).Sorry to hear this. I hope the Parnate kicks in soon.
> >
> > > > > I'm not generally interested in support groups, but that does sound interesting.
> > Well, I have a strong need for community right now.
> Well, I remember you said you missed the community of work. Are you looking for any community, or are you still feeling that you need to be around more people who understand depression? Does a sense of community mean fitting into a group of some sort, e.g. work group, support group, etc. I mean what does that phrase mean for you?Community is something that I never had when I was growing up. We moved and moved and moved and moved. Each new school year, I stood before that class (quaking in my SA) and introduced myself to a new group of classmates. We weren't army brats, so this group wasn't a bunch of drifters like us, they had all grown up together. We had no consistent family friends; we didn't go to church; noone knew us. We were always strangers. So a need for community is pretty strong with me in it's own right. Then when I get very depressed and start thinking that I may not win the lottery this time around on my game of med roulette, I feel like there is not enough holding me to this earth and I need to be here for my children, my husband, my mother, my friends. This specific need then becomes the need for others like me (depressed folk) to anchor me, to teach me their strategies, to lend me that look of sympathy that comes only from someone who Knows.
> > > So you think 10mg of parnate is really making a huge difference?Bear in mind, I am almost always on puny doses of drugs. Moclobemide was 75 mg (the average dose, i think is 300 and above); Selegiline 5 mg; Wellbutrin 100 (drove me out of my skin). I understand that for most people Parnate is between 20 and 40 mg. I wouldn't be surprised if I end up here or 5 mg higher. I am biting my nails and cuticles again--an indication that I am probably a bit overstimulated. What can I say, I take small doses and I feel things quickly--Effexor took the longest for me to feel positive effects from.
>
> Also, btw, my gyn doesn't think there is any reliable test for hormone levels, including the saliva test.She may be right. I don't think saliva testing has been used in controlled experiments. And I know--from personal experience-- that serum testing is pure b.s. What can I say? Women's needs haven't topped the medical research lists...
> > How is Parnate treating you?
> No complaints, no ad affects yet.Yea! What's your titrating schedule? By the way, I'm seeing my pdoc on Friday and will ask him re sleeping.
Lorraine
>
> Shelli
Posted by shelliR on August 9, 2001, at 0:20:15
In reply to Re: Update -- Shelli et al., posted by Elizabeth on August 7, 2001, at 15:46:31
>> > Once I start, I can't stop, unless I am at someone's house or at a restaurant (and embarrassment saves me) and I even throw things out so I won't eat them.
>
> It sounds like there might be something wrong with the mechanism that tells you when you're full (I think the hypothalamus is supposed to be in charge of this sort of thing). I experienced something similar on Nardil, and I do think it gave me a sense of what it's like to be an addict.No it's not about being hungry or full. Because I might not eat it all at one sitting. When I'm full, I'll wait until I'm not full then start on a cake for instance, again. And I won't eat anything else, no meals, just cake.
>
> > The difference between sugar and say alcohol is that if I don't have sugar, I don't crave it.
>
> Cravings are an essential feature of anything that is truly an "addiction," IMO.
Well there is something than other than habituation. It's sort of like the alcoholic can't take one drink thing. I'm sitting here not craving, sugar, carbs. But if I start on sugar then the cravings begin. So yes there is craving, but it's got to be set off.
>
re therapy terminations.I was talking to my therapist friend today about whether she would terminate a patient, who lets say, can't control her drinking, won't go to any support groups around it, and no therapy work is really being done. All the time is spent just cleaning up the damage in her life because of her addiction (relationships, drunk driving etc.) You could either work with this person with the hope that with your influence and support she would finally get into a program for her addiction, or you could feel like this is a losing battle and I'm not going to waste my time. We both decided we would probably choose the later, because it is so frustrating to work with addicts who won't admit, or do anything about their addiction.
So I think my therapist believes that if I self-medicate, I will go straight downhill, sabotaging any therapeutic work we could do. Except I've been self-medicating for almost four years now; premenstually only for the first three; more often in the last year. And I have not as yet gone straight downhill. It must be hard for her to give up a presumption that she has invested so much in, apparently.
> I wonder why she believes that so strongly? I really do think she's crossing a professional boundary by making threats like that to you, even if it is only around that one issue. It seems to me that she might have personal issues of her own surrounding addiction.
I very much doubt that she has her own issues, but maybe in her family. Or she is just very opinionated ; on my
behalf:-)
>
>
>
> > She thinks if you're with a doctor you do exactly what he/she tells you to do, or you leave and find another doctor.
>
> See, I think that regardless of whether or not it's necessary to follow your doctor's orders to the letter, that's an issue between you and your doctor, and it's not your therapist's business.
I agree; but pdocs seem to want to communicate with therapists and vice-versa. Sometimes I think it's social, or networking., rather than a necessity for the benefit of the patient. My last pdoc and this therapist had lunch together (my pdoc told me this, not my therapist). And I thought, how nice, perhaps they'll become friends. And how odd they didn't invite me. < g >
Also, I think at this point she thinks I choose pdocs who will give me opiates and she is right. So there is some question on her part about my choices :-)good night, all.
Shelli
Posted by Elizabeth on August 9, 2001, at 9:29:29
In reply to Re: Update -- Lorraine and others » Elizabeth, posted by Lorraine on August 8, 2001, at 11:31:37
> > I started out on 10 mg q.d. That was fine, but when I started taking 20 mg in a single dose, my blood pressure would shoot up (from low-normal to 180/100 or so) about 1/2 hour after I took the Parnate.
>
> Start low, go slow might be in order sounds like. I'll keep this in mind.Well, I didn't have any problem with 10 mg, and I think the spontaneous hypertension that I got is the exception, rather than the rule. So increasing in increments of 5 mg seems at least conservative enough to me.
> Faulty keyboard, or you spilled water on it? (if so turn it upside down and let it dry out)
I think it must have just been a temporary lapse, because it's working fine now. I didn't spill anything on it (good thing since it's not my keyboard!).
> Actually, I read an article on the "self-presentational theory of social anxiety"--which predicts that the likelihood and intensity of social anxiety increases as people become more motivated to make a particular desired impression and less certain that they will do so successfully. Pretty much fit my SA to a tee.
That seems reasonable. There is definitely a temperamental aspect to it: some people are born shy.
> > What's Recovery Inc?
>
> It's a support group for people with mental illnesses. I wrote a report in the "social" section of pyschobabble describing it last week.Ahh. Mental illnesses in general? Sounds like it could be a very diverse group.
> 8 am and approximately 1pm, but I may move them closer. Woke up at 4 am last night, couldn't get back to sleep easily.
I found that spacing them as little as 2 hours apart was fine; when I was taking 60 mg/day, I would just take one every couple hours (or whenever I remembered < g >). (30 mg definitely was not enough for me, BTW.)
> that's the hard part of this illness--riding the waves up and down and mainly trying to stay afloat when things come crashing down.
It sure is. I hope the Parnate will smooth things out for you.
> > Wow, that really got mangled. :-)
>
> Yeah, but look how fast I typed it < vbg >Two words: tortoise. hare.
> It's an interesting idea anyway. He also believes that you won't get side effects if the drug is right for you.
I'm more dubious about that. Just about any active drug has side effects. My experience has been that the ones without side effects don't have much effect at all (I'm thinking specifically of the non-drowsy antihistamines).
> Addiction is widely misunderstood.
That's for sure, and you can see it even on this board. I think it's sad how some people use the word "addict" as an insult. I mean, seriously: addicts are human beings with a serious illness.
> I agree. I usually talk with my pdoc about starting doses, and normal min and max normal doses and then he sets me free to operate in that range, reporting back and getting direction as needed.
That's how my pdoc and I operate too.
> How is it [Valium] distributed?
It gets taken up into the CNS very fast, then redistributed throughout the body. So it "hits" rapidly, but it doesn't work for nearly as long as you'd expect it to based on its elimination half-life.
> My experience has been that psychologists are more gifted in talk therapy and psychiatrists or psychopharmacologists are more gifted in meds.
That's what you might expect based on their training. But my experience with "talk" therapy has been that the match between client and therapist -- the "click" is how I think of it -- is more important than the particular type of therapy being practised.
> By the way, elizabeth, what do you talk about in talk therapy? You sound like your issues are solely medical in nature. Is this right? No split personalities, no alters, no abuse--although I would think you would have social anxiety given the age of onset of your disease.
That pretty much sums it up, yes. My childhood was pretty normal (other than some peculiar sleep problems which I've had all my life), certainly there was nothing that would explain my depression.
> I just saw your response on how you don't find talk therapy useful. I go in spells with it. If I find myself being maladaptive in my responses to something, I go back in.
That seems reasonable.
> Also---and very interesting to me--one of my most successful bouts with therapy and for my husband as well--was with a social worker, who had developed a cognitive approach to issues. She ran a group like a class, giving homework and so forth.
That sounds like CBT to me, yes.
> Before my husband went to her class he believed that the way he did things was "right" and that others who failed to live up to his way of doing things were, well, flawed.
I think that's a very common world view. I'm pleased to hear that your husband was able to change; IMO, that shows a lot of character.
> elizabeth, you can add an MAO to a TCA without a washout is my understanding. This might be the ticket for you.
I've thought about it. MAOIs and TCAs can be used together, yes. In the past I've tried to add TCAs to MAOIs without serum level monitoring, but I wasn't able to tolerate the tricylics (nortriptyline and amoxapine) at anywhere near the expected dose range (I only got up to 75 mg of each of those). Now I'm thinking that this might have been in part because I wasn't metabolising them adequately. Desipramine has such mild side effects that I tolerated it fine even at very high levels.
-elizabeth
Posted by Elizabeth on August 9, 2001, at 9:59:43
In reply to Re: Update » Elizabeth, posted by shelliR on August 8, 2001, at 11:43:26
> I know I am becoming tolerant because sometimes 10mg is not enough and the depression is breaking through. Still, I don't worry too much about habituation. Life is too short to waste depressed and I have started parnate.
That's how I feel: I think that even if you needed ever-increasing doses, it would be preferable to remaining depressed. (The DEA and state medical boards may not feel the same way, however.)
> Speaking of which, today is my second day. So far no side effects or AD effects, but I am not expecting the anti-depressant effects to manifest as quickly as they did with Lorraine.
My experience has been that MAOIs work faster than ADs are "supposed" to work (with some improvement being noticeable after 1 week). I've often wondered about the assumption that all ADs will take several weeks to start working -- is that really true, or does it only apply to TCAs?
> Geez, Elizabeth. You sound exactly like a graduate of MIT who wants to go to medical school. :-)
How odd! (What would such a person sound like, anyway? < g >)
> I did placements on psych units as an undergraduate with the lamest residents.
Residents can be pretty lame. They're just starting out, after all. (IMO they really ought to be supervised, at least the 1st-year ones.)
> If I had to pick for therapy between psychiatrists vs. psychologists, (not knowing the individual), I'd go for the psychologist any time.
This is what I would have expected, but my actual experience has been different. I don't think that the specific training that psychologists, social workers, et al. get is really all that relevant to how good they are as therapists (for me, anyway).
> I can't understand why anyone would get a PhD in counseling, because that degree is not generally recognized by insurance companies.
They might have gotten the degree before managed care became widespread?
> Anyway, it is incredibly hot and I wish we would get one rain day for my flowers. Have you learned to drive yet?
I was afraid you'd ask that. :-)
> I was talking to my therapist friend today about whether she would terminate a patient, who lets say, can't control her drinking, won't go to any support groups around it, and no therapy work is really being done. All the time is spent just cleaning up the damage in her life because of her addiction (relationships, drunk driving etc.) You could either work with this person with the hope that with your influence and support she would finally get into a program for her addiction, or you could feel like this is a losing battle and I'm not going to waste my time. We both decided we would probably choose the later, because it is so frustrating to work with addicts who won't admit, or do anything about their addiction.
I think it's frustrating in general to deal with people who have problems they won't admit to or try to change; it's not unique to addictions.
-elizabeth
Posted by Lorraine on August 9, 2001, at 9:59:57
In reply to Re: Update » Lorraine, posted by Elizabeth on August 9, 2001, at 9:29:29
> > > Actually, I read an article on the "self-presentational theory of social anxiety"--which predicts that the likelihood and intensity of social anxiety increases as people become more motivated to make a particular desired impression and less certain that they will do so successfully. Pretty much fit my SA to a tee. > > > >
> That seems reasonable. There is definitely a temperamental aspect to it: some people are born shy.Yes, but people who have SA are not necessarily shy, although they can be.
>
> > > What's Recovery Inc?
> Ahh. Mental illnesses in general? Sounds like it could be a very diverse group.Could be, but my meeting only had 3 others in it and at least 2 were depressed.
> > > I found that spacing them as little as 2 hours apart was fine;
I may end up doing that and basically taking my whole dose in the am.
> > >(30 mg definitely was not enough for me, BTW.)
No, of course, not. I think I am a slow metabolizer (so drugs build up in my system quickly) and you are a slow metabolizer (or a partial non-metabolizer?) so that you need more drug to have an effect.
> > > It sure is. I hope the Parnate will smooth things out for you.Right now it is. I've also stopped taking the estratest, although I'll probably go back on it in a new formula that has progesterone in it.
> > It's an interesting idea anyway. He also believes that you won't get side effects if the drug is right for you.
>
> I'm more dubious about that.Me too.
> > Addiction is widely misunderstood.
>
> That's for sure, and you can see it even on this board. I think it's sad how some people use the word "addict" as an insult. I mean, seriously: addicts are human beings with a serious illness.Watched Traffic on Sunday--great movie.
> > How is it [Valium] distributed?
>
> It gets taken up into the CNS very fast, then redistributed throughout the body. So it "hits" rapidly, but it doesn't work for nearly as long as you'd expect it to based on its elimination half-life.Unless the effects that you want are not CNS but body effects, like breath rate?
> > > That's what you might expect based on their training. But my experience with "talk" therapy has been that the match between client and therapist -- the "click" is how I think of it -- is more important than the particular type of therapy being practised.Clicking is important especially if you need to be vulnerable to make progress, but my experience with CBT is that vulnerability and disclosure aren't as important and so "click" isn't either.
> > >My childhood was pretty normal (other than some peculiar sleep problems which I've had all my life), certainly there was nothing that would explain my depression.elizabeth, did you get SA as a result of having early onset depression?
> > > I think that's a very common world view. I'm pleased to hear that your husband was able to change; IMO, that shows a lot of character.
My husband is great. You marry one person and then 20 years later you are both different, having changed so much. The trick to marriage is to keep connected through all that change. My husband says that with all of the change I have gone through and my depression, he realizes that it is the prenumbra of me that he loves---it's like there is me and then there is who I might be at any given moment (actually he uses quantum physic metaphors to make his point).
>
> > elizabeth, you can add an MAO to a TCA without a washout is my understanding. This might be the ticket for you.I reread this--I'm wrong I think. You can add TCAs to MAOs but not visa versa, right?
When's your pdoc home? And how are you coping day to day? I see my pdoc tomorrow re sleep. Last night I upped the Neurontin from 300 to 500 and slept like a rock. Not sure this approach will last, who knows?
Posted by Elizabeth on August 9, 2001, at 16:42:05
In reply to Re: Update » Elizabeth, posted by Lorraine on August 9, 2001, at 9:59:57
> Yes, but people who have SA are not necessarily shy, although they can be.
Point taken.
> Could be, but my meeting only had 3 others in it and at least 2 were depressed.
That still leaves room for a lot of diversity. "Depression" is a big umbrella.
> > I found that spacing them as little as 2 hours apart was fine;
>
> I may end up doing that and basically taking my whole dose in the am.That might be helpful, although once you are at steady state, it shouldn't make much difference at what times you take it.
> I think I am a slow metabolizer (so drugs build up in my system quickly) and you are a slow metabolizer (or a partial non-metabolizer?) so that you need more drug to have an effect.
People who metabolise drugs slowly need to take lower doses; people who metabolise them rapidly need higher doses. Also, not all drugs are metabolised via the same pathways -- so someone who metabolises tricyclics slowly (like, say, me) might not have a problem metabolising, for example, Parnate. Usually these problems arise from drug interactions or enzyme deficiencies. Some people are just sensitive to side effects without having any sort of metabolic quirk.
> > It gets taken up into the CNS very fast, then redistributed throughout the body. So it "hits" rapidly, but it doesn't work for nearly as long as you'd expect it to based on its elimination half-life.
>
> Unless the effects that you want are not CNS but body effects, like breath rate?I think those are probably centrally mediated, actually.
> Clicking is important especially if you need to be vulnerable to make progress, but my experience with CBT is that vulnerability and disclosure aren't as important and so "click" isn't either.
Yes. I think that CBT tries too hard to take the "click" out of the picture -- to be uniform regardless of the personality of the therapist -- probably because cognitive-behavioural psychologists would like to be able to claim "objective" results. (Of course, these results are rated in a completely subjective fashion.)
> elizabeth, did you get SA as a result of having early onset depression?
No, I wouldn't say so. (I've always had some performance anxiety, though.)
> I reread this--I'm wrong I think. You can add TCAs to MAOs but not visa versa, right?
You can do either as long as you're careful. Starting with the TCA alone and then adding the MAOI is the preferred order.
> When's your pdoc home?
The important thing for me is not when he's home, but when he's back at the office. :-) (Middle of next week.)
> And how are you coping day to day?
Well enough.
> I see my pdoc tomorrow re sleep. Last night I upped the Neurontin from 300 to 500 and slept like a rock. Not sure this approach will last, who knows?
I've found that most sedating drugs stop working after a couple days, so that I need to increase the dose. Ambien is the one exception.
-elizabeth
Posted by shelliR on August 9, 2001, at 19:07:12
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 8, 2001, at 23:53:50
> Hi Lorraine, all
>>
> > > > > btw, did you read any of the thread about attachment? Do you know what I mean now?
>
> You shamed me into it.
I didn't mean to, just thought it was easier than me explaining again.>I think I understand. My kids always say "look at this", "watch this, Mommy", "come listen to my new guitar piece, Mom". It's like their life only comes fully alive when I am there to witness it. My husband is the same way. His idea of a great day is to do anything and have me watch him. These is something about this--validate me by letting me be the center of your universe. It is supposed to be (according to my therapist) very important for kids to get their fill of this. The other piece--which I have thought about a lot--is the drive toward symbiosis with another person. Symbiosis, the melding of two into one. I felt it the first time I breast fed my children. I was transported. Also--at least for me--the need to be fully known and loved. I get this stuff in other ways--not with my therapist. You see where the children come in, and symbiosis of sorts with my husband (there is something like patina that comes with time), and being fully known and loved by husband and dear friends. I think I understand what you are talking about. Do I sound on track?
>
Not really. Because some of the people writing in that thread and also many in my real life, have children, and I don't think the hole left from abuse and lack of protection/safety/mothering can be filled by parenting. It is the pain of something lost, really, developmental stages lost, and while children and spouse are very satisfying emotionally, (I hope), I think the other work is an inner work of griefing, etc. Actually I think it is best if it is worked out before motherhood, because an adult who still feels that emptiness/hurt might expect too much from her children--put too much pressure on them to "need" her. It may be that somewhere along the line, someone did mother you, or meet that need, or it may be something you worked out either with or without therapy.
> > Aside from feeling a bit depressed, I am feeling a bit down tonight (two different things for me).
> Sorry to hear this. I hope the Parnate kicks in soon.Today I had a migraine, hopefully not from the parnate. I didn't catch it early enough, like you said in a previous post, timing can matter. If I take advil, etc. at the first tiny sign, somethings that can avert the migraine. My migraines are fairly mild as far as migraines, but still annoying (pain behind my eye, sick in my stomach, but no vomiting or anything)
> > >
> > > > So you think 10mg of parnate is really making a huge difference?
>
> Bear in mind, I am almost always on puny doses of drugs. Moclobemide was 75 mg (the average dose, i think is 300 and above); Selegiline 5 mg; Wellbutrin 100 (drove me out of my skin). I understand that for most people Parnate is between 20 and 40 mg. I wouldn't be surprised if I end up here or 5 mg higher. I am biting my nails and cuticles again--an indication that I am probably a bit overstimulated. What can I say, I take small doses and I feel things quickly--Effexor took the longest for me to feel positive effects from.So are you saying "yes" ? < g >
>
>
< What's your titrating schedule? By the way, I'm seeing my pdoc on Friday and will ask him re sleeping.My pdoc wants me to go up other day by 5mg until I reach 30mg. He says he will be very happy if I can tolerate 30mg, but he doesn't have a ceiling. He's not worried about sleep; he thinks we can medicate that also. :-)
So tomorrow I will go up to 15mg and if I have another migraine I will probably go back down to 10mg for longer. He'll be away next week
later,
Shelli
Posted by Elizabeth on August 9, 2001, at 21:53:28
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 9, 2001, at 19:07:12
> Today I had a migraine, hopefully not from the parnate.
Some people do get headaches on MAOIs. Unfortunately, the triptans (which are serotonin agonists) can't be used safely with MAOIs.
A lot of the people I know who get migraines seem to have mood or anxiety disorders as well. I'm interested in the relationship, if there is one.
> My pdoc wants me to go up other day by 5mg until I reach 30mg. He says he will be very happy if I can tolerate 30mg, but he doesn't have a ceiling. He's not worried about sleep; he thinks we can medicate that also. :-)
If you have trouble tolerating meds, increasing it in increments of 5 mg is probably a good idea. It also might help to take it in divided doses to the extent that you're able.
I think he's right to be optimistic about the sleep thing. There's bound to be something that will work for you, and sedative-hypnotics are generally safe to take with MAOIs.
Best of luck to you, as always.
-elizabeth
Posted by Lorraine on August 10, 2001, at 0:21:33
In reply to Re: Update » Lorraine, posted by Elizabeth on August 9, 2001, at 16:42:05
> > > That still leaves room for a lot of diversity. "Depression" is a big umbrella.
Too broad an umbrella for drug selection efficacy, but not for CBT--which is how this group is oriented.
> > I may end up doing that and basically taking my whole dose in the am.
>
> That might be helpful, although once you are at steady state, it shouldn't make much difference at what times you take it.That should have been the case with Effexor also, but wasn't. I think sometimes there is more of a kick shortly after the drug is taken---although, honestly, if I took Effexor at 11 am I was fine with sleep at 3pm, I had difficulties.
>
> > >Some people are just sensitive to side effects without having any sort of metabolic quirk.Wouldn't you then expect that they would not reach a therapeutic dose before having side effects? You're right; it could just be sensitivity to side effects although low doses of some drugs, Effexor and Adderal, did work. I'll have to see what the break down is of drugs I've quit b/c of side effects and drugs I've abandoned b/c I could only achieve a partial response.
>
> > > Clicking is important especially if you need to be vulnerable to make progress, but my experience with CBT is that vulnerability and disclosure aren't as important and so "click" isn't either.
>
> Yes. I think that CBT tries too hard to take the "click" out of the picture -- to be uniform regardless of the personality of the therapist -- probably because cognitive-behavioural psychologists would like to be able to claim "objective" results. (Of course, these results are rated in a completely subjective fashion.)The CBT people I have seen act more like teachers than therapists.
>
> > elizabeth, did you get SA as a result of having early onset depression?
>
> No, I wouldn't say so.That's a stroke of luck, I'd say. The other kids didn't know about your depression and your depression didn't make you an odd duck socially? Good for you.
>
> I've found that most sedating drugs stop working after a couple days, so that I need to increase the dose. Ambien is the one exception.I'll keep that in mind. Thanx.
Lorraine
Posted by Lorraine on August 10, 2001, at 0:56:06
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 9, 2001, at 19:07:12
Hi Shelli:
> > You shamed me into it.
> I didn't mean to, just thought it was easier than me explaining again.You were right; it was an extensive thread. I was teasing about the shame.
>
> >I think I understand. My kids always say "look at this", "watch this, Mommy", "come listen to my new guitar piece, Mom". It's like their life only comes fully alive when I am there to witness it. My husband is the same way. His idea of a great day is to do anything and have me watch him. These is something about this--validate me by letting me be the center of your universe. It is supposed to be (according to my therapist) very important for kids to get their fill of this. The other piece--which I have thought about a lot--is the drive toward symbiosis with another person. Symbiosis, the melding of two into one. I felt it the first time I breast fed my children. I was transported. Also--at least for me--the need to be fully known and loved. I get this stuff in other ways--not with my therapist. You see where the children come in, and symbiosis of sorts with my husband (there is something like patina that comes with time), and being fully known and loved by husband and dear friends. I think I understand what you are talking about. Do I sound on track?
> >
> Not really. Because some of the people writing in that thread and also many in my real life, have children, and I don't think the hole left from abuse and lack of protection/safety/mothering can be filled by parenting.Fair enough. But what about the wanting to be at the center, wanting undiluted attention--not in a general way, but that thing that kids do "look at me"; Mommy listen to me.
> > >while children ... are very satisfying emotionally, (I hope), I think the other work is an inner work of griefing, etc.
My children forced me to do a lot of internal work in order to be a good mother---still when my youngest was turning 7 or so, I found that I had manuevered myself into a position of abandoning my children emotionally, the same way that I had been abandoned. Namely, my career was on such a hot track, that I was never home and didn't have time for them. I'm not sure I would have done the depth of work that I did without them because I would have been doing it for "me" and I'm not sure that would have been enough motivation for me. I really could not bear the thought of doing to them what had been done to me.
> > >Actually I think it is best if it is worked out before motherhood, because an adult who still feels that emptiness/hurt might expect too much from her children--put too much pressure on them to "need" her. It may be that somewhere along the line, someone did mother you, or meet that need, or it may be something you worked out either with or without therapy.
It's hard to say. I can't know your reality to know that difference. Certainly, it sounds like your abuse was more intense and deliberate than mine was. I know that I have always thought that I didn't really have a childhood. In fact, I didn't want to have children--they terrified me, plus I didn't understand "play" very well. I had my children to prevent my husband from leaving me. He desperately wanted children and would have left the relationship if I hadn't been willing to do this. Once I had my first child, everything change inside me. I used to say that it was like finding this remarkable sun roon in your house that you never knew was there. I don't know how much was hormone driven and how much was that I was so masculine in my career approach that I had blinders on the feminine. I'm glad I did it now, of course. It has given me an opportunity to build the family that I never had. I worry about the issue of enmeshment though also, it will be very hard on me when they leave home. I know that I have to start filling other pieces of my life so that there will not be so great a vacuum when they leave.
Ho, ho, shelli, here I am going on and on about the kids, well, you know that my mom and I have actually done some pretty intensive healing. she came to my therapy a couple of time and then I wrote her the letter that all mothers live in fear of receiving and read it to her. And, she, for whatever reason managed to stay with me toe-to-toe during this--it must have been very tough for her. And, then, my mother's abuse was neglect, which while not wonderful is much more forgivable than physical abuse. I do know that working through this stuff was pure he** though for me. Still, I may not have done the work without the kids pushing me from behind
> > > Today I had a migraine, hopefully not from the parnate.
Let's hope.
> > > > > So you think 10mg of parnate is really making a huge difference?
> >
>
> So are you saying "yes" ? < g >Yes.
> >
> < What's your titrating schedule? By the way, I'm seeing my pdoc on Friday and will ask him re sleeping.
>
> My pdoc wants me to go up other day by 5mg until I reach 30mg. He says he will be very happy if I can tolerate 30mg, but he doesn't have a ceiling. He's not worried about sleep; he thinks we can medicate that also. :-)Good. I have gotten a headache on this, but I think it is bruxism (teeth grinding) related--which is still med related.
>
> So tomorrow I will go up to 15mg and if I have another migraine I will probably go back down to 10mg for longer. He'll be away next weekWhat is with these guys and there vacations< vbg >?
Take careLorraine
Posted by Elizabeth on August 10, 2001, at 12:39:47
In reply to Re: Update » Elizabeth, posted by Lorraine on August 10, 2001, at 0:21:33
> > That still leaves room for a lot of diversity. "Depression" is a big umbrella.
>
> Too broad an umbrella for drug selection efficacy, but not for CBT--which is how this group is oriented.So it's a self-help CBT group as well as a support group? That's cool. There's a similar group (SMART Recovery) aimed specifically at addictions.
(I remain unconvinced that CBT has any specific effect in depression.)
> > That might be helpful, although once you are at steady state, it shouldn't make much difference at what times you take it.
>
> That should have been the case with Effexor also, but wasn't.Immediate release or XR? The immediate-release formulation can cause quite a roller coaster. Before Effexor XR was available, I remember a lot of people complaining about that.
> >Some people are just sensitive to side effects without having any sort of metabolic quirk.
>
> Wouldn't you then expect that they would not reach a therapeutic dose before having side effects?There's a good chance of that. It's just been my experience that there is wide variability in people's ability to tolerate side effects. And of course, some people are more bothered by particular side effects than others; some are more willing to wait if they believe the side effects will subside with time; etc.
> You're right; it could just be sensitivity to side effects although low doses of some drugs, Effexor and Adderal, did work.
Can you tell me more about what Effexor and Adderall did, and what doses you were on? The effective ranges for both these drugs are quite variable.
> I'll have to see what the break down is of drugs I've quit b/c of side effects and drugs I've abandoned b/c I could only achieve a partial response.
I'd be interested to see the results. :-)
> The CBT people I have seen act more like teachers than therapists.
Yes, exactly. They want to take the human element out of therapy because they're concerned with being "objective" and "scientific." But my experience has been that the human element is the most important (perhaps the *only* important) aspect of talk therapy.
> > > elizabeth, did you get SA as a result of having early onset depression?
> >
> > No, I wouldn't say so.
>
> That's a stroke of luck, I'd say. The other kids didn't know about your depression and your depression didn't make you an odd duck socially?I was an odd duck for other reasons -- I was labelled "highly gifted" when I was very young, I was reading long before most people my age, etc. I did have some social troubles when I was 10 or 11 (that was the time that I think I was depressed but didn't see a doctor or anything for it). I wasn't very interested in hanging out with other kids, so I became very isolated. Mostly I tried to immerse myself in school work as a form of distraction or sublimation.
About pdocs taking vacations: for unknown reasons, a large percentage of pdocs take a big vacation in August. I think they must all be holing up in a hotel in Paris or some kind of psychiatrists-only resort or something. :-)
Klonopin is usually effective for treating antidepressant-induced bruxism, I think. It also might help you sleep.
-elizabeth
Posted by shelliR on August 10, 2001, at 23:01:56
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 10, 2001, at 0:56:06
Hi Lorraine, etc.
.............
> Fair enough. But what about the wanting to be at the center, wanting undiluted attention--not in a general way, but that thing that kids do "look at me"; Mommy listen to me.I think obviously that is a very "filling " experience, and yes, you do get to be the center of someone's universe. So, I'm not debating how connected and "attached" that makes you feel. I just know many moms who are very connected to their kids (and husbands) still have the experience of an almost desperate attachment to their therapist, if they were abused as children. There are actually people who attend the day hospital (where I was inpatient) when their therapist goes on a vacation. So I'm not convinced that being connected to your children touches the same needs.
Having not been in a relationship for a while, I do (sometimes) miss being the center for someone else. I think it is a good balance, having that, in negotiating your way in the world. Like when something comes, even little things like car repairs, I miss not being able to say "what are we going to do this?" Luckily I have a close close friend who can be there for me, even though he is married, but not in the same way as before he got re-married, two years ago. I don't know a lot of people with good marriages. I would not trade my life for the life of some very close friends with only partially satisfying marriages, although even that relationship does add to a feeling of security in life. A very bad marriage probably doesn't. I think a good marriage is a treasure, and it is wonderful that you have one; especially such a long one.
>
> My children forced me to do a lot of internal work in order to be a good mother---still when my youngest was turning 7 or so, I found that I had manuevered myself into a position of abandoning my children emotionally, the same way that I had been abandoned. Namely, my career was on such a hot track, that I was never home and didn't have time for them. I'm not sure I would have done the depth of work that I did without them because I would have been doing it for "me" and I'm not sure that would have been enough motivation for me. I really could not bear the thought of doing to them what had been done to me.I understand that. In terms of myself, however, my creative urges really have to be played out. I have to be totally self absorbed for part of my work, and interestly, for the other part I must be totally without ego. I'll send you my website address, so I won't sound so mysterious. I'm not Van Gogh! I might have been able to give that up when I was younger, but now that would be impossible, I would not be happy. I *have* to be creating something. So maybe it is good that I am not a mom, although it was not especially by choice. I have some shame issues about that; interestingly it brings up shame, rather than loneliness for me.
>>. Once I had my first child, everything change inside me. I used to say that it was like finding this remarkable sun roon in your house that you never knew was there.
That's a really beautiful description, and again you are very lucky to have discovered that part of you because you love it so.
Back to meds: I have had a totally awful last two days, depression and very bad migraines. I have totally drugged myself up; I'm scared about that, but I can't take most of the impressive migrane remedies because of the parnate. I think it is definitely hormonal; it feels like I'm am having pms time all the time. I saw my gyn (of course on a really good day), and we both thought I should wait to add estrogen until I saw the effects of the parnate. Today I am not at all sure, and may decide to add the estrogen again and can only stop if/when the parnate takes effect. I have to remember it was a full five weeks until I felt any anti-depressant effects from nardil. Luckily, because it gave me very few side effects *and* because I had read a book saying that MAOIs may take up to six weeks, I hung in there. It was not a gradual thing; when it kicked in it was just all different for me.
Posted by shelliR on August 10, 2001, at 23:22:49
In reply to Re: Update » shelliR, posted by Elizabeth on August 9, 2001, at 21:53:28
Hi Elizabeth
> > Today I had a migraine, hopefully not from the parnate.
>
> Some people do get headaches on MAOIs. Unfortunately, the triptans (which are serotonin agonists) can't be used safely with MAOIs.
> A lot of the people I know who get migraines seem to have mood or anxiety disorders as well. I'm interested in the relationship, if there is one.
>This migraine thing is a totally new thing for me in the past year and a half. I'm positive that it's related to hormones; first it started premenstually, and now my hormones are so out of wack that it is happening much more frequently. So I don't really think it has to do with parnate, unless it is being exacerbated by it. The last two days, depression and migraine-wise, have been hellish.
FYI, many people with DID have migraines from switching, especially between parts that sap their energy. Outside of the hospital, the people who I know who get migraines do not have mood disorders (of course very small population.)
>
I posed a question to either you or Cam on the thread about parnate about a possible consequence of taking opiates on ADs, specifically parnate in my case. I think I'm being blackballed by Cam perhaps because of some (I thought) minor disagreements or some other reason I am not aware of. Could you address this question, do you have any ideas about this? I'm just wondering why a pdoc once said that to me. And now that I am becoming worried about it, my pdoc is gone for a week.BTW, in this area, not just shrinks, but almost everyone with kids takes their vacation in August. Schools are out *and* the camp sessions have ended.
> Best of luck to you, as always.
DitttoShelli
Posted by Elizabeth on August 11, 2001, at 0:02:00
In reply to Re: Update » Elizabeth, posted by shelliR on August 10, 2001, at 23:22:49
> This migraine thing is a totally new thing for me in the past year and a half. I'm positive that it's related to hormones; first it started premenstually, and now my hormones are so out of wack that it is happening much more frequently. So I don't really think it has to do with parnate, unless it is being exacerbated by it. The last two days, depression and migraine-wise, have been hellish.
MAOIs do have cardiovascular effects, and they've actually been used in the treatment of migraine. In some situations they could exacerbate it, though.
> FYI, many people with DID have migraines from switching, especially between parts that sap their energy.
Huh. What do you mean by "parts that sap their energy?"
> I posed a question to either you or Cam on the thread about parnate about a possible consequence of taking opiates on ADs, specifically parnate in my case. I think I'm being blackballed by Cam perhaps because of some (I thought) minor disagreements or some other reason I am not aware of. Could you address this question, do you have any ideas about this? I'm just wondering why a pdoc once said that to me. And now that I am becoming worried about it, my pdoc is gone for a week.
I'd be glad to answer, if I recalled what the question was!
> > Best of luck to you, as always.
> Dittto
:-)-elizabeth
Posted by Lorraine on August 11, 2001, at 1:34:14
In reply to Re: Update » Lorraine, posted by Elizabeth on August 10, 2001, at 12:39:47
> > > So it's a self-help CBT group as well as a support group? That's cool. There's a similar group (SMART Recovery) aimed specifically at addictions.
Mainly, a CBT type group.
>
> (I remain unconvinced that CBT has any specific effect in depression.)Have you tried it? I do think that there are the physical and the mental aspects. Now, when physical is the only issue, I wouldn't expect it to be of too much help. But lots of times, both mental and physical is involved.
>
> Immediate release or XR? The immediate-release formulation can cause quite a roller coaster. Before Effexor XR was available, I remember a lot of people complaining about that.Immediate Release, it is.
>
> > >Some people are just sensitive to side effects without having any sort of metabolic quirk.Turns out there are people who are insensitive to side effects also--that might be you?
>
> Can you tell me more about what Effexor and Adderall did, and what doses you were on? The effective ranges for both these drugs are quite variable.Effexor--I was at 150 XR. It seemed to completely control my depression. I was very active and really had good mood control, although in retrospect I was a bit too tranquil. The Adderal was in conjunction with Selegiline (Adderal 7.5 mg 2x day; Selegiline 2.5 2x day; Neurontin 300 3x day). During washout it was 10 mg of Adderal 2x day with the Neurontin. And, remarkably that held the course pretty steady, although I felt a bit speedy and had trouble sleeping.
> I'd be interested to see the results. :-)Actually, I'm doing a retrospective mood chart (like the one the NIMH uses) as a project right now. Just finished reviewing my files. If you are interested in the final result (which include my own cool chart in Word Format), Id be willing to share. O/w I will let you know what the results of the side effect/ partial response survey is.
>
> > The CBT people I have seen act more like teachers than therapists.
>
> Yes, exactly. They want to take the human element out of therapy because they're concerned with being "objective" and "scientific." But my experience has been that the human element is the most important (perhaps the *only* important) aspect of talk therapy.Oh. Well, I've found some of my most useful therapy in CBT. I've also found regular talk therapy useful. I think it depends on what you are trying to address.
> > > I was an odd duck for other reasons -- I was labelled "highly gifted" when I was very young, I was reading long before most people my age, etc. I did have some social troubles when I was 10 or 11 (that was the time that I think I was depressed but didn't see a doctor or anything for it). I wasn't very interested in hanging out with other kids, so I became very isolated. Mostly I tried to immerse myself in school work as a form of distraction or sublimation.It's one thing to not be interested in hanging out with the other kids; it's another to not fit in and hunger for it. I was the latter. It sounds like you were the former. That is a stroke of luck--genetic luck--to have found been inner directed rather than outer directed. That's great.
> > > About pdocs taking vacations: for unknown reasons, a large percentage of pdocs take a big vacation in August. I think they must all be holing up in a hotel in Paris or some kind of psychiatrists-only resort or something. :-)No, all the investment brokers take off in August and the therapists are forced to go on holiday out of boredom;-)
>
> Klonopin is usually effective for treating antidepressant-induced bruxism, I think. It also might help you sleep.Thanks, it's on my list.
Lorraine
Posted by Lorraine on August 11, 2001, at 2:02:50
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 10, 2001, at 23:01:56
Hi Shelli, elizabeth.
> > Fair enough. But what about the wanting to be at the center, wanting undiluted attention--not in a general way, but that thing that kids do "look at me"; Mommy listen to me.
I wasn't saying this from the mother's perspective; I meant from the child's perspective--that perhaps that's one of the things the therapists hour helps fill--this unmet need from childhood. And, of course, you're right that being the mother in this situation does not fill that void (not at all).
> > >So, I'm not debating how connected and "attached" that makes you feel.hmmm. The kids make me feel attached and connected, but, I think it's because I have always wanted a chance to be part of a family that is healthy. Shelli, it probably comes back to your point that I had already done my healing before I was able to truly connect with them in this way.
And, by the way, I wanted to be in the center as well (even though I had terrible SA)--my center was the center of success in the business world, maybe this was safer for me. I suspect that people can be similarly wounded and look to heal those wounds differently.
> > >I don't know a lot of people with good marriages.Isn't that the truth?
> > >I would not trade my life for the life of some very close friends with only partially satisfying marriages, although even that relationship does add to a feeling of security in life.
I agree.
> > >I think a good marriage is a treasure, and it is wonderful that you have one; especially such a long one.
I feel pretty lucky here. Although you know, it's like any other relationship, they all require work, tune-ups and so forth. My husband and I have gone in and out of therapy about every 5 years. People change and patterns that work for the old relationship start to fail. So we go back in to reconnect.
> > > I understand that. In terms of myself, however, my creative urges really have to be played out. I have to be totally self absorbed for part of my work, and interestly, for the other part I must be totally without ego. I'll send you my website address, so I won't sound so mysterious. I'm not Van Gogh! I might have been able to give that up when I was younger, but now that would be impossible, I would not be happy. I *have* to be creating something. So maybe it is good that I am not a mom, although it was not especially by choice. I have some shame issues about that; interestingly it brings up shame, rather than loneliness for me.
I think it's great that you have a creative outlet. It sounds wonderful. I'm glad you are able to fully explore this part of you. There is a certain focus required. It's interesting that you have shame issues surrounding this, yes. Shelli, it would be a pretty boring world if we all chose the same path. The key is to do what fits for you and it sounds like you are doing this beautifully. I'm afraid that I have sounded a bit like a poster child for motherhood. Yikes!
> > > Back to meds: I have had a totally awful last two days, depression and very bad migraines.I'm so sorry to hear this.
> > >I think it is definitely hormonal; it feels like I'm am having pms time all the time. I saw my gyn (of course on a really good day), and we both thought I should wait to add estrogen until I saw the effects of the parnate.
Does she think estrogen is the right course for hormonally related PMS? I had thought it was Progesterone for that.
> > >Today I am not at all sure, and may decide to add the estrogen again and can only stop if/when the parnate takes effect.
You can always simplify later.
> > > I have to remember it was a full five weeks until I felt any anti-depressant effects from nardil.
I have read that Parnate is quicker than Nardil in it's effects. Let's hope so.
My pdoc, by the way, decided that I should stay the course at 10 mg/day and try to take the full dose in the morning--augmenting with 2.5 mg of Adderal in the afternoon if necessary. He thinks for sleep, I should just bump up the Neurontin.
I hope things start turning up for you soon.
Lorraine
Posted by Lorraine on August 11, 2001, at 2:07:25
In reply to Re: Update » Elizabeth, posted by shelliR on August 10, 2001, at 23:22:49
Shelli; elizabeth
I asked my pdoc about drug interactions to be careful of with Parnate. He said the major ones were Demmeral and morphene. Are opiates morphene? Also, he could be wrong-he said it casually and for me it wasn't an issue.
Shelli--I thought your comment to Cam was actually a good one. It made me rethink things a bit.
Posted by Elizabeth on August 11, 2001, at 13:06:14
In reply to Re: Update » Elizabeth, posted by Lorraine on August 11, 2001, at 1:34:14
(re Recovery Inc.)
> Mainly, a CBT type group.But it's a self-help group, there isn't a psychologist or anyone like that involved?
> > (I remain unconvinced that CBT has any specific effect in depression.)
>
> Have you tried it?Yes; I was very into it for a while. I was convinced by the research that it was superior to other types of psychotherapy and that I needed to try it. And maybe it was a good idea to try, but in the end it didn't do much good for my depression. I did learn some tricks that have helped a lot with the panic attacks. I was first dx'ed with panic disorder by the psychologist I was seeing for CBT, and just knowing what it was helped a lot; I also learned some relaxation techniques. So I can't say it was completely useless. :-)
> I do think that there are the physical and the mental aspects. Now, when physical is the only issue, I wouldn't expect it to be of too much help. But lots of times, both mental and physical is involved.
What do you mean by all this? It's a little confusing to me.
> Turns out there are people who are insensitive to side effects also--that might be you?
Not especially. I notice them, but I tolerate them. It's just stoicism, nothing more.
> Effexor--I was at 150 XR. It seemed to completely control my depression.
150 is a reasonable dose, not unusually low. Why did you stop taking it?
> The Adderal was in conjunction with Selegiline (Adderal 7.5 mg 2x day; Selegiline 2.5 2x day; Neurontin 300 3x day).
Again, 15 mg/day isn't that unusual a dose of Adderall for an adult, especially with all the other stuff you were using.
> Actually, I'm doing a retrospective mood chart (like the one the NIMH uses) as a project right now. Just finished reviewing my files. If you are interested in the final result (which include my own cool chart in Word Format), Id be willing to share. O/w I will let you know what the results of the side effect/ partial response survey is.
Except for the Word part, I'd like to see that, although charting retrospectively isn't ideal. (I've seen too many viruses that are transmitted through Word to be willing to open a .doc attachment. < g >)
> Oh. Well, I've found some of my most useful therapy in CBT. I've also found regular talk therapy useful. I think it depends on what you are trying to address.
That's probably true. As I mentioned, I found some of the things I learned in CBT helpful for panic disorder.
> It's one thing to not be interested in hanging out with the other kids; it's another to not fit in and hunger for it. I was the latter. It sounds like you were the former.
Not generally, but when I was depressed I was. I usually (when not depressed) come out right in the middle when I take those tests that are supposed to rate how extroverted or introverted you are. I have friends, I like to party and so forth, but I also need quite a lot of time to myself, and a lot of my interests and hobbies are pretty solitary.
> That is a stroke of luck--genetic luck--to have found been inner directed rather than outer directed. That's great.
How so?
> No, all the investment brokers take off in August and the therapists are forced to go on holiday out of boredom;-)
< G > (I thought a joke like that needed to be made there!)
> > Klonopin is usually effective for treating antidepressant-induced bruxism, I think. It also might help you sleep.
>
> Thanks, it's on my list.Benzos, Klonopin in particular, seem to be good for a variety of sleep disorders. I take Klonopin for RBD, and it works great.
You and Shelli both agreed that there don't seem to be many successful marriages. I've been seeing that a lot. Seeing the effect that divorce has on children has made me more appreciative of my own parents, who've been together for 27 years.
[re rapid onset of effects]
Parnate has a stimulant-like action that you may notice very shortly after starting it. I think that this should be looked into further; it might be the reason why some people have spontaneous episodes of hypertension on Parnate.> I asked my pdoc about drug interactions to be careful of with Parnate. He said the major ones were Demmeral and morphene.
Demerol yes, morphine no. Morphine (the main active constituent of opium) is the treatment of choice if a person on MAOIs needs opioids for moderate-severe pain. I've taken morphine with Parnate a couple of times, as well as codeine and hydrocodone. As Shelli's experience demonstrates, oxycodone (which is comparable to morphine in its efficacy but has much better oral bioavailability) is also safe. Demerol and Ultram are the only ones that I know of that are unsafe; you might be cautious of other synthetic ones, like Darvon. The natural (codeine, morphine) and semisynthetic (oxycodone, hydrocodone, oxymorphone (NuMorphan), hydromorphone (Dilaudid), and of course heroin) ones are all okay, as is buprenorphine. I think methadone is too. I'm not sure about Stadol, Talwin, or Nubain. I think that covers most of them. :-)
-elizabeth
Posted by shelliR on August 11, 2001, at 18:48:59
In reply to Re: Update » shelliR, posted by Elizabeth on August 11, 2001, at 0:02:00
> > FYI, many people with DID have migraines from switching, especially between parts that sap their energy.
> Huh. What do you mean by "parts that sap their energy?"I had seen people (in the hospital) who have had very angry parts (alters). One woman had to work with a certain alter because she was not co-conscious with the alter and the alter was putting her life in danger. This was a very interesting case because the woman was very very conservative, but the alter was a lesbian. So she felt very humiliated when she talked about it in group therapy. She had been sexually abused by her mother, so probably this alter developed out of those experiences. Her primary "self" was a straight wife/mother. Anyway negotiations had to take place about safety. Every time this alter came out she was enraged (about something, I don't know the gritty details) and the woman always came "to" with a horrible migraine. Lucky for her, she was not on an MAOI, so she was given a shot for migraines and it did work for her.
And actually I have seen variations of this-- that the alters who are angry when out take a toll on the body. In my case when alters are out I do not feel possessed, but in cases where extremely angry alters are out, the main personaity can feel in her body that something has happened, and it sort of is like a possession in a way.
> > > Best of luck to you, as always.
> > Dittto
> :-)
:-)
Shelli
Posted by shelliR on August 11, 2001, at 19:42:11
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 11, 2001, at 2:02:50
Hi Lorraine.
> > > Fair enough. But what about the wanting to be at the center, wanting undiluted attention--not in a general way, but that thing that kids do "look at me"; Mommy listen to me.
>
> I wasn't saying this from the mother's perspective; I meant from the child's perspective--that perhaps that's one of the things the therapists hour helps fill--this unmet need from childhood. And, of course, you're right that being the mother in this situation does not fill that void (not at all).yes, I understand now. Every child does need that from someone, I think best senario from the mother. And you are the mother . :-)
>
>
> And, by the way, I wanted to be in the center as well (even though I had terrible SA)--my center was the center of success in the business world, maybe this was safer for me. I suspect that people can be similarly wounded and look to heal those wounds differently.
>
> > > > I understand that. In terms of myself, however, my creative urges really have to be played out. I have to be totally self absorbed for part of my work, and interestly, for the other part I must be totally without ego. I'll send you my website address, so I won't sound so mysterious. I'm not Van Gogh! I might have been able to give that up when I was younger, but now that would be impossible, I would not be happy. I *have* to be creating something. So maybe it is good that I am not a mom, although it was not especially by choice. I have some shame issues about that; interestingly it brings up shame, rather than loneliness for me.
>
> I think it's great that you have a creative outlet. It sounds wonderful. I'm glad you are able to fully explore this part of you. There is a certain focus required.I thought you had your e-mail listed but I don't see it. If you want just create a temp e-mail and I'll send you the url for my website. I am one of about three or four people who are well known and highly respected for this type of work in the fairly large area that is my client base. In an area of mostly attorneys, government, journalists, research (NIH), consulting, I get to be the one of the best of a few people who are well known with my style. So I guess that is the way that I kind of get to be in the center; although I had no idea that it was going to happen that way. It was a gift that came out of much turmoil in my life. I was unable to work. I had planned to become a clinical psychologist, but wasn't together enough (I knew that, but even so got a masters), so this came out of going back to take a couple of art classes at my therapist's insistance at the time that I create some structure in my life. I now have absolutely no desire to be a therapist.
> It's interesting that you have shame issues surrounding this, yes. Shelli, it would be a pretty boring world if we all chose the >same path. The key is to do what fits for you and it sounds like you are doing this beautifully. I'm afraid that I have >sounded a bit like a poster child for motherhood. Yikes!
>
Well maybe I'd feel less shame if I had *chosen* not to have children. Anyway, my therapist and I do work on that shame part, under the category of "shame of my earlier adulthood" ,different from "childhood shame" :-)
> > > >I think it is definitely hormonal; it feels like I'm am having pms time all the time. I saw my gyn (of course on a really good day), and we both thought I should wait to add estrogen until I saw the effects of the parnate.
>
> Does she think estrogen is the right course for hormonally related PMS? I had thought it was Progesterone for that.Well, it has a perimenopausal element to it; it's all very confusing to me. Today I got my period for the second time in three weeks, so that's why this has been such a hard time. This is the third day I've felt really sick, although for most of today I was okay, fell asleep and then woke up very sick in my stomach again, but at least without the migraine. I should be through this tomorrow and it probably would have helped if I had taken natural progesterone, but I didn't even realize why I felt so bad until I started spotting.
>
> > > > I have to remember it was a full five weeks until I felt any anti-depressant effects from nardil.
>
> I have read that Parnate is quicker than Nardil in it's effects. Let's hope so.
I do hope so but remembering the nardil experience helps me hang in there without any disappointmnet day to day. Plus the absence of any side effects (I think) doesn't hurt either. If I wasn't going through this woman stuff, I could easily wait for the parnate to kick in because the oxy gets me through. Today, I had no depression; it was all physical bad stuff.
>
> My pdoc, by the way, decided that I should stay the course at 10 mg/day and try to take the full dose in the morning--augmenting with 2.5 mg of Adderal in the afternoon if necessary. He thinks for sleep, I should just bump up the Neurontin.
>You sound like you have a really good doctor; I can't remember why you were thinking of changing.
> I hope things start turning up for you soon.
Moi aussi.Shelli
Posted by shelliR on August 11, 2001, at 19:57:12
In reply to Re: Update » shelliR, posted by Lorraine on August 11, 2001, at 2:07:25
Lorraine...
>
> I asked my pdoc about drug interactions to be careful of with Parnate. He said the major ones were Demmeral and morphene. Are opiates morphene? Also, he could be wrong-he said it casually and for me it wasn't an issue.Well I wasn't worried about oxycontin and parnate in terms of hypertension. I was more focusing on if the oxy could stop the parnate from full effectivenss. Obviously my pdoc didn't think so, but I don't know what the other pdoc guy meant.
>
> Shelli--I thought your comment to Cam was actually a good one. It made me rethink things a bit.I don't understand this. Do you mean about the poster that he was angry at? I sort of wanted to address this issue (lack of response when directly asked ), but I didn't want to say it in that thread or on the admin board, because the last thing I wanted was people riled up on sides! I would have emailed him if I had his address, just to ask. Because it is pretty bad, I think, not to answer a person's technical question because of prior bad feeling or just not liking someone. And I could tell it was not an oversight because questions to him were addressed both above and below my post. But whatever. I am less upset today and can wait a week until my pdoc returns.
What did my comment make you rethink?
Shelli
Posted by shelliR on August 12, 2001, at 0:40:10
In reply to Stuff » shelliR, posted by Elizabeth on August 11, 2001, at 22:20:43
> Hi Shelli. I get what you mean now about energy-sapping alters -- thanks. I'm really learning some useful things about dissociative disorders from you, I think.
>
I'm glad; it's a topic I know a lot about, unlike uh medical stuff. :-)
> [re migraines]
> If Imitrex and the other -triptans are contraindicated (e.g., if the patient is on a MAOI), morphine or Dilaudid or somesuch can always be used (just not Demerol). Of course, doctors hate to prescribe or dispense those drugs, especially injectable formulations, so many people who take MAOIs and who get migraines probably are undertreated (or just plain untreated).
>
well, I just have been loading myself with various and sundry synthetic codeine and it works for the migraine, but then I may be jeopardizing the anti-depressant effects by building up a tolerance. It doesn't seem like that yet, though. When I load up on it because of a migraine, if I don't have a migraine the next day I'm able to go back to my regular dose.> [re your career history:]
> > ... I was unable to work. I had planned to become a clinical psychologist, but wasn't together enough (I knew that, but even so got a masters), so this came out of going back to take a couple of art classes at my therapist's insistance at the time that I create some structure in my life. I now have absolutely no desire to be a therapist.
> Grad school is tough, probably even in psychology. :-) I didn't even make it through a trimester (I was briefly a math grad student; this was when I was on Nardil for the second time, and just like the first time, it pooped out on me).:-) As far as grad school in psychology, most of all I really loved my course on methodology. I think everyone should be required to take a methodology course, no matter what field they are in. It makes you a more educated reader of any study. One of my most fun research jobs was to write the methodology instrument used for evaluating results of studies funded by congress on crime and the environment. Evaluating the studies was a joke, because right off there was no control group in most of the studies. These studies were a total waste of money. One of my neighbors has a great position at a local university. She teaches one class a semester and all the rest of the time she gets to do her own research. Criminology is a good field to go into because congress always throws a lot of money into "fighting crime".
>> I love this idea that some therapists seem to have that your life will be fine if only you get some "structure," which usually means either (1)getting a job that you're way overqualified for, on the grounds that it will be easy for you -- which isn't necessarily true -- and that it's a "stepping stone" to getting where you want to be, or (2) getting involved in a day treatment or partial program (intensive group therapy). I think that in option (1) the job is usually something that's so ill-suited to the individual that s/he just can't do it (and his/her self-esteem is lowered even more over being unable to do a theoretically "easy" job), and option (2) just further isolates a person further from the real/normal/sane world (okay, maybe "sane" is a bit much < g >).
Yes, I totally agree with your analysis of options (1) and (2) and I would add regarding option (1) that one can still experience horrible boredom even when one is depressed, another major problem with that option. Boredom is worse than anything for me. Now there could be option (3) however: just going to a non-career oriented class--one of the arts, or yoga, whatever. (maybe for you, math) < vbg >
In defense of my therapist (who was about three therapists ago), I didn't ever get the impression that she thought my life would be fine if I got some structure, but I do think if you can find the right structure, it is a healthier way to go, rather than hang out at home everyday by yourself. And it doesn't have to be like all day, every day. Just sort of someway to know it's Tuesday instead of Thursday. Also I was living alone, so I really did need to get out and communicate in some way. I had no idea that it would turn out to have everything to do with my future profession. Taking art classes at a community college was perfect for me. There were your basic 18 year olds, but there were also your senior citizens, and your emotionally disabled, because classes are free for the later categories. It turned out to be a really comfortable place for me to hang out, and my evening class (drawing) was mostly working people, so taking one day class and one evening class was good. But it was good because I wasn't trying to tie it in to career at all, just trying to have a relaxing class with no homework. Some of the design and color classes had tons of homework, so I never took any of them.
> I have a question for you: in your last post, the one directed to Lorraine, you referred to some dispute in a different thread. Could you point me toward the posts in question (the ones where you had the dispute)? Just curious.
no dispute, just a difference of opinion (and one of several over the last year): starts with http://www.dr-bob.org/babble/20010725/msgs/72674.html. But I'm not sure that Lorraine even meant that, and I definitely feel strange talking about someone instead of to them. If there was any way that I could have said it to the person involved without everyones else's .02, and the possibility of a heated battle, that would have been the decent thing to do. I just I feel like I can say anything on this thread because I would assume that most people, even those who started reading it, would have given up following it out of confusion, boredom, whatever. < g >
Wow, 1:36 am est!
Goodnight.....................................
Shelli
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