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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 82 to 106 of 488. Go back in thread:
Posted by sid on January 30, 2002, at 23:56:59
In reply to Re: assumptions « elizabeth, posted by Dr. Bob on January 30, 2002, at 18:59:24
> > It is possible for people who are in talk therapy to recognize why it may not be working for them (often, as has been mentioned, because they're just too depressed) and decide to pursue other forms of talk therapy (e.g., psychodynamic psychotherapy instead of CBT) or that talk therapy in general isn't likely to help them (or that they need to wait until they're less depressed, for example). In contrast, we can't see what's going on in our brains at the molecular level, so we don't have a way of evaluating what medication is most likely to yield success, or whether medication is likely to help at all. I hope this illustrates why people feel justified in making a decision to pursue psychotherapy or not but can't be certain that medications will or will not work for them without trying them (it's a mixed blessing that there are so many of them to try these days). I also think there are things that we don't understand about how talk therapy works (although in this regard CBT is probably the most simplistic type of talk therapy), so it's not necessarily a good idea to rule it out altogether.
Well, we agree then. I was under the impression that you were against therapy after reading a few comments you wrote. We still know little about therapy (its effect on depression and why or how it might have an effect) and about meds and other alternatives as well. Depression itself is not well well yet. I guess I was so traumatized by my major depression that I am doing all I can not to have it again. I used therapy (CBT + other unidentified types - if it made me progress, I did not worry about what exactly it was) and acupuncture at that time. Both helped me and now meds seem to work too (for dysthymia), so in my experience, having tried different approaches to heal was a good thing. So when I read comments that seem to rule out some approaches altogether (not saying you did), I feel the need to say that many things did help me and that perhaps one should consider different things in order to maximize the probability of healing.I realize I was lucky that it all had some positive effect. Although I went through a number of therapist because it did not work with some of them (one especially). Finding the right person and the right approach for oneself can be long and costly however. Same thing with the acupuncture. I moved away and have not found another acupuncturist that could treat me the same way. The first one I had made a difference in my major depression, and she could help with what I now know is anxiety. Whenever I was too stressed out to function well, her treatments would help tremendously. But I am still looking for another acupuncturist in my new city. That's one advantage of the drugs: Effexor XR anywhere is the same. Other approaches vary greatly because of the human contact and the ability of the service provider, and so they are difficult to assess and compare with drugs or with each other.
> > > So I decided to try meds for the residual depression. As it turns out, it seems I have an anxiety disorder, and my doc is not convinced that I still have depression.
> >
> > What sort of residual symptoms do you have? Residual depression is by its nature hard to treat, since it's the part of the disorder that doesn't improve with the treatment being utilized. I think that it often requires some creativity to treat residual symptoms.Well, I'm not up to date in my depression vocabulary. I've had dysthymia for 21 years, and that's what I think I still have. I have no symptoms of major depression anymore, but there remained a deep sadness in me that I could not explain. During my major depression I read about the different types of depression and realized I had had dysthymia for a long time. In my case, therapy and acupuncture did not cure the dysthymia. Now meds seem to be helping, even though I am not yet at a supposedly effective dose (75mg Effexor XR a day). I don't feel sad anymore and a specific irrational negative attitude (thought and feeling, strong reaction) I've had for a long time have decreased in the past 2 months. So it seems the meds are helping already. The info I've read on effective doses of Effexor XR were for major depression, so for dysthymia perhaps it takes less? I am not sure. My doc also diagnosed my me some anxiety problem, hence her choice of Effexor. I am not sure what the exact diagnostic would be, but indeed, I freak out more often than most people, sometimes about nothing. I did not know about the anxiety before. I am taking yoga too now to help with it, and as a long run investment for the future stressful times of my life.
I've had dysthymia for so long that I am not sure if I can ever heal from it, but I hope so and I am doing all I can to be mentally healthy some day, hopefully without meds, but with them if need be. Plus I want to do all in my power to avoid recurrent major episodes because I am not sure I could live through it again. I am not sure I would want to either. My desire to live is conditional on my metal health at this point. I can't imagine living the never ending lightless pit that depression felt like.
> > > I did a test the other day and ranked very very low for depression and high for anxiety.
> >
> > Which test was it? IME, the results of self-report rating scale tests can be misleading. Self-report is important, but it's only one tool in making a diagnosis. Sometimes people's answers on these tests can be misleading. For example, I've noticed that some people with dysthymia seem to exaggerate the severity of their depression. (This is understandable, since dysthymia is chronic.) A problem I sometimes have in trying to answer questions on diagnostic questionnaires is that I tend to take the questions on these tests more literally than they probably were intended to be taken.
It was an informal test on www.brainplace.com., nothing formal. It pointed out which parts of my brain could be problematic and what it means in term of illness or disorder. I ranked "may be possible" for limbic system hyperactivity (associated with depression) and "probable" for basal ganglia hyperactivity (associated with anxiety disorders). All other categories were rated "not probable." I realize it is not a comprehensive test, but it is in line with how I feel these days.I wish I had taken meds before as I think my major depression would have cleared faster and I would possibly have lessened the likelihood of recurrence. But I made the choice not to take meds at the time because I was too scared of them. I looked for more info since then, and I decided to try them for the dysthymia.
Posted by Elizabeth on February 1, 2002, at 18:41:55
In reply to Re: depression, etc. « elizabeth, posted by sid on January 30, 2002, at 23:56:59
> Well, we agree then. I was under the impression that you were against therapy after reading a few comments you wrote.
I'm not terribly impressed with it (CBT in particular), but I don't think that it's bad or useless.
> We still know little about therapy (its effect on depression and why or how it might have an effect) and about meds and other alternatives as well.
I think that CBT makes implicit assumptions about why people get depressed, or have panic attacks, or whatever. (It's unfashionable for therapists to admit this, of course; they claim to be interested only in fixing the problem, not in knowing the cause.) And I don't think that these assumptions apply to everybody.
> I guess I was so traumatized by my major depression that I am doing all I can not to have it again.
Believe me, I'm doing everything I can, too -- but that doesn't mean I continue to do things that are ineffective! (If what you're doing isn't working, find something else -- you learned that in CBT, right? :-) )
> So when I read comments that seem to rule out some approaches altogether (not saying you did), I feel the need to say that many things did help me and that perhaps one should consider different things in order to maximize the probability of healing.
That's reasonable, although I'm wondering what you read that seemed to rule out certain approaches. I remember people posting things that they found harmful or unhelpful about CBT, but I don't recall anyone saying that it's not even worth trying.
> Although I went through a number of therapist because it did not work with some of them (one especially).
Heh. :-) I think that finding a therapist who's a good match is essential to any kind of talk therapy. It's important to be able to work with a medical doctor, too, but you really have to "click" with a therapist, IMO.
> Other approaches vary greatly because of the human contact and the ability of the service provider, and so they are difficult to assess and compare with drugs or with each other.
That's very true, and it's one reason I'm not impressed with the attempts that have been made to test psychotherapies in clinical trials. (There are a lot of design issues as well.)
> Well, I'm not up to date in my depression vocabulary.
You can still say how you feel, though, right? :-) I was curious about the quality of the residual depression/anxiety.
My residual symptoms have to do with a sort of general emotional "dulling" (no, it's not medication-induced). I have trouble enjoying things, and I seldom feel very motivated or energetic. I also can't concentrate very well. Buprenorphine helps a lot with these problems.
BTW, 75 mg of Effexor is at the low end of the therapeutic range. The threapeutic range is quite wide -- I'm taking 225 mg/day, with a target of 300 or more.
> My doc also diagnosed my me some anxiety problem, hence her choice of Effexor.
Generalized anxiety disorder, maybe? Paxil is labelled for that too, and I think pretty much any of the new ADs could get approved for it if the drug companies wanted to get them approved. Generalized anxiety overlaps a *lot* with depression, and most depressed people (including dysthymics) have some anxiety.
> I wish I had taken meds before as I think my major depression would have cleared faster and I would possibly have lessened the likelihood of recurrence. But I made the choice not to take meds at the time because I was too scared of them. I looked for more info since then, and I decided to try them for the dysthymia.
Well, what's done is done; you seem to be doing pretty well, so I wouldn't worry about it. I'm glad things seem to be working so well for you -- a lot of us aren't so lucky!
-elizabeth
Posted by sid on February 2, 2002, at 12:04:09
In reply to Re: depression, etc. » sid, posted by Elizabeth on February 1, 2002, at 18:41:55
> > Well, I'm not up to date in my depression vocabulary.
>
> You can still say how you feel, though, right? :-) I was curious about the quality of the residual depression/anxiety.For the past 3 months I've started to talk about my (major) depression in the past tense. So I am not very afraid for it to come back. I feel it's far enough from me not to be scared all the time and not to constantly ask myself how I'm doing (like someone with a heart disease would check his BP or pulse all the time). I think it's dysthymia I'm left with, although even that seems to be lifting. From time to time, I find myself feeling as happy as when I was about 12 years old, and that was before the dysthymia. There is more joy and potential for craziness (in a good sense) in me now. I can have fun again, which I have not had in a very long time.
> My residual symptoms have to do with a sort of general emotional "dulling" (no, it's not medication-induced). I have trouble enjoying things, and I seldom feel very motivated or energetic. I also can't concentrate very well. Buprenorphine helps a lot with these problems.I felt like that for a long time too, I know what you mean. I could function again, but nothing mattered much to me. I had trouble making plans for the future because nothing seemed worth the effort I had to put in. I preferred being a couch potato to being active and social. Weirdly enough, it's going away now, so there's hope! The Effexor (even such a low dose?) might be helping. I did make changes in my life that may have helped though. I moved back to where I grew up (the previous 8 years had been spent in foreign countries) and last summer I spent time with old friends, swimming on hot days, playing ball, etc... things I would do before I ever know what depression was. That seems to have helped. I would be surprised at how much fun I was having and how carefree it made me feel. I never thought about it doing me good, I just went swimming one day and remembered how I was before. Somehow I found part of my old self back in that swimming pool, with pleasant memories of summer vacations.
> BTW, 75 mg of Effexor is at the low end of the therapeutic range. The threapeutic range is quite wide -- I'm taking 225 mg/day, with a target of 300 or more.
Yes, I know. I find it weird that I am doing so well, although before starting the meds I was on an upward trend. So I am not sure if it's just the upward trend continuing or if the meds are doing me some good already. I started meds when I was feeling the best I have in a long time, so it's hard to evaluate anything. I knew I could feel better and felt brave enough to try meds (I was and still am sh** scared of them). I felt strong enough to deal with the side effects, stick to a plan, discuss it with my doc and defend my point of view if I needed to. As it turns out, I found someone I agree with a lot without arguing, so at least that's going well. I am not feeling 100% yet, but things are improving. I know that 150mg+ of Effexor XR is needed to treat anxiety, so I guess we'll get there at some point.
I do exercise a lot more than before too. I went from nothing at all to badminton once a week, yoga class once a week plus home routine everyday, twice a week of threadmill and once a week of swimming. And I FEEL like moving, like exercising, I am not forcing myself to. That's a major thing. My body is toning up, I lost some weight (still lots to lose, but I don't focus on that for now), and that's making me feel less tired and less prone to sleep too much and eat too much.
As much as during the major depression I seemed to be on a downward spiral and after I seemed stuck at a less than happy place for a long time, now I seem to be on an upward spiral. I hope it lasts! Lately I've been thinking that I was happy (wow!) even though my current situation is less than enviable (esp. money problems, no stable job yet), but it's still fragile. I'm still anxious (of course) about it getting away from me again.
> > My doc also diagnosed my me some anxiety problem, hence her choice of Effexor.
>
> Generalized anxiety disorder, maybe? Paxil is labelled for that too, and I think pretty much any of the new ADs could get approved for it if the drug companies wanted to get them approved. Generalized anxiety overlaps a *lot* with depression, and most depressed people (including dysthymics) have some anxiety.We did not get into the details, but yes, it's probably GAD, from what I read. I'll talk to her some more about it next week. I see her every 3 weeks (unless there is a problem), so sometimes it takes time to get answers. I read about Paxil too, but for now the Effexor XR is satisfying, so I'm keeping Paxil in mind in case Effexor XR poops out later on. I may ask you med advice as my treatment continues; you certainly are knowledgeable about that. Do you work/study in mental health?
In any case, I do hope you feel better soon. My experience has been that it takes time, and I often lost patience. I felt it was unfair for me to go through all this just to feel OK, which was the norm for most people, without any effort.
Let's all keep trying and hoping for the best.
- sid
Posted by Elizabeth on February 3, 2002, at 23:42:49
In reply to Re: depression, etc. » sid, posted by Elizabeth on February 1, 2002, at 18:41:55
> For the past 3 months I've started to talk about my (major) depression in the past tense.
It's a great feeling, isn't it?
> I feel it's far enough from me not to be scared all the time and not to constantly ask myself how I'm doing (like someone with a heart disease would check his BP or pulse all the time).
A hypochondriac with a heart disease, anyway!
> I think it's dysthymia I'm left with, although even that seems to be lifting.
I think that what I need right now is mostly to get my life back on track: depression has been incredibly disruptive to my education and my career plans. So now I'm trying to get on track, to salvage some scrap of those plans. A big roadblock is my inability to drive; unlike Boston and New York (and even, sort of, Jersey), this North Carolina town doesn't have any public transportation to speak of. My difficulties controlling my attentional focus (maintaining focus, or shifting it -- shifting is actually the bigger problem) have prevented me from being able to drive safely enough to get a license (just one screwup is all it takes). I haven't had a seizure since September, but that's something that's been at the back of my mind too. Anyway, I've gotten to the point where I'm just not improving with practice; the limiting factor is my attention problem. I worry about how this would affect my ability to work, too. But that's sort of moot at the moment. I could go back to Boston, but I'd need some money to pay the rent until I could find a job (rent in the Boston area is painfully high); so I'd have to work here for a while at least.
> From time to time, I find myself feeling as happy as when I was about 12 years old, and that was before the dysthymia. There is more joy and potential for craziness (in a good sense) in me now. I can have fun again, which I have not had in a very long time.
I think that a lot of people don't appreciate the effect that emotional blunting can have on a person. It is a joy to be free of it.
> I could function again, but nothing mattered much to me.
I was more functionally impaired by the anergia-anhedonia, I think. With the buprenorphine, I'm pretty much back to normal. That's why it's so frustrating to be held back for want of a driver's license.
> I moved back to where I grew up (the previous 8 years had been spent in foreign countries) and last summer I spent time with old friends, swimming on hot days, playing ball, etc... things I would do before I ever know what depression was.
I'm starting to get back in touch with old friends as well. It's nice to be able to hang out and not just be a downer. Being in NC is kind of tough because I can't get anyplace on my own, but it's also sort of a vacation, and of course a chance to be with my family.
> I never thought about it doing me good, I just went swimming one day and remembered how I was before. Somehow I found part of my old self back in that swimming pool, with pleasant memories of summer vacations.
When I was "down" -- when I had untreated residual symptoms, that is -- I found I wasn't able to enjoy things like that. I'd visit friends but I couldn't think of anything to talk about with them. I'd try going swimming (I like to swim too) but it just didn't do anything for me. Even reading, which has been a favorite passtime ever since I learned how (i.e., as long as I can remember), didn't come easy; I'd keep reading the same sentence over and over without really grasping the meaning, and I couldn't get myself interested regardless of what the material was. It's a thrill to be able to enjoy reading a good book or going for a walk or being with friends now that I can. I've even reviewed a bit of math and chemistry.
> Yes, I know. I find it weird that I am doing so well, although before starting the meds I was on an upward trend. So I am not sure if it's just the upward trend continuing or if the meds are doing me some good already.
How long have you been taking the 75 mg? I've been on 225 for a couple of weeks.
> I knew I could feel better and felt brave enough to try meds (I was and still am sh** scared of them).
Why scared?
> I felt strong enough to deal with the side effects, stick to a plan, discuss it with my doc and defend my point of view if I needed to.
Being able to advocate for yourself as a patient is crucial, and this creates big problems in doctor-patient relationships (especially in psychiatry, where patients are particularly unlikely to be able to speak up for themselves).
> As it turns out, I found someone I agree with a lot without arguing, so at least that's going well.
That's ideal. I find that so many doctors want to fight with me about the medication that I'm already taking, that I know works, and that I need, which is frustrating.
> I am not feeling 100% yet, but things are improving. I know that 150mg+ of Effexor XR is needed to treat anxiety, so I guess we'll get there at some point.
I don't think that's always true; it's possible that 75 will prove to be enough for you. Remember that generalized anxiety is a really broad diagnostic category; people with GAD are a very heterogeneous group.
> ... I FEEL like moving, like exercising, I am not forcing myself to. That's a major thing. My body is toning up, I lost some weight (still lots to lose, but I don't focus on that for now), and that's making me feel less tired and less prone to sleep too much and eat too much.
I'm eating more now that I'm feeling better, but I'm also more active. It's nice. One thing I miss about Boston is that I got to walk around a lot (I was about a 30 minute walk from Harvard Square and 15 minutes from MIT) -- there's not really anywhere I can get to on foot from here.
> As much as during the major depression I seemed to be on a downward spiral and after I seemed stuck at a less than happy place for a long time, now I seem to be on an upward spiral. I hope it lasts!
I'm still struggling uphill, but that's more a lifestyle thing than a mood thing. (Still, I wouldn't say I'm on an "upward spiral!")
> I read about Paxil too, but for now the Effexor XR is satisfying, so I'm keeping Paxil in mind in case Effexor XR poops out later on.
Any SSRI would be fine; it doesn't have to be Paxil. Remeron or Serzone could be good too. And the MAOIs (Nardil especially) are the best antidepressants for most anxiety disorders, IMO.
> I may ask you med advice as my treatment continues; you certainly are knowledgeable about that. Do you work/study in mental health?
I'm a mathematician by training, and more recently I was taking classes (a couple of the basic sciences that I didn't take in college) to prepare for the MCAT. I haven't worked in a while. But neurobiology and psychopathology (and the bridge between them) are among my interests(one could even call them hobbies -- I have a lifelong history of weird hobbies).
> In any case, I do hope you feel better soon. My experience has been that it takes time, and I often lost patience. I felt it was unfair for me to go through all this just to feel OK, which was the norm for most people, without any effort.
I have trouble even understanding what it's like to be "normal." You know?
> Let's all keep trying and hoping for the best.
Or trying in the absence of hope, if need be.
-elizabeth
Posted by sid on February 4, 2002, at 17:35:04
In reply to Re: depression, etc., posted by Elizabeth on February 3, 2002, at 23:42:49
> I think that what I need right now is mostly to get my life back on track: depression has been incredibly disruptive to my education and my career plans. So now I'm trying to get on track, to salvage some scrap of those plans.
I know about that! There have been delays in my Ph.D. and now in my career. Because of them, I am not sure I still have a career. Had I survived cancer, I could explain it in a presentation letter, while looking for a job. But depression still has a stigma to it; that would possibly ruin my career for good instead of help. This is really unfair. We are sick, we suffer AND there are long term consequences to it too.
> A big roadblock is my inability to drive; unlike Boston and New York (and even, sort of, Jersey), this North Carolina town doesn't have any public transportation to speak of. My difficulties controlling my attentional focus (maintaining focus, or shifting it -- shifting is actually the bigger problem) have prevented me from being able to drive safely enough to get a license (just one screwup is all it takes). I haven't had a seizure since September, but that's something that's been at the back of my mind too. Anyway, I've gotten to the point where I'm just not improving with practice; the limiting factor is my attention problem. I worry about how this would affect my ability to work, too. But that's sort of moot at the moment. I could go back to Boston, but I'd need some money to pay the rent until I could find a job (rent in the Boston area is painfully high); so I'd have to work here for a while at least.
Well, I hope you get well enough soon to get some attention back and get the driver's license. You could then be more active and that could possibly help a lot in the healing process.
> How long have you been taking the 75 mg? I've been on 225 for a couple of weeks.I was on 37.5mg Effexor XR for 6 weeks (I felt better already; after 10 days or so, there were some improvements), and I've been on 75mg for about a month now. I'm seeing my doc on Thursday.
> Why scared (of meds)?I told you a few months ago, but I'll tell the story again. My father was hospitalized with major depression when I was 20 years old. After a few weeks in the hospital, he'd come out on weekends. One weekend he decided not to take his meds, and we knew nothing about dosage, etc, it basically his responsibility without supervision. He "lost it" threatening to kill himself or us if we didn't leave him alone, etc... Major crisis. I managed to reach our family doctor, and he said that he probably didn't take his meds, that we needed to put him to bed and force him to take his meds, physically control him if we needed to. When it's your father, you freak out, and I did. Else we needed to call an ambulance and get him right back to the hospital. That threat is what I reasoned him with to go to bed, rest, and take his meds. Thereafter, I swore I'd never take ADs.
> Being able to advocate for yourself as a patient is crucial, and this creates big problems in doctor-patient relationships (especially in psychiatry, where patients are particularly unlikely to be able to speak up for themselves).
I have a general doctor, which may make things easier relationship-wise. I know that she treats a lot of people for mental illnesses, so she developed some expertise over time. I'll go see a pdoc if I feel the need to, but for now, things are going OK.
> it's possible that 75 will prove to be enough for you. Remember that generalized anxiety is a really broad diagnostic category; people with GAD are a very heterogeneous group.That would be great. We'll see, on Thursday I should know better whether I'll increase the dosage or not.
> I'm eating more now that I'm feeling better, but I'm also more active.
I'm more active and I eat less. Thank God because I loaded up on carbs like crazy during the depression and I gained a lot of weight. I find myself physically repugnant now. I'm not too severe in the sense that I went through a lot of hardship, but I want to improve my physical appearance. I've been a mess for a long time and it shows still. It's not my priority, but it's on my to-do list.
> I'm still struggling uphill, but that's more a lifestyle thing than a mood thing. (Still, I wouldn't say I'm on an "upward spiral!")
Upward spiral was strong. Let's say that I don't have to do as much as before to feel good. That in itself makes me feel even better!
> Any SSRI would be fine; it doesn't have to be Paxil. Remeron or Serzone could be good too. And the MAOIs (Nardil especially) are the best antidepressants for most anxiety disorders, IMO.OK, thanks. I'll take note of it in case it's needed later. I know my doc told me we'd augment at some point with another molecule in order to affect the brain in a different way and cover more bases (or something like that... I don't know much about it).
> I'm a mathematician by training, and more recently I was taking classes (a couple of the basic sciences that I didn't take in college) to prepare for the MCAT. I haven't worked in a while. But neurobiology and psychopathology (and the bridge between them) are among my interests(one could even call them hobbies -- I have a lifelong history of weird hobbies).Cool. I love math. I use it rather than develop it, but I do use it (pretty basic stuff) everyday.
> I have trouble even understanding what it's like to be "normal." You know?Oh yeah. A couple of weeks ago I asked on this board how it felt to be "OK". My doc said I'll take the meds at the same dosage for at least 1 more year, providing it doesn't poop out, once we consider I'm "OK." Then we'll taper and see what happens (I pray not to have to take meds all my life, but I may have to). I asked what she meant; she simply said "one thing at a time." So I'm not too sure. Perhaps I'm close to it, perhaps I'm still far. No idea.
Take care, and take your meds (this is Psycho-Babble after all)!
- sid
Posted by Elizabeth on February 7, 2002, at 13:04:06
In reply to Re: depression, etc. » Elizabeth, posted by sid on February 4, 2002, at 17:35:04
> I know about that! There have been delays in my Ph.D. and now in my career. Because of them, I am not sure I still have a career. Had I survived cancer, I could explain it in a presentation letter, while looking for a job. But depression still has a stigma to it; that would possibly ruin my career for good instead of help. This is really unfair. We are sick, we suffer AND there are long term consequences to it too.
Yeah -- some people at least pretend to believe depression is a medical condition like any other, but we do still get treated differently, and there's plenty of reason for us not to want to "come out of the closet," so to speak. Maybe if people pretend long enough, future generations will really believe it.
> Well, I hope you get well enough soon to get some attention back and get the driver's license. You could then be more active and that could possibly help a lot in the healing process.
I agree. The concentration thing is a real problem for me, though. And I'm sort of hesitant to ask for a stimulant when I'm already taking buprenorphine (which is also a stimulant for me).
> I was on 37.5mg Effexor XR for 6 weeks (I felt better already; after 10 days or so, there were some improvements), and I've been on 75mg for about a month now. I'm seeing my doc on Thursday.
Wow, that's cool. You've been increasing it pretty slowly, but it sounds like it's paying off for you. The 225 is definitely helping some, but I think I could stand to go up to 300.
> I told you a few months ago, but I'll tell the story again.
I'm sorry! I have trouble keeping up with all the stories people tell here, although I do like to read them (I almost typed "hear" instead of "read" there!).
> My father was hospitalized with major depression when I was 20 years old. After a few weeks in the hospital, he'd come out on weekends. One weekend he decided not to take his meds, and we knew nothing about dosage, etc, it basically his responsibility without supervision. He "lost it" threatening to kill himself or us if we didn't leave him alone, etc... Major crisis. I managed to reach our family doctor, and he said that he probably didn't take his meds, that we needed to put him to bed and force him to take his meds, physically control him if we needed to. When it's your father, you freak out, and I did. Else we needed to call an ambulance and get him right back to the hospital. That threat is what I reasoned him with to go to bed, rest, and take his meds. Thereafter, I swore I'd never take ADs.
Things have changed since then, I think. But I would have been scared of *not* taking meds based on what you've told me there!
> I have a general doctor, which may make things easier relationship-wise.
I don't know. I think that the attitudes of GPs toward us (psych patients, that is), overall, are probably similar to those of psychiatrists. If I had a GP who I had known for a long time and who I felt was qualified to treat my depression, I'd see him/her instead of a psychiatrist.
> I know that she treats a lot of people for mental illnesses, so she developed some expertise over time.
A lot of GPs treat depression and anxiety, at least -- not so much the more serious things like schizophrenia, and I think that most GPs would want to make a referral to a psychiatrist if someone had severe treatment-resistant or psychotic depression, bipolar, OCD, ADHD, or borderline personality. Most of them have experience prescribing the new ADs, TCAs, and benzos, at least. I don't know how exceptional your GP is.
> That would be great. We'll see, on Thursday I should know better whether I'll increase the dosage or not.
Are you getting any side effects? I haven't noticed any so far.
> I'm more active and I eat less. Thank God because I loaded up on carbs like crazy during the depression and I gained a lot of weight.
That's always surprised me, that some people do that. Like, "who wants to eat when they're depressed???"
> I find myself physically repugnant now.
I felt that way when I was depressed. I avoided mirrors.
> I'm not too severe in the sense that I went through a lot of hardship, but I want to improve my physical appearance.
So do I (I'm not fat as such, but I am out of shape), but it's no longer something I worry so much about.
> I've been a mess for a long time and it shows still. It's not my priority, but it's on my to-do list.
Yeah, that's how I feel too.
> Upward spiral was strong. Let's say that I don't have to do as much as before to feel good. That in itself makes me feel even better!
I had given up on feeling good and settled for feeling flat. Being *able* to feel good feels like such a blessing now.
> OK, thanks. I'll take note of it in case it's needed later. I know my doc told me we'd augment at some point with another molecule in order to affect the brain in a different way and cover more bases (or something like that... I don't know much about it).
That's a typical strategy, adding something that has a different mechanism or affects different neurotransmitters. One of the first things that I tried when I became depressed in college (this was my second diagnosed episode -- I may have had one episode before I was diagnosed) was prozac + desipramine (this was 1993, and the SSRIs were the only "new-generation" ADs around). Augmenting SSRIs or Effexor with Remeron or Wellbutrin is also a popular strategy. Sometimes stimulants or direct dopamine agonists are used. I'm finding that the Effexor + buprenorphine strategy is working nicely, activating the endogenous opioid system in addition to monoamines.
> Cool. I love math. I use it rather than develop it, but I do use it (pretty basic stuff) everyday.
Maybe you've said this already, but what do you do?
> Oh yeah. A couple of weeks ago I asked on this board how it felt to be "OK".
Ahh yes. Well, I wish you luck in your search for OKness. :-) I'm really beginning to regain my confidence, feeling like "I can do this" ["this" being living life]. It was scary feeling like I might have to depend on my family for the rest of my life. I don't know how close I am to getting back to where I was (living on my own, working, taking classes, etc.), but I know that I now feel like it's a real possibility. And that's a big step in itself.
-elizabeth
Posted by sid on February 7, 2002, at 20:38:22
In reply to Re: depression, etc. » sid, posted by Elizabeth on February 7, 2002, at 13:04:06
> > I was on 37.5mg Effexor XR for 6 weeks (I felt better already; after 10 days or so, there were some improvements), and I've been on 75mg for about a month now. I'm seeing my doc on Thursday.
>
> Wow, that's cool. You've been increasing it pretty slowly, but it sounds like it's paying off for you. The 225 is definitely helping some, but I think I could stand to go up to 300.Saw my doc today. She gave me something to help me sleep (fall asleep, has 4 hours of effect only) and I'm staying at 75mg for at least 3 more weeks. She confirmed what I felt: I'm doing better already. We'll see, but I may not even go higher than 75mg of Effexor XR.
> > I told you a few months ago, but I'll tell the story again.
>
> I'm sorry! I have trouble keeping up with all the stories people tell here, although I do like to read them (I almost typed "hear" instead of "read" there!).No problem; same for me. I'm rather visual and remember faces more than names, so on a board like this I have trouble keeping track of who's who and who said what.
> > I know that she treats a lot of people for mental illnesses, so she developed some expertise over time.
>
> I don't know how exceptional your GP is.Wel,, she was recommended to me by 2 people she treated for depression, and I notice in her waiting room, there's a lot of info on mental diseases. She may not be exceptional, but it seems like people go to her a lot for depression.
> Are you getting any side effects? I haven't noticed any so far.
Oh yeah! I never took any drug before except aspirin, birth control pills or antibiotics. The first week at 37.5mg per day, I slept about 2 hours per night. The first 5 days I felt "drugged." I was spacey and had trouble with my vision and psychomotricity. I payed badminton one night and I looked like I was drunk or something. Couldn't follow the birdie, had trouble coordinating my movements, etc. Couldn't think straight either.
Then most side effects subsided except recurring constipation and sleep problems. After 6 weeks, I went up to 75mg and I've had sleep problems since. Once I fall asleep I sleep well, don't wake up before about 7-8 hours after, but falling sleep is a challenge. I fell asleep at 4AM this morning and had a doctor's apptment at 8:15AM.
:-(
Anyway, we're trying to address that. I waste too much time because of the sleep deprivation and my work is suffering from it. I still have recurrent constipation; I simply adjust my diet accordingly.
> That's always surprised me, that some people do that. Like, "who wants to eat when they're depressed???"Well, I ate carbs without even noticing I was eating, I was like an eating zombie. I wouldn't say I wanted to eat, I just did it automatically. There was no pleasure in it, it was almost like an addiction: carbs, carbs, carbs. And I slept way too much during the depression. A big couch potato. :-(
> Maybe you've said this already, but what do you do?
Reasearch and teaching in economics. Writing mathematical models of human, firm and institutional behavior all the time.
> Ahh yes. Well, I wish you luck in your search for OKness. :-) I'm really beginning to regain my confidence, feeling like "I can do this" ["this" being living life]. It was scary feeling like I might have to depend on my family for the rest of my life. I don't know how close I am to getting back to where I was (living on my own, working, taking classes, etc.), but I know that I now feel like it's a real possibility. And that's a big step in itself.Good for you. It sounds like you're on the right path to OKness or at least for now for betterness!
- sid
Posted by Elizabeth on February 9, 2002, at 0:13:32
In reply to Re: depression, etc. » Elizabeth, posted by sid on February 7, 2002, at 20:38:22
> Saw my doc today. She gave me something to help me sleep (fall asleep, has 4 hours of effect only)
Ambien? Halcion? (Don't make me play this guessing game. :-} )
> and I'm staying at 75mg for at least 3 more weeks. She confirmed what I felt: I'm doing better already. We'll see, but I may not even go higher than 75mg of Effexor XR.
That would be cool. G'luck.
> I'm rather visual and remember faces more than names, so on a board like this I have trouble keeping track of who's who and who said what.
It could be worse: I'm not good with faces *or* names!
> Wel,, she was recommended to me by 2 people she treated for depression, and I notice in her waiting room, there's a lot of info on mental diseases. She may not be exceptional, but it seems like people go to her a lot for depression.
A lot of people go to their GPs for depression. HMOs don't like specialists. I don't think most GPs have much experience treating very severe mental disorders like agitated, psychotic, or melancholic depression, bipolar I, schizophrenia, etc. (Bipolar II is apparently such an all-encompassing category that I'm sure that GPs are now diagnosing and treating it.)
> I never took any drug before except aspirin, birth control pills or antibiotics.
Do you think that had anything to do with your initial reaction to Effexor?
BTW, birth control pills gave me a really bad time (depression relapsed while on Parnate). So I don't think those are necessarily lightweight drugs!
> The first week at 37.5mg per day, I slept about 2 hours per night. The first 5 days I felt "drugged." I was spacey and had trouble with my vision and psychomotricity.
"Psychomotricity?" Is that a word? :-)
> Then most side effects subsided except recurring constipation and sleep problems. After 6 weeks, I went up to 75mg and I've had sleep problems since. Once I fall asleep I sleep well, don't wake up before about 7-8 hours after, but falling sleep is a challenge. I fell asleep at 4AM this morning and had a doctor's apptment at 8:15AM.
Yeah, I've been noticing a little bit of trouble falling asleep (not normally a problem for me), and I expect it to get worse if I go up to 300 mg. I think I'll ask my pdoc for some Ambien when I see him.
> Anyway, we're trying to address that. I waste too much time because of the sleep deprivation and my work is suffering from it. I still have recurrent constipation; I simply adjust my diet accordingly.
Constipation is pretty difficult to manage. I've been taking a lot of Metamucil in the last year, and I have to say, Metamucil + anything is not my favorite beverage. < g >
> Well, I ate carbs without even noticing I was eating, I was like an eating zombie. I wouldn't say I wanted to eat, I just did it automatically. There was no pleasure in it, it was almost like an addiction: carbs, carbs, carbs. And I slept way too much during the depression. A big couch potato. :-(
The sleeping thing I can understand. My sleep was terrible, and it would have been cool to have some escape.
> Good for you. It sounds like you're on the right path to OKness or at least for now for betterness!
Yeah, one day we'll all reach OK. (I wonder if the Oklahomans are ready for us? :-} )
-elizabeth
Posted by sid on February 9, 2002, at 9:03:21
In reply to Re: depression, etc. » sid, posted by Elizabeth on February 9, 2002, at 0:13:32
> > Saw my doc today. She gave me something to help me sleep (fall asleep, has 4 hours of effect only)
>
> Ambien? Halcion? (Don't make me play this guessing game. :-} )zaleplon
> > Wel,, she was recommended to me by 2 people she treated for depression, and I notice in her waiting room, there's a lot of info on mental diseases. She may not be exceptional, but it seems like people go to her a lot for depression.
>
> A lot of people go to their GPs for depression. HMOs don't like specialists. I don't think most GPs have much experience treating very severe mental disorders like agitated, psychotic, or melancholic depression, bipolar I, schizophrenia, etc. (Bipolar II is apparently such an all-encompassing category that I'm sure that GPs are now diagnosing and treating it.)Well, I'm in Canada and thank God we don't have HMOs. We can go to any doc we want too. So some GPs kind of specialize through experience and interest. For e.g., my obgyn is really a GP, but all she does is obgyn. She refers you to a real obgyn if needed, but otherwise, I deal with her. And this GP I go to for my depression treats a lot of people for mental illnesses. Of course she'd refer me to a pdoc if my case became more complicated than it is now. I used to have another gp whom I'd go to for colds, the flu or a sprained ankle, but I didn't feel at ease to go to him for my depression - he knows my entire family and that would have been weird. Plus, I'm not sure he has that much experience with depression. Anyway... all this to say the situation here is a bit different than in the US.
> > I never took any drug before except aspirin, birth control pills or antibiotics.
>
> Do you think that had anything to do with your initial reaction to Effexor?From what I read here, the more ADs you took before, the less effect they seem to have. So yes, it might have something to do with my initial reaction to Effexor and the fact that it's effective, even at a low dose. I may be wrong here, but that's something I picked up on by reading posts and reading about ADs in general (although I limited that to a minimum).
> BTW, birth control pills gave me a really bad time (depression relapsed while on Parnate). So I don't think those are necessarily lightweight drugs!
I know, I had to switch brand last spring because I was getting depressive on Diane-35. What I meant is I never took benzos or ADs before. And I've been taking birth control pills recently only (past year) because of major PMS (suicidal 3 days per month).
> "Psychomotricity?" Is that a word? :-)
It is in French anyway. I freely translate sometimes. Psychomotricité.
> Constipation is pretty difficult to manage.Del Montes's prunes in juice work well for me. Oh, and humongous, delicious navel oranges. They're expensive, but MMMMMMMM they're good!
> Yeah, one day we'll all reach OK. (I wonder if the Oklahomans are ready for us? :-} )
lololololol !
Take care, elizabeth. And take your meds. :-)
- sid
Posted by sid on February 9, 2002, at 9:09:33
In reply to Re: depression, etc. » sid, posted by Elizabeth on February 9, 2002, at 0:13:32
I forgot to tell you... increased bruxism was a problem for a while. Now it's not as bad as it was about a month ago. I wear a mouth guard every night, and my jaw does not hurt anymore, so I must not have so much bruxism while I sleep. Otherwise my jaw would hurt even though my teeth would be protected by the mouth guard.
So, another side effect I had to deal with.
Posted by Elizabeth on February 10, 2002, at 12:10:56
In reply to Re: depression, etc. » Elizabeth, posted by sid on February 9, 2002, at 9:03:21
> > > Saw my doc today. She gave me something to help me sleep (fall asleep, has 4 hours of effect only)
> >
> > Ambien? Halcion? (Don't make me play this guessing game. :-} )
>
> zaleplonSonata: that lasts more like 2 hours, I thought. If you wake up early or if your only problem is initial insomnia, I imagine it'd be great -- assuming it works, of course!
> Well, I'm in Canada and thank God we don't have HMOs.
I guess God doesn't like your neighbors down south. :-(
> We can go to any doc we want too.
Here there's a *lot* of variation depending what kind of insurance you have. Medicaid, the state program that disabled people typically get (it's harder to get in some states than others), often covers a lot, but it's common for doctors in private practice not to take it because it doesn't pay them enough.
> So some GPs kind of specialize through experience and interest.
That's cool. I think it's true to an extent here too.
> For e.g., my obgyn is really a GP, but all she does is obgyn.
I think most insurance plans allow you to see an ob/gyn as your "primary care provider."
> She refers you to a real obgyn if needed, but otherwise, I deal with her. And this GP I go to for my depression treats a lot of people for mental illnesses.
So they're both doctors of internal medicine (or whatever you guys call it) by training?
> Of course she'd refer me to a pdoc if my case became more complicated than it is now.
How complicated is it? Have you had a lot of treatment resistance?
> I used to have another gp whom I'd go to for colds, the flu or a sprained ankle, but I didn't feel at ease to go to him for my depression - he knows my entire family and that would have been weird.
Actually, I think it's good for a pdoc to meet your family (I try to introduce my immediate family to my pdocs where feasible), but if he knows them already then that would be kind of odd.
> From what I read here, the more ADs you took before, the less effect they seem to have.
I don't think that's necessarily true of side effects. Also, I think it's more likely that because all of the currently recognized ADs have similar (monoaminergic) mechanisms, if you don't respond to one or two then it becomes quite a bit less likely that others will work for you. (On the other hand, of course, many people who don't respond to SSRUs will respond to MAOIs or TCAs, say, since the different monoamines aren't all the same.)
> I know, I had to switch brand last spring because I was getting depressive on Diane-35.
I tried Ortho-Tricyclen. I decided it wasn't worth it to try a different brand.
> What I meant is I never took benzos or ADs before. And I've been taking birth control pills recently only (past year) because of major PMS (suicidal 3 days per month).
I was taking them to try to prevent cramps (only one or two days but really bad). I think I'm lucky that I don't get any kind of PMS, because it seems like many, maybe most, women do.
> > "Psychomotricity?" Is that a word? :-)
>
> It is in French anyway. I freely translate sometimes. Psychomotricité.Damned Canadians. :-)
> Del Montes's prunes in juice work well for me. Oh, and humongous, delicious navel oranges. They're expensive, but MMMMMMMM they're good!
I'll keep that in mind -- I like navel oranges, although prunes aren't my favorite food (to put it mildly). I've been trying to use Metamucil regularly, but it's a bit of a PITA.
> > Yeah, one day we'll all reach OK. (I wonder if the Oklahomans are ready for us? :-} )
>
> lololololol !I thought that joke was really bad, myself!
> I forgot to tell you... increased bruxism was a problem for a while.
With Effexor, you mean? I think I've heard of that happening with SSRIs and maybe Effexor before.
> Now it's not as bad as it was about a month ago. I wear a mouth guard every night, and my jaw does not hurt anymore, so I must not have so much bruxism while I sleep.
FWIW, I think Klonopin (Rivotril) is supposed to help with that. It's become sort of the standard for movement disorders in sleep.
> Take care, elizabeth. And take your meds. :-)
Yeah, you too :)
-elizabeth
Posted by IsoM on February 10, 2002, at 13:48:55
In reply to Re: depression, etc. » sid, posted by Elizabeth on February 10, 2002, at 12:10:56
> > Del Montes's prunes in juice work well for me. Oh, and humongous, delicious navel oranges. They're expensive, but MMMMMMMM they're good!
>
> I'll keep that in mind -- I like navel oranges, although prunes aren't my favorite food (to put it mildly). I've been trying to use Metamucil regularly, but it's a bit of a PITA.TCAs caused me terrible constipation. I found two foods were better than any others for mine. Have either of you ever tried eating raw brocolli stalks? I LOVE the taste & can munch on them all day like some people do peanuts or celery. Very high in fibre & it's quite gentle too. The other is any sort of dried beans. Not everyone likes beans but again I love them too. Beans is another very high fibre food & lots of soluble fibre. Just a suggestion.
Posted by sid on February 10, 2002, at 15:34:14
In reply to Re: depression, etc. » sid, posted by Elizabeth on February 10, 2002, at 12:10:56
> > zaleplon
> Sonata: that lasts more like 2 hours, I thought. If you wake up early or if your only problem is initial insomnia, I imagine it'd be great -- assuming it works, of course!
Different name here of course (Starnoc). It's 10mg, so perhaps it's a higher dosage than Sonata, which would explain it potentially lasting longer. And yes it works. I took it last night and finally went to sleep thanks to it!
> > She refers you to a real obgyn if needed, but otherwise, I deal with her. And this GP I go to for my depression treats a lot of people for mental illnesses.
>
> So they're both doctors of internal medicine (or whatever you guys call it) by training?No. The GP does not have an actual doctorate (calling medical providers "doctor" is often wrong). Those who specialize (5-10 more years in school) have an actual doctorate. "Real" obgyn's do that. My GP who only does obgyn-related consultations refers you to a "real" obgyn if you are a more complicated case. You go to her for annual exams, uncomplicated pregnancies, usual stuff.
> > Of course she'd refer me to a pdoc if my case became more complicated than it is now.
>
> How complicated is it? Have you had a lot of treatment resistance?No resistance (except my own resistance to take meds for a long time!). I've responded to therapy, acupuncture and now to Effexor XR. Yoga is helping me with the anxiety these days; I started a class a few weeks ago and I love it. I cross my fingers that I continue to respond well to the meds.
> Actually, I think it's good for a pdoc to meet your family (I try to introduce my immediate family to my pdocs where feasible), but if he knows them already then that would be kind of odd.
Not my family. There are people in my family who like nothing better than to put me down, I'm not about to tell them the story of my life. I've learned to grow and live despite my family.
> I think I'm lucky that I don't get any kind of PMS, because it seems like many, maybe most, women do.Not all women do, not all as bad as me. How old are you? It's new to me... I'm 34 and apparently, PMS is the worse in a woman's 30's. I used to have cramps a few times a year, but this hormone-driven suicidal thing, that's 2 years old, no more.
> I'll keep that in mind -- I like navel oranges, although prunes aren't my favorite food (to put it mildly). I've been trying to use Metamucil regularly, but it's a bit of a PITA.
PITA? Prunes are good with vanilla yogourt. Alone, they're not great.
> > > Yeah, one day we'll all reach OK. (I wonder if the Oklahomans are ready for us? :-} )
> >
> > lololololol !
>
> I thought that joke was really bad, myself!
Well I'm not American, so I would not have thought of it myself. Surprise effect.> With Effexor, you mean? I think I've heard of that happening with SSRIs and maybe Effexor before.
Yes. I have bruxism to start with, and it was (is still perhaps?) worse with Effexor XR.
> FWIW, I think Klonopin (Rivotril) is supposed to help with that. It's become sort of the standard for movement disorders in sleep.
Yes, trying to avoid benzos. My doc is reluctant and me too. I find that I already take enough meds. Roght now I do well with the mouth guard only, we'll reassess if needed later. At least now I'm done taking meds for my allergy (I ate some mussel sauce by mistake on Thursday and had to take lots of Immodium and Gravol in order for my body not to react too strongly). Back to Effexor XR, Allesse, Starnoc if needed, and vitamins. I hate to take meds and can't wait to be free of them.
Bye...- sid
Posted by sid on February 10, 2002, at 15:35:54
In reply to Elizabeth and Sid..., posted by IsoM on February 10, 2002, at 13:48:55
> TCAs caused me terrible constipation. I found two foods were better than any others for mine. Have either of you ever tried eating raw brocolli stalks? I LOVE the taste & can munch on them all day like some people do peanuts or celery. Very high in fibre & it's quite gentle too. The other is any sort of dried beans. Not everyone likes beans but again I love them too. Beans is another very high fibre food & lots of soluble fibre. Just a suggestion.
Thanks, IsoM. I know about these other sources of fiber. I do eat them from time to time, but not everyday; unlike oranges when they are available...... MMMMMMMMMMMM !
Posted by Elizabeth on February 13, 2002, at 18:21:29
In reply to Re: depression, etc. » Elizabeth, posted by sid on February 10, 2002, at 15:34:14
> Different name here of course (Starnoc). It's 10mg, so perhaps it's a higher dosage than Sonata, which would explain it potentially lasting longer.
No, I think Sonata comes in 10's....
> And yes it works. I took it last night and finally went to sleep thanks to it!
Cool. I haven't heard too many success stories about it, so it's nice to know somebody finds it helpful!
> No. The GP does not have an actual doctorate (calling medical providers "doctor" is often wrong). Those who specialize (5-10 more years in school) have an actual doctorate. "Real" obgyn's do that. My GP who only does obgyn-related consultations refers you to a "real" obgyn if you are a more complicated case. You go to her for annual exams, uncomplicated pregnancies, usual stuff.
This is pretty confusing! Here's our system: often, people see a nurse practitioner or physician's assistant (a "mid-level provider") as their primary care provider (HMOs are happy to recognize mid-level providers as PCPs, since they generally cost less to see than physicians do). I believe that mid-level providers can write some prescriptions; I don't know exactly how it works. There are also internists (doctors of internal medicine) and family doctors (family medicine; I don't know exactly how this is different from internal medicine) who aren't specialists and who generally act as PCPs, but who have more training than nurse practitioners or PAs. Some HMOs will also let women see their ob/gyn as a PCP. Usually if you belong to an HMO (and I think that Medicaid -- state-paid insurance for disabled people, the closest thing we have to nationalized health care -- is run like an HMO in most states), you have to get a referral from your PCP in order to see a specialist like a psychiatrist, dermatologist, cardiologist, etc. So for example, an internist or nurse practitioner would probably be comfortable treating an uncomplicated case of depression with one of the newer ADs or perhaps a TCA, but at some level of complicatedness (depending on the individual PCP's experience) -- psychotic features, mania, treatment resistance, suicidality, need for multiple medications, etc. -- the PCP would want to refer the patient to a psychiatrist. The last time I had a PCP was when I was living in Boston; I was seeing a resident in internal medicine at the clinic at one of the Harvard-affiliated teaching hospitals.
> No resistance (except my own resistance to take meds for a long time!). I've responded to therapy, acupuncture and now to Effexor XR.
Ahh, okay. I don't think that PCPs here typically do talk therapy or acupuncture, but I wouldn't expect you to get referred to a psych if you were seeing a PCP here.
> Yoga is helping me with the anxiety these days; I started a class a few weeks ago and I love it. I cross my fingers that I continue to respond well to the meds.
Crossing mine for you too. :-)
> Not my family. There are people in my family who like nothing better than to put me down, I'm not about to tell them the story of my life.
Oh, I didn't mean that! I meant that meeting a patient's family can give the therapist an idea of what kind of atmosphere the patient is living in, or grew up in. Doesn't mean that they sit in on all your therapy sessions! (And I would expect a therapist to know better than to take everything that the family says as gospel.)
> I've learned to grow and live despite my family.
Ack. How come there seem to be so many people who have/had awful relationships with their families? Is this just to be expected, or is it a societal problem, or what?
> Not all women do, not all as bad as me. How old are you?
25.
> It's new to me... I'm 34 and apparently, PMS is the worse in a woman's 30's.
Yikes.
> I used to have cramps a few times a year, but this hormone-driven suicidal thing, that's 2 years old, no more.
Huh. Weird that something like that would start in your 30's. I do get bad cramps, but that's on day 1 (occasionally day 2 as well), not premenstrual, and there aren't any associated mood symptoms.
> PITA?
"pain in the *ss"
> Prunes are good with vanilla yogourt. Alone, they're not great.
I'm not convinced that *anything* would make prunes much better than "slightly tolerable" to me! :-} I'll stick with the Metamucil (every doctor I've talked to about my problem seems to take Metamucil every day, so I figure it probably won't kill me, at least).
> Yes, trying to avoid benzos. My doc is reluctant and me too. I find that I already take enough meds. Roght now I do well with the mouth guard only, we'll reassess if needed later.
Do you ever find that your mouth hurts from clenching? I've never had bruxism myself (at least, not that I know of), but I have had jaw pain a couple of times and it was very distracting/irritating. I think if I had that problem often I'd want to be able to do something about it. A mouth guard does help with most of the problems that are usually associated with bruxism, though, and it's certainly a better choice for nightly use. (Kind of unsexy if you happen to be spending the night with somebody, though!)
> At least now I'm done taking meds for my allergy (I ate some mussel sauce by mistake on Thursday and had to take lots of Immodium and Gravol in order for my body not to react too strongly).
That sounds dreadful. Please spare me the details. :-} Seriously, I hope you're feeling okay now.
> Back to Effexor XR, Allesse, Starnoc if needed, and vitamins. I hate to take meds and can't wait to be free of them.
How are vitamins different, effectively? I don't take any vitamin or mineral supplements unless I have some specific need for them (like anemia or something) -- those pills are huge. I prefer good old-fashioned food when I'm feeling okay, and when I'm depressed -- hopefully, never again -- "not taking vitamin supplements" is pretty low on the list of ways that I fail to take care of myself.
-elizabeth
Posted by sid on February 13, 2002, at 22:50:19
In reply to Re: depression, etc. » sid, posted by Elizabeth on February 13, 2002, at 18:21:29
> This is pretty confusing! Here's our system:...
Here, we don't have APs, and nurses can't give prescriptions, although that will change in a few years I think. We see general practitioners (GP), who are sometimes called family doctors. They give us referrals to specialists when needed. Or we can see specialists without referrals, but it takes longer, since patients with referrals have priority.
> > No resistance (except my own resistance to take meds for a long time!). I've responded to therapy, acupuncture and now to Effexor XR.
> Ahh, okay. I don't think that PCPs here typically do talk therapy or acupuncture, but I wouldn't expect you to get referred to a psych if you were seeing a PCP here.My GP treats me for dysthymia and anxiety: some CBT (suggests that I do things that may help) and talk in order to figure out how I'm doing. She prescribes meds.
Therapy was done with psychologists and acupunture with an acupuncturist. Neither were medical doctors. I saw these specialists while in the US, where I lived several years. I decided to see a medical doctor recently, in Canada, to get meds and attempt to finally (I hope!) be free of mental illness. I have not found an acupuncturist to treat my depression here, I really miss the one I had in the US. And I've dome all the therapy I care for, for now at least. Since I had trouble dealing with stress (anxiety) and I still had dysthymia, I went to see a GP. Had I had access to my US acupunturist, I would probably have continued with her. But no luck finding a replacement.
> Ack. How come there seem to be so many people who have/had awful relationships with their families? Is this just to be expected, or is it a societal problem, or what?Don't know. I feel like Lisa Simpson: I look at my family, and I can't believe I'm one of them. Family reunions are very stressful for me. That was the good thing about living in foreign countries for several years: I never saw them! Actually, I get along well with my mom; it's my sister and my in-laws I can't stand. My sister's husband especially since he has sexually harrassed and molested me since I was about 8 (he's 20 years older than me). And many other things that bother me, but his behavior towards me is what bugs me most.
> Huh. Weird that something like that would start in your 30's. I do get bad cramps, but that's on day 1 (occasionally day 2 as well), not premenstrual, and there aren't any associated mood symptoms.Don't know why... I was told by 2 doctors of mine and some older women who had PMS that it's worse in one's 30's. It's certainly true for me so far.
> Do you ever find that your mouth hurts from clenching? I've never had bruxism myself (at least, not that I know of), but I have had jaw pain a couple of times and it was very distracting/irritating. I think if I had that problem often I'd want to be able to do something about it. A mouth guard does help with most of the problems that are usually associated with bruxism, though, and it's certainly a better choice for nightly use. (Kind of unsexy if you happen to be spending the night with somebody, though!)My jaw hurts sometimes, the joints on both sides especially. Although these days that's OK. But I have bruxism during the day too! The other day I bit my tongue while watching TV!!! I try to keep my mouth open a bit in order to avoid clenching my teeth all day. A custom made mouth guard is supposed to last about 2 years, but mine will barely last 1 year... the other night I was dreaming that I was chewing something. I woke up and I was trying to chew my mouth guard! :-) Sometimes I have to take it out though because it makes me nausceous (sp?) from time to time. Anyway, if you have bruxism, I think it's a good investment. And regardless of the pain in the jaw joints, it does protect you teeth. I must say I had bruxism before though; it's just worse with Effexor XR. I even broke a tooth during my major depression in 1995 - that was the worse bruxism I had.
> That sounds dreadful. Please spare me the details. :-} Seriously, I hope you're feeling okay now.Yes, I did not suffer much allergy reactions this time. Last time I had mussels (before I knew I had become violently allergic), I thought I would die. Thank God I ran to a pharmacy and saw to it that my body was put on "neutral" for a few days. It worked; I wasn't sure it would. I never had allergies before, it's weird.
> How are vitamins different, effectively? I don't take any vitamin or mineral supplements unless I have some specific need for them (like anemia or something) -- those pills are huge.Different from meds? Well, for one thing I have no side effects from them! I just take Centrum each day, especially in the Canadian winter, which is dang tough on our bodies (and minds too!).
Take care.
- sid
Posted by mdmicky on March 2, 2002, at 14:55:10
In reply to Re: MAOI diet short list, posted by Lisa01 on January 14, 2002, at 20:46:11
i'm a psychiatrist.
i've been on parnate for just over 6 yrs. i take 60 mg/d. i've never had a relapse and i think it's a great medication.
for the first three years i didn't cheat at all on the STRICT diet. then i started cheating bit by bit until eventually i stopped observing a diet at all. i must admit that i drink draft beer (all sorts including local microbrews and in fairly large quantities), red wine, and all sorts of cheeses. i don't like kraut or liver so i haven't had those. because i work very long days and rarely have time for lunch or dinner, i also eat several LUNA bars or Harvest bars every day. i never thought to look for soy...
i also have to say, of course, that being a doctor i'm definitely not as careful as i should be and i don't check my blood pressure very often. also, my pressure normally runs 90s/50s so i have some room for increase without consequence.
i wouldn't advise my "restriction-free" diet to any of my patients (and i do prescribe parnate occasionally) or to any of you. i only learned of this site because one of my partners sent me the link as he, too, finds my diet a bit reckless and foolish. in any case, i thought i'd at least pass along my experiences.
and elizabeth, thanks for the list that started this thread, i may use it for my patients as i've had difficulty makeing a list that was balanced.
Posted by Bobbiedobbs on March 23, 2002, at 13:33:03
In reply to Re: MAOI diet short list, posted by mdmicky on March 2, 2002, at 14:55:10
I have taken Nardil (30-45 mg.)for 15 years and Parnate (20-30 mg) for about two. I think Elizabeth's short list comes the closest I've seen to being accurate, and least as far as my own experience. I observed the crazy dietary restrictions for the first 10 years or so, then, on the advice of Dr. Shulman and others' studies, began consuming some of the items for which their appeared to be only anecdotal evidence - i.e. evidence without any basis in actual tyramine content/absorption studies.
This is my experience: On the above drug regimens I have consumed the following foods regularly (as above as several times a week for 7 years), without the SLIGHTEST side effect:
Pizza with mozzarella cheese.
Ricotta
Yogurt.
Beer - bottled, canned, domestic and exported - up to 3 per four hours.
White wine, red wine (in quantities) hard liquor.
Sausage, pepperoni - mostly on pizza.
Sauerkraut - in the U.S. and France.
Soy sauce - all sorts of brands and in Chinese restaurants - generally small quanities.
Processed American (Kraft) cheese slices.
Chocolate, raspberries, etc.
The only time I had a side effect was when I mistakenly took a decongestant. I got a terrible headache, was sweating and my blood pressure was way high. I went to the hospital, they gave me Mellaril, and I was discharged.
I have heard that absorption rates and sensitivity can vary among users. Yet the fact that I have been able to consume these for so many years without ANY measureable effect would at least give pause for doubt.... think the shame of the whole thing is that these medications can be enormously helpful (they have been to me) but doctors won't prescribe them becuase of the food restrictions, which, in this individuals's opinion, and except for the hard cheeses, other medications and a few other oddball items, are largely bogus. Phil.
Posted by djmmm on March 25, 2002, at 17:31:49
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on March 23, 2002, at 13:33:03
I couldn't agree more. When the "list" was originally created, all food that contained tyramine was restricted, regardless of content, etc.
The MAOI diet is based on poor scientific evidence, and shouldn't be a factor when deciding depression treatment.
Posted by djmmm on March 26, 2002, at 9:52:50
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on March 23, 2002, at 13:33:03
From
http://www.vh.org/Providers/Conferences/CPS/19.htmlA retrospective analysis of the incidence of acute hypertensive crisis in 692 patients treated with MAOIs found that the incidence was 8.4% prior to instituting dietary restrictions but 3.3% after dietary restrictions were imposed (Bethune 1964). In the Rabkin chart review (1985) study, 11 patients (8%) on phenelzine and one patient (2%) taking tranylcypromine experienced hypertensive reactions.
The Rabkin, et al study included 198 patients
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6386898&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3973068&dopt=Abstract
Posted by Elizabeth on March 26, 2002, at 18:44:40
In reply to Re: MAOI diet short list, posted by djmmm on March 25, 2002, at 17:31:49
> I couldn't agree more. When the "list" was originally created, all food that contained tyramine was restricted, regardless of content, etc.
It's even worse than that. There were also foods that don't contain significant amounts of tyramine (or other biogenic amines); they were included based on old and flawed techniques for measuring the tyramine content (such as Chianti), vague and poorly documented case reports (e.g., chocolate), etc., as well as foods that were simply related to foods that were known (or believed) to interact with MAOIs (for example, based on putative interactions with a few types of alcoholic drinks, the recommendation was made that people avoid *all* alcoholic drinks).
The effect of all this has been (not surprisingly) much like the effect of telling kids that marijuana is a highly dangerous and addictive drug: once people realize that they can "cheat" on the diet, they don't take *any* of the recommendations seriously -- even the ones that really should be taken seriously.
> The MAOI diet is based on poor scientific evidence, and shouldn't be a factor when deciding depression treatment.
Well, the old MAOI diets are (there are many, many different versions). That's why some Canadian researchers went and did the actual research to figure out which foods actually should be avoided. (This research is the main basis for my version of the dietary restrictions list.) There are still doctors out there who use one of those invalid lists that contain a lot of foods that shouldn't be included, though. Educate them, everybody! :-)
-elizabeth
Posted by LLL on July 13, 2002, at 12:40:18
In reply to Re: MAOI diet short list, posted by mdmicky on March 2, 2002, at 14:55:10
I am on Parnate again after a 4 year break and am not remembering some of the diet restricitons. Is canned tuna OK? what about the use of Lipton soup mixes (the dried variety) for cooking? Is everything with yeast extract and soy protein out? I haven't heard anything mentioned of MSG, isn't that a big no-no?
Posted by Bobbiedobbs on July 14, 2002, at 23:18:38
In reply to Re: MAOI diet short list, posted by LLL on July 13, 2002, at 12:40:18
To answer your question, canned tuna is fine, same with lipton's soup mix. I never had any particular problem with MSG and don't know of any. Yeast extract I guess is a no-no. Regarding soy protein, I recently had an extensive dialogue with the folks at the company that makes Parnate (Glaxo) concerning a variety of soy=based products. Rather than commit to memory I will find my notes later this week and post. The general rule was soy was OK but fermented soy was not, and that included a lot. You have to keep in mind that these are the folks who say you can't have chocolate or yogurt! Will post what company doctors said vis-a-vis soy. If you look at some of the earlier messages, I think Elizabeth had a good post on soy products.
Posted by LLL on July 15, 2002, at 10:08:03
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 14, 2002, at 23:18:38
> To answer your question, canned tuna is fine, same with lipton's soup mix. I never had any particular problem with MSG and don't know of any. Yeast extract I guess is a no-no. Regarding soy protein, I recently had an extensive dialogue with the folks at the company that makes Parnate (Glaxo) concerning a variety of soy=based products. Rather than commit to memory I will find my notes later this week and post. The general rule was soy was OK but fermented soy was not, and that included a lot. You have to keep in mind that these are the folks who say you can't have chocolate or yogurt! Will post what company doctors said vis-a-vis soy. If you look at some of the earlier messages, I think Elizabeth had a good post on soy products.
More questions - what about the use of vinegar? distilled white vinegar, rice vinegar, tarragon white whine vinegar as well as Marsala cooking wine and sesame oil. Can these be safely used during cooking while on Parnate?
Posted by LLL on July 15, 2002, at 14:57:33
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 14, 2002, at 23:18:38
Thank you for your response. After taking a closer look at the dry packaged Lipton Soup Mix box as well as the cans of Swansons beef and chicken broth, they all contain yeast extract and or autolyzed yeast extract and thus sound like they should be prohibited. I used to use both a lot in my cooking. I also noticed a can of re-fried beans that I have contains autolyzed yeast extract. I always remember before while on Parnate ('93-'97), looking out for MSG but never yeast extract. I'd appreciate you getting back to me on the soy protein and soy flour as I don't eat meat (just turkey/chicken/fish) and some of the convenience foods and snacks I use contain these.
I also have a question about "leftovers". If I make a meal with turkey/chicken one night, I cannot have it again the next? Also, what about marinating meat for several hours in the fridge (I make my own marinade) before cooking?
As you can see I'm very anxious about starting this medication again and having a hypertensive crisis. Thanks.
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