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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 319 to 343 of 434. Go back in thread:
Posted by Elizabeth on September 12, 2001, at 3:43:08
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 9, 2001, at 0:11:21
> Well, let's see. oversleeping-yes; overeating-no;
> leaden paralysis-um, does horrible pain in the chest fit under leaden paralysis?Probably not. Leaden paralysis means your body, especially arms and legs, feels really heavy.
> I don't even *get* the difference between residual effects and an unresolved hypertensive crisis. Really.
The difference would be whether your blood pressure is still high! (People whose BP runs low seem to have worse symptoms than those with higher baseline BPs.)
> BTW, I had no residual effects after the episode. But my BP didn't go that high. For me I had a strong tightening of my shoulder muscles (well right on either side of my neck) and my pulse went way down.
That's a compensatory measure: your heart is attempting to compensate for the vasoconstriction by decreasing its output.
> Looking back, I don't know how I even knew it was a hypertensive reaction.
It probably was, though it may not have been a true "crisis." Since you've been having possible reactions, I really suggest that you try to find a BP monitor so that you can check these things. The digital self-inflating ones are expensive but a manual one should only run about $15-25.
> I had always heard a horrible headache in the back of the head.
That's the main one, yeah.
> No antipsychcotics or tricyclics.
What did these do when you tried them (if you did)?
> I think I've tried every mood stabilizer.
Tegretol? Trileptal? Keppra?
> I probably would wait until the stiffness and headache go away if you can wait it out. Have you tried a muscle relaxer for the stiffness? (not a benzo, a real one :-)
Soma, perhaps.
> Welcome back Elizabeth, if you read this.
Thanks. :-) I'm slowly catching up.
-elizabeth
Posted by Elizabeth on September 12, 2001, at 3:47:17
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 9, 2001, at 12:46:15
> Yeah, ok, but a crick in the neck can take weeks to go away.
I don't think it's a crick -- that is, it's not musculoskeletal, but vascular.
> I'd be curious what elizabeth thinks of a Nardil and Desipramine combo.
It could be worth a try, and I think it would be safe (although I'd suggest monitoring your BP closely). I haven't had any appetite loss on desipramine, so I'm not sure it would counteract the weight gain from Nardil very effectively.
-elizabeth
Posted by Elizabeth on September 12, 2001, at 3:51:20
In reply to Re: Hypertensive crises, update » Elizabeth, posted by Lorraine on September 10, 2001, at 20:24:39
> > > Doing my washout from Parnate to Nardil with adderal and neurontin. Took 10 mg adderal this > > >[re hypertensive crises]Took blood pressure 165/97, i think.
> >
> > That's about the point where I was instructed by my pdoc to take nifedipine. (BTW, "bite and swallow" seems to work better than SL.)
>
> I think if I had to do it over again, I would start the nifedipine right when the headache starts rather than based on the blood pressure.I wouldn't. People have differing levels of reactivity depending on various factors (e.g., baseline BP). You want to have a number, you know? It's a bad idea to take nifedipine if you aren't sure that your BP has reached a certain level. Also, although it's high, 160-170/90-100 isn't terribly dangerous -- it's just a good safe point to take nifedipine if the BP is still rising.
> I did actually bite, put under the tongue for about 2 second and then swallowed.
That sounds like a great compromise. :-)
> elizabeth: are you still on buprenorphine?
Yup.
> Is the Desipramine still doing you good?
Yes, it is.
-elizabeth
Posted by Elizabeth on September 12, 2001, at 4:06:26
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 10, 2001, at 23:11:56
> Valium doesn't work for me (or most people) as a muscle relaxer. Or if it did, you have to take enough to pretty much knock you out. I've never heard of a doc giving valium anymore for muscle pulls, etc.; it's generally only used as a sedative now.
Some doctors try to pass it off as a muscle relaxer.
> I will start nardil tomorrow with wellbutrin. Saw my pdoc today. He wanted to go to remeron next (with wellbutrin), and I burst out crying and said I want to go on nardil, again. He was a bit nervous about the combo.
Honestly, I think it's safe. I've heard of a number of people who tried it with no ill effects, and I've *NEVER* heard of any noticeable interaction.
> So I went back in again, caught him in the hall, and he told me that I should watch for my diabolic BP going above 110.
"Diabolic?" You mean diastolic, right? < g >
> I have never even paid attention to that number, and I didn't get the opportunity to ask him why.
It means that your heart's "at rest" state is resulting in a high pressure.
> Also, he said he didn't want me to take a nifedipine-type antidote and I should call him and go to the hospital.
I don't agree, but I understand his reasoning.
> I'm going fax him tomorrow and ask him what the deal is; why can't I have one--isn't that what they would give me at the hospital, anyway?
No, they'd give you phentolamine or nitroprusside. They'd also monitor you to make sure you were okay (no BP crash, etc.).
> When he left he said, "don't worry, I will make sure you get better." And I replied that he will blame me for not trying remeron. And then he said, "Please don't feel guilty, you are feeling bad enough. It's okay that you don't want to try remeron now." That was about the nicest thing he's ever said to me.
I think that's really sweet of him.
> I did some research before on nifedipine with MAOIs and there are really contrary views about giving it to patients.
I think that many doctors really need to have confidence that you know what you're doing before they'll give you nifedipine. It does have its dangers.
> If I remember correctly (and I may not, really), I think some pdocs think their MAOI patients might take it too early and then the nifedipine might make them very sick.
Yes. It can make your blood pressure "crash," which can progress to shock (worst-case scenario).
> I don't know how fast it works ; I guess that would determine how high to go up before taking the antidote.
IME, about 10-15 minutes when taken by "bite & swallow."
-e
Posted by shelliR on September 12, 2001, at 22:21:30
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 11, 2001, at 13:10:13
Hi Lorraine,
>
> Back from my vacation, and *not* relieved.
> That's a good sign:-0
> It definitely is insecurity, not lonliness.
> Yeah, I rarely, rarely get lonely. Insecurity about being alone?
Thinking something is wrong with me because none of my relationships worked out and not even certain that I want to try again. The old shame thing again.
> I love the Santa Fe area
> Me too. I wasn't wild about Sedona though.Did you go to Arizona on the same trip? Interesting. I've never been to Sedona, but many people have told me it's very magical. What was it that you didn't like about it?
I don't love Santa Fe or even Taos per say; I love the weather, I love the tremendous range of visual art, and I love driving out there: total overwhelming beauty in every direction.. And I do like the friendliness, especially the curtesy in driving. I mean, you signal, and people actually let you change lanes. And it completely awesome to realize that one woman (Mable Dodge) encouraged artists to come out there--really at that time in the middle of nowhere. Of course O’Keefe, but also Willa Cather and D.H. Lawrence among others, even from Europe.
On the topic of art, I would miss the general lack of culture there, not much music, independent film, concerts besides the opera. It is increasing, but it feels pretty much a void after all the access in D.C. and the closeness to NYC. I actually don’t go to NY very often, last went for the Edward Hopper exhibit; he’s probably my favorite painters of all time. At last, we have one or two direct flights a day which makes it now much much easier to get there and back without wasting two days. Maybe next year my sister and niece will come with me, if I go back. My sister and I can't spend too much time together without getting on each others' nerves. (hey, you want to meet me in santa fe next summer? :-) )> but it just gets too darn cold. Plus not the right population for my work, I don't think, although one of my clients moved out there and he manages Winton Marcelis. So I might have a in with the rich and famous. :-) You know, Ophrah, Jane Fonda, Julia Roberts, etc. HA.
> I don't know--the tourists might be interested, but it might entail a different work schedule or mailing prints when done. There is a ton of foot traffic.I don't see it as a good place for my type of work. They would have to be quick, tacky pictures, because I don't think people on vacation would find it important to spend several hours with a photographer while on vacation. I know , I wouldn't. I can't particularly envision mountain pictures in the same way I have seen beautiful beach pictures. I love simplicity. My niece once had a school picture done in what looked to me like the alps behind her. Very bizarre background for a school photo. I always wonder: "what are these photographers thinking?" Are California school pictures as strange?
> It's what I think is the next obvious step. I started Nardil at 15 mg and, of course, like it very much. (I know I'm not supposed to be able to tell, but I do feel a slight boost and I do feel more hunger than usual.) So as usual I'm optimistic. I guess that's fine--this random walk through pharmacology. May as well be optimistic.
I think nardil is a great antidepressant, and since you obviously respond to MAOIs (based on your parnate experience), I think you *should * be very optimistic. And since your body is so sensitive, you probably are perceiving some AD effect.
>
>
> Anyway, I realized after my appointment that I never asked him about taking an antidote. . He did check that I had a BP cuff, but that's about all. There is a more than minute chance for me to have a hypertensive reaction So I went back in again, caught him in the hall, and he told me that I should watch for my diabolic BP going above 110. I have never even paid attention to that number, and I didn't get the opportunity to ask him why. Also, he said he didn't want me to take a nifedipine-type antidote and I should call him and go to the hospital.
Shelli-- I was in genuine pain, excruciating headache, intense throbbing at the base of my skull--I still have slight remnants of it. I would be very uncomfortable without the antidote. So you call him and he acalls you back in fifteen minutes or worse it's half an hour and you are in the emergency room and they are making you wait. It just seems to happen very quickly and I know elizabeth had a bad experience in the emergency room. I'm aware of the controvery re the antidote. There is actually a good discussion of it in the tips section--a rebutttal to the concerns that I thought was pretty convincing. I think that doctors follow standard medical procedures until it's their head and then they take the antidote. (Isn't that a vicious thought?)Well I saw my pdoc again today, because I have plummeted down in the last two days and we were talking hospitalization. Again. I am now pretty sure it has to do with the horror of yesterday piled up on top of my depression. I couldn’t trace it though, until I read a post from Anna (sweetmarie) saying how she had definitely experienced a downward plunge, after the news. And she’s in the UK! Monday I was fine; Tuesday afternoon I was seriously contemplating suicide and today woke up severely hopeless. I have to start working again Friday—it was supposed to be today, but there was luckily a cancellation due to the airports closing and the client being out of town. I am very shaky and not sure that I can handle work.
Anyway, I did get to talk to my pdoc about the antidote. His feeling is that I will not have an immediate reaction. Sort of like last time, if I do have a reaction—where it went up to 168 and then back down within minutes. That it takes a buildup of a drug combination to get you into the stoke range, and if you pay attention to the signals, you will not get there. I am trusting him on this because he has no reason not to be completely frank with me. My friend had several hypertensive reactions with bad headaches and it was pretty scary how long they took to get to her at the hospital. I took her there once after she had a reaction to ale and was appalled. But her BP also never went over 170. I do have a blood cuff with me now at all times, until I am passed any danger point, and it if comes down to it I would not feel self-conscious bypassing triage and walking right into the ER and demanding attention.
> > > >He said to start with 15mg tomorrow; I think I'll start with 7.5 or less.I >thought the lowest dose was 7.5 mg and my pharmacist told me that I could not split the tablets--he could be wrong, but you might want to check.Too late, I already took a split pill. It’s not time release so I can’t imagine why there would be a problem. The lowest dose is 15mg. Today a whole pill, no problem, but I will continue to keep watch, especially because I will raise it on Friday to 22.5mg then Sunday to 30mg. And I have very much in mind that a buildup over several days might cause a problem. That was the case with adrafinil. It took several days until I felt a reaction, but didn’t have any physical signs and didn’t have a BP cuff. I am very hopeful that there will be no problems.
>
>It is a very good point--whether the antidote itself makes you ill.
That is the impression in my reading and also from my pdoc.So day three, any more news? When are you going to raise your dose and do you have any idea of how high you are intending to go? I started on 45mg (well, within one week, if I remember right), but generally through the years I have kept my dose at 30mg because of sleep disturbances which were minimal at 30mg. I also had very strange and scarey experiences not adjusting to natural light changes (especially from inside to outdoor sunlight) when I had been on 45mg for about six months.
Were the schools closed in California? They were closed, of course, in NY, but I was suprised that the D.C. and Philadelphia schools were closed. Maybe out of respect? I don't really understand why; I'll have to go back to the metro section of the Post.BTW, before the horror of yesterday, how was being alone all day, with the kids in school?
Take care, Shelli
Posted by Lorraine on September 13, 2001, at 11:06:20
In reply to Re: Hypertensive crises, update » Lorraine, posted by Elizabeth on September 12, 2001, at 3:51:20
9/12/01 elizabeth to Shelli
> > I don't even *get* the difference between residual effects and an unresolved hypertensive crisis. Really.
>
Ø The difference would be whether your blood pressure is still high! (People whose BP runs low seem to have worse symptoms than those with higher baseline BPs.)Elizabeth, help me understand this. When you have a hypertensive crises your blood pressure shoots up because of vascular contraction (veins get smaller) and your pulse rate decreases to compensate for this. When you take the antidote, it lowers the blood pressure by dilating the veins and the pulse rate returns to normal? (I’m sure my language is all wrong, but you get the gist.) So that crick in my neck was probably the result of residual the vascular contraction in that area. It would make sense, although my BP came down very significantly (well within the average range) after the antidote it did not return to pre-hypertensive readings (which were low because the Parnate had decreased my BP readings generally) until about 5 days later.
.
9/12/01 elizabeth to Lorraine> > I'd be curious what elizabeth thinks of a Nardil and Desipramine combo.
>
Ø It could be worth a try, and I think it would be safe (although I'd suggest monitoring your BP closely). I haven't had any appetite loss on desipramine, so I'm not sure it would counteract the weight gain from Nardil very effectively.Thanks for the info. Just want to have a next step in mind if the Nardil doesn’t do it. I know I am jumping the gun so to speak but it makes me feel better emotionally to do this. Then when things don’t work out, I don’t panic or go too low, but just take the next step and distract myself.
9/12/01 elizabeth to Lorraine (msg 2)
> > > > Doing my washout from Parnate to Nardil with adderal and neurontin. Took 10 mg adderal this > > >[re hypertensive crises]Took blood pressure 165/97, i think.
> > >
Ø > > That's about the point where I was instructed by my pdoc to take nifedipine. (BTW, "bite and swallow" seems to work better than SL.)I had searched Psychobabble and believe that I found a post of yours saying your pdoc had used these levels.
> >
> > I think if I had to do it over again, I would start the nifedipine right when the headache starts rather than based on the blood pressure.
>
Ø I wouldn't. People have differing levels of reactivity depending on various factors (e.g., baseline BP). You want to have a number, you know? It's a bad idea to take nifedipine if you aren't sure that your BP has reached a certain level. Also, although it's high, 160-170/90-100 isn't terribly dangerous -- it's just a good safe point to take nifedipine if the BP is still rising.I know, it’s just that it took so long for the episode to fully resolve. I was very out of sorts (although functional) for a good 5 days. I felt like I’d been in an auto accident and had whiplash. (Although I don’t suppose you’d know how that felt? How are the driving lessons going?)
> > Is the Desipramine still doing you good?
>
Ø Yes, it is.I am so pleased to hear this Elizabeth.
9/12/01 elizabeth to Shelli> > So I went back in again, caught him in the hall, and he told me that I should watch for my diabolic BP going above 110.
>
Ø "Diabolic?" You mean diastolic, right? < g >I thought she was referring to him when she said diabolic < vbg >.
> > I'm going fax him tomorrow and ask him what the deal is; why can't I have one--isn't that what they would give me at the hospital, anyway?
>
Ø No, they'd give you phentolamine or nitroprusside. They'd also monitor you to make sure you were okay (no BP crash, etc.).Yes, but aren’t you looking at a significant delay to treatment (driving to the hospital; getting admitted; having them draw blood to make sure you’re not on cocaine?; treating you like an idiot?) Bad attitude, I know.
> > If I remember correctly (and I may not, really), I think some pdocs think their MAOI patients might take it too early and then the nifedipine might make them very sick.
>
Ø Yes. It can make your blood pressure "crash," which can progress to shock (worst-case scenario).OK, I’ll be careful. Elizabeth, how long to hypertensive crises usually last? I thought about taking another BP reading 5 minutes after my high one to see if it was coming down, but got too scared to wait.
Lorraine
Posted by Lorraine on September 13, 2001, at 11:53:33
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 12, 2001, at 22:21:30
Shelli,
Insecurity about being alone?
> Thinking something is wrong with me because none of my relationships worked out and not even certain that I want to try again. The old shame thing again.I'm sorry to hear that. I know first hand how difficult shame can be to deal with.
> Did you go to Arizona on the same trip? Interesting. I've never been to Sedona, but many people have told me it's very magical. What was it that you didn't like about it?
Well, I loved the place we ended up staying at (don't remember the name--some exclusive resort type of place that my airline friend got for a song). Otherwise, I just wasn't inspired by the rest of Sedona--the landscape did not send me (it reminded me of California desert but red) and I missed the culture of Sante Fe. I am definately in the minority. I've been to Phoenix and it was OK. I've been on Lake Powell and that was beautiful.
> On the topic of art, I would miss the general lack of culture there, not much music, independent film, concerts besides the opera. It is increasing, but it feels pretty much a void after all the access in D.C. and the closeness to NYC. I actually don’t go to NY very often
I lived in DC for a summer as a law intern. Loved it. Might not want to live there because I suspect it's a bit provicial for all it's big city trappings--at least it was then (25 years ago).
(hey, you want to meet me in santa fe next summer? :-) )I thought you didn't like meeting psychobabblers;-). I don't know how our summer plans are shaping up (what with the kids and all summer gets crazy). But I might go to the east coast next summer. If I do, we might get together.
> I don't see it as a good place for my type of work. They would have to be quick, tacky pictures, because I don't think people on vacation would find it important to spend several hours with a photographer while on vacation.You're right.
My niece once had a school picture done in what looked to me like the alps behind her. Very bizarre background for a school photo. I always wonder: "what are these photographers thinking?" Are California school pictures as strange?Yes, very strange. No Alps thought, but I have not gotten a good picture of the kids from the school photographer.
> I think nardil is a great antidepressant, and since you obviously respond to MAOIs (based on your parnate experience), I think you *should * be very optimistic. And since your body is so sensitive, you probably are perceiving some AD effect.
> >One hopes.
> > > Well I saw my pdoc again today, because I have plummeted down in the last two days and we were talking hospitalization. Again.I'm so sorry to hear this. You are going through a terribly rough patch, right now. Eventually, it will get better. The hard part is that you (and I) don't even know if we are on the right meds now and the urge to find an answer is so strong; it's easy to just move on before the right med has a chance to work (Nardil took 5 weeks for you--I just finished 5 weeks on Parnate.) It's the old advice shelli, when you are depressed don't look at the big picture only focus on details or distract yourself. This is a terrible time to try to distract yourself with TV though. I know you know all this, still...
I am now pretty sure it has to do with the horror of yesterday piled up on top of my depression. I couldn’t trace it though, until I read a post from Anna (sweetmarie) saying how she had definitely experienced a downward plunge, after the news.
I've been feeling this too. I try not to listen to the news too much. My husband wants it on all the time, but I feel like climbing out of my skin when it's on so much. I reorganized the cabinets in the house to distract myself. I definately need to distract myself from this--I have no tolerance for stress and this is definately stressful. Avoidance is how I now deal with stress. I try to insulate myself from it. I have to. I've thought of looking at churches to attend actually, although I am not religious, I just think the structure, the ritual, the "words" might be soothing now.
> >I am very shaky and not sure that I can handle work.
So this is a photo shoot. Long time commitment. And you don't just get lost in the work once you start? Photo shooting sounds like the essence of detail and distraction to me if you are up to it.
That it takes a buildup of a drug combination to get you into the stoke range, and if you pay attention to the signals, you will not get there. ...if comes down to it I would not feel self-conscious bypassing triage and walking right into the ER and demanding attention.
That's great. My reaction came after 5 weeks on Parnate (which is more prone to causing hypertensive crises) and was in reaction to adding stimulants (although the day I took the Adderal I was off the Parnate, still it was in my system) and I added too much stimulant (really, I went full dose on day one) So in retrospect I was really being careless. I have a new respect for drugs, now, of course. :-)
> > > Too late, I already took a split pill. It’s not time release so I can’t imagine why there would be a problem.
Well, I was told I could split Parnate so I don't understand why not either. I think the pharmacist was just unwilling to look it up. I'm glad it worked out.
The lowest dose is 15mg. Today a whole pill, no problem, but I will continue to keep watch, especially because I will raise it on Friday to 22.5mg then Sunday to 30mg. And I have very much in mind that a buildup over several days might cause a problem.
Wow, you are moving fast. I need to increase my dose of Nardil (still 15 mg) but am a bit anxious about doing it. Do you remember if you had any anxiety when you were beginning Nardil?
> So day three, any more news? When are you going to raise your dose and do you have any idea of how high you are intending to go? I started on 45mg (well, within one week, if I remember right), but generally through the years I have kept my dose at 30mg because of sleep disturbances which were minimal at 30mg.
I'll probably go to 1 1/2 pills today this is how sure I am that my pharmacist was not right). I probably won't get to a very high dose. I'd be surprised if I go over 30 mg.
I also had very strange and scarey experiences not adjusting to natural light changes (especially from inside to outdoor sunlight) when I had been on 45mg for about six months.
Wellbutrin caused me to have visual trails and made lights dance--especially coming from a dark space (movie theatre or waking up) to a light space (movie theatre restroom).
> Were the schools closed in California?It was up to the parents and we took the kids to school to maintain a sense of normalacy. Their school were not near location that I thought would be potential targets and they are fairly close by.
> > > BTW, before the horror of yesterday, how was being alone all day, with the kids in school?
You know I like being alone. And I have been so busy--I'm painting the house and so forth. Also when I drive the kids, the other parents pull me aside and talk to me. They like me :-) So I'm actually a bit more social than usual.
Lorraine
Posted by Elizabeth on September 13, 2001, at 14:43:22
In reply to Re: Hypertensive crises, update » Elizabeth, posted by Lorraine on September 13, 2001, at 11:06:20
> > > I don't even *get* the difference between residual effects and an unresolved hypertensive crisis. Really.
> >
> Ø The difference would be whether your blood pressure is still high! (People whose BP runs low seem to have worse symptoms than those with higher baseline BPs.)So you mean by "residual effects" continued symptoms after BP has returned to normal? I wouldn't expect any such symptoms, unless the HT did damage.
Calcium channel blockers, like nifedipine, lower your BP by dilating blood vessels. Sometimes this can cause your body to try to compensate by raising your pulse. This is why treating hypertension is so complicated and often requires elaborate drug cocktails: the cardiovascular system tries to maintain its homeostasis by compensating for the effects of drugs.
> So that crick in my neck was probably the result of residual the vascular contraction in that area.
I don't know exactly what causes the particular symptoms, for the most part.
> It would make sense, although my BP came down very significantly (well within the average range) after the antidote it did not return to pre-hypertensive readings (which were low because the Parnate had decreased my BP readings generally) until about 5 days later.
How high was it for those 5 days before it went back to normal?
> Thanks for the info. Just want to have a next step in mind if the Nardil doesn’t do it. I know I am jumping the gun so to speak but it makes me feel better emotionally to do this. Then when things don’t work out, I don’t panic or go too low, but just take the next step and distract myself.One thing you might want to consider is that TCAs don't work very well for atypical depression. It might be worth a try, but there might be something else that's more likely to help.
> > ...although it's high, 160-170/90-100 isn't terribly dangerous -- it's just a good safe point to take nifedipine if the BP is still rising.
>
> I know, it’s just that it took so long for the episode to fully resolve. I was very out of sorts (although functional) for a good 5 days. I felt like I’d been in an auto accident and had whiplash. (Although I don’t suppose you’d know how that felt? How are the driving lessons going?)Dude, I don't have a license, but it's not like I've never ridden in a car! < g > I think it is weird that it took so long for it to go away completely. Some people just seem to be more sensitive to side effects than the average person is.
> > > Is the Desipramine still doing you good
> >
> Ø Yes, it is.
>
> I am so pleased to hear this Elizabeth.Thank you. I'm pleased to say it.
> Ø No, they'd give you phentolamine or nitroprusside. They'd also monitor you to make sure you were okay (no BP crash, etc.).
>
> Yes, but aren’t you looking at a significant delay to treatment (driving to the hospital; getting admitted; having them draw blood to make sure you’re not on cocaine?; treating you like an idiot?) Bad attitude, I know.When I showed up at an ER (or at the MIT Medical Center) with high blood pressure, I got seen at once. (MIT Medical didn't actually help me in any way, but they did monitor my BP -- they didn't just tell me to sit in the waiting room.) I think it's worth it to get a portable BP monitor (they'll fit in a reasonable-sized purse or handbag) so you can check it if you start getting symptoms.
> Ø Yes. It can make your blood pressure "crash," which can progress to shock (worst-case scenario).
>
> OK, I’ll be careful.Thanks. I would hate for something like that to happen to you.
> Elizabeth, how long to hypertensive crises usually last? I thought about taking another BP reading 5 minutes after my high one to see if it was coming down, but got too scared to wait.
I think they usually resolve within a few hours, but I might be misremembering.
-elizabeth
Posted by shelliR on September 14, 2001, at 11:06:10
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 13, 2001, at 11:53:33
Hi Lorraine,
>> I lived in DC for a summer as a law intern. Loved it. Might not want to live there because I suspect it's a bit provicial for all it's big city trappings--at least it was then (25 years ago).
I think it's probably still true in lawyer circles and some other work type situations, but I'm not much connected to that world. I imagine though in general, it is more formal. Like I wouldn't ever go into the city wearing shorts, even discounting my age and my enlarged body. Like in Santa Fe, all bodies wore shorts. :-) (or western hippie attire.)
>
> (hey, you want to meet me in santa fe next summer? :-) )
> I thought you didn't like meeting psychobabblers;-). I don't know how our summer plans are shaping up (what with the kids and all summer gets crazy). But I might go to the east coast next summer. If I do, we might get together.Well, I actually I don't think I was serious. And I'm still not feeling like bringing board life into real life. I am too vulnerable now, and need to stay light. Today I got an invitation to come out to Sierra Vista, AZ, which is supposed to be quite beautiful. The invite was from a client who just moved out there, but I don't know them well; just photographed them once recently. So I wouldn't feel comfortable taking her up on it, although I would call them if I get out there.
I meet a lot of interesting people doing what I do, but they are generally in a very different life situation, so although we like each other very much, the friendship doesn't extend into private social interactions, generally, although there have been exceptions. Interestingly, the exceptions are generally from the UK--I think they are more open about who they invite to their parties; they seem to enjoy diversity.
> > > > Well I saw my pdoc again today, because I have plummeted down in the last two days and we were talking hospitalization. Again.
> I'm so sorry to hear this. You are going through a terribly rough patch, right now. Eventually, it will get better. The hard part is that you (and I) don't even know if we are on the right meds now and the urge to find an answer is so strong; it's easy to just move on before the right med has a chance to work (Nardil took 5 weeks for you--I just finished 5 weeks on Parnate.) It's the old advice shelli, when you are depressed don't look at the big picture only focus on details or distract yourself. This is a terrible time to try to distract yourself with TV though. I know you know all this, still..Well, I've never used TV as a distraction. It doesn't engage enough of my mine for it to be a distraction. Although watching tennis is a large distraction for me (and it doesn't engage my mind either). If I can get into reading, that engages me more than anything, and it's good if I am already into a book so it doesn't involve transition.
I have not done any work this week so far, including printing, etc. I finally started returning phone calls today. I also had a few conversations with my sister (out of state) and can feel her concern and just talked to my therapist friend for about an hour on the phone, about therapy; sort of her view as a therapist; do any patients make her feel insecure, etc. It sounds like she feels very confident in her work and enjoys it quite a bit. She is working with more children recently and finds the pressure much greater. This is because of the part their parents play in creating (or reinforcing) their problems, and also because, sort of what you say about your kids, they are only this age once. You don't want them to have to compensate later for missing a developmental stage, so there is much a more immediate need to get them on track. It's always interesting to talk to her. She's about the only friend that I talk about medication with, more than just mentioning that it has changed again.
>> I am now pretty sure it has to do with the horror of yesterday piled up on top of my depression. I couldn’t trace it though, until I read a post from Anna (sweetmarie) saying how she had definitely experienced a downward plunge, after the news.
> I've been feeling this too. I try not to listen to the news too much. My husband wants it on all the time, but I feel like climbing out of my skin when it's on so much. I reorganized the cabinets in the house to distract myself. I definately need to distract myself from this--I have no tolerance for stress and this is definately stressful. Avoidance is how I now deal with stress. I try to insulate myself from it. I have to. I've thought of looking at churches to attend actually, although I am not religious, I just think the structure, the ritual, the "words" might be soothing now.I tried that years ago, and never found that, unfortunately. I have always had a hard time identifying with groups that I can't embrace completely. Sometimes that is not a good way to be, but I think it's just a part of my makeup.
>
> > >I am very shaky and not sure that I can handle work.
>
> So this is a photo shoot. Long time commitment. And you don't just get lost in the work once you start? Photo shooting sounds like the essence of detail and distraction to me if you are up to it.I hope it will feel like that; it always has before. I am going to *try* to limit my sittings this fall because of my depression. I would rather do that than go in the hospital. I don't see any benefit in being in the hospital now, aside from keeping me alive, which I'd rather do outside the hospital.
>
> > > > Too late, I already took a split pill. It’s not time release so I can’t imagine why there would be a problem.
>
> Wow, you are moving fast. I need to increase my dose of Nardil (still 15 mg) but am a bit anxious about doing it. Do you remember if you had any anxiety when you were beginning Nardil?I'm going fast, because I've been there before without any startup problems. I'd be going much faster if I wasn't taking wellbutrin still.
I don't recall having any side effects when I started, but it was so long ago. I was just aware of waiting for it to kick in , and waiting and waiting, feeling very depresssed and then it really did kick in. I went with some friends to the beach (just for the day) right after it kicked in and I remember that I couldn't stop talking. I talked the entire day without shutting up. That's why I am suspicious of this new trend of labeling people bipolar II based on drug induced hypermania. Because it was a temporary thing for me, but the antidepressant events went on for years.> > So day three, any more news? When are you going to raise your dose and do you have any idea of how high you are intending to go? I started on 45mg (well, within one week, if I remember right), but generally through the years I have kept my dose at 30mg because of sleep disturbances which were minimal at 30mg.
> I'll probably go to 1 1/2 pills today this is how sure I am that my pharmacist was not right). I probably won't get to a very high dose. I'd be surprised if I go over 30 mg.Well, as I said, I did consistently okay on 30mg, but I never felt totally without depression in my life. But I had a lot of stuff to work out. This feels much more biochemical, and that's how my pdoc refers to it.
> I also had very strange and scarey experiences not adjusting to natural light changes (especially from inside to outdoor sunlight) when I had been on 45mg for about six months.
> Wellbutrin caused me to have visual trails and made lights dance--especially coming from a dark space (movie theatre or waking up) to a light space (movie theatre restroom).This was very very scary because I would "white" out. I became literally blinded by light and it became dangerous because at one point I couldn't figure out where the sidewalk connected to the street, and I had to get some workmen to help me across the street into a building. I'm sure they thought I was drunk. I am sensitive to light, but not literally blinded by it. Coming off the beach, out of the bright light and reflection, same experience. When I went back to 30mg and 45mg premenstrually it never happened again.
>
> You know I like being alone. And I have been so busy--I'm painting the house and so forth. Also when I drive the kids, the other parents pull me aside and talk to me. They like me :-)
:-)
So I'm actually a bit more social than usual.Yes, being a parent does have some social advantages like that, connections. Because I work with kids all the time and find them interesting, I talk easily to parents about their kids. Some confide a lot to me. It's nice; many times I get to follow kids through different ages.
I am rethinking lamictal, since it was of such benefit to me as an adjunct. Rethinking that perhaps there is a safe way to prevent all the fluid retention it caused me. I know it’s not as simple as taking diuretics, because I already tried that, but I have copied some info off the board which may be useful.
Shelli
Posted by Elizabeth on September 14, 2001, at 23:27:26
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 14, 2001, at 11:06:10
[re DC:]
> I think it's probably still true in lawyer circles and some other work type situations, but I'm not much connected to that world.DC always seemed like a very segregated city -- there's the little part of town where all the politicians and lawyers hang out, and the rest of it is just as bad as any part of New York or L.A.
> I imagine though in general, it is more formal.
Yes, compared with other big cities, DCers seem to dress conservatively (like, everybody wears a suit -- no "business casual," no high fashion, etc.).
> Like I wouldn't ever go into the city wearing shorts, even discounting my age and my enlarged body.
I didn't know that you're having weight problems. Sorry to hear it. Was it related to meds? (trying desperately to find some way to make this post marginally topical)
> Like in Santa Fe, all bodies wore shorts. :-) (or western hippie attire.)
Santa Fe always sounded to me like an all-around cool town. I've only been to NM once, and I didn't make it to Santa Fe that time. And I don't have an excuse to go back -- at the time, my boyfriend from college was working at one of the national labs, but he's since moved to Rockville, MD (which is, coincidentally, where I lived until I was 8), and is working for a biotech company. He must be making a lot of money doing that, because I seem to recall that Sandia was paying him a lot already. (I guess a Ph.D. from MIT is really worth something. < g >)
> Well, I've never used TV as a distraction. It doesn't engage enough of my mind for it to be a distraction.
< g > I was about to suggest reading, but then I read further where you brought it up! Are you reading anything right now? I think it's been a while since I read anything other than textbooks, journals, or the occasional magazine or newspaper.
> I have not done any work this week so far, including printing, etc.
A lot of people I've talked to say they haven't been getting anything done this week (even the ones who don't work in New York). I know I haven't, but that's nothing new. :-}
> I hope it will feel like that; it always has before. I am going to *try* to limit my sittings this fall because of my depression. I would rather do that than go in the hospital. I don't see any benefit in being in the hospital now, aside from keeping me alive, which I'd rather do outside the hospital.
Yeah, I never saw the point of psych hospitals unless someone is in danger of hurting themselves (or somebody else). Have you ever gotten anything out of a hospital stay?
> I went with some friends to the beach (just for the day) right after it kicked in and I talked the entire day without shutting up. That's why I am suspicious of this new trend of labeling people bipolar II based on drug induced hypermania. Because it was a temporary thing for me, but the antidepressant events went on for years.
I agree. MAOIs have some effects similar to those of stimulants, and they can cause some initial wiredness. Parnate did that to me more than Nardil did. It was only temporary for me, too. Unipolar depressives do sometimes have AD-induced mania, but that doesn't mean they're bipolar -- any effective AD can cause mania, IMO. (It's "hypomania," BTW.)
> Well, as I said, I did consistently okay on 30mg, but I never felt totally without depression in my life.
30 mg of Nardil is not much. 45 is marginal, and most people seem to need at least 60.
-elizabeth
Posted by Lorraine on September 17, 2001, at 9:24:46
In reply to Re: Hypertensive crises, update » Lorraine, posted by Elizabeth on September 13, 2001, at 14:43:22
Elizabeth:
> > > So you mean by "residual effects" continued symptoms after BP has returned to normal? I wouldn't expect any such symptoms, unless the HT did damage.
Yes, residual effects, stiff neck lasted about 5 days. My blood pressure was around 128/87 druing those five days. Before the episode my BP was 105/67 (MAO influenced low BP) and before taking MAOs it was 124/72. Now it has returned to 106/71.
>
> Calcium channel blockers, like nifedipine, lower your BP by dilating blood vessels. Sometimes this can cause your body to try to compensate by raising your pulse.Well, I guess this happened. My pulse during the episode was 59 and it rose to 73 after I took the antidote, but 73 is not high.
[re: crick in neck] It is funny. I used to get cricks in my neck fairly frequently and I used to get migraines also. Now that we are talking about vascular things, I just wonder if they might have been related. Haven't had a crick in the neck in a long time--more than a year ago. They started being very infrequent. My migraines went away also (one of the few benefits of menopause in my case.)
> > Thanks for the info. Just want to have a next step in mind if the Nardil doesn’t do it. I know I am jumping the gun so to speak but it makes me feel better emotionally to do this. Then when things don’t work out, I don’t panic or go too low, but just take the next step and distract myself.
>
> One thing you might want to consider is that TCAs don't work very well for atypical depression. It might be worth a try, but there might be something else that's more likely to help.Well, I'd talk with the pdoc at any rate well before a change to get his thinking. I know you are right re atypical depression.
> > > Dude, I don't have a license, but it's not like I've never ridden in a car! < g >Hadn't really thought of that:-)
I think it is weird that it took so long for it to go away completely. Some people just seem to be more sensitive to side effects than the average person is.
Perhaps that would be me. Anyway, it is gone now.
> > > When I showed up at an ER (or at the MIT Medical Center) with high blood pressure, I got seen at once. (MIT Medical didn't actually help me in any way, but they did monitor my BP -- they didn't just tell me to sit in the waiting room.) I think it's worth it to get a portable BP monitor (they'll fit in a reasonable-sized purse or handbag) so you can check it if you start getting symptoms.
I'm glad they were attentive anyway.
>
> > Ø Yes. It can make your blood pressure "crash," which can progress to shock (worst-case scenario).
> >
> > OK, I’ll be careful.You know, I do remember you telling me to be careful re amphetamines and MAOs. It's awfully generous of you not to mention that.
I'm glad your meds continue to function.Lorraine
Posted by Elizabeth on September 17, 2001, at 10:04:15
In reply to Re: Hypertensive crises, update » Elizabeth, posted by Lorraine on September 17, 2001, at 9:24:46
> Yes, residual effects, stiff neck lasted about 5 days. My blood pressure was around 128/87 druing those five days. Before the episode my BP was 105/67 (MAO influenced low BP) and before taking MAOs it was 124/72. Now it has returned to 106/71.
So your BP *was* elevated above baseline for you during the five days. Okay. People with low baseline BP can experience symptoms of HT at BP levels that wouldn't be noticeable for most people.
> > Calcium channel blockers, like nifedipine, lower your BP by dilating blood vessels. Sometimes this can cause your body to try to compensate by raising your pulse.
>
> Well, I guess this happened. My pulse during the episode was 59 and it rose to 73 after I took the antidote, but 73 is not high.That's right. I'm surprised your pulse runs low along with the low BP and the MAOI, though.
> [re: crick in neck] It is funny. I used to get cricks in my neck fairly frequently and I used to get migraines also. Now that we are talking about vascular things, I just wonder if they might have been related.
What did you use for the migraines?
> > When I showed up at an ER (or at the MIT Medical Center) with high blood pressure, I got seen at once. (MIT Medical didn't actually help me in any way, but they did monitor my BP -- they didn't just tell me to sit in the waiting room.) I think it's worth it to get a portable BP monitor (they'll fit in a reasonable-sized purse or handbag) so you can check it if you start getting symptoms.
>
> I'm glad they were attentive anyway.Are you kidding? Small consolation for me. Should have sued the bastards. (I did mention the pulmonary hemorrhage that resulted, didn't I?)
> You know, I do remember you telling me to be careful re amphetamines and MAOs. It's awfully generous of you not to mention that.? I'm confused.
> I'm glad your meds continue to function.
I think I'm the one who's functioning (sort of). My meds are just *working*! :-)
-elizabeth
Posted by Lorraine on September 17, 2001, at 12:22:42
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 14, 2001, at 11:06:10
Hey, Shelli:
Day 7 of Nardil; Day 3 of 22.5 mg Nardil. Still alive and kicking; no sexual side effects so far (it's early, but, hey, hope is free). I'm doing ok, taking it day-by-day.
> > (hey, you want to meet me in santa fe next summer? :-) )
> > I thought you didn't like meeting psychobabblers;-). I don't know how our summer plans are shaping up (what with the kids and all summer gets crazy). But I might go to the east coast next summer. If I do, we might get together.
>
> Well, I actually I don't think I was serious. And I'm still not feeling like bringing board life into real life.I understand. I was skittish at the thought myself.
> > >Today I got an invitation to come out to Sierra Vista, AZ, which is supposed to be quite beautiful. The invite was from a client who just moved out there, but I don't know them well; just photographed them once recently. So I wouldn't feel comfortable taking her up on it, although I would call them if I get out there.
Maybe you could suggest they leave town for your visit < g >
>
> > This is a terrible time to try to distract yourself with TV though. I know you know all this, still..
>
> > > Well, I've never used TV as a distraction. It doesn't engage enough of my mine for it to be a distraction. ... If I can get into reading, that engages me more than anything, and it's good if I am already into a book so it doesn't involve transition.I'm actually thinking that reading a fiction book should be part of my wellness plan. You are right that it is very hard to "start" a book when you are down, but continuing it is not that hard. I'm also making a list of programs (radio) that I enjoy for my plan--I guess a list of distractors that I enjoy.
> > >She is working with more children recently and finds the pressure much greater. This is because of the part their parents play in creating (or reinforcing) their problems, and also because, sort of what you say about your kids, they are only this age once.
I can see that. Certainly, that is how I feel as a parent.
> > >I've thought of looking at churches to attend actually, although I am not religious, I just think the structure, the ritual, the "words" might be soothing now.
>
> I tried that years ago, and never found that, unfortunately. I have always had a hard time identifying with groups that I can't embrace completely.It's interesting. I was talking with my son about religion and which church he might want to go to and he said very much the same thing--that he doesn't accept all of the tenents of any of the religions, therefore he should form his own. Then I was reading a book about community and it said that you do not need to accept all of the tenets of a group, you just have to agree that this is what the group's tenets are--that the subordination of individuality or conformity to the group norm is no longer necessary for most modern groups and communities. Anyway, I suppose I hunger for community because I did not have it as a child. Anyway, maybe we will try it out--if it doesn't fit, well so what? Nothing lost.
> > > I hope it will feel like that; it always has before. I am going to *try* to limit my sittings this fall because of my depression.This is a good idea--just take it day by day and see how you do until you are stabilized. You might want to introduce some "structure" to take the place of the lost activities though.
> > >I would rather do that than go in the hospital. I don't see any benefit in being in the hospital now, aside from keeping me alive, which I'd rather do outside the hospital.
I suppose it is a matter of having sufficient coping skills to avoid hospitalization and realizing the limitation of your coping skills. I read somewhere that suicide occurs when someone's pain exceeds their ability to cope with pain. It places an interesting emphasis on coping skills.
> > > Well, as I said, I did consistently okay on 30mg, but I never felt totally without depression in my life. But I had a lot of stuff to work out. This feels much more biochemical, and that's how my pdoc refers to it.
Funny how we can tell the difference isn't it?
>
> > I also had very strange and scarey experiences not adjusting to natural light changes (especially from inside to outdoor sunlight) when I had been on 45mg for about six months.
> > Wellbutrin caused me to have visual trails and made lights dance--especially coming from a dark space (movie theatre or waking up) to a light space (movie theatre restroom).
>
> This was very very scary because I would "white" out. I became literally blinded by light and it became dangerous because at one point I couldn't figure out where the sidewalk connected to the street, and I had to get some workmen to help me across the street into a building. I'm sure they thought I was drunk. I am sensitive to light, but not literally blinded by it. Coming off the beach, out of the bright light and reflection, same experience. When I went back to 30mg and 45mg premenstrually it never happened again.Wellbutrin has a known side effect of seizure and I figured that these were like minor seizures or temporal lobe epilepsy sort of stuff. Not unpleasant, just unsettling and I worried that if I was driving in the dark and someone had their brights on, I'd become disoriented. I'll be alert to this side effect of Nardil tho, thanks for the heads up.
> So I'm actually a bit more social than usual.
>
> Yes, being a parent does have some social advantages like that, connections.It's even better. Because if your are social phobic (which I have some of), they provide natural conversation starters and help keep the focus off of yourself. Everyone talks to mothers of babies.
> > > I am rethinking lamictal, since it was of such benefit to me as an adjunct. Rethinking that perhaps there is a safe way to prevent all the fluid retention it caused me. I know it’s not as simple as taking diuretics, because I already tried that, but I have copied some info off the board which may be useful.
Lamictal drove me nuts with anxiety. Ah well--glad it worked for you and hope your attempts to moderate the side effects work.
Lorraine
Posted by Lorraine on September 18, 2001, at 10:14:30
In reply to Re: Hypertensive crises, update » Lorraine, posted by Elizabeth on September 17, 2001, at 10:04:15
> > Yes, residual effects, stiff neck lasted about 5 days. My blood pressure was around 128/87 druing those five days. Before the episode my BP was 105/67 (MAO influenced low BP) and before taking MAOs it was 124/72. Now it has returned to 106/71.
>
> So your BP *was* elevated above baseline for you during the five days. Okay. People with low baseline BP can experience symptoms of HT at BP levels that wouldn't be noticeable for most people.This sounds right, elizabeth.
>
> > > Calcium channel blockers, like nifedipine, lower your BP by dilating blood vessels. Sometimes this can cause your body to try to compensate by raising your pulse.
> >
> > Well, I guess this happened. My pulse during the episode was 59 and it rose to 73 after I took the antidote, but 73 is not high.
>
> That's right. I'm surprised your pulse runs low along with the low BP and the MAOI, though.It does run low on MAOs. Who knows what normal is? I know it ran fast on Effexor and Adderal--on Effexor it would go as high as 120 (this is during my last short trial) on Adderal I don't think it ever went over 95. It's very noticable to me though when it becomes fast. I don't like it.
>
> > [re: crick in neck] It is funny. I used to get cricks in my neck fairly frequently and I used to get migraines also. Now that we are talking about vascular things, I just wonder if they might have been related.
>
> What did you use for the migraines?Nothing. I never found anything that worked. I just stayed in bed, drew the blinds and waited it out. They lasted a couple of days.
> >I think it's worth it to get a portable BP monitor (they'll fit in a reasonable-sized purse or handbag) so you can check it if you start getting symptoms.
This is a good idea. I'll look into it. Of course, it won't fit in my purse, which is of the 5 x 7 wallet/organizer variety.
> >
> > I'm glad they were attentive anyway.
>
> Are you kidding? Small consolation for me. Should have sued the bastards. (I did mention the pulmonary hemorrhage that resulted, didn't I?)This is my point, elizabeth. Don't you think that any doctor in their right mind would carry an antidote if they were on an MAO? Don't you think this "I'm not sure if the patient can be trusted" stuff is a bit patronizing? Tell me about the pulmonary hemorrhage. What is it? Are you OK now? It won't happen to you again, right?
>
> > You know, I do remember you telling me to be careful re amphetamines and MAOs. It's awfully generous of you not to mention that.
>
> ? I'm confused.Well, at one point I told you that my pdoc said I could take some Adderal with the Parnate if I needed to and you advised me to be careful. My hypertensive crises came from taking Adderal during my washout period (too much, too soon).
>
> > I'm glad your meds continue to function.
>
> I think I'm the one who's functioning (sort of). My meds are just *working*! :-)It's grand when things fall in place though. My reading--Solomon's book "Noon Day Demon"--was great (about his experiences and more on depression) and now I'm reading the NAMI stuff at the California website. I love their stuff (www.mhsource.com/hy/j94.html).
The Nardil is making me "warmer" towards people. I hope I can take it. I have some side effects that I am wrestling with--skin picking and skin irritation. I am just going to go slow with this titration. I'm at 22.5 now; down 2 pounds and no sexual impairment so far. Well, it's early in the trial. But no sexual impairment means I could actually feel things like I used to--what a delight and it has been a long time. I had forgotten who I was, you know?
Lorraine
Posted by Lorraine on September 19, 2001, at 9:25:07
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 14, 2001, at 11:06:10
Shelli: Are you ok? Haven't heard in a while--worried.
Lorraine
Posted by shelliR on September 19, 2001, at 11:12:05
In reply to Re: Shelli are you ok? » shelliR, posted by Lorraine on September 19, 2001, at 9:25:07
> Shelli: Are you ok? Haven't heard in a while--worried.
>
> LorraineHi Lorraine.
I haven't had much good to write. I am not doing too well.
It is so horrible to say this but I feel like I'm ready to give up. But I could not do that to my parents, and my sister has been so clear in how much I mean to her. I actually used to get something from going into the hospital, sort of a place to get a way from work and get stable. But the last two times have been more negative than positive, so I am trying to stay out.Yesterday I faxed my pdoc (he's left today for five days), asking if I could increase my morning dose of oxy and even though I talked to his office staff and they promised me they would get back to me by the end of the day, they didn't. So I have upped the oxy in the morning by 10mg. If he has a problem with that, too bad. I am having no problem with the nardil and wellbutrin (no BP problems) but he wants to wait a week for the next increase. As I said in the last post I am rethinking nardil and lamictal, my best combo, if my pdoc can plan out a way to cut at least half of the water weight gain. (I cannot accept adding 15 lbs, and it was also very uncomfortable weight). Last time I weighed myself I had lost 10.5 lbs since May, so I have 20 more to go until I feel comfortable in my body. (I'm 5'6, just to give you an idea that with twenty extra pounds I am not obese or anything, just not me, or more of me than I can tolerate!)
It is so hard to work with my pdoc; he keeps ignoring me when I want to talk about buprenorphine over oxy or try to talk about lamictal. He says I'm changing enough at the moment, and as you truely understand, it works better for me to always have one eye to the future, to what's next. So eventually, I think he will let me try it, but I'm not sure how I will react to it anyway. I'm not sure what the answer is for me.
Monday, I was thinking of having businesses both here, and in Arizona. Then Tuesday, I was completely suicidal. I do believe that the happenings of Tues have affected me much more than I am consciously aware and just sort of sent me into a different zone, that I can't seem to climb out of. Lots of people in my life are telling me this about their lives. Not that they want to die, but just how things have not yet gone back to normal in their psyches. In addition, in the middle of this I have gotten my period three times in the last seven weeks. I have an appointment next week to see my gyn but I think she's pretty much thinking the depression has been there too long for me to treat exclusively through hormones, but I definitely know that is the reason, everything got thrown off in the last year and a half. It is so frustrating because before that, things in my life were finally feeling really managable and I was willing to move into "new" areas regarding relationships. Actually it will be two years ago this Christmas that nardil was no longer able bounce me back from short depressions, as it had for years and years.
So that's good that you aren't having any side effects with nardil. I truely am very optimistic for you. Nardil is my security drug and I'd rather take it and work with adjuncts again, then to try again a new base antidepressant.
Please don't worry. I have good friends, healthy parents, a sister, and a therapist to support me. And if I lose faith in mypdoc I would probably go to Boston and check myself into either McLean or Mass General.
I hate writing bad news. Again that damn shame thing comes into play. Have a lot of work to do on that even if/when this depression lifts
I hope you are continuing to do well,
Shelli
Posted by Lorraine on September 20, 2001, at 10:00:40
In reply to Re: Shelli are you ok? » Lorraine, posted by shelliR on September 19, 2001, at 11:12:05
Hello, Shelli
> > > It is so horrible to say this but I feel like I'm ready to give up. But I could not do that to my parents, and my sister has been so clear in how much I mean to her.I'm sorry you are in this place. Are you still seeing your talk therapist? Remember that feelings come and go even the really awful ones.
> > > Yesterday I faxed my pdoc (he's left today for five days), asking if I could increase my morning dose of oxy and even though I talked to his office staff and they promised me they would get back to me by the end of the day, they didn't. So I have upped the oxy in the morning by 10mg. If he has a problem with that, too bad.
You are doing what you need to do to survive. Is the Oxy working otherwise? What is your current dose? The lack of responsiveness is normally irritating but when you are feeling desparate becomes very upsetting. I have an almost panic reaction if my meds aren't working and I need an adjustment and it's Friday.
> > >As I said in the last post I am rethinking nardil and lamictal, my best combo, if my pdoc can plan out a way to cut at least half of the water weight gain. (I cannot accept adding 15 lbs, and it was also very uncomfortable weight). Last time I weighed myself I had lost 10.5 lbs since May, so I have 20 more to go until I feel comfortable in my body. (I'm 5'6, just to give you an idea that with twenty extra pounds I am not obese or anything, just not me, or more of me than I can tolerate!)
Have you tried Topamax or thought of augmenting with it? It is reputed to help with weight loss. Woman at my NDMDA meeting swore by it.
> > > It is so hard to work with my pdoc; he keeps ignoring me when I want to talk about buprenorphine over oxy or try to talk about lamictal. He says I'm changing enough at the moment, and as you truely understand, it works better for me to always have one eye to the future, to what's next. So eventually, I think he will let me try it, but I'm not sure how I will react to it anyway. I'm not sure what the answer is for me.
I guess this is why I decided to stay with my pdoc--he does let me lead the charge so to speak while he "consults" with me. It helps me feel more in control. I suppose if these guys haven't been depressed they don't know how frantic we become looking for a solution. Even if our solution is the wrong one (doesn't work), there is some piece of mind in crossing it off our list. At least that is how it is for me.
> > >In addition, in the middle of this I have gotten my period three times in the last seven weeks. I have an appointment next week to see my gyn but I think she's pretty much thinking the depression has been there too long for me to treat exclusively through hormones, but I definitely know that is the reason, everything got thrown off in the last year and a half.
I think you are right, shelli. This is why I am focusing on getting my hormone mix right--although you know it's another complication. You might look at www.mhsource.com/hy. In their journal devoted to women and mental health they note:
"As women reach their 30s to 50s, there begins an increase in sensitivity to the change in estrogen and progesterone levels that leads to a cluster of symptoms now called the premenstrual dysphoric disorder. Many women who suffer depression often have these symptoms preceding their actual onset of depression. The underlying mechanism may be the neurodynamics of the individual losing its constraints, shifting the balance towards a more chaotic mood state.
This is also a time when many women with bipolar disorders notice an increase in symptoms, including a shift to more rapid cycles of mood change and even mixed states of both mania and depression. Researchers have found that estrogen and progesterone directly influence the balance of other neurotransmitter systems whose function, in part, may be to minimize excessive swings in mood. Estrogen increases the activity of the glutamate system, which helps keep memory functioning. Increased activity in this system may also lead to hypomanic behavior. Progesterone is crucial to keeping the neuroreceptors for GABA operational. When progesterone levels drop, the ability for GABA to tone down neuronal activity decreases dramatically. This can lead to sleep disturbances, increased agitation, irritability and anxiety."
Shelli, I have no doubt that it is the changes in your hormones that destabilized you. That is what precipitated my depression. So you may need to work with both hormones and meds to find your footing again.
> > >It is so frustrating because before that, things in my life were finally feeling really managable and I was willing to move into "new" areas regarding relationships. Actually it will be two years ago this Christmas that nardil was no longer able bounce me back from short depressions, as it had for years and years.
Shelli, I have been mourning the disruption in my life lately. It's like just recently I have understood that this is a chronic illness, that it doesn't "go away" and that I will need to be able to manage it, through it's ups and downs when the meds are working and when they are not. What I mean is that I need to reclaim my life and stop waiting for a cure before I resume my old life. The truth is that my old life died and I need to move on from there. I was reading a quote about the difference between religiousness and spirituality that said essentially that religion is for those who want to avoid going to hell and spirituality is for those who have been to hell and don't want to go back. I have been feeling like no matter how hokey group meetings can be, no matter how unintellectual spirituality feels to me, I have to add things to my support system to help keep me afloat. I'm not saying you should do this because you should do what works for you--nothing more, nothing less. At one of the hospitals here they have a day program as well as an in-patient program for people with mental illness. Could this be a possibility for you? All you are trying to do is make the time pass between now and when meds start working--any tricks can help.
> > > So that's good that you aren't having any side effects with nardil.
Well, I increased my dose to 15mg 2x day. Let's see what that does. I was dipping in the afternoon. I am having some hyperventilating and back aches. I have also been having hot flashes like made (really worse than I have ever had them) so I have restarted the estrogen and added some progesterone. This on my own pretty much. I see the doctor tomorrow re hormone mix.
> > > Please don't worry. I have good friends, healthy parents, a sister, and a therapist to support me. And if I lose faith in mypdoc I would probably go to Boston and check myself into either McLean or Mass General.
Shelli, I'm concerned, not worried I guess. I hate to see you go through this. I hadn't realized it has been two years since you were stabilized. That's a long time--that's more or less my time frame too. I know how awful it can be to do the survival mode thing and wait for something to work.
> > > I hate writing bad news. Again that damn shame thing comes into play. Have a lot of work to do on that even if/when this depression lifts
I don't know--is it shame? I always want to be "competent" and this illness robs me of that. Continue to write please. What do you do to add structure to your days when you can't work?
Taking extra special care of yourself---
Lorraine
Posted by shelliR on September 20, 2001, at 11:40:34
In reply to Re: Shelli are you ok? » shelliR, posted by Lorraine on September 20, 2001, at 10:00:40
> Hello, Shelli
>
>
> > > > It is so horrible to say this but I feel like I'm ready to give up. But I could not do that to my parents, and my sister has been so clear in how much I mean to her.
> I'm sorry you are in this place. Are you still seeing your talk therapist? Remember that feelings come and go even the really awful ones.yes, I am still seeing my therapist.
> You are doing what you need to do to survive. Is the Oxy working otherwise?
I increased by 10mg and I'm feeling a lot better and am planning on going ahead with work commitments.
> > > >As I said in the last post I am rethinking nardil and lamictal, my best combo, if my pdoc can plan out a way to cut at least half of the water weight gain. (I cannot accept adding 15 lbs, and it was also very uncomfortable weight). Last time I weighed myself I had lost 10.5 lbs since May, so I have 20 more to go until I feel comfortable in my body. (I'm 5'6, just to give you an idea that with twenty extra pounds I am not obese or anything, just not me, or more of me than I can tolerate!)> Have you tried Topamax or thought of augmenting with it? It is reputed to help with weight loss. Woman at my NDMDA meeting swore by it.
Yes, did a trial for five weeks (I have some anger at my last pdoc for insisting on such long trials,) and all I did was sleep; no anti-depressant effects.
>
>
> > > >In addition, in the middle of this I have gotten my period three times in the last seven weeks. I have an appointment next week to see my gyn but I think she's pretty much thinking the depression has been there too long for me to treat exclusively through hormones, but I definitely know that is the reason, everything got thrown off in the last year and a half.
> I think you are right, shelli. This is why I am focusing on getting my hormone mix right--although you know it's another complication. You might look at www.mhsource.com/hy. In their journal devoted to women and mental health they note:
> "As women reach their 30s to 50s, there begins an increase in sensitivity to the change in estrogen and progesterone levels that leads to a cluster of symptoms now called the premenstrual dysphoric disorder. Many women who suffer depression often have these symptoms preceding their actual onset of depression. The underlying mechanism may be the neurodynamics of the individual losing its constraints, shifting the balance towards a more chaotic mood state.
> This is also a time when many women with bipolar disorders notice an increase in symptoms, including a shift to more rapid cycles of mood change and even mixed states of both mania and depression. Researchers have found that estrogen and progesterone directly influence the balance of other neurotransmitter systems whose function, in part, may be to minimize excessive swings in mood. Estrogen increases the activity of the glutamate system, which helps keep memory functioning. Increased activity in this system may also lead to hypomanic behavior. Progesterone is crucial to keeping the neuroreceptors for GABA operational. When progesterone levels drop, the ability for GABA to tone down neuronal activity decreases dramatically. This can lead to sleep disturbances, increased agitation, irritability and anxiety."yes, I'll look into that, but I have an appointment with my gyn and she is not thinking that hormones are the larger answer. My depression is the only increase, no agitation, irritability and not much anxiety, unless I am go to the hospital and I become much more agitated and my anxiety goes up.
>
>
At one of the hospitals here they have a day program as well as an in-patient program for people with mental illness. Could this be a possibility for you? All you are trying to do is make the time pass between now and when meds start working--any tricks can help.I have a hard time with the term mental illness. I feel much more comfortable with the term depressed. The term mental illness puts everyone in the same category. If you say you are mentally ill, pictures come up of schizophrenia, and other psychoses. And if you simply go into a program for all mental illnesses, that's pretty much what you get. (Sorry if I am not being politically correct.) I have been lucky to go into abuse programs which feel a bit closer to home. But I think I do not get much knowledge or therapeutic use out those groups anymore. Frankly, I find them unstimulating or insultingly childish. I am continuing to work when it is possible, and that is the best tactic for me. If I become too suicidal, I'll go inpatient, where I generally also skip most of the groups (been there, done that, wasn't learning anything new). I don't think I have the same needs for community as you do. And there is always an element of being treated like a child in a day hospital (or regular hospital) and I can't contend with the authority issue things at this point in my life. I am depressed, not a child. I like the idea of self-help groups the best, but truthfully for me now it is better to spend time with people who are not having such a *major* struggle in their lives, and use this board and my therapist to talk about depresssion. That is enough now.
> > > > So that's good that you aren't having any side effects with nardil.
> Well, I increased my dose to 15mg 2x day. Let's see what that does. I was dipping in the afternoon.do you mean depression, or tiredness, by the term dipping?
I am having some hyperventilating and back aches. I have also been having hot flashes like made (really worse than I have ever had them) so I have restarted the estrogen and added some progesterone. This on my own pretty much. I see the doctor tomorrow re hormone mix.
It sounds like things also get confusing for you between depression, anxiety, and hormones. I don't believe that nardil will increase your anxiety; you just may have to deal with anxiety separately.
>
>
> Shelli, I'm concerned, not worried I guess. I hate to see you go through this. I hadn't realized it has been two years since you were stabilized. That's a long time--that's more or less my time frame too. I know how awful it can be to do the survival mode thing and wait for something to work.As long as the oxy is working, I am able to work. I became very worried about work, it has taken many years to build my business. I did start printing again last night and have work scheduled tomorrow and Saturday, both with families that I know, then a four day break from shooting. Hopefully, the nardil will kick in; I'd like to increase, but my pdoc is being cautious and I cannot argue with that.
>
> > > > I hate writing bad news. Again that damn shame thing comes into play. Have a lot of work to do on that even if/when this depression lifts
> I don't know--is it shame? I always want to be "competent" and this illness robs me of that. Continue to write please. What do you do to add structure to your days when you can't work?I understand the importance of structure, but I don't feel a lack of structure. If I am "can't stand it depresssed", it is best for me to sleep off the worst--distraction does not work for me. But generally days go quickly. I have lots of paper work to do, take long naps in the afternoon, return messages, etc. I have not been bored.
>
> Taking extra special care of yourself---Thanks,
Shelli
Posted by Lorraine on September 22, 2001, at 13:06:10
In reply to Re: Shelli are you ok? » Lorraine, posted by shelliR on September 20, 2001, at 11:40:34
Shelli:
> > > > > It is so horrible to say this but I feel like I'm ready to give up. But I could not do that to my parents, and my sister has been so clear in how much I mean to her.
Did I tell you that I am keeping a "why I live" file for tough times? It includes wonderful notes that people have sent me over the years about how much I mean to them. I keep it in my notebook with my mood chart and so forth. It helps to know that it is there and when times are tough to read it and remember all of the people who care. The insidious thing about this illness is that it robs us of our past by shading what we remember and how we remember it and then robs us of our future when we project our present mood onto what will be. So it seems like it has always been as bad as it is and will always be as that bad. But neither is true. Our past includes bright spots--how many years on Nardil worked for you and how long for it to take effect (5 weeks)? I guess what I am trying to do with my notebook is represent a better reality in it. For you it might include some of your photography that you are proud of. I hope it has gotten better, Shelli. It sounds like the Oxy is helping.
> > I'm sorry you are in this place. Are you still seeing your talk therapist? Remember that feelings come and go even the really awful ones.
>
> yes, I am still seeing my therapist.Is she being helpful?
> > > Have you tried Topamax or thought of augmenting with it? It is reputed to help with weight loss. Woman at my NDMDA meeting swore by it.
>
> Yes, did a trial for five weeks (I have some anger at my last pdoc for insisting on such long trials,) and all I did was sleep; no anti-depressant effects.Topamax is a mood stabilizer (or anti-convulsant). I didn't think these were supposed to have anti-depressant effects, although Neurontin can for me.
> > > [re hormones] yes, I'll look into that, but I have an appointment with my gyn and she is not thinking that hormones are the larger answer.They probably are not the larger answer. But sometimes having some of these small pieces in place helps to balance the equation. It's complicated because hormones affect neurons as do anti-depressants.
> > > I have a hard time with the term mental illness. I feel much more comfortable with the term depressed. The term mental illness puts everyone in the same category. If you say you are mentally ill, pictures come up of schizophrenia, and other psychoses.
I sat in a Recovery, Inc. meeting one day with only 5 of us there (including the leader), two of the people were very heavily medicated (maybe with schizo-affective disorder). Anyway the meeting was fairly humorous because the leader was trying valiantly to keep the ball moving from one person to the other and keep participation up, although at least two people were not capable of truly contributing to the meeting. So she would say "Now Sally wouldn't you say that you spot [blah,blah, blah] with Lorraine?....Of course, you would". You are right about the mixed bag of nuts that the term mental illness represents. And among the stigmas, depression is merely viewed as self indulgent, whereas schizophrenia is actually frightening to public at large. The issue of level disability is also a big one, depending on the illness. Still, for me, I've been trying to come to grips with the fact that this is first and foremost an illness and that it is a chronic illness without a known cure. I feel like I have to accept that level of reality to move forward in my life.
> > >[re: support groups]Frankly, I find them unstimulating or insultingly childish.Did you try NDMDA? I don't find it childish. Unstimulating? Well, sometimes, but then the manics help keep the energy level up even though they take most of the focus. Shelli, you know the best way for you to get support. I'm not trying to push you one way or the other.
> > > > > So that's good that you aren't having any side effects with nardil.
> > Well, I increased my dose to 15mg 2x day. Let's see what that does. I was dipping in the afternoon.
>
> do you mean depression, or tiredness, by the term dipping?I meant depression. At 15 mg 2x day, I still feel the depression but I am not that far into the trial (2 weeks). I do feel better, although the hyperventilating is still an issue as are the backaches but these may resolve or I may find a way to deal with them. A benefit is that I am able to back down on my bedtime meds b/c falling asleep is not the struggle that it was on Parnate.
> > >[re hormones] I saw the new doctor regarding hormones and I finally feel like I have found someone who knows what they are doing. I got so tired of seeing ob/gyns that had waiting rooms full of pregnant women and knew nothing about hormones. This woman tested all of my hormone levels: DHEA, estrogen, progesterone, testosterone, thyroid and as well as my adrenal glands. Taking this info and taking into account the history of breast in my family, they sent a prescription to a compounding pharmacy for a combination hormone mix that she will adjust according to my reaction. She also will do a new test that measures hormone levels to make sure that they are in a range that minimizes breast cancer risk. Anyway, I am pleased.
> It sounds like things also get confusing for you between depression, anxiety, and hormones. I don't believe that nardil will increase your anxiety; you just may have to deal with anxiety separately.They are confused b/c each of these element impacts the others. Hormones and AD's both impact brain chemistry; plus they interact with each other so that it becomes a simultaneous equation to be solved. You are probably right about the nardil not increase, but not addressing the anxiety component.
>
> > > As long as the oxy is working, I am able to work. I became very worried about work, it has taken many years to build my business. I did start printing again last night and have work scheduled tomorrow and Saturday, both with families that I know, then a four day break from shooting. Hopefully, the nardil will kick in; I'd like to increase, but my pdoc is being cautious and I cannot argue with that.It's important to keep the work part of your life in place. I hope the Nardil kicks in for you soon, Shelli.
Lorraine
Posted by shelliR on September 22, 2001, at 21:49:47
In reply to Re: Shelli are you ok? » shelliR, posted by Lorraine on September 22, 2001, at 13:06:10
Hi Lorraine
>
> > > > > > It is so horrible to say this but I feel like I'm ready to give up. But I could not do that to my parents, and my sister has been so clear in how much I mean to her.
> Did I tell you that I am keeping a "why I live" file for tough times? It includes wonderful notes that people have sent me over the years about how much I mean to them. I keep it in my notebook with my mood chart and so forth. It helps to know that it is there and when times are tough to read it and remember all of the people who care.That's a nice idea, especially since you've been organized enough to save stuff like that.
I hope it has gotten better, Shelli. It sounds like the Oxy is helping.
Yes, the oxy is helping, but the constant need to raise the dose is alarming. And here I am picking nardil as my AD when I really have no reason to believe that it will work for me; I've retried it before since it lost it's effectiveness with no results. The wellbutrin helps with activation; I sort of see it as a booster similar to adding say, ritalin or any other stimulent. But I get no antidepressant effects from it. So I go up (hopefully this week) on the nardil, then what's next? I guess at some point my thinking was that if I was stabilized on an AD (nardil, now) then I might be more stable on the oxy--less tolerance. I feel like I've tried everything I can think of. There is something going on with the oxy and I know it's rebound depression in the morning, because never in my entire life have a woken up every single day this depressed. I think I might add a pill tonight at about 11pm and see if that stops the rebound effect. I'm curious to see if that has any effect on lowering the magnitude of the morning depression. It may be too activating, however, to sleep at night. Tonight I am feeling the depression more than I have for the past few days. It is scary to me.
> > yes, I am still seeing my therapist.
> Is she being helpful?I don't even know. I guess any ally is good right now.
> > > > Have you tried Topamax or thought of augmenting with it? It is reputed to help with weight loss. Woman at my NDMDA meeting swore by it.
> > Yes, did a trial for five weeks (I have some anger at my last pdoc for insisting on such long trials,) and all I did was sleep; no anti-depressant effects.
> Topamax is a mood stabilizer (or anti-convulsant). I didn't think these were supposed to have anti-depressant effects, although Neurontin can for me.Mood stablizers are very often used to boost ADs; so yes, in that sense, the whole idea is for them to have anti-depressant effects. That was the case for me with lamictal, and I assume the reason you take neurotin, since neither of us are bi-polar.
>
>
> > > > I have a hard time with the term mental illness. I feel much more comfortable with the term depressed. The term mental illness puts everyone in the same category. If you say you are mentally ill, pictures come up of schizophrenia, and other psychoses.
> I sat in a Recovery, Inc. meeting one day with only 5 of us there (including the leader), two of the people were very heavily medicated (maybe with schizo-affective disorder). Anyway the meeting was fairly humorous because the leader was trying valiantly to keep the ball moving from one person to the other and keep participation up, although at least two people were not capable of truly contributing to the meeting. So she would say "Now Sally wouldn't you say that you spot [blah,blah, blah] with Lorraine?....Of course, you would".< vbg >. I have been in that situation, and yes it can be pretty funny; or irritating, depending on my mood.
Still, for me, I've been trying to come to grips with the fact that this is first and foremost an illness and that it is a chronic illness without a known cure. I feel like I have to accept that level of reality to move forward in my life.
I was thinking when I got your post this morning that I don't really understand how your depression feels. Like for me it is a huge weight in my chest, a very physical pain. And a tightness when I try to talk, or really even breathe. You said you have atypical depression so I know what the list is. You once mentioned sadness welling up behind your eyes. Is sadness a large part of it? Well maybe you could just describe it for me.
> > > >[re: support groups]Frankly, I find them unstimulating or insultingly childish.
> Did you try NDMDA? I don't find it childish. Unstimulating? Well, sometimes, but then the manics help keep the energy level up even though they take most of the focus. Shelli, you know the best way for you to get support. I'm not trying to push you one way or the other.Well, I do feel pushed, sort of like you can't help it, despite your best intentions. < g > I tell you I don't feel the need for community in that sense, and you come back with , "did you try........" It's not a big deal, it doesn't make me feel guilty or bad or anything, really. It feels sort of like it would make you feel better if I went to a group because then you would know I was getting support. (And that's very nice for you to want me to have support.)
> > > > > > So that's good that you aren't having any side effects with nardil.
> > > Well, I increased my dose to 15mg 2x day. Let's see what that does. I was dipping in the afternoon.
> > do you mean depression, or tiredness, by the term dipping?
> I meant depression. At 15 mg 2x day, I still feel the depression but I am not that far into the trial (2 weeks). I do feel better, although the hyperventilating is still an issue as are the backaches but these may resolve or I may find a way to deal with them. A benefit is that I am able to back down on my bedtime meds b/c falling asleep is not the struggle that it was on Parnate.See this is where I get mixed up about your depression. Aside from dipping in the afternoon, are you without depression in the morning and evening? When you describe your depression you use very mild terms (like dipping) and then on the other hand you say you are trying to come to terms with having an illness without a known cure, which implies severe impairment. So I get confused. Do you think my confusion is semantics? Like in the morning to you want to get out of bed? And then later in the afternoon (during your dip) do you feel like getting into bed and pulling your covers over your head. That's what I'm trying to understand.
>
>
> > > >[re hormones] I saw the new doctor regarding hormones and I finally feel like I have found someone who knows what they are doing. I got so tired of seeing ob/gyns that had waiting rooms full of pregnant women and knew nothing about hormones. This woman tested all of my hormone levels: DHEA, estrogen, progesterone, testosterone, thyroid and as well as my adrenal glands. Taking this info and taking into account the history of breast in my family, they sent a prescription to a compounding pharmacy for a combination hormone mix that she will adjust according to my reaction. She also will do a new test that measures hormone levels to make sure that they are in a range that minimizes breast cancer risk. Anyway, I am pleased.I just get confused because my gyn (who I think is very smart), but yes, is also an ob, thinks that hormone tests are not very significant because they constantly fluctuate from day to day. Adjustment done on reaction is what she is big on, I think. I see her a week from Tuesday and I'll try to ask her again about getting me tested, but I think I already know what she thinks. Right now I'm taking synthetic estrogen and will probably go on natural progesterone, and then at some point I'll do more work on the right combination of synthetic and natural estrogen. Now I could probably get by with black cohosh, because it has become evident that despite the study on estrogen and depression, estrogen at the level of the study has not impacted my depression at all, and I'm not having any physical symptoms other than hot flushes. Actually I'm sweating a lot (like my face, mostly) and I don't know if that is hormonal or from wellbutrin. Also, in the southwest I was totally dry, always.
Anyway, I have been good about doing the treadmill 45minutes almost everyday, so hopefully between that and the lost of appetite on the wellbutrin, I'll at least become a thinner depressive.
Shelli
>
Posted by Lorraine on September 23, 2001, at 13:00:59
In reply to Re: Hypertensive crises, update » Lorraine, posted by Elizabeth on September 13, 2001, at 14:43:22
Hi, elizabeth:
Sorry for the delay. I keep thinking that I have replied to posts that I haven't. I think I have a mental illness:-)
> > > > I don't even *get* the difference between residual effects and an unresolved hypertensive crisis. Really.
> > >
> > Ø The difference would be whether your blood pressure is still high! (People whose BP runs low seem to have worse symptoms than those with higher baseline BPs.)Thank-you. This is helpful and pretty much what I thought.
> > So that crick in my neck was probably the result of residual the vascular contraction in that area.
>
> I don't know exactly what causes the particular symptoms, for the most part.
>
> > It would make sense, although my BP came down very significantly (well within the average range) after the antidote it did not return to pre-hypertensive readings (which were low because the Parnate had decreased my BP readings generally) until about 5 days later.
>
> How high was it for those 5 days before it went back to normal?It was about 125/80; or 130/88 ish.
> > >[re desipramine and Nardil] One thing you might want to consider is that TCAs don't work very well for atypical depression. It might be worth a try, but there might be something else that's more likely to help.The more I have read about it, the more I have come to believe that atypical depression is at least part of what is going on with me. I have this odd suspicion that BP II may be part of the deal. And, yes, i suppose we aren't supposed to mix and match, but i just have this feeling. You know going to the NDMDA (thanks again for the turn on to this group) and listening to people talk about how many open projects they have--well, it makes me edgy. Then there have been some period of that I now believe are hypomania--my encounter with the stock market for one. Then there is the fact that meds seem to work and then don't. It all just gives me pause...
> > > > Is the Desipramine still doing you good
> > >
> > Ø Yes, it is.
> >
> > I am so pleased to hear this Elizabeth.
>
> Thank you. I'm pleased to say it.Desipramine still good? and are you still doing the buprophimine?
I think it's worth it to get a portable BP monitor (they'll fit in a reasonable-sized purse or handbag) so you can check it if you start getting symptoms.
You are probably right, although my purse is wallet style and not much will fit in it. Anyway, don't you think that once you've had that particular headache you will know it? By the way, if vascular dialation is the method of action then aspirin or Ginko might help in a pinch.
I'm still on Nardil (14 days). I was taking 1/2 valium (2.5 mg) plus 1 ambien and 900 mg Neurontin to get to sleep on Parnate. Now I have scaled back to 600 Neurontin; no valium and 1/2 ambien to sleep. (Tried 500 Neurontin and no ambien last night but woke up too many times with too much awake time in between). I had discontinued my estrogen but started hot flashing too much and so I am back on HRT but this is estrogen/progesterone combo. I am feeling lower energy on the Nardil, but also feeling some of the hyperventilation. Shelli says, and she may be right, that the Nardil probably is not causing but is not correcting the physical anxiety. I am reluctant to try the benzos regularly b/c of the withdrawal associated with them and b/c I think they dummy me down. I am reluctant to take Neurontin during the day b/c of the sedation. And then I have so many variable going here, that it is enough to make me just want to sit down and cry at the notion of trying to figure out what is what. The Nardil is not providing sufficient AD support (I'm at 30 mg). What a twisted uphill road I walk right now. The funny thing is that I have gotten irritable at times--causing my husband to say "what is going on" and me to respond with "you insensitive lout, I'm on a new med, give it a rest already will you!!!" Then on the other hand, I have actually had a good fight or two with him--almost like I have the will to fight back. So there you have it--life in this edge of the universe.Lorraine
Posted by Lorraine on September 23, 2001, at 16:19:50
In reply to Re: hanging in there » Lorraine, posted by shelliR on September 22, 2001, at 21:49:47
> Hi Lorraine
> > >
> [re: why i live folder] That's a nice idea, especially since you've been organized enough to save stuff like that.Shelli, i have a million folders. I organized this one within the last 2 months. I just happened to get a wonderful email from my father in law and then a note from my mom and I thought i need to save these--at the time they both felt like they were saving me.
> > >And here I am picking nardil as my AD when I really have no reason to believe that it will work for me
It's such a bumber when what worked b/4 poops out
> > > I've retried it before since it lost it's effectiveness with no results.
For how long did you retry it? No results or partial response?
> > > The wellbutrin helps with activation; I sort of see it as a booster similar to adding say, ritalin or any other stimulent.
Me too.
But I get no antidepressant effects from it. So I go up (hopefully this week) on the nardil, then what's next?
Have you tried the other MAOs? You had a positive response to one. My pdoc says until you have tried all of the MAOs you haven't tried MAOs--meaning that they are all different.
> > >There is something going on with the oxy and I know it's rebound depression in the morning, because never in my entire life have a woken up every single day this depressed. I think I might add a pill tonight at about 11pm and see if that stops the rebound effect. I'm curious to see if that has any effect on lowering the magnitude of the morning depression. It may be too activating, however, to sleep at night. Tonight I am feeling the depression more than I have for the past few days. It is scary to me.
I've been feeling depressed as well, but not as low as you are. What about a sleeping aid at night if the oxy is too activating?
> > > Mood stablizers are very often used to boost ADs; so yes, in that sense, the whole idea is for them to have anti-depressant effects. That was the case for me with lamictal, and I assume the reason you take neurotin, since neither of us are bi-polar.I'm not confident that I am not bipolar II. But the reason I take Neurontin is because my EEG and QEEG show activity much like temporal lobe epilepsy--lots of spiking. I did find that Neurontin was mood supportive at a certain dose (900 mg), but that hasn't really held.
> Still, for me, I've been trying to come to grips with the fact that this is first and foremost an illness and that it is a chronic illness without a known cure. I feel like I have to accept that level of reality to move forward in my life.
>
> I was thinking when I got your post this morning that I don't really understand how your depression feels. Like for me it is a huge weight in my chest, a very physical pain. And a tightness when I try to talk, or really even breathe. You said you have atypical depression so I know what the list is. You once mentioned sadness welling up behind your eyes. Is sadness a large part of it? Well maybe you could just describe it for me.OK. Weepy, lethargic, complete and profound lack of energy and motivation, like walking through mud. Everything is too much effort; everything is too hopeless. Want to sleep all the time. Complete withdrawal from people. Do not leave the house. These days we can add to it anxiety. Hyperventilate; cannot bear to "wait"; read about certain things; bear the risk of certain things (especially with my kids).
>
> > >Shelli, you know the best way for you to get support. I'm not trying to push you one way or the other.
>
> Well, I do feel pushed, sort of like you can't help it, despite your best intentions. < g >Yeah, I know, it's hard for me not to want to fix things when someone is in pain and it is hard for me not to want to fix them my way--meaning what would work for me even tho I fully know that my way doesn't necessarily fit. I'm intellectually aware of this stuff. I don't think I've had anyone call me on it quite like you do, although from my perspective it's good timing b/c it is time to change this particular pattern. I have been focused on it even b/4 you brought it up. I do wish the best for you and, yes, i can see that i cannot make it happen for you anymore than you can make it happen for me.
> > > See this is where I get mixed up about your depression. Aside from dipping in the afternoon, are you without depression in the morning and evening? When you describe your depression you use very mild terms (like dipping) and then on the other hand you say you are trying to come to terms with having an illness without a known cure, which implies severe impairment. So I get confused. Do you think my confusion is semantics? Like in the morning to you want to get out of bed? And then later in the afternoon (during your dip) do you feel like getting into bed and pulling your covers over your head. That's what I'm trying to understand.If i stay still with myself right now (which I try not to do b/c it is too painful), I am depressed most of the time. I can get out of bed in the morning (that's probably Nardil)--I don't want to pull the covers over my head b/c then i would have to sit with the pain of my depression and that is just way, way, way too difficult for me. I am functioning to the extent that I am able to do and be with my family. I am not capable of much else. I could not, for instance, work. The depression is with me constantly--it does not descend upon me and then leave, it is not episodic, it is ever present and sometimes i respond to the meds, but i do not remit, i do not approach normal. I fluctuate between hope and despair and i try not to think about despair. I try to just keep walking. I get up in the morning b/c one does; i drive my son to school b/c i can; i try to "move" through my days. Today is not a good day and i feel like the Nardil is not doing anything.
The Essential Guide to Psychiatric Drugs describes atypical depression as follows:
"Patients with atypical depression maintain a reactive mood throughout their depression..this has nothing to do with how deeply depressed they feel. From time to time something good will happen that temporarily cheers the paient up to the point where she actually experiences pleasure."
Shelli--that happens with me and it confuses me b/c i think i'm coming out of my depression, but i am not.
"Many of the vegtative signs observed in major depression and dysthymia are reversed in atypical depression. Patients with atypical depression tend to overeat and oversleep. Patients with atyp8ical depression have no trouble falling asleep or staying aleep; in fact (they oversleep). The patient may explain the sleeping as his only escape."
That is me unmedicated. Most of my meds get me out of bed, at least. And, i don't return to bed b/c it makes me feel worse.
"In his groundbreaking work on classifying depression, Donald F. Klein, M.D. has likened the life of a pateint with atypical depression to being on a roller coaster."
This is why I started keeping a mood chart. I distrusted what i would say when i saw my pdoc--it depended on how i was feeling right then (the past days or weeks forgotten and the future assured). Shelli, this is probably why you can't figure out my depression also b/c of this little roller coaster thing going on. One day I sound one way and another day, another way. Today, I'm really down. Was my good mood the other day an illusion?
"unlike the discrete episodic nature of major depression, atypical depression seems to last for years"
> > > I just get confused because my gyn (who I think is very smart), but yes, is also an ob, thinks that hormone tests are not very significant because they constantly fluctuate from day to day. Adjustment done on reaction is what she is big on, I think.Well, mine is big on this as well, but also takes tests. The test she is talking about is new to determine level for breast cancer risk is new--i think it is urine based. She does believe in the tests although they clearly just measure a point in time. She says when you are first becoming perimenopausal, most doctors look at the estrogen level and this is a mistake b/c the first indication of perimenopausal activity is a decrease in progesterone.
> > > Anyway, I have been good about doing the treadmill 45minutes almost everyday, so hopefully between that and the lost of appetite on the wellbutrin, I'll at least become a thinner depressive.
That is a lot of will power to get yourself going 45 minutes a day. I have become a thin depressive. I hope you do too. It doesn't cure depression, but it is one less thing to feel bad about:-)
Lorraine
Posted by shelliR on September 24, 2001, at 0:12:09
In reply to Re: hanging in there » shelliR, posted by Lorraine on September 23, 2001, at 16:19:50
> > Hi Lorraine
> > > >> Shelli, i have a million folders.
Are they all organized in alphabetical order or by color? Just curious!>
> > > >And here I am picking nardil as my AD when I really have no reason to believe that it will work for me
> It's such a bumber when what worked b/4 poops out
> > > > I've retried it before since it lost it's effectiveness with no results.
> For how long did you retry it? No results or partial response?I went off it for only a short time around this time last year (did a fairly long trial of serzone) and totally crashed and wanted to go back on nardil. But I must not have gotten more than a very partial response, because we keep trying adjunct after adjunct. And then I was supplementing with vicodin almost everyday, but staying at the same low level. I had left my pdoc because she disallowed the vicodin and kept throwing APs at me and I was very sick of trials. So I switched to a guy who didn't care if I took vicodin (didn't prescribe them for me, though) and I only saw him once. He just kept refilling prescriptions for nardil and klonopin. I guess things kept getting worse and I was seaching the net and PB for new ideas and decided I wanted to try selegilene and called him and said that he had never used it and felt that I was "over his head" and should go back to my old pdoc.
So then I went into the hospital and have been off nardil ever since--I guess that was this June. The thing is that this time I am willing to go higher on nardil this time as long as my pdoc will give me something to knock me out at night. He says he will. And it will be in combination with wellbutrin which will help with the tiredness, if the depression lifts. And the oxy might stay if the AD stops me from having to keep going up. My last pdoc didn't want to add anything besides an AP to sleep. I was already taking valium and aterex (a strong antihistimine) . Once I added serequel to sleep and it kept me up the entire night. I can't justify taking an AP for sleep anyway; there are other things I could have tried that don't cause TD and don't cause weight gain. She's had several patients who developed TD and she has this cavilier attitude about it (it *only* took four months for it to go away). Well, I couldn't stay in my profession for four months with a twiching face, so we had some words about that.
> Have you tried the other MAOs? You had a positive response to one. My pdoc says until you have tried all of the MAOs you haven't tried MAOs--meaning that they are all different.Well. remember I tried parnate just after you. So there's really just one non-reversible MAOI that I haven't tried.
>
> > > >There is something going on with the oxy and I know it's rebound depression in the morning, because never in my entire life have a woken up every single day this depressed. I think I might add a pill tonight at about 11pm and see if that stops the rebound effect. I'm curious to see if that has any effect on lowering the magnitude of the morning depression. It may be too activating, however, to sleep at night. Tonight I am feeling the depression more than I have for the past few days. It is scary to me.
> I've been feeling depressed as well, but not as low as you are. What about a sleeping aid at night if the oxy is too activating?I can't really add more than I am taking now unless I add a new one. (not more valium and not more aterex). And I didn't tell him about the "experiment". I tried it last evening and I did wake up less depressed, but I did not get a good night's sleep.
> > > > Mood stablizers are very often used to boost ADs; so yes, in that sense, the whole idea is for them to have anti-depressant effects. That was the case for me with lamictal, and I assume the reason you take neurotin, since neither of us are bi-polar.
> I'm not confident that I am not bipolar II. But the reason I take Neurontin is because my EEG and QEEG show activity much like temporal lobe epilepsy--lots of spiking. I did find that Neurontin was mood supportive at a certain dose (900 mg), but that hasn't really held.Yes, I didn't know that until I read your post to Eliz. Are you continuing on the neurontin as you build up the nardil?
>>
> OK. Weepy, lethargic, complete and profound lack of energy and motivation, like walking through mud. Everything is too much effort; everything is too hopeless. Want to sleep all the time. Complete withdrawal from people. Do not leave the house. These days we can add to it anxiety. Hyperventilate; cannot bear to "wait"; read about certain things; bear the risk of certain things (especially with my kids).Thanks for explaining. Our depressions are very different I think. Sometimes now I feel no depression due to the oxy. That's why I am still able to work, do the treadmill, etc. Most of the time is okay, not great, but okay. But the oxy needs to go up for me to maintain this mood ........(and I don't even want to go there).
>
> > > >Shelli, you know the best way for you to get support. I'm not trying to push you one way or the other.
> > Well, I do feel pushed, sort of like you can't help it, despite your best intentions. < g >
> Yeah, I know, it's hard for me not to want to fix things when someone is in pain and it is hard for me not to want to fix them my way--meaning what would work for me even tho I fully know that my way doesn't necessarily fit. I'm intellectually aware of this stuff. I don't think I've had anyone call me on it quite like you do....Well, it's different to react in posts, different from if someone is actually engaged in conversation with you. Also it is easy for me to point things out like that because we have no "stuff" already there, so mentioning it wouldn't probably make you defensive. Anyway, you set yourself up by saying, "I'm not trying to..........", so it is amusing to me to say, "Of course you are." Like I'm not talking about any serious flaw. :-)
>
> The Essential Guide to Psychiatric Drugs describes atypical depression as follows:
> "Patients with atypical depression maintain a reactive mood throughout their depression..this has nothing to do with how deeply depressed they feel. From time to time something good will happen that temporarily cheers the paient up to the point where she actually experiences pleasure."
> Shelli--that happens with me and it confuses me b/c i think i'm coming out of my depression, but i am not.because when you experience pleasure, sometimes it is pure pleasure, not at all hazy?
>
> "In his groundbreaking work on classifying depression, Donald F. Klein, M.D. has likened the life of a pateint with atypical depression to being on a roller coaster."I don't understand that. Because you can experience pleasure sometimes, that is a roller coaster? I think of a roller coaster as Bipolar II, which I realize you think you may have, but I don't get the imagine of a roller coaster when you describe your days.
Unless it is not a very steep roller coaster?> This is why I started keeping a mood chart. I distrusted what i would say when i saw my pdoc--it depended on how i was feeling right then (the past days or weeks forgotten and the future assured). Shelli, this is probably why you can't figure out my depression also b/c of this little roller coaster thing going on. One day I sound one way and another day, another way. Today, I'm really down. Was my good mood the other day an illusion?
Okay, so you have whole days in which you don't feel the depression and you attribute that to the anti-depressant working, and then the next day, if it is not good, to the anti-depressant not working. (yes?) Well maybe you are having good days and bad days in your depression and when the AD really works you will feel different from both your good days and bad days. Certainly you will not always be questioning.
>
When the AD worked for me the first time (in my twenties) it was an "oh my god, this is what life can feel like" But I did have lots of downs throughout those years, just no long horrible downs. I was just starting to feel no downs for a while, just premensturally then I got to an all the time down (that's where I think hormones come in). It is hard for me to really know whether I'd still be alive without the oxy, whether I could stand that amount of pain. It was truely awful for me. So I would probably become a drug addict and have a good time, before I decided to kill myself. I'm serious. And then I guess I would try ECT.I really have the feeling that nardil may be right for you. Remember it took 5 weeks for me at 45mg. I know you react quicker, but still, you have just gone up to 30mg. I know it is hard to hold hope, but I think given the lack of side effects, you do have reason to be optimistic. I even think that maybe you could have worked with parnate, if you had been willling to add benzos, if I am recalling right. (I might not be; I have a hard time remembering my own reactions, let alone yours) :-)
Shelli
>>
>
>
>
Posted by Elizabeth on September 24, 2001, at 10:11:53
In reply to Re: Hypertensive crises, update » Elizabeth, posted by Lorraine on September 18, 2001, at 10:14:30
> > That's right. I'm surprised your pulse runs low along with the low BP and the MAOI, though.
>
> It does run low on MAOs. Who knows what normal is?I don't think there's a clear line, but 73 is definitely normal-ish, and 59 is a little on the low side. My resting pulse on MAOIs used to run around 100 or more (presumably in an effort to compensate for decreased BP). It wasn't usually uncomfortable, but sometimes it did bother me.
> > What did you use for the migraines?
>
> Nothing. I never found anything that worked. I just stayed in bed, drew the blinds and waited it out. They lasted a couple of days.Sounds awful. Did you ever try sumatriptan or any of the other triptans that are out there?
> This is my point, elizabeth. Don't you think that any doctor in their right mind would carry an antidote if they were on an MAO? Don't you think this "I'm not sure if the patient can be trusted" stuff is a bit patronizing? Tell me about the pulmonary hemorrhage. What is it? Are you OK now? It won't happen to you again, right?
Yes, doctors who refuse to give you nifedipine or some other effective vasodilator (beta blockers are not suited to this use, BTW) are being unacceptably patronising. I'm not sure why I didn't have it when that happened, because my pdoc at the time was *not* a patronising doctor at all. Anyway -- a pulmonary hemorrhage just means that there was bleeding in my lung (the right one only, not both, in this case). While I was waiting for my BP to go down, I started coughing. At the time I thought I was just coming down with a cold or having an allergic reaction to something. But the next day I was still coughing, and some of the stuff I was coughing up was bloody. So I went back to the med center and they ordered an x-ray (I had to go to Mass. General for that because it was a Sunday night and the lab at MIT Medical was closed). When it came back, the radiologist pointed to a spot and said, "you see this grey area?" (It all looked grey to me, but I just nodded.) It looked to them like it was either a hemorrhage or pneumonia, probably the former given what had happened the previous night. So I had to stay in bed for a week or so.
> Well, at one point I told you that my pdoc said I could take some Adderal with the Parnate if I needed to and you advised me to be careful. My hypertensive crises came from taking Adderal during my washout period (too much, too soon).
Oh, yeah. I had problems with amphetamines and MAOIs too. (I'm still confused as to whether you truly had a "hypertensive crisis" or whether it was just mildly elevated BP. It doesn't sound like it was anything too serious ("crisis" is supposed to imply a serious medical emergency).)
> The Nardil is making me "warmer" towards people. I hope I can take it. I have some side effects that I am wrestling with--skin picking and skin irritation.
Have you tried an antihistamine? Chlorpheniramine (ChlorTrimeton) is my personal favourite.
> I am just going to go slow with this titration. I'm at 22.5 now; down 2 pounds and no sexual impairment so far.
That's good news! I hope it continues going well.
best,
-elizabeth
Posted by Elizabeth on September 24, 2001, at 10:31:06
In reply to Re: Hypertensive crises, update » Elizabeth, posted by Lorraine on September 23, 2001, at 13:00:59
> > How high was it for those 5 days before it went back to normal?
>
> It was about 125/80; or 130/88 ish.I don't think that would be anything to worry about, although you might have some symptoms if your BP tends to run low normally.
> The more I have read about it, the more I have come to believe that atypical depression is at least part of what is going on with me. I have this odd suspicion that BP II may be part of the deal. And, yes, i suppose we aren't supposed to mix and match, but i just have this feeling.Mixing and matching is probably more accurate than trying to pigeonhole yourself. It's all a spectrum, you know? Like, I definitely have major depression, the traditional type, unipolar. But I also have problems that resemble mild ADD or Asperger's that predate the depression. My response to opioids is similar to the effects reported by addicts (and people who later go on to become addicts), which I think should be considered a psych disorder itself. (It's a feeling of not-rightness that predisposes people to addiction, but is there whether or not a person ever takes drugs). I also have panic attacks which may or may not be related to the depression. And then there are my sleep qurks. So you know, it's not all cut-and-dried.
> Then there have been some period of that I now believe are hypomania--my encounter with the stock market for one. Then there is the fact that meds seem to work and then don't. It all just gives me pause...
A suggestion: consider ADD as an alternative explanation.
> Desipramine still good? and are you still doing the buprophimine?
Nice try :-) It's buprenorphine. And yes, all still fine. (I'll post in a separate thread about where I've been for the last few days.)
> You are probably right, although my purse is wallet style and not much will fit in it. Anyway, don't you think that once you've had that particular headache you will know it?
Yes, but that doesn't mean you'll be able to tell from the headache exactly how high your BP is!
> By the way, if vascular dialation is the method of action then aspirin or Ginko might help in a pinch.
I've never heard either of those suggested. I'm not sure they would work fast enough, what the required dose would be, etc.
> I'm still on Nardil (14 days). I was taking 1/2 valium (2.5 mg) plus 1 ambien and 900 mg Neurontin to get to sleep on Parnate. Now I have scaled back to 600 Neurontin; no valium and 1/2 ambien to sleep.
Hey, that's good to hear.
> I am reluctant to try the benzos regularly b/c of the withdrawal associated with them and b/c I think they dummy me down.
You might only need them for a short time. As for the cognitive problems, trying a different bzd might be worthwhile.
> I am reluctant to take Neurontin during the day b/c of the sedation.
If you took it regularly, I'd expect the sedation to go away.
> The Nardil is not providing sufficient AD support (I'm at 30 mg).
I wouldn't expect 30 mg to work. Don't give up!
-e
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