Re: Suggestions for a depressed HIV+ person on disability

[Guest guest]

Normally these days, I find that when

people mention antidepressants, they are only talking about SSRIs.

I also took a few different SSRIs because

I was told to try them.

The fact is that SSRIs don't work for

many, and possibly even most people.

Prescribing psychiatrists seem to rarely

ever consider anything else.

After doing my own research, I decide that

my depression….which btw sounds like yours…. exhausted and

hopeless, sleeping and crying…. was Dopamine….not Serotonin based.

This was not casual research ; I immersed

myself for months ( I don't recommend it ) before coming to that conclusion.

I have been taking an antidepressant

called EMSAM for 5 years now. It is

a transdermal patch.

It is slow to work….and in my case

it took 6 months to feel the full effects. That could be because I insisted on the

lowest dose. Even though it

took a long time to get me out of my torpor, I felt a tiny bit better each

week. What else did I have to do

with my time anyway feeling so hopeless ?

I took it, lived a simple life, did only

what I could manage, and waited.

For me, it worked. People in mid life lose something life

13% of their circulating Dopamine every year. Dopamine controls movement and mood.

SSRIs are the newest advance, but there

are older drugs like Selegiline ( the active ingredient in EMSAM) that have

been pushed to the side in favor of SSRIs because they have some side effects

and interactions.

For me, the side effects of Serotonin

based antidepressants was far worse than the caution that I have to use to

continue on Selegiline. It is a

transdermal patch.

If you are feeling this poorly, you should

give Dopamine a try. There are very

few Dopamine targeting antidepressants and they usually fall into the category

of medicines that are used to treat Parkinsons Disease.

Not everyone's depression is Serotonin

based. A lot of doctors forget

that.

Certainly no harm in trying this one. Another good thing about Dopamine targeting

antidepressants is that they do not ruin your sex drive like SSRIs seem to.

It is an easy one to try.

Phil

Any

original elements and / or substance count in the virtual void. Please

display your own perticular brand of it.

Cheers.

[Guest guest]

Normally these days, I find that when

people mention antidepressants, they are only talking about SSRIs.

I also took a few different SSRIs because

I was told to try them.

The fact is that SSRIs don't work for

many, and possibly even most people.

Prescribing psychiatrists seem to rarely

ever consider anything else.

After doing my own research, I decide that

my depression….which btw sounds like yours…. exhausted and

hopeless, sleeping and crying…. was Dopamine….not Serotonin based.

This was not casual research ; I immersed

myself for months ( I don't recommend it ) before coming to that conclusion.

I have been taking an antidepressant

called EMSAM for 5 years now. It is

a transdermal patch.

It is slow to work….and in my case

it took 6 months to feel the full effects. That could be because I insisted on the

lowest dose. Even though it

took a long time to get me out of my torpor, I felt a tiny bit better each

week. What else did I have to do

with my time anyway feeling so hopeless ?

I took it, lived a simple life, did only

what I could manage, and waited.

For me, it worked. People in mid life lose something life

13% of their circulating Dopamine every year. Dopamine controls movement and mood.

SSRIs are the newest advance, but there

are older drugs like Selegiline ( the active ingredient in EMSAM) that have

been pushed to the side in favor of SSRIs because they have some side effects

and interactions.

For me, the side effects of Serotonin

based antidepressants was far worse than the caution that I have to use to

continue on Selegiline. It is a

transdermal patch.

If you are feeling this poorly, you should

give Dopamine a try. There are very

few Dopamine targeting antidepressants and they usually fall into the category

of medicines that are used to treat Parkinsons Disease.

Not everyone's depression is Serotonin

based. A lot of doctors forget

that.

Certainly no harm in trying this one. Another good thing about Dopamine targeting

antidepressants is that they do not ruin your sex drive like SSRIs seem to.

It is an easy one to try.

Phil

Any

original elements and / or substance count in the virtual void. Please

display your own perticular brand of it.

Cheers.

[Guest guest]

On Sat, Aug 4, 2012 at 3:23 PM, Fall River <philzao@...> wrote:

Normally these days, I find that when

people mention antidepressants, they are only talking about SSRIs.

 

I also took a few different SSRIs because

I was told to try them.

 

The fact is that SSRIs don't work for

many, and possibly even most people.

 

Prescribing psychiatrists seem to rarely

ever consider anything else.

 

After doing my own research, I decide that

my depression….which btw sounds like yours…. exhausted and

hopeless, sleeping and crying…. was Dopamine….not Serotonin based.

 

This was not casual research ; I immersed

myself for months ( I don't recommend it ) before coming to that conclusion.

 

I have been taking an antidepressant

called EMSAM for 5 years now.  It is

a transdermal patch.   

 

It is slow to work….and in my case

it took 6 months to feel the full effects.  That could be because I insisted on the

lowest dose.   Even though it

took a long time to get me out of my torpor, I felt a tiny bit better each

week.  What else did I have to do

with my time anyway feeling so hopeless ?

 

I took it, lived a simple life, did only

what I could manage, and waited.

 

For me, it worked.  People in mid life lose something life

13% of their circulating Dopamine every year.  Dopamine controls movement and mood.

 

SSRIs are the newest advance, but there

are older drugs like Selegiline ( the active ingredient in EMSAM) that have

been pushed to the side in favor of SSRIs because they have some side effects

and interactions.

 

For me, the side effects of Serotonin

based antidepressants was far worse than the caution that I have to use to

continue on Selegiline.  It is a

transdermal patch. 

 

If you are feeling this poorly, you should

give Dopamine a try.  There are very

few Dopamine targeting antidepressants and they usually fall into the category

of medicines that are used to treat Parkinsons Disease.

 

Not everyone's depression is Serotonin

based.  A lot of doctors forget

that.

 

Certainly no harm in trying this one.  Another good thing about Dopamine targeting

antidepressants is that they do not ruin your sex drive like SSRIs seem to.

 

It is an easy one to try.I am reminded of a graphic I saw on Facebook once. The caption read: These are the two things that make you happy. Above the caption were the diagrams for serotonin and dopamine. But in all seriousness, Phil makes a good point, and he's right about doctors and psychiatrists overlooking these drugs.

EMSAM belongs to a class of antidepressants known as monoamine oxidase inhibitors, or MAOIs. The big disadvantage to these drugs, and I hope your doctor told you about these, Phil, is that you have to be very careful about the foods you eat and the over-the-counter meds you take.  Certain foods (I can't recall what they are now, but you can probably find out more at www.emsam.com) and certain OTC drugs like some of the cold remedies interact with the MAOIs in very toxic ways.

In addition to the MAOIs there are the tricyclic antidepressants which are older, but still used sometimes.  Their chief disadvantage is that they tend to cause drowsiness and sedation, which is why prescribing doctors were so quick to jump on the SSRI bandwagon.

For what we call " refractory depression " -- depression that doesn't respond to any of the anti-depressants -- some psychiatrists have started using some of the mood stabilizers like valproate and atypical antipsychotics like olanzapine or Abilify with success.  This is cutting edge stuff, however, and you need a psychiatrist who is really on top of his game and keeping up with the current literature to know about these developments in the field.

There are a lot of options.  There's really no need these days for someone to remain as depressed as the fellow who wrote to .  The advice I might have given him would have been to find a new (and better) psychiatrist!  In the end, however, there is the deep, dark secret of the mental health field:  some people don't respond to any medication or any type of psychotherapy. I hope 's writer is not one of those, but he has to get out of bed and start trying some of these alternatives before giving up.

Regards,Nick-- Nick , LSW

6631 Clemens Ave., Apt. 1EUniversity City, MO 63130

thenick58@...

http://nicknicholas.net

[Guest guest]

On Sun, Aug 5, 2012 at 11:40 AM, Nick <thenick58@...> wrote:I know it's bad form to follow up on your own message, but I just read something I think it's important to share.

EMSAM belongs to a class of antidepressants known as monoamine oxidase inhibitors, or MAOIs. The big disadvantage to these drugs, and I hope your doctor told you about these, Phil, is that you have to be very careful about the foods you eat and the over-the-counter meds you take.  Certain foods (I can't recall what they are now, but you can probably find out more at www.emsam.com) and certain OTC drugs like some of the cold remedies interact with the MAOIs in very toxic ways.

In addition to the MAOIs there are the tricyclic antidepressants which are older, but still used sometimes.  Their chief disadvantage is that they tend to cause drowsiness and sedation, which is why prescribing doctors were so quick to jump on the SSRI bandwagon.

For what we call " refractory depression " -- depression that doesn't respond to any of the anti-depressants -- some psychiatrists have started using some of the mood stabilizers like valproate and atypical antipsychotics like olanzapine or Abilify with success.  This is cutting edge stuff, however, and you need a psychiatrist who is really on top of his game and keeping up with the current literature to know about these developments in the field.

There are a lot of options.  There's really no need these days for someone to remain as depressed as the fellow who wrote to .  The advice I might have given him would have been to find a new (and better) psychiatrist!  In the end, however, there is the deep, dark secret of the mental health field:  some people don't respond to any medication or any type of psychotherapy. I hope 's writer is not one of those, but he has to get out of bed and start trying some of these alternatives before giving up.

I happen to be in the middle of writing a major paper on the psychiatry of AIDS, and I just came across the following in Comprehensive Textbook of AIDS Psychiatry: " Similarly, monoamine oxidase inhibitors are not recommended for patients with HIV and AIDS.  This class of medications poses an extraordinary risk, since persons with HIV and AIDS are often on complex and frequently changing drug regimens and also have the concurrent risk of hypertensive crisis if exposed to food or other medications.  These include epinephrine for asthma or meperidine for prevention of rigors from amphotericin B treatment of cryptococcal meningitis or other fungal infections. "

My takeaway from this is that it underscores the need to ensure your psychiatric care is coordinated with your HIV and primary care so that your MAOI does not have a toxic interaction with any other medication you may be taking now or in the future.  I'm glad to know that EMSAM is working for you, but proceed with caution, and always let your physician(s) and pharmacist know all of the drugs you are taking so that these adverse drug-drug interactions do not occur.

Regards,Nick -- Nick , LSW

6631 Clemens Ave., Apt. 1EUniversity City, MO 63130

thenick58@...

http://nicknicholas.net

[Guest guest]

On Sun, Aug 5, 2012 at 11:40 AM, Nick <thenick58@...> wrote:I know it's bad form to follow up on your own message, but I just read something I think it's important to share.

EMSAM belongs to a class of antidepressants known as monoamine oxidase inhibitors, or MAOIs. The big disadvantage to these drugs, and I hope your doctor told you about these, Phil, is that you have to be very careful about the foods you eat and the over-the-counter meds you take.  Certain foods (I can't recall what they are now, but you can probably find out more at www.emsam.com) and certain OTC drugs like some of the cold remedies interact with the MAOIs in very toxic ways.

In addition to the MAOIs there are the tricyclic antidepressants which are older, but still used sometimes.  Their chief disadvantage is that they tend to cause drowsiness and sedation, which is why prescribing doctors were so quick to jump on the SSRI bandwagon.

For what we call " refractory depression " -- depression that doesn't respond to any of the anti-depressants -- some psychiatrists have started using some of the mood stabilizers like valproate and atypical antipsychotics like olanzapine or Abilify with success.  This is cutting edge stuff, however, and you need a psychiatrist who is really on top of his game and keeping up with the current literature to know about these developments in the field.

There are a lot of options.  There's really no need these days for someone to remain as depressed as the fellow who wrote to .  The advice I might have given him would have been to find a new (and better) psychiatrist!  In the end, however, there is the deep, dark secret of the mental health field:  some people don't respond to any medication or any type of psychotherapy. I hope 's writer is not one of those, but he has to get out of bed and start trying some of these alternatives before giving up.

I happen to be in the middle of writing a major paper on the psychiatry of AIDS, and I just came across the following in Comprehensive Textbook of AIDS Psychiatry: " Similarly, monoamine oxidase inhibitors are not recommended for patients with HIV and AIDS.  This class of medications poses an extraordinary risk, since persons with HIV and AIDS are often on complex and frequently changing drug regimens and also have the concurrent risk of hypertensive crisis if exposed to food or other medications.  These include epinephrine for asthma or meperidine for prevention of rigors from amphotericin B treatment of cryptococcal meningitis or other fungal infections. "

My takeaway from this is that it underscores the need to ensure your psychiatric care is coordinated with your HIV and primary care so that your MAOI does not have a toxic interaction with any other medication you may be taking now or in the future.  I'm glad to know that EMSAM is working for you, but proceed with caution, and always let your physician(s) and pharmacist know all of the drugs you are taking so that these adverse drug-drug interactions do not occur.

Regards,Nick -- Nick , LSW

6631 Clemens Ave., Apt. 1EUniversity City, MO 63130

thenick58@...

http://nicknicholas.net

[Guest guest]

Thanks, Phil, for bring up the topic of dopamine. The research of Dr.

Breggin has shown that, in addition to the well known dangers of SSRIs, their

mechanism is not one of helping the brain but rather of impairing it. Dopamine

has a much longer history of use and research which, as the poster points out,

is largely neglected in the treatment of depression. My father had Parkinson's,

so I know something about dopamine and how remarkable the dopamine-boosting

drugs are until, alas, they stop working.

As emphasized here by and others, it is always prudent to rule out often

overlooked causes of depression, such as nutritional and hormonal (e.g. thyroid,

testosterone) deficiencies, before targeting the brain directly. I am aware of

the selegeline patch, but I did not know that it took so long to have an effect.

If that is the case, you can test whether you will respond to a dopamine boost

by trying the Aryuvedic herb, mucuna pruriens, aka dopa bean. You will know

within hours whether it improves your mood. A standard extract of mucuna

contains 15% l-dopa. The product that I use is 333 mg, so a capsule contains 50

mg l-dopa. One capsule taken on an empty stomach in the morning at least an hour

before consuming protein, I have better mood and energy throughout the day,

particularly toward the evening when I typically am at my lowest. I have taken

up to two capsules, but it is too stimulating for me. In addition to its mood

enhancing effects, dopamine also lowers blood pressure, lowers blood sugar, and

lowers prolactin. It also can result in more vivid dreams, so I don't know how

it might affect sleep in a person taking Sustiva.

Mucuna, like all dopamine substrates, should probably not be taken every day. If

you look around you'll find lots of information and advice. Some people say they

have taken it every day for years without diminishing effectiveness. Research on

mucuna and Parkinson's suggests that this may be because mucuna contains other

botanicals in addition to l-dopa, some of which may not be well understood but

could contribute to the herb's more lasting effectiveness versus the

pharmaceutical derivatives. I prefer to exercise caution, however, as dopamine

receptors, like other neurotransmitter receptors, can burn out or shut down.

Generally I only take it on days when I feel I will need it, though I have also

taken it on a 5-day on, 2-day off schedule.

Selegeline, by the way, is also available as a compounded transdermal lotion. I

use it every day, whether or not I take mucuna. Both selegeline lotion and

mucuna pruriens were recommended to me by Dr. Eugene Shippen, an outstanding

endocrinologist whom some here will know.

in SF

[Guest guest]

Yes Nick, thank you. I do know all this. This is why I said:

" SSRIs are the newest advance, but there are older drugs like

Selegiline ( the active ingredient in EMSAM) that have been pushed to the side

in favor of SSRIs because they have some side effects and interactions.

For me, the side effects

of Serotonin based antidepressants was far worse than the caution that I have

to use to continue on Selegiline. "

* Personally, having tried an anti

psychotic ( as an adjunct hahaha ) and having been on many discussion sites

where people are taking anti psychotics….and running around with

permanent tics and experiencing anhedonia from

irrecoverable dopamine depletion ( anti-psychotics are dopamine antagonists ) …..

I think that anti psychotics are crap and are dangerous. I am pretty sure that I did more research

than you did.

Far more dangerous than using an

interactions checker when I am prescribed any new medications and making sure

that I don’t eat a ton of sauerkraut, among certain other foods like aged

meats.

I wouldn’t be advocating for " checking

with your doctor " so much if I were you. If they went to med school 20 years ago,

they remember about as much as I do about sophomore year organic chemistry and

they care even less. I had a

shithead who had me on both a dopamine antagonist and a dopamine agonist at the

same time.

Then the same shithead put me on Adderall. I

don't think that you should be campaigning so hard for people to trust their

doctors. Someone might get killed.

Phil

From: Nick

[mailto:thenick58@...]

Sent: Sunday, August 05, 2012 2:44

PM

Fall

River

Cc:

Subject: Re: Re:

Suggestions for a depressed HIV+ person on disability

On Sun, Aug 5, 2012 at

11:40 AM, Nick <thenick58@...>

wrote:

I know it's bad form to follow up on your own message, but I just read

something I think it's important to share.

EMSAM belongs to a class of antidepressants known as monoamine oxidase

inhibitors, or MAOIs. The big disadvantage to these drugs, and I hope your

doctor told you about these, Phil, is that you have to be very careful about

the foods you eat and the over-the-counter meds you take. Certain foods

(I can't recall what they are now, but you can probably find out more at www.emsam.com) and certain OTC

drugs like some of the cold remedies interact with the MAOIs in very toxic

ways.

In addition to the MAOIs there are the tricyclic antidepressants which are

older, but still used sometimes. Their chief disadvantage is that they

tend to cause drowsiness and sedation, which is why prescribing doctors were so

quick to jump on the SSRI bandwagon.

For what we call " refractory depression " -- depression that doesn't

respond to any of the

anti-depressants -- some psychiatrists have started using some of the mood

stabilizers like valproate and atypical antipsychotics like olanzapine or

Abilify with success. This is cutting edge stuff, however, and you need a

psychiatrist who is really on top of his game and keeping up with the current

literature to know about these developments in the field.

There are a lot of options.

There's really no need these days for someone to remain as depressed as the

fellow who wrote to . The advice I might have given him would have

been to find a new (and better) psychiatrist! In the end, however, there

is the deep, dark secret of the mental health field: some people don't

respond to any medication or any type of psychotherapy. I hope 's

writer is not one of those, but he has to get out of bed and start trying some

of these alternatives before giving up.

I happen to be in the middle of writing a major paper on the psychiatry of

AIDS, and I just came across the following in Comprehensive

Textbook of AIDS Psychiatry:

" Similarly, monoamine oxidase inhibitors are not recommended for patients

with HIV and AIDS. This class of medications poses an extraordinary risk,

since persons with HIV and AIDS are often on complex and frequently changing

drug regimens and also have the concurrent risk of hypertensive crisis if

exposed to food or other medications. These include epinephrine for

asthma or meperidine for prevention of rigors from amphotericin B treatment of

cryptococcal meningitis or other fungal infections. "

My takeaway from this is that it underscores the need to ensure your

psychiatric care is coordinated with your HIV and primary care so that your

MAOI does not have a toxic interaction with any other medication you may be

taking now or in the future. I'm glad to know that EMSAM is working for you,

but proceed with caution, and always let your physician(s) and pharmacist know all of the drugs you are taking so that

these adverse drug-drug interactions do not occur.

Regards,

Nick

--

Nick , LSW

6631 Clemens Ave.,

Apt. 1E

University City, MO 63130

thenick58@...

http://nicknicholas.net