Posted by Elizabeth on September 17, 2001, at 9:22:57
In reply to Re: in case of an accident... LONG...LONG » Elizabeth, posted by v on September 17, 2001, at 7:22:29
> good morning elizabeth... i know it's taken me some time to finish responding, but for what it's worth, here goes.. :)
No problem. I was away for a while, so I've posted a couple of very-late responses (much later than yours!).
> i's the only thing that seems to make sense is my opiad tolerance increased when i added ritalin to my meds... now painkillers don't really do a good job for me on the pain, so much as allowing me to just not mind it as much... perhaps it's the dopamine?
I don't know. Let me ask my in-house consultant < g > when he comes home. Opioids, of course, have effects on dopamine, thought to be linked to the observable behavioural reinforcement that makes them so hard to stay off for people (and other animals) who've been addicted. In animals, acute administration elevates extracellular dopamine levels in the nucleus accumbens (NA) (an effect also associated with stimulant administration). Increased firing rates of dopamine neurons in the NA and the ventral tegmental area (VTA) are associated with activation of opioid receptors in these areas.
(Of note, pharmacologic or "physical" dependence is not necessary for behavioural reinforcement to occur.)
> i really don't know much about this stuff... but i have a VERY low threshold for pain, probably due to the pain in my past, the traumas and the depression itself
That's interesting. I'm very curious to learn what my pharmacologist friend will have to say about this.
> now this one's been bothering me since you wrote it because that is the "therapeutic" definition...what they are really saying is addiction is substance abuse and i stress the word abuse since in the explanation for substance dependence they were talking about abuse... not dependence
The key difference between the "physiological dependence" caused by these drugs and "substance dependence" as defined in DSM-IV is drug cravings. Do you have cravings for Effexor or Klonopin (similar to cravings for food when you're really hungry)?
> the dictionary definiton of addiction is: compulsive physiological need for a habit forming drug
That's silly. Pharmacologic dependence isn't a result of psychopathology -- it's a normal, expected response to chronic drug administration. Most people who take opioids, stimulants, alcohol, etc. do not become addicated. Use of stimulants in the treatment of childhood ADHD is associated with a *decreased* risk of later substance abuse, in fact.
> i'd say anything that causes withdrawal symptoms when removed fits the definition...
That depends how broadly you define "withdrawal symptoms." Lots of drugs -- including plenty that aren't even psychoactive -- cause specific withdrawal symptoms (e.g., antihypertensive drugs often cause rebound hypertension if they're discontinued too fast). Only the "drugs of abuse," for want of a better term, cause "cravings" and drug-seeking behaviour, which are *not* specific effects associated with any particular mechanism of drug action (that is, they're caused by a wide variety of drugs with a variety of mechanims).
> their "definition" or rather their distortion of the definition is self-serving and is the very reason it is so hard for people to often get the drugs they need... substance use and substance abuse are such different things.
And so are pharmacologic dependence and addiction. Don't conflate them.
> > IMO, some doctors have pet diagnoses that they see in everybody they encounter.
>
> this is a bit of a problem for me particularly as my personality is so fragmented, he right is some ways but not in all... my add actually seems worse latelyHow do you mean that when you say your personality is fragmented?
> > A friend of mine tells me that when he asked to try adding stimulants to his Xanax, he was told that "stimulants and benzodiazepines are only seen together in abuse."
>
> what can i say to that, it's so idiotic... makes me angry to even hear itMe too. I broached the subject of trying psychostimulants (which were somewhat helpful to me in the past), and my pdoc didn't seem to think that adding them to clonazepam was a problem.
re Wellbutrin:
> they already use it for quitting nicotine but i don't know if it would really work as a diet pill, because although it does help my impulse control, i must make a concerted effort to use it that way - it might help for compulsive overeaters but only if they also sought help for the need to compulsively overeat.. and they would probably also benefit from an ad to help their seratonin levels so you end up back with just us "admitted nut cases" - the magic pill it ain't... :)No, Wellbutrin really decreases appetite. SSRIs don't necessarily, and I don't think they would be a great treatment for binge-eating. Wellbutrin (which is related to a marketed diet pill, Tenuate (diethylpropion), BTW) might even help long-term. It just occurred to me, though, that based on a single, possibly skewed study, there's a warning in the labelling and Wellbutrin isn't "supposed" to be used in treating *any* eating disorder. An alarmingly high percentage of bulimic patients (4/55, or about 7%) given WB in the study in question had seizures. Somehow, based solely on this single result, it was concluded that bulimics (and by extension all eating disorder patients!) are more susceptible to the seizure threshold-lowering effects than are non-eating-disordered people.
> well, enough babbling for now... as always i hope you are well
Same back atcha. :-)
> BTW, is there anything that can be done to help with the short term memory loss, word finding difficulty - even spelling! and general stupidity that seems to accompany these drugs? it frustrates the hell out me...
Umm...Aricept? Amisulpride? I dunno, this is a common problem with antidepressants but there hasn't been much research into what causes it or how it can be alleviated.
-elizabeth
poster:Elizabeth
thread:76946
URL: http://www.dr-bob.org/babble/20010917/msgs/78917.html