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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by iforgotmypassword on September 30, 2005, at 17:42:58
Dr. Goldstein seems really keen on these for chronic fatigue. would they help someone who often deals with inertia/paralysis and lack of energy and apathy and extreme amotivation?
he spoke very highly of NEURONTIN and KETAMINE.
he placed much importance on regulating glutamate and antagonizing NMDA receptors, but also even the opposite stimulating NMDA receptors to achieve "salience"... hmm does anyone know what he's getting at here.
he doesn't seem to have as much hope in lamictal, but it does inhibit glutamate right? i have a bunch of it all over my house. it was really helping with anger (i think). would it help to try going past the dose i was once on?
he also doesn't seem to put much emphasis on amantadine... is it just too weak as a NMDA receptor antagonist to be very relevant?
another drug he seemed to like was adenosine? he wrote a whole bunch of stuff about that one but i still cant understand what it would do?
i'm kind of finding the structure of this book really random, is there a best way to read it. (not to critize it though, i'm just a really poor reader and everything needs to follow the structure in order for me to be able to grasp things properly) and i like reading technical aspects, but some of them i start to wonder if they are the ones that have any significance or are even fully proven yet, sometimes. i need to be able to get to the points i really need, i am very slow.
he also said estradiol has antidepressant effects by AGONIZING 5HT2 receptors, or would this be a typo?
Posted by lunesta on September 30, 2005, at 18:30:44
In reply to any luck with NEURONTIN? legal KETAMINE?, posted by iforgotmypassword on September 30, 2005, at 17:42:58
nimodpine and neurontin ack similary , both of his top 5 treatments.. they block the high voltage L-Type Calcium channels, lower glutamate (spinal) and lower substance P. Gaba is increased in this procress usually. Neurontin is more systemic and specific to the alpha2delta subunit of the l type high voltage calcium channel. the other blood pressure meds (nimodipine, verimipal(SP)?) act on the same channels those less specifically...
I am familar with his work, i suffer with CFS/FM.
Posted by Phillipa on September 30, 2005, at 18:49:53
In reply to Re: any luck with NEURONTIN? legal KETAMINE?, posted by lunesta on September 30, 2005, at 18:30:44
Seriously is there a way to test for these two illnesses? I was dx'd with both of them. But no one seems to think they are a problem for me. Just a catch all if you know what I mean. Fondly, Phillipa
Posted by lunesta on September 30, 2005, at 20:24:47
In reply to Re: any luck with NEURONTIN? legal KETAMINE? » lunesta, posted by Phillipa on September 30, 2005, at 18:49:53
CFS usually you are tired all the time , unrefreshing sleep and if you test for the virus EBV, CMV or HHV-6 it will be high titers, and is a good indicator of CFS since those viruses are often reactivated.
Fibromyalgia is serious sleep problems with severe muscle pains all over your body but in specific trigger points which can be tested by a doctor and diagnosed.
So yes, they can be tested and diagnosed, though CFS is usually a diagnosis of exclusion of other illnesses first.
Posted by iforgotmypassword on September 30, 2005, at 20:53:42
In reply to Re: any luck with NEURONTIN? legal KETAMINE?, posted by lunesta on September 30, 2005, at 18:30:44
oh god. my message was lost somehow. :( oh god this is so frustrating. it takes so much effort to do anything. just to write. its like every day is this sabotage.
i really really really really follow his impression of how cognitive defecit/motivational problems work in CFS... he was saying it was overstimulation without any salience. that could even explain my horrible apathy and anhedonia, but even more so, the fact that anything you do will result in the need to rest... and thats the way EVERYTHING IS IN MY LIFE. its just one huge rest period that i cant get out of. EVERYTHING is a huge huge task. decisions are pure torture. and this may also explain why stimulants are so ineffective and usually just make me feel so anxious and angry (i destroyed an expensive cellphone on ritalin once, and seriously damaged another, oh and im sure some of these holes in my walls were during one of those periods :( )
did neurontin help you (esp. on the cognitive/motivational front)???
should i be exploring other drugs?
verapamil and nimodipine arent mentioned much in 'tuning the brain', is there another book i should be reading? i actually have access to neurontin right this second... do you have any idea what dose i should start on? on what dose and for how long before i should know if im having an effect or not?and if neurontin doesnt work are there any other drugs i should be reading about?
Posted by iforgotmypassword on September 30, 2005, at 21:23:02
In reply to Re: any luck with NEURONTIN? legal KETAMINE?, posted by lunesta on September 30, 2005, at 18:30:44
Posted by neuroman on October 3, 2005, at 12:30:15
In reply to any luck with NEURONTIN? legal KETAMINE?, posted by iforgotmypassword on September 30, 2005, at 17:42:58
Hi,
Sorry I missed this thread. I love Dr. Goldstein's book. When I read his theory as to why people develop neurosomatic illnesses (CFS, chronic pain, etc.) I was like, "Yes! Someone finally understands!" Unfortunately, the only doctor that "gets it" is retired... :-(
> i'm kind of finding the structure of this book really random, is there a best way to read it.
I know what you mean. Dr. Goldstein was a great doctor, but he's a lousy writer. I had to read it several times before some stuff started sinking in. Also, I would suggest using a hi-lighter.
> he spoke very highly of NEURONTIN and KETAMINE.
IV ketamine was his most successful treatment. I'm still trying to find a doctor who'll let me try this. Neurontin was his favorite oral medication. I have a huge bottle of it. I like neurontin. It helps me sleep, helps with neuropathic pain and makes me horny?! But it's short duration of action is a major problem for me. If only they had an extended release version.
> he placed much importance on regulating glutamate and antagonizing NMDA receptors, but also even the opposite stimulating NMDA receptors to achieve "salience"... hmm does anyone know what he's getting at here.
It's way beyond my ability to explain all this. The NMDA receptor is responsible for long term potentiation and learning. Apparently, it is the main "coincidance detector". NMDA hyperactivity can lead to overlearning and hypersensitivty of the nervous system to stimuli which are benign to "normal" people but trigger a negative physiological response to someone with a neurosomatic disorder. This is probably why many people with CFS and other neurosomatic disorders are often over-sensitive to psychological and emotional stress and often are bothered by chemical smells and bright lights and loud noises and do poorly in high stimulus environments. Here are some relevant quotes:
"...'salient' is used to refer to stimuli with special biological significance."
"A postulate to which I shall continually refer in this book is that patients with neurosomatic disorders have overly learned and overly generalized associative responses and that the primary molecular basis of this memory dysfunction involves the NMDA receptor."
"One aspect of the pharmacology of ketamine relevant to the subsequent sections is that ketamine decreases one's ability to attend to stimuli, and neurosomatic disorders may be conceptualized as overattending to nonsalient stimuli."
By the way, dopamine is an NMDA antagonist. This is probably why DA and NE raise the signal-to-noise ratio (a good thing) and why he believes low DA (Via transmitter depletion, synaptic fatigue or receptor malfunction, etc.) is one of the main problems in people with neurosomatic disorders.
> he doesn't seem to have as much hope in lamictal, but it does inhibit glutamate right? i have a bunch of it all over my house. it was really helping with anger (i think). would it help to try going past the dose i was once on?
Actually, he thinks it's one of the more useful meds. I'm on a low dose now and it seems to be causing too much suppression of my already low dopamine levels. It may be blocking too many ion channels. I lowered the dose and noticed an increase in diffuse neuropathic pain. I don't know if I should stick with it and add something to it or if I should stop it. I'm always worried I'm going to do more damage to my already fried brain/nervous system. This stuff is hard to figure out when you trying to do it on your own.
Paul
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