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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by cadburyhesychasm on September 1, 2018, at 3:11:00
I have reactive rage disorder with comorbid depression, no clear diagnosis except schizoaffective possibly, personally don't agree with it. I have catastrophic rage, destruction, screaming, profound irritability at minimal provocation, along with tearful griefy depression w sensitivity. Only drug that works is Risperidone somewhat and that only if I take a gram of Divalproex CR with it. Unfortunately tried many other neuroleptics, anxiolytics, beta blockers, antidep (raise symptoms), anticonv. drugs (unfortunately none work for me), and I can't tolerate the two drugs I'm taking. Hence, the need to go experimental. Now, I have read interestingly that acetylcholine is implicated in aggression and modulation of nicotinic receptors has effects on dep and aggression in various neuropsych disorders.
One article is here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486625/
Now I'm not quite sure the take home points except that partial agonist of a4b2 receptor and antagonism of a7 nAchR might help. So I would like to know if anyone can help, is there more research on what can help the symptom and what safe drugs might help that act on the nicotinic receptors (I'm in India). Thanks for your help.
Posted by bleauberry on September 1, 2018, at 8:54:44
In reply to Nicotinic ACh receptors drugs and dep/rage, posted by cadburyhesychasm on September 1, 2018, at 3:11:00
You need to try antibiotics. Most of the patients who walked into the offices of my LLMDs had stories identical to yours. That includes me. The vast majority of those patients were poorly managed with psychiatric drugs and poorly managed by multiple doctors. Only an LLMD is trained to make complicated diagnosis in a clinical setting when reliable testing is decades away.
LLMD = Lyme Literate MD
9 out 10 undiagnosed or misdiagnosed cases of Lyme or Lyme experience depression, anxiety and schizophrenia of the type which are difficult to treat with drugs and often with sensitivities.,
I'm just saying that whatever journey you think you are on might be the wrong one. And that if I am right, that would totally explain why things are not working well.
The rage thing most especially is a huge clue. I don't want to write a book on it here. It's just that the rage thing, for a variety of reasons, is a really good hint.
You might want to consider, just consider, think about it, googling or searching your state for LLMDs. Every state has a few. And most of them have long waiting lists to get in. But try to set yourself up with one of them for a second opinion. Let them ask you a bunch of questions and see what they think of your situation.
Another approach that makes sense, though not as thorough, not as deeply healing, is to find an Integrative MD who can help you work OTC supplements and herbs into your protocol. I mean, for example, if you were sitting here with me, I would hand you a couple capsules of Lemon Balm and a couple of Passionflower and then in an hour I would ask you how you feel. I can almost guarantee you would find that rage stuff way diminished. If not enough, fine, add Skullcap capsules.
Another route is CBD oil. This stuff is amazing. It is especially helpful in psychiatry and mystery diseases (like Lyme) so this one really fits good, in my opinion. It's a legal oil from the hemp plant, it has no psychoactive effects. But it can be very helpful for anxiety, schizophrenia, tremors, rage and agitation.
I wouldn't spend any more time doing the armchair quarterback routine of this receptor, that receptor, agonism, antagonism, whatever, all that, but instead try new approaches to diagnosing the whole thing and treating it differently.
Even simple things like Magnesium Glycinate or GABA can help quickly.
So I am just suggesting using other tools besides just prescription meds - because in my experience those other tools are going to help you more than the drugs are - and to rethink the diagnosis, go back and start from scratch on that.
just opinions based on gut instinct with limited patient history
Posted by cadburyhesychasm on September 1, 2018, at 12:50:52
In reply to Re: Nicotinic ACh receptors drugs and dep/rage, posted by bleauberry on September 1, 2018, at 8:54:44
I need more opinions on mr/s bleauberry's post. Is Lyme actually a thing, here in north-east India? I've considered trying antibiotics, when I did read that toxoplasma manifests as neuropsych disorder also, but I read in one place that in patients who took antibiotic, improvement was only seen as long as the drug was being taken. Is it ACTUALLY worth the risk to take an antibiotic for any significant amount of time, and messing up my body and immune system. Thoughts?
CBD Oil is not a thing here, the real deal is too steep to buy and does not seem to be legalized as of yet.
I've done the supplement round with magnesium to no effect. GABA I've not taken but gabaergic drugs I've taken, benzodiazepines and gaba analogues which raise the gaba concentration and they make me feel sick. I don't want to damage my receptors, or affect the natural gaba production in my brain.
Posted by linkadge on September 2, 2018, at 7:14:01
In reply to Re: not quite sure what to make of your post » bleauberry, posted by cadburyhesychasm on September 1, 2018, at 12:50:52
Hi cadburyhesychasm,
No offence to Blueberry, but he recommends antibiotics for everything.
As far as nicotine modulators - not sure. Varenicline is a partial agonist nicotinic receptors (not sure if this is available in India), but I don't know it's effect on your symptoms (it can sometimes cause depression as a side effect - which can, sometimes worsen anger).
Other than that, there's not a lot available. Wellbutrin does interact with acetylcholine receptors, but it is also a norepinephrine, dopamine reuptake inhibitor (and can increase irritability).
You might try nicotine itself (not sure if nicotine replacement patches / gum are available in India). Nicotine calms some people down (purportedly).
Not sure if you have tried lithium.
Other options may include melatonin, 5-ht1a agonists like buspirone, or marijuanna.
Rauvolfia serpentina (Indian Snakeroot) is a traditional Indian treatment for certain psychiatric disorders. It contains reserpine, which has been shown to exert antihypertensive, anti-manic, anti-schizophrenic, anti-agresstive effects. It lowers levels of monoamines (dopamine, norepinephrine). You have to be careful with this one though, as it can sometimes cause depression.
https://en.wikipedia.org/wiki/Rauvolfia_serpentinaLinkadge
Posted by SLS on September 2, 2018, at 9:36:30
In reply to Nicotinic ACh receptors drugs and dep/rage, posted by cadburyhesychasm on September 1, 2018, at 3:11:00
I read that you tried anticonvulsants. Did you try Tegretol (carbamazepine)? Tegretol is often chosen for anger and aggression issues, but can produces sedation. I have seen it work. With Tegretol, frequent blood tests are required to screen for agranulocytosis. A related drug, Trileptal (oxcarbazepine), might also work, although it has not been studied as closely as Tegretol has. Trilelptal is generally not sedating, and does not require regular blood-tests. You might want to have your electrolytes checked every now and then. Although infrequent, hyponatremia (low sodium) is a possibility. It can be treated by increasing salt intake and remaining well hydrated.
I guess it makes sense to try Trileptal first and then switch to Tegretol if necessary.
Valerian root is an herb that might help.
- Scott
Posted by cadburyhesychasm on September 2, 2018, at 15:51:58
In reply to Re: not quite sure what to make of your post, posted by linkadge on September 2, 2018, at 7:14:01
Thanks Scott and linkadge, I have tried Carbamazepine and Oxcarbazepine to no effect. The reserpine suggestion is interesting but I suffer from depression so severe I do not really wish to try it. Before trying other drugs, a doctor just recommended Tofisopam which seems interesting, so I will look into that first. Thank you
Posted by linkadge on September 3, 2018, at 7:53:38
In reply to Re: not quite sure what to make of your post » linkadge, posted by cadburyhesychasm on September 2, 2018, at 15:51:58
If you are still suffering from depression, ensure you get this completely under control. For some people (more so, men) anger is a symptom of depression. (i.e. women get sad, men get mad).
Did you try lithium? This can be good for depression and irritability.
Linkadge
Posted by Prefect on September 4, 2018, at 6:44:02
In reply to Nicotinic ACh receptors drugs and dep/rage, posted by cadburyhesychasm on September 1, 2018, at 3:11:00
Do you have gastrointestinal symptoms? I'm asking because if you do, you might want to get tested for parasites. They can cause psyche symptoms.
Posted by bleauberry on September 4, 2018, at 9:29:10
In reply to Re: not quite sure what to make of your post » bleauberry, posted by cadburyhesychasm on September 1, 2018, at 12:50:52
> I need more opinions on mr/s bleauberry's post. Is Lyme actually a thing, here in north-east India?
Lyme disease in north India: a case for concern - Pavit Tevatia, Sohaib ...
journals.sagepub.com/doi/full/10.1177/0049475518789552
Aug 19, 2018 - While 13% seroprevalence has been reported in the healthy population in north- east Indian states, reports of Lyme disease from the ... yes it is in India and pretty much everywhere.I've considered trying antibiotics, when I did read that toxoplasma manifests as neuropsych disorder also, but I read in one place that in patients who took antibiotic, improvement was only seen as long as the drug was being taken.
The only way you know is to try because the other people did not have your body. In my journeys I have seen multiple mysteries vanish multiple times by using antibiotics in multiple people. We don't know why exactly. Could be any one of a couple dozen various bacteria or virus in the brain. Anything to help the immune. system helps the psychiatric symptoms.
Is it ACTUALLY worth the risk to take an antibiotic for any significant amount of time, and messing up my body and immune system. Thoughts?
I have some gut issues from years of antibiotic use. But I was going to be dead 5 years ago. I would have been dead twice before from suicide if I had been successful at it. Like everything else in life, you have to make a personal benefit/risk decision. In my case I decided that a somewhat less-than-perfect-health situation was better than being in a coffin. Untreated or poorly treated psychiatric patients end up in coffins prematurely.
> CBD Oil is not a thing here, the real deal is too steep to buy and does not seem to be legalized as of yet.
Or any kind of marijuana if you can get it.
> I've done the supplement round with magnesium to no effect. GABA I've not taken but gabaergic drugs I've taken, benzodiazepines and gaba analogues which raise the gaba concentration and they make me feel sick. I don't want to damage my receptors, or affect the natural gaba production in my brain.
The receptors and other things in the brain are already damaged. It's not as if you have a perfectly healthy brain to protect. That is likely not the case. If it was you wouldn't be dealing with all this. A better approach might be to accept the fact that the brain has been compromised and to treat it that way.
I would buy capsules of each of these and experiment with them. Get to know how they feel, what they do, find the right dose, not too much, not too little, with each one of them. And experiment with combining them in different ways. 2,3 or 4 herbs usually works better than 1. Lemon Balm. Passionflower. Skullcap. Valerian.
Benefit vs. risk.
Posted by bleauberry on September 4, 2018, at 9:33:56
In reply to Re: not quite sure what to make of your post, posted by linkadge on September 2, 2018, at 7:14:01
Linkage exaggerates when he claims I say antibiotics for everything. I don't. Just psychiatry.
And you can't help but notice that the ones who gripe about that the most, who push back against it the hardest, are the ones who remain the sickest for the longest, the ones who refuse to even try it, don't dare go there, blows up conventional thinking, something like that, not sure, great skepticism, great hesitancy, none of it justified.
No offense to anyone it's just that their unjustified condemnation of antibiotics in psychiatry is flat wrong. imo
> Hi cadburyhesychasm,
>
> No offence to Blueberry, but he recommends antibiotics for everything.
>
> As far as nicotine modulators - not sure. Varenicline is a partial agonist nicotinic receptors (not sure if this is available in India), but I don't know it's effect on your symptoms (it can sometimes cause depression as a side effect - which can, sometimes worsen anger).
>
> Other than that, there's not a lot available. Wellbutrin does interact with acetylcholine receptors, but it is also a norepinephrine, dopamine reuptake inhibitor (and can increase irritability).
>
> You might try nicotine itself (not sure if nicotine replacement patches / gum are available in India). Nicotine calms some people down (purportedly).
>
> Not sure if you have tried lithium.
>
> Other options may include melatonin, 5-ht1a agonists like buspirone, or marijuanna.
> Rauvolfia serpentina (Indian Snakeroot) is a traditional Indian treatment for certain psychiatric disorders. It contains reserpine, which has been shown to exert antihypertensive, anti-manic, anti-schizophrenic, anti-agresstive effects. It lowers levels of monoamines (dopamine, norepinephrine). You have to be careful with this one though, as it can sometimes cause depression.
>
> https://en.wikipedia.org/wiki/Rauvolfia_serpentina
>
> Linkadge
Posted by cadburyhesychasm on September 4, 2018, at 21:28:06
In reply to Re: not quite sure what to make of your post, posted by bleauberry on September 4, 2018, at 9:33:56
Dear bleauberry, one thing you mentioned is that my out of character extreme rage attacks is a big "clue". In what way would a biological cause differ in quality of rage or any associated symptoms with dep compared to psychiatric diseases? so what info can I use to be sure that a biological cause is a more appropriate thing to target? any thing i can read about on the net and not just articles but proper arriving at differential diagnosis and best practices of treating such a thing???? because i don't have the capacity yet to go find a specific lyme or toxoplasmosis specialist here if there is such a practicioner.
Posted by rjlockhart37 on September 4, 2018, at 22:16:07
In reply to Re: not quite sure what to make of your post, posted by bleauberry on September 4, 2018, at 9:33:56
yeah there's no doctor I know of that will do an antibiotic treatment, they do but you have to find a specialist who would use it, was told the same too....if i told my current doctor it would be considered weird and would not try it
Posted by bleauberry on September 6, 2018, at 6:05:24
In reply to Re: not quite sure what to make of your post » bleauberry, posted by cadburyhesychasm on September 4, 2018, at 21:28:06
The point I mean to get across is that the vast majority of people who suffer from Lyme disease or other mystery chronic infections (there are at least 6 different bacteria and several viruses that come from ticks, not just the lyme bacteria, and they are all bad, all look similar in symptoms, all can be picked up in other ways besides ticks, and our medical community generally speaking totally ignores this angle of disease causation).
Practically everyone I've known or heard of who was dealing with lyme or any of its co-infections (often worse than lyme itself) deals with psychiatric symptoms that don't respond well to mainstream medicines, and displays patterns of agitation and rage during flare-ups or die-offs or continuously. It's just a common thing. That's why in your case I think it makes total sense to highlight it and look at it.
You could get a book called "Why Can't I Get Better" by Horowitz. You can also roam the web and read anything you can find by Marty Ross MD and Bill Rawls MD. Both of these guys are Lyme experts but I don't want you to read their stuff for lyme. I want to you read their stuff to see in detail how all these other things we ignore or don't consider tie directly to brain performance and the mood center. It's way too much to explain here and I would not do a good job of it.
At the very least, when mainstream conventional treatments are disappointing, that all by itself is a pretty strong clue you're barking up the wrong tree, it's something else.
Example - any of these mystery infections can load the body full of toxins. These toxins have affinity for our opioid receptors. So they crowd out our own natural opioids. They contaminate serotonin molecules. So you don't get pure serotonin. They clog receptors. They cause inflammation and havoc. None of this is good for your mood and all of it is cause for rage. The entire balance of how neurotransmitters are formed from nutrition and how they operate are dramatically stunted and impacted by toxins of stealth unsuspected chronic low-mid level infections.
When you first hear someone talk the way I am talking it can be shocking to discover there is a whole world of healing that nobody told you a bout. But when you aren't getting better doing whatever you are doing, then you have to open the eyes wider.
What I am saying is that your rage is not a psychological thing. It's not a thing a counselor can talk to you about and solve it. It's a physical thing that has nothing to do with your thoughts or emotions. It's like a poisoning. It is actually a poisoning. That's what toxins do.
Whether you want to learn about lyme or not doesn't matter - those 3 authors will demonstrate how everything else going on in your body is what is impacting your brain. It isn't your brain that is the problem. Their writings will help you to discover how to fill in the gaps and mysteries in your own health situation. You will be able to figure things out that your doctors cannot figure out. That's because these authors are way, way better doctors than most of us ever get to see.
> Dear bleauberry, one thing you mentioned is that my out of character extreme rage attacks is a big "clue". In what way would a biological cause differ in quality of rage or any associated symptoms with dep compared to psychiatric diseases? so what info can I use to be sure that a biological cause is a more appropriate thing to target? any thing i can read about on the net and not just articles but proper arriving at differential diagnosis and best practices of treating such a thing???? because i don't have the capacity yet to go find a specific lyme or toxoplasmosis specialist here if there is such a practicioner.
Posted by bleauberry on September 21, 2018, at 10:42:38
In reply to Re: not quite sure what to make of your post » bleauberry, posted by cadburyhesychasm on September 4, 2018, at 21:28:06
If you are attempting to treat it with physical chemicals then you are acknowledging it is a biological thing. If it wasn't a biological thing, you would be with a psychologist or counselor instead. But you aren't. You are treating it as if it is something in the body.
I suffered as much or more than anybody here for 20 solid years and that included attempted suicide and failed E.C.T. Now, when you get to the 20 year mark, and you aren't a whole lot better than you were 20 years earlier, then you have to acknowledge you are on the wrong path. You got it wrong. I did that. I got it wrong.
It is my opinion that most patients here have also gotten it wrong, and that that is the very reason they are still sick and why they have come here to find comfort and ideas.
Some people make fun of the Lyme angle, believing it is hogwash, without any evidence or experience on their part. Or more accurately, they make fun of me for saying it. They just feel that way in the gut so they believe and they say it. What people don't understand - it's probably my fault for not articulating well - is that what I am actually saying is that your symptoms are not coming from low serotonin or whatever neurotransmitter nonsense, they are coming from one of these 4 variables which are impacting the integrity of those neurotransmitters and how they function.
1. Inflammation - brain or systemic - many causes - not just injury - toxins - plastics - aluminum - amalgams - mercury - lead - cadmium - fluoride - gluten - genetic modifications to food - wrong foods - excess sugar - petroleum products - chronic infection - and more.
2. Toxins - also mentioned above. Our genes and diet determine whether we excrete trace toxins or whether we accumulate and store them. Not at all friendly to serotonin or dopamine.
3. Chronic infection - Lyme, HIV, various viruses, various bacteria, various fungi. Testing is generally poor for most stealth unsuspected infections, such as Lyme, which is epidemic. Symptoms come on so slowly and gradually over time that you never put 2+2 together and figure it out.
4. Immune system dysfunction - either too hot, too cold, or confused as in autoimmune. Everything in the body is attached to the performance of the immune system. If it isn't working right, neither is the brain, neither are the neurotransmitters.
It just so happens that the word Lyme covers all of that. So I use the term a lot. But it doesn't have to necessarily be from a tick bite that you get the inflammation, the infection, the toxins, the bad diet. In my experience, there is no greater source than ticks for all of those problems. I know that for a fact. Whether anyone else wants to embrace that or not is not my concern. But I feel it is each of our duty's to contribute what we've got and share what we know.
> Dear bleauberry, one thing you mentioned is that my out of character extreme rage attacks is a big "clue". In what way would a biological cause differ in quality of rage or any associated symptoms with dep compared to psychiatric diseases? so what info can I use to be sure that a biological cause is a more appropriate thing to target? any thing i can read about on the net and not just articles but proper arriving at differential diagnosis and best practices of treating such a thing???? because i don't have the capacity yet to go find a specific lyme or toxoplasmosis specialist here if there is such a practicioner.
This is the end of the thread.
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