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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by johnj on April 7, 2002, at 21:28:38
HI,
I just read the thread on sam-e and I found it very informative. I have unipolar depression and kept it at bay for about 8 years. I take lithobid(300 mg twice daily), 50 mg of pamelor(nortryptline) and 7.5 mg of tranxene for anxiety and sleep. Well, last year I started jogging and insomnia crept back with depression/anxiety. If It is like the drug side effects were magnified and the AD and/or combination of drugs became kind of whacked out. I have started and stopped running about 3 times due to the same occurence. Doctors don't see any correlation between the aerobic workout and the meds. I DO feel a direct relation. I tried to switch to remeron, but the spacey side effect has taken me down to 15 mg from a high of 45. The sleep is great but feelings and emotions are numb on the high dose. My goal is to find a good combo and then get off the pamelor. I have an idea the aerobic excercise of the past kept my depression at bay or maybe remission. I would like to try sam-e and see what it does, but don't know much about it. I would like to find something to help me sleep and then maybe the sam-e along with other vitamins or a small dose of another AD might allow me to run again. I lift weights and that does NOT have any negative effect like the running. I would like to get off the pamelor for sure in the future and maybe the lithium. No one really has given me a good reason for the lithium expect that it "boosts" the AD. I believe the rational is much more than that. If you read my other posts you may get a little more feel for what I am looking to do. I would like to tweak my current regime and maybe put together a "cleaner" package of meds/supplements to allow me to help myself a little more. Thanks for listening to my rambling. Take care and healing for all.
Johnj
Posted by Ron Hill on April 8, 2002, at 17:29:28
In reply to Ron Hill and Colin Wallace, posted by johnj on April 7, 2002, at 21:28:38
>I have started and stopped running about 3 times due to the same occurence. Doctors don't see any correlation between the aerobic workout and the meds. I DO feel a direct relation.
I disliked AD's for a number of reasons, one of which was the lack of consistency. It seemed that I was forever "chasing a dose". In other words, changes in the environmental influences of my life (e.g. increase in stress, increase in work out intensity, etc.) would get my meds totally out of whack.
>I would like to try sam-e and see what it does, but don't know much about it. I would like to find something to help me sleep and then maybe the sam-e along with other vitamins or a small dose of another AD might allow me to run again.
SAM-e works great for me, but it may or may not be right for you. I hope it works for you because it is much smoother and gentler than AD's. Here are my recommendations:
1) Read all you can about SAM-e. See links in my prior post to you in an above thread to get started.
2) Talk to your pdoc if you decide to conduct a SAM-e trial. Take key SAM-e documents with you to show pdoc.
Please feel free to ask me further questions if I can help you.
Before I started taking meds, I unknowingly self-medicated with exercise. I'm BP II, but was initially mis-dx'ed as ADHD and put on Ritalin. Paxil was added a couple months latter to try to control the irritable mood swings brought on by the Ritalin. This med combo pushed me into full blown mania and then eventually dumped me into a depression pit too deep to climb out of. I mention all this in order to explain how exercise interacted with these meds.
Given that I had always worked out, I continued to do so when given Ritalin. Low doses of Ritalin initially caused a mild euphoria. Exercise elevated this euphoric effect during the training, and also worsened the insomnia (which made it difficult for me to function well at work). When Paxil was added, exercise greatly amplified the serotogenic effects during the training session and the insomnia continued to be a problem. For example, I was able to stay at work totally focused and on task for 36 hours straight, but then I would need to sleep for two days. Needless to say, this schedule did not go over real well at work. Therefore, in an attempt to solve the insomnia (and save my job), I quit working out. But by this time I was manic. The irony is that once the Ritalin/Paxil med combo quit working and dropped me into depression, I had allowed my self-medication tool to become so rusty that I could not use it to lift me up as I always had done prior to taking meds. The point I'm trying to make with this rant is that, like you, I found that exercise greatly influences the effects of medication.
Colin trains for, and competes in, triathlons while taking a low doses of Zoloft (12.5 mg/day) and SAM-e (200 mg/day), so his input may be of value to you. Please don't quote me on Colin's med doses. He will be back to this board in a week subsequent to completing his sentence in e-jail (hope he has access to w/o equipment in jail so he can continue his training schedule).
Posted by johnj on April 8, 2002, at 20:31:44
In reply to Colin's in Dr Bob's e-jail for one week. Standby. » johnj, posted by Ron Hill on April 8, 2002, at 17:29:28
Ron,
I read your experience with much interest. Even though I have been on meds for almost 10 years it wasn't until last summer when I came down with pneumonia that excercise began to have a really noticable effect. I can now go back when had I had some problems and they match up well with aerobic excercise stints.
I have been on some remeron in hopes of weaning off the TCA, but I am odd in that meds, even at small doses, hit me hard. That is why my pameolr is only 50 mg, any more and the side effects are unbearable. So, I have backed way off the remeron(but the knock out it gave me was oh so good). I guess I am best described as unipolar with a panic/anxiety lead into depression. First time I was treated was when I was 27. I know I had some depression before then, but I was great for over 7 years. I guess one never knows when it will strike.
Sleep is the first thing in me that goes. The excercise messed up my sleep and that lead to crappy moods and severe lack of energy/motivation. I can't help but think if I could get the right kind and dose of meds I could use excercise to my advantage. This may be a pipe dream, but it is a goal never the less. I have been watching a company called neurcrine bioscience and they have a sleep med in phase III trials and it looks so promising. Well, thanks for everything, I will research the sam-e. It is really hard to find a good doc where I live, but the one I have now is pretty good and we will see how open he is to my observations. Take care
John
Posted by johnj on April 8, 2002, at 20:43:23
In reply to Colin's in Dr Bob's e-jail for one week. Standby. » johnj, posted by Ron Hill on April 8, 2002, at 17:29:28
I also experienced the negative effects post excercise. I always felt good right after, but it seemed to build up and throw things out of whack later. Your explanation regarding "chasing the dose" is so accurate and I know exactly what you mean. Thanks again
John
Posted by Ron Hill on April 9, 2002, at 0:51:23
In reply to Thanks a million Ron, I will Standby., posted by johnj on April 8, 2002, at 20:31:44
John,
On the one hand, some of your symptoms (e.g. hypersensitive to meds) fit my hypothesized profile of a patient who may respond favorably to SAM-e. Please click to read about my (layman) profile hypothesis:
http://www.dr-bob.org/babble/20020402/msgs/101492.html
However, one the other hand, the panic/anxiety symptom reminds me of Lizzyg, and although she says SAM-e helps to relieve her depression somewhat, it does little or nothing for her panic/anxiety. Please click to read about Lizzyg:
http://www.dr-bob.org/babble/20020402/msgs/101647.html
John, have you ever thought about taking Serzone? From what I hear, Serzone can help depression and/or anxiety depending on the dose. Just a thought. JohnX2 and Beardedlady both take Serzone and would probably answer a few questions, if you are interested.
-- Ron
-------------------
> Ron,
> I read your experience with much interest. Even though I have been on meds for almost 10 years it wasn't until last summer when I came down with pneumonia that excercise began to have a really noticable effect. I can now go back when had I had some problems and they match up well with aerobic excercise stints.
> I have been on some remeron in hopes of weaning off the TCA, but I am odd in that meds, even at small doses, hit me hard. That is why my pameolr is only 50 mg, any more and the side effects are unbearable. So, I have backed way off the remeron(but the knock out it gave me was oh so good). I guess I am best described as unipolar with a panic/anxiety lead into depression. First time I was treated was when I was 27. I know I had some depression before then, but I was great for over 7 years. I guess one never knows when it will strike.
> Sleep is the first thing in me that goes. The excercise messed up my sleep and that lead to crappy moods and severe lack of energy/motivation. I can't help but think if I could get the right kind and dose of meds I could use excercise to my advantage. This may be a pipe dream, but it is a goal never the less. I have been watching a company called neurcrine bioscience and they have a sleep med in phase III trials and it looks so promising. Well, thanks for everything, I will research the sam-e. It is really hard to find a good doc where I live, but the one I have now is pretty good and we will see how open he is to my observations. Take care
> John
Posted by johnj on April 9, 2002, at 20:04:52
In reply to Re: SAM-e » johnj, posted by Ron Hill on April 9, 2002, at 0:51:23
Ron,
Thanks for the links, I am new at this and it is a little hard navigating my way around this site. I have thought of serzone, and today I actually feel decent even thought I didn't sleep well last night. I am down to 15 mg remeron and I can finally think straight. I loved the sleep, but it made me dull and blunted. I have never experienced anything like it before. At least when I was really depressed I still could feel some physical and emotional changes. Remeron is weird stuff, at least for me.
I do think I would have to start with a low low dose of sam-e. I ordered some off the net and it should be coming soon. I need to find some B vitamins to take with it. I have a plain old multi-B and I think if I take it together I should be ok. I can't get into the doctor unless things go real far south until the first or so of May. I really want to give the sam-e a try in the morning at maybe 100mg and see how I feel. The only thing about serzone is the live scare. Thanks again. take care and get well.
John
Posted by Ron Hill on April 9, 2002, at 23:29:36
In reply to Re: SAM-e (Ron Hill), posted by johnj on April 9, 2002, at 20:04:52
> I do think I would have to start with a low low dose of sam-e. I ordered some off the net and it should be coming soon. I need to find some B vitamins to take with it. I have a plain old multi-B and I think if I take it together I should be ok.
John, have I previously given you my obligatory B vitamin rant? (I lose track of what I've told to whom). Just to be on the safe side here's my B vitamin spiel:
Please take plenty of B-6, B-12, and folate with the SAM-e to prevent the build up of homocysteine. Also bear in mind that most humans do not absorb B-12 efficiently when taken orally (down-the-hatch). Therefore, it is very important to take a sublingual (under tongue) tablet (or get B-12 injections). Further, buy the bioactive form of B-12 (Methylcobalamin). Here is an article that says it better than I can:
Supercharged SAM-e: B Vitamins, Folate Increase the Supplement’s Effectiveness
by ImmuneSupport.com Staff
12-01-1999 - Homocysteine is a sulfur-containing amino acid involved in several important methyl and sulfur transfer reactions, and is actually beneficial in small amounts. When homocysteine levels begin to rise in the body, excessive accumulation of homocysteine in the body fluid compartments is normally prevented by degradation through two enzymatic reactions called transsulfuration and remethylation. These two processes have to be functioning for homocysteine to be kept in control and for SAM-e to function in the body. Importantly, these same enzyme reactions cannot occur without proper levels of folate, vitamin B 6 (pyridoxal 5- phosphate), and vitamin B12 (cobalamin). If you take SAM-e to promote better health (lighter mood, comfortable joints and a detoxed liver), you also need adequate levels of B vitamins and folic acid to help the SAM-e do its job.
When the body has proper levels of folic acid, Vitamins B6 and B12, the enzymatic break-down of homocysteine occurs either through remethylation, which converts it into methionine, the SAM-e building block; or through transsulfuration, which turns it into glutathione, a powerful antioxidant.
But when those processes become sluggish, the homocysteine levels in the body begin to rise. Large homocysteine levels left unchecked in the body, become an invitation to disease, including heart attack, stroke, cancer, birth defects, depression and perhaps CFS and FM.
A published Swedish study showed results of which demonstrate consistently high homocysteine levels and low concentrations of vitamin B12 in the cerebrospinal fluid (CSF) of patients meeting established clinical criteria for Chronic Fatigue Syndrome and Fibromyalgia.
Those taking SAM-e should be aware that the healthy benefits they experience are not due to SAM-e alone. SAM-e may be the “team leader” however, folic acid, vitamin B6 and vitamin B12 are crucial members of the team that contribute to its success. It is only by incorporating the entire team that one can achieve the victory of better health and well-being.
Source:
Evarts, Jeremy Lucius. “New Study Links Fibromyalgia and Chronic Fatigue Syndrome to Low Vitamin B12 and High Homocysteine in Cerebrospinal Fluid.” Healthwatch, August 1998.
Cowley, Geoffrey and Underwood, Anne. "What is SAMe?" Newsweek, July 5, 1999.
Brown, Richard, M.D., Bottigileri, Teodoro, Ph.D., Colman, Carol. Stop Depression Now. New York, 1999.http://www.arthritissupport.com/track/goto/rtgoto30l.cfm
-- Ron
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Posted by johnj on April 10, 2002, at 12:48:55
In reply to Re: SAM-e » johnj, posted by Ron Hill on April 9, 2002, at 23:29:36
Ron,
thanks for the info. Could you tell me what are the doses of B vitamims you take? Do you take them right after your take the sam-e? Or do you also take some at a later time just to be safe? I assume excess B vitamins are just excreted like C? thanks again!
Johnj
Posted by Ron Hill on April 11, 2002, at 2:04:23
In reply to Re: SAM-e (Ron Hill), posted by johnj on April 10, 2002, at 12:48:55
>Could you tell me what are the doses of B vitamims you take?
B-100 for the complex once per day. 1000 mcg of bioactive sublingual B-12 twice a day. But that's just me.
>Do you take them right after your take the sam-e?
No. Take vitamins immediately following meal; take SAM-e on relatively empty stomach.
>I assume excess B vitamins are just excreted like C?
Yes. Expensive urine.
-- Ron
This is the end of the thread.
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