![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by blueberry on April 13, 2006, at 19:59:12
OK, so I've mentioned it in several posts and folks here have been very kind with responses. No meds right. At about 4:00am I get a massive rush or either dopamine or norepinephrine, can't tell which. It results in immediate terror, fear, paranoia, over-speeding, viscious anxiety, insane-like. By 9am or 10am, it fades away on its own and transforms into depression. All kinds of tests have resulted in nothing except low cortisol levels and elevated mercury/lead.
Out of the dozen or so things I think could be at fault...unknown tumor secretion, weird glucose insulin condition, adrenal gland malfunction, pituitary gland malfunction, strange form of bipolar...the glandular thing makes the most sense, considering the daily/nightly repetitive predictable pattern.
I quick diagnosis and fix is not coming. Doctors are stumped. So I am forced into a situation of suppressing symptoms. How to shut down a catecholamine/adrenaline rush during sleep? Whatever the cause, how do I shut it down for a few hours?
I was thinking maybe medium to high dose benzo of about 8 hour duration? I tried squashing it out with lexapro and it only helped a little, while at the same time deepening the daytime depression. Regardless of the cause, do you think a benzo could shut something like that down?
Posted by Declan on April 13, 2006, at 20:25:15
In reply to How to shut down the catecholamine rush?, posted by blueberry on April 13, 2006, at 19:59:12
Hi Blueberry
I've heard that a large proportion of strokes and cardiovascular events happen at 4 in the morning. Could it be that what you have is a very exagerrated form of a statistically normal pattern?
Declan
Posted by mattw84 on April 13, 2006, at 23:52:08
In reply to Re: How to shut down the catecholamine rush?, posted by Declan on April 13, 2006, at 20:25:15
Posted by SLS on April 14, 2006, at 6:27:10
In reply to How to shut down the catecholamine rush?, posted by blueberry on April 13, 2006, at 19:59:12
The clonidine and propranalol are interesting ideas. However, both have the potential to make depression worse. It still might be worth a try, though.
I know this is reaching, but you might have something going on with melatonin. Ideally, melatonin secretion by the Pineal Gland peaks at 2:00am and declines steadily for the balance of the night. Perhaps you are having too rapid a reduction in melatonin levels and are experiencing a sort of rebound. You might want to give melatonin a try to see how it affects you. If you find it helpful, but still inadequate, a new antidepressant named agomelatine should be available in Europe within a year. It stimulates melatonin receptors. If melatonin makes you feel worse, which is a possibility, then you need to rethink things. You should probably start off by taking melatonin at bedtime only.
Trimipramine is a tricyclic antidepressant that does not inhibit the reuptake of NE or 5-HT. It is known to improve sleep architecture in addition to being a good antidepressant. I imagine it would be well suited for you because you seem to fit the profile for the classic endogenous depression. This type of depression seems to be best treated with tricyclics. Response to antidepressants produces an increase in melatonin levels.
Still reaching...
- Scott
Posted by nellie7 on April 14, 2006, at 7:09:53
In reply to How to shut down the catecholamine rush?, posted by blueberry on April 13, 2006, at 19:59:12
Hi blueberry,
I used to suffer from similar problems for many years, though without a predictable pattern.
One thing you can try is supplementing with vitamins and minerals such as calcium and magnesium or B complex. Sometimes such supplements can help, but it is best not to try anything without asking your doctor first.Take care,
Nellie.
Posted by crabwalk on April 14, 2006, at 9:14:32
In reply to How to shut down the catecholamine rush?, posted by blueberry on April 13, 2006, at 19:59:12
Hi Blueberry,
Believe it or not your symptoms sound eerily close to mine. I've experienced the exact rush you describe pretty much at the same time in the morning (can vary depending on bedtime), this started two years ago and was only slightly alleviated by paxil and prozac. Terribly, prozac ultimately has made my life close to unbearable because it gave me SEVERE sexual side effects that have not improved a year after quitting (I'm 23, and my genitals feel withered and dead, completely numb, save for an on-and-off dull pain in my testicles, I have no libido). This has exacerbated my anxiety/depression beyond anything I ever had before antidepressants. I've had the cycles of fierce anxiety/terror a few times a day too. Right now I'm on a low dose of tianeptine (~10mg, 3x day, dissolved in water) which does help to control the awful sick/anxious feeling during the day somewhat, but not in the early morning hours, and I can't tell whether it's making my genitals even more numb. I just lost what may have been the love of my life to another man because of the permanent sexual/emotional numbness from prozac, and that has made me much worse. I'm thinking of trying emsam because it may raise dopamine, which I think may be a huge source of my problems in general, but I can't say for sure. Before tianeptine, benzos and sleep aids like ambien exacerbated the terrible feelings like crazy, at times I would lie on my bed and moan from the suffering. Now they are not quite as bad, but still exacerbate things a little.
Have you tried tricycics, can you tolerate them? I would try a sedating one, but I'm sure it would only further kill my sexual functioning, if it is still alive at all in there. I'm hoping for a miracle in that emsam will somehow help me sleep and return my old sexual functioning and drive, but that is a long shot.
Agomelatine looks interesting too, but won't be available in the US for years probably.
Wish I had more advice, but I am more lost than ever. Best of luck.
Posted by ed_uk on April 14, 2006, at 14:57:05
In reply to Re: How to shut down the catecholamine rush? » blueberry, posted by crabwalk on April 14, 2006, at 9:14:32
Hello C
Can you feel anything from your penis? Or is it that you can feel things but they are no longer at all pleasurable?
Regards
Ed
Posted by blueberry on April 14, 2006, at 19:10:22
Doc has no idea what the early morning fear, terror, paranoia, anxiety, overspeeded thing is. All we both know is that it pretty much started when zyprexa was weaned off 8 weeks ago. I thought it was a withdrawal effect that would pass. It isn't passing.
Did a urine test of neurotransmitter levels...
Epinephrine...2....supposed to be 8 -12.
Norepinephrine...30...supposed to be 30-75
Norep/Epinep ratio...13...supposed to be 3-6.
Serotonin...67...supposed to be 175-225.
Gaba...4...supposed to be 1-4.
Glutamate...64...supposed to be 10-25.
PEA...314...supposed to be 175-350.I can see why I respond well to anything that boosts both norepinephrine and serotonin, but not either alone. Not sure what that norepinephrine/epinephrine ratio means though.
The one that caught my attention was glutamate. That is really high. Maybe that's my problem. Maybe that is a post-zyprexa phenomenon.
Doc had two suggestions, my choice...
-Restart prozac and zyprexa.
-Begin a nutritional program of targetted amino acids to bring them all into proper range.Not sure what to do. I do know zyprexa will shut down that morning craziness immediately and completely, but leave me blah and empty, requiring prozac to liven things up, but sometimes with too much anxiety/akathisia kind of stuff. The aminos...pure experiment with no clinical backing as far as I'm concerned.
Posted by SLS on April 14, 2006, at 19:29:08
In reply to How to shut down the catecholamine rush...update., posted by blueberry on April 14, 2006, at 19:10:22
Does your doctor use this test routinely?
I was not aware that these tests were available. How much did they cost?
- Scott
> Doc has no idea what the early morning fear, terror, paranoia, anxiety, overspeeded thing is. All we both know is that it pretty much started when zyprexa was weaned off 8 weeks ago. I thought it was a withdrawal effect that would pass. It isn't passing.
>
> Did a urine test of neurotransmitter levels...
> Epinephrine...2....supposed to be 8 -12.
> Norepinephrine...30...supposed to be 30-75
> Norep/Epinep ratio...13...supposed to be 3-6.
> Serotonin...67...supposed to be 175-225.
> Gaba...4...supposed to be 1-4.
> Glutamate...64...supposed to be 10-25.
> PEA...314...supposed to be 175-350.
>
> I can see why I respond well to anything that boosts both norepinephrine and serotonin, but not either alone. Not sure what that norepinephrine/epinephrine ratio means though.
>
> The one that caught my attention was glutamate. That is really high. Maybe that's my problem. Maybe that is a post-zyprexa phenomenon.
>
> Doc had two suggestions, my choice...
> -Restart prozac and zyprexa.
> -Begin a nutritional program of targetted amino acids to bring them all into proper range.
>
> Not sure what to do. I do know zyprexa will shut down that morning craziness immediately and completely, but leave me blah and empty, requiring prozac to liven things up, but sometimes with too much anxiety/akathisia kind of stuff. The aminos...pure experiment with no clinical backing as far as I'm concerned.
Posted by blueberry on April 14, 2006, at 19:37:58
In reply to Re: How to shut down the catecholamine rush? » blueberry, posted by crabwalk on April 14, 2006, at 9:14:32
I hear you about the benzos and hypnotics actually intensifying the morning craziness stuff. I thought maybe xanax or lunesta would dull it down, but they actually seemed to intensify it.
With the benefit of hindsight, I think when a doctor prescribes an ssri they should always give it with a 5ht2a/2c blocker at the same time, like either low dose remeron or zyprexa. They not only turbocharge the ssri, but prevent most of the sexual side effects too. When those 5ht2a/2c receptors are flooded with serotonin, that's where the common ssri side effects such as sex, insomnia, and nausea come from. Even at this late stage of the game, you might find a med like to maybe help reverse things.
The way the ssri changed dopamine function might be at play too. Maybe a dopamine med like wellbutrin could respark things.
Posted by crabwalk on April 14, 2006, at 22:39:36
In reply to Re: How to shut down the catecholamine rush? » crabwalk, posted by ed_uk on April 14, 2006, at 14:57:05
I can feel things, just not pleasurable, like rubbing a limp elbow. The skin on my penis is also very dry and pale, and my testicles are slightly smaller than they were before ssris.
> Hello C
>
> Can you feel anything from your penis? Or is it that you can feel things but they are no longer at all pleasurable?
>
> Regards
>
> Ed
Posted by ed_uk on April 15, 2006, at 12:42:32
In reply to Re: How to shut down the catecholamine rush?, posted by crabwalk on April 14, 2006, at 22:39:36
Hello C
Have you been evaluated by a urologist? Have you tried any medications in attempt to treat your lack of penile sensitivity?
Kind regards
Ed
Posted by crabwalk on April 15, 2006, at 15:10:50
In reply to Re: How to shut down the catecholamine rush? » crabwalk, posted by ed_uk on April 15, 2006, at 12:42:32
I was evaluated by a urologist. He gave me an exam, said everything was normal, and said that he sees this problem in people with my 'psychological profile'. I don't think he really understood my complaints, I don't think anyone that hasn't had them and knows what they feel like actually does.
I've tried gingko, yohimbe, buspar, tianeptine, chrysin (herbal aromatase inhibitor, raises testosterone), also acupuncture. Nothing has worked and right now I am severely sexually dysfunctional and scared that nothing will be able to solve it. I never thought anything like this could happen. I'm very, very depressed over it.
Posted by ed_uk on April 15, 2006, at 15:51:57
In reply to Re: How to shut down the catecholamine rush? » ed_uk, posted by crabwalk on April 15, 2006, at 15:10:50
Hi C
Your urologist sounds unhelpful :(
Did you ever try Wellbutrin?
Regards
Ed
Posted by Caedmon on April 15, 2006, at 22:33:12
In reply to How to shut down the catecholamine rush...update., posted by blueberry on April 14, 2006, at 19:10:22
Yeah the glutamate is high.(I guess... like Scott, I didn't know they could do such a test! Cool!) What about something that affects that such as Topamax or Lamictal?
- C
Posted by crabwalk on April 15, 2006, at 22:39:13
In reply to Re: How to shut down the catecholamine rush? » crabwalk, posted by ed_uk on April 15, 2006, at 15:51:57
nope, i seriously doubt i could handle it as i am generally agitated and sleepless anyway. won't rule it out though.
Posted by ed_uk on April 16, 2006, at 6:15:03
In reply to Re: How to shut down the catecholamine rush? » ed_uk, posted by crabwalk on April 15, 2006, at 22:39:13
Hi C
What about a dopamine agonist like ropinirole? Perhaps that would help.
Ed
Posted by crabwalk on April 16, 2006, at 22:36:54
In reply to Re: How to shut down the catecholamine rush? » crabwalk, posted by ed_uk on April 16, 2006, at 6:15:03
Hi Ed,
There's a large group of people like me (with post-ssri sexual dysfunction) on a yahoo group. A good amount have tried requip/mirapex with not much benefit. Dostinex is another one. One guy was numb/impotent for a year, took dostinex for awhile and as far as I know came back to normal. However, he had only taken ssris for two weeks. Others who had been on ssris for longer have tried dostinex with not much benefit. I haven't ruled out trying these though.
My plan now is probably to try emsam based on its mao-b inhibtion properties. Hopefully it can raise dopamine enough to awaken my dormant/damaged sexuality. We'll see what happens...
I forget, are you still on ssris?
Posted by ed_uk on April 17, 2006, at 8:35:57
In reply to Re: How to shut down the catecholamine rush? » ed_uk, posted by crabwalk on April 16, 2006, at 22:36:54
Hi C
>A good amount have tried requip/mirapex with not much benefit.
What else have they tried?
>I forget, are you still on ssris?
Yes, citalopram 80mg. I've been on SSRIs for years. They haven't made my penis numb or caused anorgasmia but they have reduced my libido quite a lot. If ever I try to reduce the dose, my genitals become hypersensitive and premature ejaculation sets in.
Ed
Posted by crabwalk on April 19, 2006, at 10:01:21
In reply to Re: How to shut down the catecholamine rush? » crabwalk, posted by ed_uk on April 17, 2006, at 8:35:57
> What else have they tried?
A dizzying mixture of different drugs and herbs. Just about anything that is touted for sexual health or has increased libido as a possible effect. Lots have tried testosterone supplementation. One even tried abilify as he was advised it could 'reset' dopamine receptors. Lots of things seem to have an initial minimal benefit, but don't go past that and then stop doing much at all.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.