![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by medlib on October 26, 2001, at 15:34:50
Hi Cam--
Since your sense of humor is in evidence once more, I'm hoping that that means your new job is going well; how about a progress report? Thanks so much for all the citations! (I'll try to avoid acquiring the dreaded ring.) I notice that most of your list are available from Neuroscion, but I'll probably have to order the BrJPsych one. I'm ready for medicine and related disciplines to follow the commitment of many scientists--to make their pubs freely available to all after 6 months.
Right now I'm wading through the online psychopharm text you recommended. First, I read Stahl on a topic (for context), then, the related articles from the online text (for more tech detail). Your recent post on PB re NTs was helpful, too. I still envision you as the ideal "Ask a Pharmacist" for some big online pharmacy site; your ability to successfully modify your vocab to fit your audience is an undervalued asset.
A Q that probably should be on PB (but I'm reluctant to push my posting luck too far). Do you subscribe to the Serotonin Hypothesis outlined in the 4th Gen text? Specifically, that serotonin's primary NT function is as a modulator of tonic firing of axial motor neurons and balancer of sensory/motor input?
I'm grappling with the role(s) that 5HT2A antagonism may have played in the EPSE of jaw tension I experienced taking Geodon. I'm also trying to understand how d/cing the Geodon led to "false suffocation syndrome"/panic attacks. (I'm having mini-versions of the same thing tapering off Mirapex. It's bound to be a dopamine-mediated response, but what kind? Mirapex has no 5HT action at all.) My main reason for trying to unravel all this is to ascertain if there is something I can take w. Geodon which will ameliorate the EPSE while retaining its mood/energy benefits. So far, Geodon has been the only med that really "worked" (as opposed to "helped") for me.
It's interesting to me that there's no consensus on the definition of atypical APs, even among authors in the same textbook. Such ambiguity makes understanding that much more difficult for my cognitively dulled brain.
Must be "higher-order motor neuron" fatigue---a muddled medlib
Posted by susan C on October 26, 2001, at 17:40:10
In reply to Re: Thanks to Cam, posted by medlib on October 26, 2001, at 15:34:50
Hi medlib, were does this post connect to? I think I will use it to start my training in medicine...you guys are amazing, talk about OVER my head...
Oh, I want a Cam Job Update too, please.
Mighty Mouse treading water
susan C> Hi Cam--
>
> Since your sense of humor is in evidence once more, I'm hoping that that means your new job is going well; how about a progress report? Thanks so much for all the citations! (I'll try to avoid acquiring the dreaded ring.) I notice that most of your list are available from Neuroscion, but I'll probably have to order the BrJPsych one. I'm ready for medicine and related disciplines to follow the commitment of many scientists--to make their pubs freely available to all after 6 months.
>
> Right now I'm wading through the online psychopharm text you recommended. First, I read Stahl on a topic (for context), then, the related articles from the online text (for more tech detail). Your recent post on PB re NTs was helpful, too. I still envision you as the ideal "Ask a Pharmacist" for some big online pharmacy site; your ability to successfully modify your vocab to fit your audience is an undervalued asset.
>
> A Q that probably should be on PB (but I'm reluctant to push my posting luck too far). Do you subscribe to the Serotonin Hypothesis outlined in the 4th Gen text? Specifically, that serotonin's primary NT function is as a modulator of tonic firing of axial motor neurons and balancer of sensory/motor input?
>
> I'm grappling with the role(s) that 5HT2A antagonism may have played in the EPSE of jaw tension I experienced taking Geodon. I'm also trying to understand how d/cing the Geodon led to "false suffocation syndrome"/panic attacks. (I'm having mini-versions of the same thing tapering off Mirapex. It's bound to be a dopamine-mediated response, but what kind? Mirapex has no 5HT action at all.) My main reason for trying to unravel all this is to ascertain if there is something I can take w. Geodon which will ameliorate the EPSE while retaining its mood/energy benefits. So far, Geodon has been the only med that really "worked" (as opposed to "helped") for me.
>
> It's interesting to me that there's no consensus on the definition of atypical APs, even among authors in the same textbook. Such ambiguity makes understanding that much more difficult for my cognitively dulled brain.
>
> Must be "higher-order motor neuron" fatigue---a muddled medlib
Posted by Noa on October 26, 2001, at 19:01:30
In reply to Re: Thanks to Cam and MED-i--c-a-l-L-I-B-r-a-r-y, posted by susan C on October 26, 2001, at 17:40:10
Medlib--
My eye was drawn to the 5HT2 antagonism and jaw tension thing--can you explain if you think the 5HT2 antagonist contributed to the jaw tension or helped to relieve it? Thanks.And,btw--Cam Update! Cam Update! Yeah!
> > Hi Cam--
> >
> > Since your sense of humor is in evidence once more, I'm hoping that that means your new job is going well; how about a progress report? Thanks so much for all the citations! (I'll try to avoid acquiring the dreaded ring.) I notice that most of your list are available from Neuroscion, but I'll probably have to order the BrJPsych one. I'm ready for medicine and related disciplines to follow the commitment of many scientists--to make their pubs freely available to all after 6 months.
> >
> > Right now I'm wading through the online psychopharm text you recommended. First, I read Stahl on a topic (for context), then, the related articles from the online text (for more tech detail). Your recent post on PB re NTs was helpful, too. I still envision you as the ideal "Ask a Pharmacist" for some big online pharmacy site; your ability to successfully modify your vocab to fit your audience is an undervalued asset.
> >
> > A Q that probably should be on PB (but I'm reluctant to push my posting luck too far). Do you subscribe to the Serotonin Hypothesis outlined in the 4th Gen text? Specifically, that serotonin's primary NT function is as a modulator of tonic firing of axial motor neurons and balancer of sensory/motor input?
> >
> > I'm grappling with the role(s) that 5HT2A antagonism may have played in the EPSE of jaw tension I experienced taking Geodon. I'm also trying to understand how d/cing the Geodon led to "false suffocation syndrome"/panic attacks. (I'm having mini-versions of the same thing tapering off Mirapex. It's bound to be a dopamine-mediated response, but what kind? Mirapex has no 5HT action at all.) My main reason for trying to unravel all this is to ascertain if there is something I can take w. Geodon which will ameliorate the EPSE while retaining its mood/energy benefits. So far, Geodon has been the only med that really "worked" (as opposed to "helped") for me.
> >
> > It's interesting to me that there's no consensus on the definition of atypical APs, even among authors in the same textbook. Such ambiguity makes understanding that much more difficult for my cognitively dulled brain.
> >
> > Must be "higher-order motor neuron" fatigue---a muddled medlib
Posted by medlib on October 26, 2001, at 22:54:17
In reply to Re: Thanks to Cam and MED-i--c-a-l-L-I-B-r-a-r-y, posted by Noa on October 26, 2001, at 19:01:30
Hi Susan and Noa--
So, guess my "handle" isn't so anonymous; hey, no one ever called me creative. It's not really applicable anymore, since I no longer hold a salaried position. (I'd reregister, but just got through doing that.) I was (belatedly, as usual) replying to Cam's reply on the previous PSB board. Here's his post; the last paragraph is funny:
http://www.dr-bob.org/babble/social/20011015/msgs/12881.htmlSorry to put all that gobbledigook on PSB; 'twas a combination of paranoia and laziness. I've had so much trouble posting lately, that I try to hit multiple targets with 1 shot, er post. I'm a little like Scott (SLS), in that some combination of my illness and multiple meds leaves me slogging in stuff I used to zip through at warp speed. When I can read and process anything substantive, it's only slightly faster, and probably less accurately, than I can type. (Noa, you may recall that's at turtle speed.) Also like Scott, I had a 2 week "window" on Geodon during which I "awakened". Having to give it up because my jaw locked shut was heartbreaking, not to mention terrifying.
Noa and Cam--if you don't mind, I'l take the rest of this neurotransmitter stuff over to PB where it won't look quite so weird, before Dr. Bob redirects it himself.
A disorganized former ---medlib
Posted by medlib on October 27, 2001, at 15:32:50
In reply to Re: Thanks to Cam and MED-i--c-a-l-L-I-B-r-a-r-y, posted by medlib on October 26, 2001, at 22:54:17
Hi again--
Since my "cover" is blown, and this is Medical Librarians Month, I thought I'd better try to absolve the innocent. Most medical librarians are perfectly capable of finding everything "out there" on a topic without feeling compelled to read any of it. My current obsession with neuropsychopharm is a personal quest by a quirky, Aspergerish personality, *not* a typical professional characteristic. As a former colleague told me (with some exasperation) re multiple ongoing computer problems, "It's not necessary to know how something works, or why it's not working now in order to get the job done. Either we can fix it with what we know or can logically infer, or we develop alternatives." She's a "bottom line" person; I think I suggested carrier pigeons.
Well. I lost (a version of) this post and the one I tried to take over to PB re neurotransmitter stuff when Dr. Bob closed the boards to posting last night. Sort of reminds me of the original PB; I had impeccable timing--nearly every time I posted, the board "rolled over" an hour later. (Cyberspace sure ages quickly.)
Guess I'll go and try to reconstruct another post. An abashed---medlib
Posted by susan C on October 27, 2001, at 16:46:12
In reply to Re: P.S., posted by medlib on October 27, 2001, at 15:32:50
Hi, Really? They designated this month just to Medical Librarians????
I seriously considered an MLS...as the people I have been most impressed by were librarians...at one point the public librarian said to me, "we may need to have a limit on the number of questions one person can ask"...like you say, they just can find/figure stuff out...in one of my former 'lives' I was (briefly) a marketing rep for a library automation company. We were at a big, what are they called, conference, in the hall where all the sales people hang out, setting up, (this is in the late 80's) and the son of the lead developer (considered genius) could not COULD not figure out how to get the demo going...now here I am, total bumbling techno no, and I look at it as you quoted your former collegue: It's not necessary to know how something works, or why it's not working now in order to get the job done. Either we can fix it with what we know or can logically infer, or we develop alternatives..I am a 'bottom line' type person, tho I really like your comment about carrier pigeons...anywho, I got it up and running in about a minute...Don't ask me how...
mouse off to look up Aspergerish
susan CHi again--
>
> Since my "cover" is blown, and this is Medical Librarians Month, I thought I'd better try to absolve the innocent. Most medical librarians are perfectly capable of finding everything "out there" on a topic without feeling compelled to read any of it. My current obsession with neuropsychopharm is a personal quest by a quirky, Aspergerish personality, *not* a typical professional characteristic. As a former colleague told me (with some exasperation) re multiple ongoing computer problems, "It's not necessary to know how something works, or why it's not working now in order to get the job done. Either we can fix it with what we know or can logically infer, or we develop alternatives." She's a "bottom line" person; I think I suggested carrier pigeons.
>
> Well. I lost (a version of) this post and the one I tried to take over to PB re neurotransmitter stuff when Dr. Bob closed the boards to posting last night. Sort of reminds me of the original PB; I had impeccable timing--nearly every time I posted, the board "rolled over" an hour later. (Cyberspace sure ages quickly.)
>
> Guess I'll go and try to reconstruct another post. An abashed---medlib
Posted by Cam W. on October 29, 2001, at 16:23:49
In reply to Re: Thanks to Cam, posted by medlib on October 26, 2001, at 15:34:50
Med - I thought that I posted to this, yesterday, but it didn't show up (Hmmmm....). I haven't read the Serotonin chapter in the online psychopharmacology text, but I will relate some of what I know about the actions of neurotransmitters in relation to one another (this is my view of it, and it would be nice if someone with a better grasp of the interconnective relationship between neurotransmitters could fill in the blanks and make corrections).
I look at all neurotransmission as eletrical pulses of varying intensity. These pulses can be separated in strengths, depending on the action of the pulse and what kind of nerve is carrying that pulse. The two most common pulses seem to be 40Hz and 2-3Hz. These pulses have different activities and transmit signals with different meanings. It is this electrical activity that causes our movements, thoughts, and feelings.
There are two basic neurotransmitters in the brain; glutamate and GABA (gamma-amino-butyric acid). All other neurotransmitters (like dopamine, serotonin, acetylcholine, and norepinephrine; which really should be called neuromodulators), modify the effects of these glutamate and GABA. These neurotransmitters can also modify the action of the other neurotransmitters, as well. Therefore, there is an elaborate interplay amongst all of the 100's of neurotransmitters (incl. peptides, proteins, nitric oxide, etc).
The reason I pick out glutamate and GABA is because glutamate's main action is excitory. It stimulates other nerves, to which it is connected, into firing. GABA, on the other hand is an inhibitory neurotransmitter, thus slows the electrical transmission of neurons.
In addition to speeding up and slowing down of neurons, the brain needs to modify signals so that these signals will act at a certain brain structure, with a certain intensity. This is the job of neurotransmitters and neuromodulators. Since we always are talking about mood, energy and drive on this board, we most often talk about the neurotransmitters that control these systems: serotonin, dopamine, and norepinephrine.
For example, a serotonin neuron is stimulated to fire by electrical imput from glutamate acting on NMDA receptors (either primarily via NMDA receptors on the serotonin neuron, or secondarily through some other neuroreceptor-containg neuron). Several othe neurotransmitters have a variety of different receptors imbedded into the surface of our serotonin neuron. The firing (or blocking) of these receptors changes the electrical activity of our serotonin cell, ultimately causing our cell to either release a large amount of serotonin from it's synaptic terminal (and hence propagate or carry on the electrical signal to the next neuron) or to stifle the electrical signal (and our serotonin neuron does not release any serotonin). Between these polar situations, there are also a spectrum of different possibilities of what our neuron could do, which results in the exchange of electrical activities (and serotonin release) of varying degrees.
It is the action of various neurotransmitters regulating each other in countless configurations in both sensory and motor neurons, that makes us, us. For example, Serotonin regulates dopimine flow (and vice versa) for determining how aggressive one is, or how sexual one is. The serotonin input involves impulsivity and the dopamine input involves pleasure and drive. The synaptic interconnections (amount, type, and quality of) between dopamine and serotonin, and the nature of the electrical flow between neurons containing each of these neurotransmitters, determines how aggressive one is, or how sexual a person is.
The above is incredibly simplified. These systems (impulsivity and sexuality) are also modulated by other neurons and neuromodulators from various other brain regions. The brain (like the Earth) acts like an organism, where affecting one part ( neurotransmitter system, brain area, neurotransmitter concentrations, specific receptor subtype concentration) affects the whole brain. The brain can lose proper function due to injury; which can be due to physical reasons (physical trauma) or due psychological reasons (psychological trauma).
Psychological trauma occurs when a neuronal system(s) in the brain becomes overburdened or overstressed. Brain neuron systems have a maximum capacity, after which they start to break down. The brain's other component's trying to counteract the overactivity (stress) of the brain area by modifying neuron-induced electrical flow to the area, while at the same time trying to compensate for the loss or reduction of activity from the overloaded neuronal system.
For example, the HPA axis (Hypothalamus-Pituitary-Adrenal) is thought to control the body's response to stress. It initiates the body's automatic "fight or flight" response. When overtaxed or overwhelmed by stress (environmental, as well as psychological), the HPA axis starts to malufunction. This malfunction can occur in different ways and different outcomes can be measured. For exmaple, in some cases, there will be uncontrolled cortisol release from adrenals, and this may result in a deadening (or even a down-regulation) of glucocorticoid receptors in the hypothalamus and pituitary. Thus the feedback mechanism (cortisol stimulation of the above glucocorticoid receptors) which turns off the cortisol flow is dysfunctional, so the cortisol flow is not turned off, and eventually this system collapse results in the symptoms that we call depression. The body has not been able counter or reverse the stress it is receiving; the body's homeostatic mechanisms breakdown; depression ensues.
The malfunction can occur at other parts of the HPA axis (ACTH-receptor deadening) or even through other brain systems related to, and interconnected with, the HPA axis. In many cases, no matter what or where the breakdown is or what part is "broken", the final set of symptoms (eg. symptoms of depression) will look similar. In other words, many widespread and different neurochemical breakdowns can each result (as an overt endpoint) in similar symptomatology (ie. depressive symptoms).
This complexity is partially why I do not think that the monoamine theory of depression is correct. Serotonin, norepinephrine and dopamine are only part of the show. Low brain serotonin levels, while seen in depression, do not necessarily mean that low serotonin "causes" depression. There have been studies that have refuted this. We have found that in many people diagnosed with depression, when we return serotonin to the body (using a SSRI) the depression resolves, but not in everyone.
I look at adding to serotonin to a depressed brain, as being a piece of wire splicing together a malfunctioning electrical cord. The serotonin from the SSRI allows some areas of the brain to funtion better. The low serotonin that we see in the spinal cord of some people with depression may actually be a result of depression and not a cause. But, maybe by adding back serotonin into the system, the part that has broken down can slowly mend, because the increase in serotonin is altering the levels of all the other neurotransmitters and neuromodulators, by interacting with them. The interaction of the increased serotonin may help push the body back to a state of homeostasis, and the depression resolves.
The above is a guess, I really should have consulted some papers, but I am too lazy. Work has been a little rough. I have been working 12 hour days, with only a day off here and there. I am catching on to the computer system, and begininng to get a feel for my patients and docs. I am finding the overall work much easier than my last job. I am not positive that I want to go back and work in mental health again. I am finding that I can make a difference in the mental health of the minority of people with mental illness who use the store I work at. Word of mouth is already getting around this fairly large farming community (only 5000 people in town, but at least twice to 3 times that in surrounding areas). I am already being asked to talk to several people about their depression and their antidepressants.
Like I said, so far I am liking it. After 13-14 years, everyone needs a change. I do feel much better about myself, and do believe that I am growing, as a person.
Thanks for asking, everyone - Cam
Posted by Noa on October 29, 2001, at 18:06:43
In reply to Re: Thanks to Cam » medlib, posted by Cam W. on October 29, 2001, at 16:23:49
WOW, Cam. Have to print that one out to read later. Looks comprehensive. Thanks.
Posted by Noa on October 29, 2001, at 18:10:38
In reply to Re: P.S., posted by medlib on October 27, 2001, at 15:32:50
Hi, medlib--
It is funny when I think of it now, but once upon a time, for a fleeting moment, I thought about library science as a career. It's funny now because I have better awareness now of how my organizational deficits would make me quite a lousy librarian.
With the internet, databases, etc, I like the searching and like passing on references to people, etc. But if I was the one who had to actually organize info in a logical and user-friendly way? Hah.
Posted by wendy b. on October 30, 2001, at 8:58:11
In reply to Re: P.S. » medlib, posted by Noa on October 29, 2001, at 18:10:38
> Hi, medlib--
>
> It is funny when I think of it now, but once upon a time, for a fleeting moment, I thought about library science as a career. It's funny now because I have better awareness now of how my organizational deficits would make me quite a lousy librarian.
hi Noa: You can work in the library profession without an MLS... I did. But the pay is less, and in academic institutions, you are a lower man on the totem pole, as it were, than other, degree-bearing librarians.> With the internet, databases, etc, I like the searching and like passing on references to people, etc. But if I was the one who had to actually organize info in a logical and user-friendly way? Hah.
No no. A librarian does what you like doing, it's the database designers who have to organize it in a logical way. A reference librarian would do just what you enjoy, looking things up online and passing it on to library-users... Maybe you should pursue that librarian dream? Ya only go 'round once, ya know?
Encouragingly yours,
Wendy
Posted by wendy b. on October 30, 2001, at 9:14:44
In reply to Re: Thanks to Cam and MED-i--c-a-l-L-I-B-r-a-r-y, posted by medlib on October 26, 2001, at 22:54:17
Hi Medlib,
I have a quick question if you don't mind:
It's for my pdoc, who is a nurse practitioner (can prescribe meds) and a psychotherapist. She is always amazed that I can find so much info on the web about meds and other things like the DSM-IV, etc. I think she is not computer-illiterate, but needs cajoling. She is not affiliated with a medical institution, which usually grants Medline searching privileges for free to clinicians. She wants to be able to do medline searches, and get more than just abstracts to the queries, in other words, full text. Is there such a database/website out there that provides that kind of fuller info? I know how to tell her to do searches to get citations and abstracts, but I would love to help her be able to find more info.
Any help would be *greatly* appreciated...
Yours truly,
Wendy
> Hi Susan and Noa--
>
> So, guess my "handle" isn't so anonymous; hey, no one ever called me creative. It's not really applicable anymore, since I no longer hold a salaried position.
(I'd reregister, but just got through doing that.) I was (belatedly, as usual) replying to Cam's reply on the previous PSB board. Here's his post; the last paragraph is funny:
> http://www.dr-bob.org/babble/social/20011015/msgs/12881.html
>
> Sorry to put all that gobbledigook on PSB; 'twas a combination of paranoia and laziness. I've had so much trouble posting lately, that I try to hit multiple targets with 1 shot, er post. I'm a little like Scott (SLS), in that some combination of my illness and multiple meds leaves me slogging in stuff I used to zip through at warp speed. When I can read and process anything substantive, it's only slightly faster, and probably less accurately, than I can type. (Noa, you may recall that's at turtle speed.) Also like Scott, I had a 2 week "window" on Geodon during which I "awakened". Having to give it up because my jaw locked shut was heartbreaking, not to mention terrifying.
>
> Noa and Cam--if you don't mind, I'l take the rest of this neurotransmitter stuff over to PB where it won't look quite so weird, before Dr. Bob redirects it himself.
>
> A disorganized former ---medlib
Posted by SLS on November 3, 2001, at 9:49:13
In reply to Re: Thanks to Cam, posted by medlib on October 26, 2001, at 15:34:50
Hi Medlib.
I had a few thoughts regarding Geodon:
Redirected to:
http://www.dr-bob.org/babble/20011025/msgs/82909.html
- Scott
This is the end of the thread.
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