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Cranial Electrotherapy Stimulation (Ces)


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#1 fishinghat

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Posted 11 January 2020 - 09:52 AM

Cranial Electrotherapy Stimulation (CES)

https://www.ncbi.nlm...pubmed/28870799
J Pain Symptom Manage. 2018 Feb;55(2):198-206. doi: 10.1016/j.jpainsymman.2017.08.027. Epub 2017 Sep 21.
Cranial Electrotherapy Stimulation for the Management of Depression, Anxiety, Sleep Disturbance, and Pain in Patients With Advanced Cancer: A Preliminary Study.
Thirty-three of 36 patients (92%) completed the CES. Median (interquartile range) adherence CES use and satisfaction scores were 93% (89-100) and 10% (9-10), respectively, and the adherence criteria was met in the study. CES use was safe (no Grade 3 or higher adverse events). HADS anxiety (P < 0.001), HADS depression (P = 0.024), ESAS anxiety (P = 0.001), ESAS depression (P = 0.025), Brief Pain Inventory pain (P = 0.013), Pittsburgh Sleep Quality Index daytime dysfunction (P = 0.002), and medication use (P = 0.006) scores improved after four-week CES treatment.

https://www.ncbi.nlm...pubmed/23538086
Psychiatr Clin North Am. 2013 Mar;36(1):169-76. doi: 10.1016/j.psc.2013.01.006.
Cranial electrotherapy stimulation for treatment of anxiety, depression, and insomnia.
Abstract
Cranial electrotherapy stimulation is a prescriptive medical device that delivers a mild form of electrical stimulation to the brain for the treatment of anxiety, depression, and insomnia. It is supported by more than 40 years of research demonstrating its effectiveness in several mechanistic studies and greater than 100 clinical studies. Adverse effects are rare (<1%), mild, and self-limiting, consisting mainly of skin irritation under the electrodes and headaches. Often used as a stand-alone therapy, because results are usually seen from the first treatment, cranial electrotherapy stimulation may also be used as an adjunctive therapy.

Many other articles exist showing positive effects from this technique.


#2 Bent4Now

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Posted 11 January 2020 - 04:55 PM

I've used Alpha Stim for a number of months (about 8mos) and I still have chronic insomnia and anxiety.  I tried various time settings and strengths but it has never cured me; I keep using it because I think it helps a little. I noticed a few times when I don't use it my shoulders feel more tense.  I will admit that I have come to the belief most of my problem is hormonal so perhaps that is why it hasn't helped me much.


#3 fishinghat

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Posted 11 January 2020 - 05:55 PM

That is a common problem for those using antidepressants. Have you had your testosterone and estrogen fractions checked lately?


#4 Bent4Now

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Posted 06 February 2020 - 02:50 PM

Hello fishinghat,

 

I could be incorrect in my last post. I thought my hormones were the problem but now I'm leaning back towards Cymbalta withdrawal...

 

I did have blood work done to check testosterone, progesterone, and estradiol.  I have been on a testosterone gel supplement for about a month. I use a very small amount because I fear that it will interfere with my sleep. It was in the twenties prior to using supplement. I'm also using progesterone supplements 200mg (prometrium.) My estradiol seems to be fluctuates on tests but that last one was around 120's, I believe. My FSH seems to range between 20-22 right now. A week and a half ago, I started a low dose estradiol patch; however, thus far it is not helping.

 

Even though I have been off Cymbalta for over a year, I'm considering going back on a very low dose it to see if I can stabilize my sleep. Initially, when I took Cymbalta I had depression. After quitting Cymbalta, I have anxiety, excessive worry/upset over stupid little things that normally I would get over much quicker (like getting on a hamster wheel), and waking up nearly every night for 2 to 3 hours.  I'm also considering asking for Zoloft instead because I know at least 3 women that are in perimenopause and have had success with it. I have the Cymbalta now but afraid to take it because if it doesn't work, I'll have to taper and I know what unpleasant an experience that was.

 

Sorry if I should have done a separate post for this info.


#5 fishinghat

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Posted 06 February 2020 - 03:08 PM

Zoloft would be a better choice than going back on Cymbalta. How long have you been off now.

 

Also taking progesterone and testosterone at the same time is a recipe for withdrawal like symptoms as well as insomnia. It can take a long time to dial these back into balance. 

 

I will take a closer look at he doses and number you mention and get back with you in a little bit.


#6 Bent4Now

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Posted 06 February 2020 - 04:00 PM

Thank you for replying.  I have been off since Jan 2019. Late 2017 I started my second taper.  My capsules contained the mini-caplets so it was difficult to do a 10% decrease per month. Once I got to 10mg I could not stablize my sleep but continued with taper because I had a limited amount of pills left.

 

I was hoping the testosterone would help with energy, motivation, and sense of well-being.  My prescription says 5mg/gm and to use 2-4 clicks. I only use 1 click in the morning.  I looked and actually my progesterone is 300mg taken nightly to help with sleep (do not take 5 days out of month.) I started the progesterone at 100mg back in August 2019 and due to continued insomnia got approval from doctor to increase to where I am now. I was also hoping the progesterone would help heal my brain.

 

I really don't expect you to understand all the numbers but I looked it up. Back in August 2019 my estradiol was 153 (March 2019 it was in the 50's-I'm assuming in perimenopause it just fluctuates), estrone was 72, progesterone was 6.6, testosterone was 23, and FSH was 15.9.  As one gets closer to menopause FSH increases. In Jan 2020 FSH was 22.7. Didn't have my estrogen levels checked in Jan, will probably have done in April.

 

What I find interesting is that you believe Zoloft would be better. I just have wondered if my brain because of withdrawals just wants Cymbalta but I am a bit afraid it might be stimulating and make anxiety worse.  I know one thing I miss the emotional blunting that Cymbalta provided. I know some people complain the blunting prevents them from feeling happiness but mine just took the edge off of ruminating so things didn't bother me as much.

 

Was on 60mg for over 12 years so I was a very long time user.

 

Thanks 


#7 fishinghat

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Posted 06 February 2020 - 04:10 PM

OK, a lot of digging for me to do so it may be tomorrow before I reply but I can tell you this, it has taken me and my drs 6 years to get my testosterone levels dialed in so they are stable. It can be tough. I will discuss everything with you if you can be patient.

 

Thank you


#8 fishinghat

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Posted 07 February 2020 - 10:29 AM

OK, so lets start with my story.

I had nearly complete failure of testosterone production due to Cymbalta. My total testosterone went from 400 to 68 in a couple of months. I was placed on the same dosage of testosterone that you are on in March of 2013 and have just reached stability about 4 months ago. To make a long story shorter...Testosterone brands vary in application sites and whether they should be applied in the morning or evening. My pharmacy would supply the right dosage and amount but I was not aware that some were morning application and some where evening application so my effects from the testosterone was all over the place. Once we got that resolved then came the issue pf placement. Each packet of testosterone contained the same dose even from different manufacturer BUT the make up of the alcohol and gel was different. This effects how the testosterone would absorb through the skin. So placing one that absorbs slowly on the thigh would work as directed but if it was placed on the arm it would be less permeable and take much longer to absorb through the skin and not give the desires results. Once we had a set brand and location we then had to adjust schedule. When working with the testosterone manufacturers I found out that the dosage of testosterone, whether for man or women, was based on a minimum natural testosterone production HOWEVER, when a person has been on testosterone around 3 months all natural production ends and the dose has to be reevaluated. So during the first few months on testosterone replacement therapy (TRT) both physical and emotional issues are unstable. To further complicate these issues the addition of progesterone, estrogen or estradiol effect the metabolism of each other and testosterone. Estrogen fraction can be converted to testosterone and vice versa. Excess estrogen fractions re stored in fat tissue and with any subsequent weight gain or loss the levels of these hormones fluctuates up and down accordingly. I am a large man (6' 3") but I have had to keep my weight within a 10 pound range to achieve my stability. It is no different with women. I eventually received the data from my current manufacturer on the rise and fall in testosterone after application and plotted it on a graph. I was using 7.5 mg each morning but my testosterone levels during the day were too high and at night too low (depression, severe fatigue, etc). So I switched to 5 mg in the morning and 2.5 mg in the evening to get a more stable testosterone level. All of this determined by plotting the blood levels from the manufacturer at different times of the day to get the best blood levels to produce a consistent effect.

 

More information to follow.


#9 fishinghat

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Posted 07 February 2020 - 10:43 AM

Next issue, phytoestrogens.


Phytoestrogens are estrogens produced by plants. The estrogens, when consumed, are partialluy absorbed bu our bodys and shift the hormone levels.
A list of the top 50 foods that contain Phytoestrogens can be found at ...
https://www.superfoo...trogen-sources/
These food should be minimized in the diet to avoid fluctuation in the diet from their consumption.

#10 fishinghat

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Posted 07 February 2020 - 10:55 AM

You also said that "It (testosterone) was in the twenties prior to using supplement."

Was that total, bioavailable or free testosterone levels?




"I have been off (Cymbalta) since Jan 2019."
The withdrawal effects may still be present but should be minimal. I still really think this can quite likely be hormonal related but more on that later.

So do you think you are perimenopausal at this time? Does your dr agree?

More to follow

#11 fishinghat

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Posted 07 February 2020 - 12:26 PM

"I have been on a testosterone gel supplement for about a month. I use a very small amount because I fear that it will interfere with my sleep"

Testosterone peaks a few hours after applied depending on the brand. It usually wears down about 12 hours later. Are you sure it is a variety that is "apply in the morning?" Let me know the brand and maybe I can help optimize your schedule. If you take an evening variety in the morning it will peak as you are trying to go to sleep.

"My prescription says 5mg/gm and to use 2-4 clicks. I only use 1 click in the morning."

I am concerned with this statement as I use 1.5 packages (clicks) a day and I am a man so my normal levels should be a lot lower than mine. My dose raises the total testosterone by 400 points. That would be way too much for a woman. Even 1 click sounds like a heavy dose for a woman.

#12 fishinghat

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Posted 07 February 2020 - 12:56 PM

August 2019 FSH was 15.9.
Jan 2020 FSH was 22.7
That definitely indicates premenopause.

(March 2019 it (estradiol) was in the 50's-I'm assuming in perimenopause it just fluctuates
Back in August 2019 my estradiol was 153
A week and a half ago, I started a low dose estradiol patch; however, thus far it is not helping.
I don't see an issue with estradiol in the 50 to 150 range. Hopefully it will stay steady at 150ish. I am surprised that at 153 they put you on a patch but that shouldn't hurt things any.

Your testosterone of 23 was definitely low and a move to the gel was a good idea.
progesterone was 6.6, would indicate you are leaving the premenopause state and entering menopause but that was last year March so you would think you are in full menopause by now.

As you can see during all this the hormone levels fluctuate wildly and can often take a year or more to stabilize after completing menopause. May I ask what the date was of your last period?

#13 fishinghat

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Posted 07 February 2020 - 01:05 PM

According to the FDA after studying over 9,000 cases of menopause these are the main symptoms:
Depression - (465 reports)
Stress and anxiety - (443 reports)
Pain - (421 reports)
Fatigue - (413 reports)
Pain exacerbated - (406 reports)
Headache - (403 reports)
Fatigue aggravated - (398 reports)
Nausea - (393 reports)

How well does that match your symptoms? Sounds almost like withdrawal doesn't it?

How effective is Progesterone for Menopause?
Summary:
Overall ratings: 3.4/5
Long term ratings: 3.5/5

Cymbalta is one of the most common drugs that people complain to the FDA about causing early menopause. Loss of hormone function is a common side effect of long term Cymbalta use.


#14 fishinghat

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Posted 07 February 2020 - 01:26 PM

Please read carefully.



https://dailymed.nlm...dience=consumer
(FDA drug insert)

 

Did you realize that the FDA has issued "WARNING: CARDIOVASCULAR DISORDERS, BREAST CANCER AND PROBABLE DEMENTIA FOR ESTROGEN PLUS PROGESTIN THERAPY "

"Concomitant food ingestion increased the bioavailability of PROMETRIUM Capsules relative to a fasting state when administered to postmenopausal women at a dose of 200 mg."
(My note - As progesterone is fat soluble the taking of the medicine with oily/greasy food will significantly raise the amount absorbed)

 

"Progesterone is broken down in the liver by the enzyme cytochrome P450 3A4."
(My note - This is the same enzyme hat breaksdown some antidepressants so the takng of those antidepressants may build up to higher doses than expected with some one taking progesterone.)


"WHI Estrogen Plus Progestin Substudy
The WHI estrogen plus progestin substudy was stopped early. According to the predefined stopping rule, after an average follow-up of 5.6 years of treatment, the increased risk of breast cancer and cardiovascular events exceeded the specified benefits included in the "global index." The absolute excess risk of events in the "global index" was 19 per 10,000 women-years.
For those outcomes included in the WHI "global index" that reached statistical significance after 5.6 years of follow-up, the absolute excess risks per 10,000 women-years in the group treated with CE plus MPA were 7 more CHD events, 8 more strokes, 10 more PEs, and 8 more invasive breast cancers, while the absolute risk reductions per 10,000 women-years were 6 fewer colorectal cancers and 5 fewer hip fractures.

Results of the estrogen plus progestin substudy, which included 16,608 women (average 63 years of age, range 50 to 79; 83.9 percent White, 6.8 percent Black, 5.4 percent Hispanic, 3.9 percent Other) are presented in Table 5. These results reflect centrally adjudicated data after an average follow-up of 5.6 years."

 

"Women's Health Initiative Memory Study
The estrogen plus progestin Women's Health Initiative Memory Study (WHIMS), an ancillary study of WHI, enrolled 4,532 predominantly healthy postmenopausal women 65 years of age and older (47 percent were 65 to 69 years of age; 35 percent were 70 to 74 years of age; and 18 percent were 75 years of age and older) to evaluate the effects of daily CE (0.625 mg) plus MPA (2.5 mg) on the incidence of probable dementia (primary outcome) compared to placebo.

 

After an average follow-up of 4 years, the relative risk of probable dementia for CE plus MPA versus placebo was 2.05 (95 percent CI, 1.21 – 3.48). The absolute risk of probable dementia for CE plus MPA versus placebo was 45 versus 22 per 10,000 women-years. Probable dementia as defined in this study included Alzheimer's disease (AD), vascular dementia (VaD) and mixed type (having features of both AD and VaD). The most common classification of probable dementia in the treatment group and the placebo group was AD. Since the ancillary study was conducted in women 65 to 79 years of age, it is unknown whether these findings apply to younger postmenopausal women."

 

"Stroke
In the Women's Health Initiative (WHI) estrogen plus progestin substudy, a statistically significant increased risk of stroke was reported in women 50 to 79 years of age receiving daily CE (0.625 mg) plus MPA (2.5 mg) compared to women in the same age group receiving placebo (33 versus 25 per 10,000 women-years). The increase in risk was demonstrated after the first year and persisted. Should a stroke occur or be suspected, estrogen plus progestin therapy should be discontinued immediately. "

 

"Vision abnormalities
Retinal vascular thrombosis has been reported in patients receiving estrogen. Discontinue estrogen plus progestin therapy pending examination if there is sudden partial or complete loss of vision, or if there is a sudden onset of proptosis, diplopia or migraine. If examination reveals papilledema or retinal vascular lesions, estrogen plus progestin therapy should be permanently discontinued."





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