Posted by Leighwit on May 21, 2001, at 10:47:18
In reply to Re: Wellbutrin Celexa » Leighwit, posted by Paige on May 15, 2001, at 18:31:20
Paige,
A lot of your post (below) resonates with me. I'm 43, and generally concur with your overall sentiment(s).
I switched to Serzone from Celexa to augment the Wellbutrin, because the Celexa caused huge weight gain in me. Since discontinuing it, my weight gain has stopped. Stopped cold; for the first time since I started Celexa over one year ago (and 30 pounds lighter ago!)
The Serzone, after two weeks, is thus far not taking the edge off the WB side effects, nor is my depression as well treated as when I took the WB/Celexa combo.
I've been dealing with this since the birth of my first and only child ten years ago. While personal detachment is likely a requisite/critical professional skill for psychiatrists, I have indeed met one or two whose detachment level seems to reach the point of distraction. A distraction which might keep the patient from working at clear, precise communication (which is especially difficult for depressives); and a distraction that can keep the doctor from performing to the best of his or her ability. (Assuming that listening and disseminating information as "unique" to each patient is a performance measurement). --
Highly competent professional objectivity we need. Wrote verbal scripts and mechanical ears, we don't need. If it's all so standardized -- from the diagnostics to the treatment -- then perhaps all we need is a psychiatric nurse practitioner and far lower costs. I don't think it is that simple. Shame on psychiatrists who underestimate their potential value.
I have always chosen to put up with a fair amount of bland, no personality, never-a-smile practitioners if I felt the quality of their professional credentials/and or the quality of my own care experience, warranted me tolerating a lack of social grace.
Sounds like that's what you're doing with your current doctor, which might be good. IF you're feeling confident that his competence is exceptional.
Just remember, though -- lousy psychiatrists often charge the same fees as top-of-the-field psychiatrists charge. Same dollars. Vast difference in the quality of care.
People can argue semantics over this, but generally, it is true. I recently had surgery by a doctor listed in Chicago Magazine's List of Best Doctors. It didn't cost me more than the first opinion doctor would have. It might, however, have saved my life given the fact that complications kept me in the hospital for seven days following out-patient surgery.
Same thing has been true for the many endocrinogists I've been cared for over the past 32 of my 43 years. The best were not, at their respective times, more expensive than the worst.
Competence not only does not necessarily cost more, it doesn't have to come at the cost of your own personal comfort and "gut" confidence in your doctor.I have a lot of experience in this area, having been a juvenile-onset diabetic most of my entire life. I've usually seen at least six physician specialists on a regular basis; right now I see eight.
The best endocrinologist I've been treated by, was not generally considered a sociable personality type. Many patients would request to be seen by one of his partners because they couldn't get enough "warm and fuzzies" from him, typically termed "not a caring personality". In my mind, they were completely mistaken. The exceptional quality of his care produced a caring bond over the 12 years I saw him. I credit his cutting-edge efforts for being complication-free against most odds for someone diagnosed in 1968. I missed him terribly when we moved from the DC area, and continue to feel a deterioration in my previously optimum level of care. Perfect is tough to beat.
My long-developed theory on doctors is that those who excel in their field, are typically highly caring physicians. I not only do not think the two are mutually exclusive, I think they are intertwined.
I look first and foremost for exceptional credentials and competence; and then for the instinctive feeling that a doctor is not going to be a passive "witness", someone more interested in managing his time than in managing his patients' health care.
Find the "best of the breed" medical doctor or psychiatrist in your region, and you'll find a physician who, regardless of personality type, cares deeply about his/her patients.
Mediocre care from a nice doc, is not a good choice for body or mind. Top-notch care from someone we can trust, however,is a fabulous choice.
And the better the care, the farther your money will go. In your case, 100% of every expense is your money. Mediocre doctors are always more expensive. I was without insurance for several years in my twenties, and remember learning that lesson the hard way. It's particularly true for Pdocs. They aren't running tests typically, they're consulting. Once you are feeling better, you may only have to see him/her every 3-4 months. When things are not working, you need to see them more often. You don't feel well right now, and are waiting longer than you probably should in order to manage cash-flow. Is he worth this wait?
I know it's hard to make decisions, or to even think clearly at all -- when you're falling deeper in the well of depression. I also know that when you're feeling that way, and when every penny of care is from your own pocket (we have insurance and our out-of-pocket costs for 2000 reached $9K...) it's important to find the best doctor you can find your way to see. It's the mediocre ones that will empty your pockets for only mediocre results.
If your gut instinct tells you that this guy isn't going to be instrumental in continuously charting your "best possible" care and recovery, fire him. You can pick any doctor you choose since you don't have to use a PPO or an HMO...another reason not to settle for second-best.
Sorry for the ramble. Hope something here has either helped, or given you some thoughts worth adding to your own. If not, write back anyway. < g >
Leighwit
Leighwit,
>
> Boy, looking at my last post,it's a good thing i
> didn't say I was an english manjor or anything.
> Sorry for all the typos and I hope you made it though
> them okay.
>
> Yes, maybe this is a terrible way, but I love this board
> and the knowledge and support. My pdoc thinks I am a bit
> crazy when i come back at him with mucho info, but
> that is his perogative I suppose. I tried, once, some
> time ago, the combo for one day of Celexa and 150mg
> of Wellbutrin and I felt like I had food poisoning.
> It was very strange. Maybe for some people it has
> that affect . My doc is good, but he is very by the book,
> and MDish. Typical, distant, take this pill, and take that pill
> kinda guy. I guess alot of these psychiatrists are like this.
> Great field if you can't cope with getting close to
> people. Anyway! So I never bothered again and
> is one of the reasons I was so curious about your combo.
> How high of a dose of Celexa were you taking?
> Couldn't a low dose keep the side effects at bay atleast
> a little?
>
> I wish you all the luck there is out there. I hate
> feeling so blue. Most people I know do not relate
> to it at all and it leaves you feeling very much alone
> and isolated, at least it does me. Nothing has
> worked for me, nothing. I hope the Serzone combo works.
> Sounds like your doc is working on several
> "receptors" at once. Why the switch to Serzone? I have
> never tried it.
>
> I have to do something soon because I am getting at
> my lowest again which is pretty low. I don't
> see the doctor crew until June 14th and I fear I
> need them sooner. I have no insurance, so I
> can't just randomly go anytime I want, I have to plan
> every financial and psychological treatment move!
>
> Let me know how you are feeling and keep in touch too.
>
> I have clinical depression, some genetic wiring,
> some psychological. I have never felt right since
> I can remember and I am 40. It hit me real hard
> 4 years ago. I have never been the same since.
> I thinked I snapped back then and now here I am, not
> knowing who or what or where and wondered if I ever
> really did.
>
> Take care of yourself, Leighwit
>
> Paige
poster:Leighwit
thread:62367
URL: http://www.dr-bob.org/babble/20010515/msgs/63810.html