Posted by Chloe on June 18, 2002, at 20:50:54
In reply to Doxepin Dosing and Health Insurance Constraints » Chloe, posted by fachad on June 18, 2002, at 19:26:29
> Yes, I take my trimip around 7 or 8 PM, even though I don't go to bed until 10. I get two benefits from doing it that way: first, I am drowsy by bed time, and second it has had more time to wear off when it is time to wake up.
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Fachad,
It's funny, I don't really feel sedated when I wake up with Dox. In fact, I feel refreshed. I take out the dog, throw the ball, fuss a with my garden, weed, all before my shower. The tiredness does not hit until after lunch or mid afternoon. I really feel like a need a nap! But my quandery is if I take the dox earlier, will I wake up too early??? I guess i will have to experiment.> But my wife will take a little ami in the day if she has stomach pain, and I read a study where they compared dox to valium for anxiety, and gave study sujects multiple doses or either drug durning the day.
This is interesting...TCA's prn. Hum. I guess my only concern would be the toxicity of TCA's. They are very deadly in an overdose.
> Glad to hear that you are sleeping well! It may take either more time or a higher dose for the pain relief.
I think you are right on this point.
> I don't see any reason why your pdoc would not be willing to titrate up the dose until you are satisfied or the side effects become troublesome.I agree. I can e-mail my pdoc and tell her what my symtoms are, or how I am doing, etc. We have worked together for over a decade, so she trusts me to use my own judgement within reason. She will have to amend the perscription, though...that could take some time.
> Yeah, I hated Remeron too. But I still think it is the most potent sleep med ever, period. If someone was really in misery because of insomnia, and nothing else worked, I'm sure Remeron would.
I had a friend who had hysterectomy induced menopause. And from the day of the surgery, she could not sleep, at all. So I told her you have got to try remeron! It didn't help her a bit. So I guess we are all individual. But I think Remeron is more like rhino tranquiler, than an AD. I apologize to any Remeron lovers out there!
> I live in the US, and have employer provided health insurance.
> Is that $10K a yearly cap or a lifetime cap?Lifetime, unfortunately. :(
> I don't know if I have a cap on my psych coverage. I think the reason for my limitation is based more on the way psychiatry is done nowadays than anything else.
>
> I think even if I was 100% self-paying, most pdocs are just doing their thing in 15 min "med check" appointments these days. If they can classify you as "stable" by any stretch of definition, they put you into the quarterly (3month), bi-annual, or annual visit category.
>
> I think the only reason I get to see my pdoc every three months instead of yearly is because dex is Schedule II and he knows he needs to see his CII patients more often to avoid scrutiny from the State Board of Medical Examiners or the DEA. Kind of a lame reason, but at least in gets me 4 appointments per year.One appointment a year? This must be troublesome when it comes to refills. My pharamacy will only take 6 months at a time. I am glad you take the stims, so at least you can be "checked" on quarterly. However, I would think a pdoc would want to see you AS MUCH AS POSSIBLE so they can charge you. I went looking for another pdoc, he agreed to be my med doctor if I would see him once a week, at $250 a pop! I thought the price was outrageous, but so was once a week. It was not analysis, it was psychopharmacology. So I passed on that, and decided what I have is good and with this board, I feel I have very adequate med coverage!
>
> But I sometimes look back with nostalgic yearning to the old days when psychiatrists did insight psychotherapy, and were not solely focused on meds and med management. It was nice to be able to talk with your dr about how your life was going, and how you felt about life, rather than just how the meds were going, and how you were feeling from meds...(insert bitter irony emoticon here)I totally agree with you here. I had to transition with my pdoc from being my "shrink", talk and meds, to just meds. And it was difficult. Because there could be other reasons why a med is not working. It's not all biology and neurons. Sometimes "issues" actually enter into how someone feels and responds to a drug. I.e., work problems, family probs, relationship probs, perception probs, etc. And the meds can cause us to feel certain ways that can be troubling too. There are so many nasty side effects that need addressing for some people, like sweating, or sexual dysfunction, agitation. And with the SSRI's, the the insomnia, or apathy you experienced. How can that be addressed in a 15 minute session annually? What a system we have...BUT, I too, see my pdoc very rarely, a few times a year. But I do email her if there is a problem or issue. So being able to touch base (at a cost per email, however!) on how things are going is comforting.
Thanks for all your help.
Take care,
Chloe
poster:Chloe
thread:108844
URL: http://www.dr-bob.org/babble/20020617/msgs/110240.html