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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by erik98225 on November 2, 2004, at 15:32:50
I need a new pdoc.... who isn't benzophobic.... and actually LISTENS to his or her patients.
I have Social Phobia and trouble sleeping. I take Paxil 60mg and Atenolol 50mg. This effectively controls my social phobia, but I have a heck of a time falling asleep, which has been a lifelong issue for me.
I was on Klonopin 6mg (2mg tid) for a while until my pdoc insisted on taking me off of it on the grounds that it is "addictive". She has confused the concept of dependence (needing more of the drug to get the same effect) with that of addiction (continuing to abuse a drug despite harm to self). I have explained the difference to her multiple times but she just doesn't get it.
I feel she has been bought off by the SSRI companies.
She knows of my sleep problems and has tried other sleep medications in the past. Benadryl and Trazodone and Seroquel work, but they are anticholinergic. I am allergic to anticholinergics. They suck all the saliva out of my mouth and make me depressed for 3 DAYS after taking only 1/4 of the recommended dose.
Alcohol works, but it burns holes in your liver.
Klonopin worked as well or nearly as well as alcohol, without any of the side effects of drinking a toxic industrial solvent. But it is off limits, being a benzo.
I haven't asked, but Ambien and Sonata are probably off limits because they are tolerance-producing GABA agonists (like benzos).
My current pdoc schedules appointments in 15 minute blocks (yes FIFTEEN minutes) and they go like this: enter, get lectured for 15 minutes, close the door on your way out. This pdoc is not there to HELP me and not deserving of my money.
I intended to ask her today if she would be willing to prescribe Neurontin (the non-addictive GABA agonist) but had no time to do so.
My GABA system is obviously way out of whack, and sadly, alcohol is the only GABA agonist that is easy to obtain.
I want to get on some REAL medication that will help, and I hate to resort to the expensive gray market, so doctor-shopping I go. If anyone can recommend a good pdoc in the Seattle/Bellingham area I would be extremely grateful (my email is erik98225@hotmail.com)
Also, if anyone who reads this is taking Neurontin I would like to hear about your experiences with it. Thanks very much.
Posted by jboud24 on November 2, 2004, at 17:11:35
In reply to I need a new pdoc and I need some SLEEP!, posted by erik98225 on November 2, 2004, at 15:32:50
I've taken the Neurontin in the past, but it didn't help me sleep to well. It did have a very slight pro-social/anti-anxiety effect, but it also made me feel dizzy, uncoordinated, and I had cognitive impairements. Those were at the only dose I ever took, 1600mg/day all at one time in the morning. Below that level, the effect on all those things I mentions above felt very placebo like. For me, it was not worth the side-effects for such a small theraputic gain, but I'm a bit of a hardhead when it comes to meds.
Good luck,
Justin
Posted by Squiggles on November 2, 2004, at 17:45:52
In reply to I need a new pdoc and I need some SLEEP!, posted by erik98225 on November 2, 2004, at 15:32:50
Yeah, you've got your finger on the button;
I have a friend who did not sleep well at all
for about 15 yrs. until prescribed benzos.
And she had a high position. Think about that.I thought my panic disorder (chronic) was
BECAUSE of benzos, but infact it was either
tolerance (where higher dosages were needed)
or something else.It's why I was an advocate at benzo.org --
what was i thinking? Still, there is the
doubt lingering about increasing side effects
when taken too long and too many - e.g.
respiratory depression.Squiggles
Posted by King Vultan on November 2, 2004, at 18:46:49
In reply to I need a new pdoc and I need some SLEEP!, posted by erik98225 on November 2, 2004, at 15:32:50
I agree you should probably find someone else. Benzos have a legitimate use in psychiatry and are far less problematic than the barbituates that they have made essentially obsolete. I happened to see my own pdoc today regarding my sleep issues. I have been alternating 0.25 mg Halcion/triazolam with 50 mg Benadryl. I can tolerate the Benadryl, but it is not strong enough. He prescribed another antihistamine, hydroxyzine, which I don't believe is particularly anticholinergic. I don't believe it is remarkably powerful as a sleep aid, either, but perhaps it will work better for me than the Benadryl.
If it's affordable, I would suggest giving Ambien a try. I discussed this with my pdoc, who feels it can be used every night. Tolerance seems to be less of an issue with this drug, as it is not a true benzo and has a very short half life. The same would also be true of Sonata, but the half life of this drug is so short that people have more of a tendency to wake up early and perhaps not be able to get back to sleep. This can also happen with Ambien, but somewhat less so than with Sonata. I might give Ambien a try myself, but it is very expensive on my insurance ($50/month copay), and I question if it is strong enough for my insomnia, which is particularly bad because of the Parnate I'm on.
Todd
Posted by jboud24 on November 2, 2004, at 20:17:50
In reply to Re: I need a new pdoc and I need some SLEEP!, posted by King Vultan on November 2, 2004, at 18:46:49
My pdoc also taked about Sonata and Ambien with me today at my appt. He said that they work on the sub-type of the BZD receptor complex that mediates sedation. There are two components: one for sedation/hypnosis and another binding site on the oppossing sub-unit that is resposible for anxiolysis. He said that benzos have different preferences as to where they bind to, like xanax binds with a much higher ratio to the anxiolytic sub-unit, Klonopin binds to both non-preferentially, and Ambien and Sonata bind to the sedatitive sub-unit with a ratio of 13:1.
Basically I thought this was important since by not binding to the anxiolytic sub-unit, Ambien and Sonata do not have addictive qualities and do not interfere with the ability (of someone who is concurrently taking benzodiazepines) of a benzo to still keep giving its anxiolytic benefits.Just thought I'd post what my doc and I discussed today since I thought it may be relevant.
Justin
Posted by erik98225 on November 2, 2004, at 23:19:31
In reply to Re: I need a new pdoc and I need some SLEEP!, posted by jboud24 on November 2, 2004, at 20:17:50
The real question, however, is where to find a pdoc who isn't afraid of these effective medicines.
Posted by Crazy_Charlie on November 3, 2004, at 3:28:33
In reply to I need a new pdoc and I need some SLEEP!, posted by erik98225 on November 2, 2004, at 15:32:50
Hi Erik
I can't answer for your doctor, but what I can do is explain how the doctors at my work place were thinking about sleep and benzos. Now, that doesn't mean that I think you should NOT have them, I don't really have an opinion of that.The docs at my (former) place rarely prescribed benzo for sleep problems, and they had several reasons for that. You are mentioning addiction vs dependence, which I find interesting since we don't really have two different words for what you describe in my country. But here is the explanation of why our docs are very careful with prescribing benzos for sleep problems:
If you take benzo to sleep, you will most likely sleep very good. So good that you drop out of most dreamsleep (REM). This is usually not a problem, but in the long run it is. Dream sleep is just as important for you as deep sleep is, and lack of it will make you feel tired, have a hangover effect etcetc. If you stop using the benzos for sleep, you will find it more difficult than ever to sleep, and the only solution would be to go back on benzos. In addition, you have the problem with addiction/dependence in terms of needing more and similar. Continuous use of benzos to make you sleep, would actually make it so that you will need the benzos to sleep at some point, at least it works like that for most people after long time use. Whatever is keeping you from falling asleep wont be cured from using benzo, but if you use benzo anyway to sleep, you will still have the origin of your sleep problems, and thereby you will always need benzos to sleep. This means that you at some point also will need a bigger dose, because the dose that used to be effective is not effective anymore. This will very fast go into a downward spiral.
Maybe your doc means that benzos ar eno good for you because of this?This is a general problem with using sleeping medications, it simply ruins your ability to sleep without them. Now I see that you have had a sleeping problem all your life (and so have I, I know how it's tearing you apart), I really understand that you want benzo. You can also say that since it has never been normal, what difference does it makes...
What I wonder of is... have your doctor given you a proper check up on your sleeping problems? Have you been at a sleeping laboratory where they can monitor your sleep for example? There they would be able to see your rythm, what problems you have and when you have problems. In addition you should get a proper physical and neurological test... everyone with ANY kind of mental/physical problem should automaticly go through a proper check up BEFORE drugs are prescribed. In that way the chance of getting the wrong drug is reduced.
I hope I didn't step on your toes here, I didn't want to defend your doctor, it's just that after working for years with both mental patients and drug addicts, you get a bit wary. I often met patients that could tell me a story about what their doctors had given them, that made it prickle up my back when I saw what they looked like then... not necessarily becaus eof the medication they got, but the complete lack of proper diagnosis, check ups and follow ups... which at some point made the weakest ones tople over.
Good luck with your sleeping problem, I hope you find a solution.
Posted by Squiggles on November 3, 2004, at 8:14:38
In reply to Re: I need a new pdoc and I need some SLEEP! » erik98225, posted by Crazy_Charlie on November 3, 2004, at 3:28:33
I often suspect that we as consumers/patients
of psychiatric drugs, do not understand their
chemistry or the reason why they are given.And I think that this ignorance leads to believe
that the doctors don't care or don't know what
they are doing. And that we do.I think that's dangerous. Unless, you have
a degree in biochemistry for example, do you
know how to differentiate a carbon dioxide increase the blood mimicking a heart attack
from a real one?About sleep or anxiolytic effects of benzos --
some are rapidly addicting, some not (e.g.
Rivotril can be taken for a long time, but
don't try to come off it, imho):-). And
some conditions which are unavoidable or
untreatable, e.g. the effects of some antidepressants, some heart conditions, epilepsy,
make benzos absolutely necessary, and
irreplaceable. Even Dr. Heather Ashton, who
is a critic of benzos, says that.As for sleep centres and finding the cause,
that's laudible, but risky and time consuming.
You might try to search for the cause all your
life and life is short. What do you do
with chronic insomnia and a family to care,
a car to drive, a job to hold down, in the
meantime;Sorry, if I intruded here but this is one
of my pet subjects; btw, i still have the chest
tightness in adjusting to the li reintroduction, but my SO made me take a really old
Xanax last night and it helped. I confess i
do not know the cause but it has happened
every time i stop and start and it has gone
away -- see what i mean.Squiggles
Posted by Crazy_Charlie on November 3, 2004, at 8:40:33
In reply to Re: I need a new pdoc and I need some SLEEP!, posted by Squiggles on November 3, 2004, at 8:14:38
I do agree about that
but there's always a middle way. You need not to use the rest of your life in investifgating what is wrong, or what the problem is. But instead of jumping straight on a drug, I think it would be good to at least do a few investigations. I'm not saying that no one with a sleep problem should use benzo, just that there might be a few that can be helped in other, and less dangerous, ways.
I am also of the opinion that if your lifestyle makes you sick, it's better to change your lifestyle than medicating away the disease. It's never impossible to change your lifestyle, but it might be difficult for a while. And in that case I find it ok to use medications for a while, but not for a whole lifetime. On theother hand, if it is something wrong with your brain chemistry, you might need medications for the rest of your life. But in that case I find it necessary to find out as good as possible what might be the problem, so that you can get the best working medication immediately instead of trying 15 with worse side effects than effect before you find the one that is working on you.
I really hope I'm not insulting anyone here, I am certainly not trying to. Yes, I know I am critical to benzos, but I am not opposing them. They are efficient sleeping medications, anxyliotics and epilepsy medication.
Posted by Squiggles on November 3, 2004, at 9:03:57
In reply to Re: I need a new pdoc and I need some SLEEP! » Squiggles, posted by Crazy_Charlie on November 3, 2004, at 8:40:33
.."On theother hand, if it is something wrong with your brain chemistry, you might need medications for the rest of your life...."
Aye, there's the rub. How can you tell;
can *you* tell?Only a doctor can tell.
Squiggles
Posted by Crazy_Charlie on November 3, 2004, at 9:49:00
In reply to Re: I need a new pdoc and I need some SLEEP!, posted by Squiggles on November 3, 2004, at 9:03:57
> .."On theother hand, if it is something wrong with your brain chemistry, you might need medications for the rest of your life...."
>
> Aye, there's the rub. How can you tell;
> can *you* tell?
>
> Only a doctor can tell.
>
> SquigglesDear you
Thats exactly what I'm trtying to say, only a doctor.. AND proper examination can give the answer of that.
C
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