![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by blueberry1 on January 17, 2007, at 18:59:48
Of the 2 GPS and 4 Pdocs I have seen in the last 12 years, who blows them in the weeds? A nurse practioner. Go figure. She has a license in psychiatry and naturopathy. Unlike the pdocs I've seen, she is constantly doing research and keeping up. Anyway, I went back to her today after a long wait. Thought I would review it for anyone interested.
She was excited to see me. Said she had learned a lot of psychiatry from me, from research I shared with her and from our own failures.
The general agreement was that I have a confused mix of depression, ADD, and anxiety. I have never been considered to have ADD until now. She says no matter what you call it, the primary symptom cluster is 'Reward Deficiency Syndrome'. She said that is primarily a dopamine thing, but that in reality it involves all the neuros.
I wanted to try Adderall. I expected she would resist. I wanted to try Trazodone for sleep. I expected she would have no prob with that. It went just the opposite. She wrote a script for AdderallXR immediately, claiming it made perfect sense for me and that she has more success with the XR version even though it is so costly. But she would not write a script for Traz. She insisted I use my stockpiled Remeron from old days for sleep. I told her I had been on it with prozac for a couple years and never liked it. She said it is different with Adderall and that she has a number of patients doing extremely well with the Adderall+Remeron combo. I will try 5mg AdderallXR tonight at work (night shift). I am hesitant on the Remeron though. By itself it makes me more depressed.
She said an ssri of my choice is likely, but that she wanted me to sample adderall first.
Being a naturopath also, she is strong on nutritional strategies and such. She says based on my presentation she believes I have low serotonin, low dopamine, low norepinephrine, low gaba, but high glutamate. She says when we begin targeted nutritional strategies to knock down glutamate that the feedback mechanisms will kick into gear and automatically help all the others recover, so as to keep medication doses at a minimum. Fish oil of course is one of her favorites. She drew diagrams and showed me all about phopholipids and the coating around receptors and all that. When was the last time a psychiatrist ever talked in such detail? Never in my life.
So, my last pdoc wanted me to increase zyprexa back to 5mg (where I had been for 8 years already!) and then we'll go from there. Geez, $200 for that lame advice? Nothing more talented or creative than that? And this guy is supposedly real good? And he would rather shock me to hell with ECT than try a week of Adderall and then Provigil augmentation? $200? Anyway, over an hour today with this very impressive caring knowledgable nurse practitioner cost me $45. Cool.
I hope the AdderallXR goes good. I am fearful of increased anxiety, agitation, irritation, meanness, grinding teeth, and worsened depression. I want my fears to be wrong.
Posted by Phillipa on January 17, 2007, at 19:57:27
In reply to First Doc Appt in a While, Review, posted by blueberry1 on January 17, 2007, at 18:59:48
Blueberry I'm excited for you. And guess what another poster who used a different board to post on went to a Nurse Practitioner and he loved her. And he's never felt better in his life. Too busy to e-mail anymore. But that's okay as he's better and that's what's important. Love Phillipa
Posted by stargazer on January 17, 2007, at 20:11:56
In reply to First Doc Appt in a While, Review, posted by blueberry1 on January 17, 2007, at 18:59:48
Blueberry...Adderall XR is a great drug...I have been reviewing my 20+ years of TRD treatment and the only time, other than MAO's, I had any relief was when I took Wellbutrin, Celexa and Adderall. But it was the Adderall that I think was the key ingredient, not the other meds.
Now I'm sorry I didn't review all that earlier because I have lost another year to this awful disease, which continues to keep me from being a normal, functioning person.
I get so upset when I hear about others finding the right drug sooner and then being able to return to their lives with almost no time lost and no jobs lost...it's not fair...and it can be so easy to correct but so many doctors are missing it, the ADD connection is what I think I have, where I need more dopamine.
And I have given my pdoc the benefit of the doubt, it is just so sad that there are such difference in how somweone is treated. I lost most of my years on SSRI's, which I realize was horrible, but I kept thinking I was better but I wasn't, just numb!
Sorry for the rant, I know you have had a really hard time finding something that works too. But the thing I wanted to impress upon you is that ADDERALL can be the one that will work for you!
I need to bring this up again since the EMSAM/amphet mix isn't doing as much as I had hoped...I think I have to give it a little longer, but I wish I was able to try ADDERALL NOW, rather than later. Plus I took it with Wellbutrin which I also think is a good combination, if you need something else.
Stargazer
Posted by Quintal on January 17, 2007, at 22:15:54
In reply to First Doc Appt in a While, Review, posted by blueberry1 on January 17, 2007, at 18:59:48
Very refreshing blueberry. I too found that the people with the greatest insight were the psychiatric nurses, but unfortunately they aren't allowed to prescribe here. I think it has a lot to do with having a hands-on approach to dealing with sufferers (often in their own homes) and talking at length, not just a five minute review of the notes.
I think just having a practitioner empathize and see your point of view makes a big difference to the outcome of a treatment vs. one where you feel you're being forced to take meds that make you ill for little potential gain just to massage the pdoc's ego.
How did you find her?
Good luck.
Q
Posted by laima on January 18, 2007, at 2:21:57
In reply to Re: First Doc Appt in a While, Review » blueberry1, posted by Quintal on January 17, 2007, at 22:15:54
Sounds like a fantastic and very encouraging visit!What did she say about nutrition?
Posted by Meri-Tuuli on January 18, 2007, at 2:51:48
In reply to Re: First Doc Appt in a While, Review » blueberry1, posted by Quintal on January 17, 2007, at 22:15:54
I couldn't agree more Q! And don't forget we have our own p-nurse here on babble, Philipa! Who's great too.
Actually, me and my pdoc seem to have bonded quite well. We both agreed that I don't actually need medication - what I mean is, although I may have OCD, depression, anxiety etc, its all in my head literally - meaning I don't have any physiological defects, its just my faulty thinking. She agreed that the biological school of depression is very powerful and um, sometimes its forgotten that depression isn't always from having faulty biology. Anyway. I thought that was quite refreshing. Actually the whole attidude to mental health here in Finland is very freshing. I'm going to get 2 years of twice weekly psychotherapy FOR FREE! All on the state healthcare system. That is pretty amazing. Anyway I'm rambling on, and I have an exam in oh an hour and a half....
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.