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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by deniseuk190466 on April 17, 2007, at 15:53:19
try me on a drug (max dose) for two weeks at the max dose gauge the effects and then move onto the next one and so on and so on. Keeping Zyprexa on hand for emergencies. And maybe having something like Lamictal regularly in the background.
Then when we have an idea of how I initially react to each drug, go for the ones that seem to suit me the best.
I know this doesn't seem like a sensible approach but I'm sure that if the start up (mental) effects aren't too bad then that bodes well for the drug.
Would anyone agree with me?
Denise
Posted by Ines on April 17, 2007, at 17:21:11
In reply to I want a psychiatrist who will, posted by deniseuk190466 on April 17, 2007, at 15:53:19
I'd have to say I don't, Denise. Two weeks is not nearly enough to make an assessment, you'd only feel the side effects. AD's have the annoying characteristic that the side effects settle in immediately and the therapeutic effects take much longer to settle in. I think if you do that you risk 1) getting really frustrated, feeling that nothing works, 2) possibly making things worse by forcing you system to respond to a new invasive drug every two weeks and 3) still not knowing at the end of it what works for you. I completely sympathise with the impatience- I am feeling incredibly frustrated that I'm not well at all, ADs aren't working and I have to give each a sensible trial. It's awful when you feel so bad to be made worse by the medication. But have you responded positively to something in the past? If so you could give that another go unless there is a reason not to, or you could try another drug in the same class. If you have someone in the your family that has needed ADs and reponded well to a particular type you could also try that- some people think you are more likely to respond to something that has worked for a close relative. Unfortunately I have not had a successful trial yet, and no history in my family, so I'm stuck with trial and error for now...
Ines
Posted by JESSsMom on April 17, 2007, at 17:38:28
In reply to I want a psychiatrist who will, posted by deniseuk190466 on April 17, 2007, at 15:53:19
> try me on a drug (max dose) for two weeks at the max dose gauge the effects and then move onto the next one and so on and so on. Keeping Zyprexa on hand for emergencies. And maybe having something like Lamictal regularly in the background.
>
> Then when we have an idea of how I initially react to each drug, go for the ones that seem to suit me the best.
>
> I know this doesn't seem like a sensible approach but I'm sure that if the start up (mental) effects aren't too bad then that bodes well for the drug.
>
> Would anyone agree with me?
>
>
> DeniseI disagree completely, Denise. Read my other post to you about starting low and increasing a med's dosage. You will feel nothing but the side effects of a drug at it's max dose, which will in turn force you to stop taking it, and then all hope for that med will be lost.
Case in point - take Zoloft at the max dose right off the bat instead of gradually increasing it and you will not only gain zero therapeutic effect but will spend a lot of time in the bathroom with diarrhea.
~M~
Posted by Sebastian on April 17, 2007, at 18:43:36
In reply to I want a psychiatrist who will, posted by deniseuk190466 on April 17, 2007, at 15:53:19
I think you should give zyprexa a try! Read new post above.
Posted by Phillipa on April 17, 2007, at 21:54:39
In reply to Re: I want a psychiatrist who will, posted by Ines on April 17, 2007, at 17:21:11
That is so true. A lot of realativevs respond to zoloft and xanax . And Denise she's right look what my brain just went through with all those changes in a few weeks that the new pdoc made and the money wasted on meds and ER and doc trips. Back to the old pdoc feeling more stable on old meds. Love Phillipa
Posted by Deniseuk190466 on April 18, 2007, at 4:24:43
In reply to Re: I want a psychiatrist who will, posted by Ines on April 17, 2007, at 17:21:11
Hi Ines,
Thanks for responding.
Years ago, when I was in my 20s it seemed that any AD (Seroxat, doxepin, sertraline) I took worked and worked quickly without any side effects.
This time round though it's been a whole different ball game. I spent the first 2 years from 2001 trying lots of different drugs (including 20mg of Seroxat) which made me feel more anxious, agitated, horrendous really and it was only Zyprexa now and again that really got me through those years. Then after a spell off drugs and just on lamical (which did nothing) the psychiatrist decided to put me on 60mg of Seroxat, this time I had no anxiety start up effects and the drug seemed to lift my depression within about a week.
I don't know why the Seroxat suddenly worked (it just doesn't make sense) but it seemed to me that if I'm going to feel horrible anyway on low dose ADs I may as well go the full hog and take the maximum amount straight away.
How long have you been like this and what have you tried so far?
Denise
Posted by Deniseuk190466 on April 18, 2007, at 7:05:40
In reply to Re: I want a psychiatrist who will, posted by JESSsMom on April 17, 2007, at 17:38:28
Hi Jesssmom,
My point is that I spent two years trying lots of different drugs, sometimes for long periods of time with no real benefit. One of the drugs I tried during that time was 20mg of Seroxat for a month which just caused a lot of anxiety.
After the two years the psychiatrist I was seeing at the time decided to try me on 60mg of Seroxat straight away and for some reason (and I wish I knew why) I had less anxiety and it started to work after a week. I'm not sure if some of the drugs I'd taken prior to the Seroxat had done something to my brain to make me respond.
But I guess my point is that I usually get side effects anyway (mental side affects) regardless of the dose so I might as well start high.
I'd happily live with the diarreah (any physical side effects) I just can't stand the awful apathy/agitation that I seem to get when a drug is not working properly.
Denise
Posted by notfred on April 18, 2007, at 9:25:47
In reply to I want a psychiatrist who will, posted by deniseuk190466 on April 17, 2007, at 15:53:19
If I did the I would have a warped view of the meds and assume they were full of side effects. That is all I get the first few weeks. I would have never discovered AD's that work and which side effects would go away.
Posted by JESSsMom on April 18, 2007, at 9:58:33
In reply to To Jesssmom, posted by Deniseuk190466 on April 18, 2007, at 7:05:40
> Hi Jesssmom,
>
> My point is that I spent two years trying lots of different drugs, sometimes for long periods of time with no real benefit. One of the drugs I tried during that time was 20mg of Seroxat for a month which just caused a lot of anxiety.
>
> After the two years the psychiatrist I was seeing at the time decided to try me on 60mg of Seroxat straight away and for some reason (and I wish I knew why) I had less anxiety and it started to work after a week. I'm not sure if some of the drugs I'd taken prior to the Seroxat had done something to my brain to make me respond.
>
> But I guess my point is that I usually get side effects anyway (mental side affects) regardless of the dose so I might as well start high.
>
> I'd happily live with the diarreah (any physical side effects) I just can't stand the awful apathy/agitation that I seem to get when a drug is not working properly.
>
>
>
> DeniseDenise, I understand what you are saying. Your frustration is obvious. I wish I could help more. The trick is to find a pdoc who thinks like you do or at least understands your thinking. But even that isn't always enough.
I have a great pdoc and still struggle.....I'm ceratinly wishing you the best.
~M~
Posted by Ines on April 19, 2007, at 13:27:03
In reply to To Ines, posted by Deniseuk190466 on April 18, 2007, at 4:24:43
Hi Denise,
I think you can habituate to drugs, but that doesn't seem to be the case. Maybe your first depressions weren't treated fully? I've read that depression becomes harder to treat the longer you've had it for/ the more episodes you've had, particularly if episodes were never fully over.
I haven't tried that much- SSRIs, mirtazapine, reboxetine, (and St John's Wort). None of them have worked at all... :-(. I got horrible anxiety on reboxetine, so I know exactly what you mean. I just had an appointment with a psychiatrist for the first time today after a while waiting for refererral. Feeling quite low about it- the pdoc was lovely, but said he thinks mood stabilisers might be the way to go. Either that or no ADs and intensive CBT+ therapy. He wouldn't diagnose- said he doesn't like labels, but from his med suggestion I can only infer he thinks I'm bipolar spectrum. I'm just so tired of it all... want a solution fast, I've been struggling for over 10 years now... He also said I was extraordinarily competent, maybe I didn't realise how much worse it could be if I wasn't so good at managing it myself, but to be honest that didn't make me feel better at all. OK I manage to cope reasonably outwardly, but it hurts to so much inside, and I'm so tired because pretending takes up so much energy, I think he didn't quite get that. Anyway, enough wingeing.
I wonder if it's worth you talking to your GP/ psychiatrist and explaining just what you've explained to us here? Not about wanting short trials of a med (that might put them off), but about wanting to try full therapeutic dose straight away. As far as I'm aware, the reason they start on low doses and buid up is so that people can build up tolerance, and so they won't drop out of the trial. If you explain diving straight into it has worked for you in the past and that you are willing to risk side effects being that much more unpleasant to begin with, maybe they'll agree. I take your point about going full hog if you're gonna feel crap anyway.
Ines
Posted by Phillipa on April 19, 2007, at 18:40:12
In reply to Re: To Ines » Deniseuk190466, posted by Ines on April 19, 2007, at 13:27:03
Great reply. I know the feeling. Love Phillipa
Posted by Deniseuk190466 on April 20, 2007, at 9:33:14
In reply to Re: To Ines » Deniseuk190466, posted by Ines on April 19, 2007, at 13:27:03
Hi Ines,
I appreciated your note, It makes me feel a bit better when I read that somebody is going through the same frustrations as me. As many people on this board are. But you've put it so well.
I think I'm going to have to just stick with this 10mg of Lexapro for another six weeks, touch wood the anxiety hasn't been too bad over the last week but the apathy and tiredness is still there. I just hope I don't start feeling really bad again like I did the other day.
I'm not sure that even if I went up to 40mg of Lexapro it would work as the high dose Seroxat had stopped working.
I'd like to give ECT a try but at the moment work at least keeps me distracted (in fact I don't know what I would do with myself if I didn't work) and I'd hate to be rendered incapable of even doing that. Doesn't make much difference though because my psychiatrist won't even discuss ECT with me.
Sorry to harp on, I hope you do find something that works eventually. It's good to know that I'm not alone with my frustrations.
I know sometimes I act irrationally and feel like swallowing just about anything in an effort to get better. I even sort of think sometimes, if this doesn't work then I hope I get an adverse reaction to it and it kills me. I probably don't mean that really but I sometimes feel a bit gung ho about it all.
Anyway, thanks again for the response.
Denise
Posted by FredPotter on April 23, 2007, at 2:45:40
In reply to Re: To Ines » Deniseuk190466, posted by Ines on April 19, 2007, at 13:27:03
Ines I went bowling with my 13 yr old son 2 days ago. We were laughing and having fun, bless him! But at the same time there was a deep pit inside me. Atypical depression can be so frustrating as no-one, understandably, believes you. If you have your arm in plaster, people beat a path to your door to sympathise
love
Fred
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