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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by ryno on June 10, 2008, at 18:59:10
I've been reading the forums here for a month or so, and really like reading peoples experiences.
So here's my story:I've had depression problems for 8+ years. I never sought help, for the first 4 years I allways assumed my problems were due to my substance abuse issues. When I was finally clean for a few years the depression was still there, worse even.
I finally got a real job about 3 months ago. Suddenly my depression got worse. It started to interfere with my job, so I finally picked a pcp from my insurance and made an appointment.
The doc prescribed me lexapro 10mg. On the 7th day on it, I realized I was happy, for no apparent reason. It was great, the constant chatter in my head quieted, I was able to focus better.
Over the next week it gradually worked less and less. by day 14 I was a wreck. Had a hellish day at work, I'd go to the bathroom and just stay there because I couldn't face anyone like that. On my break I went home and took the remaining 28 lexapro(I started with 42, doc gave me 3 14 day sample packs). Surprisingly I was able to finish the day even though I was real messed up. 2 days later I tried again with disinfectant and then 30 advil pm. I don't remember some parts of that day, but I finished work. I'd imagine people thought I was drunk or something, I couldn't even put together a proper sentence.
I called my doctor and they wanted me to go to the emergency room. I work in the hospital, so I really didn't want all my coworkers to see me in the mental health unit. I convinced the doctor to let me go to a local crisis center. They put me into a partial hospitalization program, which I started yesterday.
Everyone I told my story to became convinced that it must be bipolar. I assume they figure this due to my great reaction to the lexapro so early.
When I met with the MD there, he decided it wasn't bipolar. He diagnosed me with depression and adhd. He prescribed me 100mg wellbutrin sr, once a day.So, to my questions:
1. Isn't wellbutrin sr meant to be taken 2x a day?
2. Why did he give me such a low dose?
3. Wouldn't a TCA be less likely to cause the bad reaction I had to the SSRI?
4. If the diagnosis is ADHD, why not treat me for that too?
5. How do you bring these concerns to the doctor without him thinking I'm some kind of drug seeking pill freak?Thanks for reading
--Ryan
Posted by med_empowered on June 10, 2008, at 19:07:54
In reply to Any advice on meds? (long), posted by ryno on June 10, 2008, at 18:59:10
1) yeah, i thought so too...ask your doc. Maybe its just a starting dose?
2) Wellbutrin can cause agitation, insomnia, seizures...its normal to start antidepressants at low doses anyway, with Wellbutrin it makes a whole lot of sense to make sure all hell doesn't break loose.
3) You have a history of OD'ing. A TCA OD can be fatal and/or take a whole lot of effort to treat. Plus, they're a pain to take.
4) Some docs are weird about adult ADHD, especially if there's a history of substance abuse. If you have a history of substance abuse AND you've recently attempted suicide, I would think most docs would hold off on a stimulant.
5) Just talk to him/her, I guess. Wellbutrin is apparently sometimes good for ADHD so it sounds like your doc is trying to cover as many bases with one pill as possible.
Posted by Zyprexa on June 11, 2008, at 0:51:42
In reply to Re: Any advice on meds? (long), posted by med_empowered on June 10, 2008, at 19:07:54
i think you need more like a mood stabilizer. Some thing to calm you and your anxiety. Maybe even an antipsychotic. I think you took all the pills because they were not working well. If you are suffering anxiety, wellbutrin is not going to help.
Posted by llurpsienoodle on June 11, 2008, at 7:02:36
In reply to Any advice on meds? (long), posted by ryno on June 10, 2008, at 18:59:10
Hi Ryan
Thank you for hanging out on Pychobabble and sharing your story. It sounds like you're going through a really tough time right now, but you are brave and seeking help.
> So, to my questions:
> 1. Isn't wellbutrin sr meant to be taken 2x a day?I take 150mg once a day of wellbutrin SR. My pdoc said that taking it 2x a day can interfere with sleep.
> 2. Why did he give me such a low dose?
I started off with 150mg. If there is some concern that you may be bipolar, they may be doing a "wait and see" approach to this medication trial. It's always better to try to get a therapeutic effect with the smallest dose possible. Also small doses might minimize side effects (which include "chattering in your head", for example).
> 3. Wouldn't a TCA be less likely to cause the bad reaction I had to the SSRI?
SSRI's have a milder side effect profile than TCA (in general) and your pcp may be more familiar and comfortable Rx'ing that class of drugs.
> 4. If the diagnosis is ADHD, why not treat me for that too?
Maybe you're being treated with the wellbutrin?
> 5. How do you bring these concerns to the doctor without him thinking I'm some kind of drug seeking pill freak?
Well, there are priorities in treating a patient. The first priority is saving your life, for which an anti-depressant is indicated. After you're stabilized on Wellbutrin (it took me about 2.5 weeks and then I was hypomanic for another 4 weeks) you can begin to work on other issues which require medication/therapy.
>
> Thanks for reading
> --RyanThanks for posting!
-Ll
Posted by blueboy on June 11, 2008, at 8:12:12
In reply to Any advice on meds? (long), posted by ryno on June 10, 2008, at 18:59:10
> Everyone I told my story to became convinced that it must be bipolar. I assume they figure this due to my great reaction to the lexapro so early.
Well, I had the same reaction. Not so much from your reaction to lexapro, but rather your general description of your problems. My layman's understanding is that bipolar people are more likely to "act crazy". However, I am not qualified to make a diagnosis, much less from a brief written post, LOL.
> When I met with the MD there, he decided it wasn't bipolar. He diagnosed me with depression and adhd. He prescribed me 100mg wellbutrin sr, once a day.
I would urge you to find a very good diagnostic specialist, maybe at a psychiatric clinic or a research-oriented university facility, if the wellbutrin doesn't work well. You need a highly qualified person to sit with you and take a really thorough history, someone who will listen for a couple of hours before making conclusions.
Posted by Phillipa on June 11, 2008, at 12:26:16
In reply to Re: Any advice on meds? (long) » ryno, posted by llurpsienoodle on June 11, 2008, at 7:02:36
Hospital took me off wellbutrin 150mg after a week as the doc thought I was hypomanic. Put me on zoloft instead with more benzos. Phillipa
Posted by ryno on June 11, 2008, at 14:01:42
In reply to Re: Any advice on meds? (long), posted by blueboy on June 11, 2008, at 8:12:12
> > Everyone I told my story to became convinced that it must be bipolar. I assume they figure this due to my great reaction to the lexapro so early.
>
> Well, I had the same reaction. Not so much from your reaction to lexapro, but rather your general description of your problems. My layman's understanding is that bipolar people are more likely to "act crazy". However, I am not qualified to make a diagnosis, much less from a brief written post, LOL.
>
> > When I met with the MD there, he decided it wasn't bipolar. He diagnosed me with depression and adhd. He prescribed me 100mg wellbutrin sr, once a day.
>
> I would urge you to find a very good diagnostic specialist, maybe at a psychiatric clinic or a research-oriented university facility, if the wellbutrin doesn't work well. You need a highly qualified person to sit with you and take a really thorough history, someone who will listen for a couple of hours before making conclusions.Thanks for the reply. I totally agree with needing a qualified person to sit down with. I saw the pdoc for less than 10 minutes.
--Ryan
Posted by ryno on June 11, 2008, at 14:12:59
In reply to Re: Any advice on meds? (long) » llurpsienoodle, posted by Phillipa on June 11, 2008, at 12:26:16
A little update:
I'm in day 3 at this partial hospitalization program. Honestly it feels like punishment for 90% of it. This program is all group sessions, and although i've taken a few things from it, I think it's all stuff I could have gotten from 1 session with a therapist one on one.
I'm trying not to be defeatist about all this, but it's hard. I came to the realization that my depression is based on feeling worthless about not living up to my potential. It's hard to fix your life if the depression makes you physiologically incapable of motivation. The counselor says the solution to that is to do the things you need to do in spite of lack of motivation. In his words, "Just do it!". It kind of chesses me off to think that my insurance is spending thousands of dollars for me to see a pdoc for 10 minutes and get told a nike slogan.
Anyway, enough of my whining, thanks for reading.
--Ryan
Posted by Racer on June 11, 2008, at 21:23:31
In reply to Re: Any advice on meds? (long), posted by ryno on June 11, 2008, at 14:12:59
That partial hospital program may not be the right one for you. It might actually be worth looking into what you've got closer to home -- even if it means letting some of your coworkers know that you're having trouble.
But, I do understand not wanting them to know.
The "Fake it 'til you make it" routine gets old fast. I have never found it anything except damaging -- "oh, great -- now I've got depression, AND I can feel guilty and ashamed for not doing the things that depression keeps me from doing..." Just what I need -- yet another club to beat myself with. It might be worth speaking up about it -- letting someone know that you're not getting anything particularly helpful from the program, and asking if there are other options, including maybe twice a week therapy, or maybe a week at a residential treatment facility. (I don't know what other options there might be -- I'm grasping, but at least they might help you with ideas.) (Oh, and residential treatment isn't the same as hospital -- there's actual treatment involved, not just warehousing for safety.)
From what you've written, I'd actually peg your initial reaction to Lexapro as something akin to placebo effect, with the subsequent crash being related to the same effect. Sometimes people have an initial response that's entirely based on the relief of having DONE SOMETHING, which gets triggered by some of the anxiolytic effects of the medications. (Anxiolytic, or sedating, or whatever -- there's often an initial tranquilizing effect to any SRI for me, and for some others I know. Small n, but worth noting.) You feel a bit calmer, get that hope going, start to feel as though you'll get better -- and then it doesn't hold up to a stressor, and you crash. That could be what you experienced.
I'm very sorry you're going through this. It sounds pretty awful.
Good luck.
Posted by blueboy on June 12, 2008, at 9:41:55
In reply to Re: Any advice on meds? (long), posted by ryno on June 11, 2008, at 14:12:59
> A little update:
>
> I'm in day 3 at this partial hospitalization program. Honestly it feels like punishment for 90% of it. This program is all group sessions, and although i've taken a few things from it, I think it's all stuff I could have gotten from 1 session with a therapist one on one.
>
> I'm trying not to be defeatist about all this, but it's hard. I came to the realization that my depression is based on feeling worthless about not living up to my potential. It's hard to fix your life if the depression makes you physiologically incapable of motivation. The counselor says the solution to that is to do the things you need to do in spite of lack of motivation. In his words, "Just do it!". It kind of chesses me off to think that my insurance is spending thousands of dollars for me to see a pdoc for 10 minutes and get told a nike slogan.
>
> Anyway, enough of my whining, thanks for reading.
>Oh, dude, tell me about it! 100% of laymen and 99% of mental health "therapists" and even doctors don't understand. It took me years to teach my mother not to say stuff like "why don't you try getting some exercise". It's like Freudian psychologists used to say "you can't get better unless you want to get better". In essence, blaming the patient because they were not capable of treating him.
It's a very prevalent mindset in the US, that anyone can do (or be) whatever they make up their mind to do (or be), including mentally healthy. We love to blame people for their problems.
In one sense, it is utterly realistic. You are the one who is going to suffer for whatever shortcomings you have. Just like you reap the rewards for whatever assets you are given by birth, like rich parents or good health. But it is a terrible cop-out when stated by health professionals whom you are paying for treatment.
The medical literature is so nearly silent on my biggest problem. I can want to do something, have great attitude, etc. If I am in a down cycle, it doesn't matter. It's like I turn the key in my car and nothing happens. People understand that if your car won't start, you can't get somewhere. They just can't grasp that the human brain can have the same problem, because they haven't experienced it.
Telling someone in that condition "just do it" is like telling the person with the broken starter to "just drive to the auto mechanic and get it fixed".
Posted by ryno on June 12, 2008, at 14:09:25
In reply to Re: Any advice on meds? (long), posted by blueboy on June 12, 2008, at 9:41:55
This would be the 3rd time the counselors tried to talk me into attending Alcoholics Anonymous. For one, I quit using 2 years ago, on my own. Secondly AA is religon not science. Science is constantly analyzing and improving their methods. The 12 steps have been the same for 50 years. No doctor would ever tell you going to church will help you.
Today we spent 2 hrs in "art therapy". This is no different than elementary school art class. It was probably helpful for the 2 people in the group who can express emotion through watercolors. But to me this seems so non-medical. As if forcing me to fingerpaint is helping.
Posted by okydoky on June 12, 2008, at 22:25:52
In reply to Re: Any advice on meds? (long), posted by blueboy on June 12, 2008, at 9:41:55
Posted by okydoky on June 12, 2008, at 22:30:48
In reply to Re: Any advice on meds? (long), posted by blueboy on June 12, 2008, at 9:41:55
I messed up the post and now I read more I am glad I did not say all I had intended. First good luck at the partial. If you feel they are holding you back get the hell out. I have a lot of experience (bad) but maybe yours will be different I hope.
I remember one assignment to paint anything to show or get our anger out. I put a big piece of white paper on the floor, took my shoes off, painted the bottom of my feet with red water color and jumped as high as I could landing on the paper. I really was trying to be creative, no particular forethought. They almost locked me up in the "quiet room" for doing exactly what they had asked me to do.
By the way I agree about the 12 step thing. I once started a support group for alcoholics and drug abusers that wanted some group support without all the religion. Unfortunately I got too sick to keep it going long enough to see if it would get off the ground. Thanks for reminding me I once had a life with purpose and was very active in my own right.
oky
Posted by okydoky on June 12, 2008, at 22:31:08
In reply to Re: Any advice on meds? (long), posted by blueboy on June 12, 2008, at 9:41:55
I messed up the post and now I read more I am glad I did not say all I had intended. First good luck at the partial. If you feel they are holding you back get the hell out. I have a lot of experience (bad) but maybe yours will be different I hope.
I remember one assignment to paint anything to show or get our anger out. I put a big piece of white paper on the floor, took my shoes off, painted the bottom of my feet with red water color and jumped as high as I could landing on the paper. I really was trying to be creative, no particular forethought. They almost locked me up in the "quiet room" for doing exactly what they had asked me to do.
By the way I agree about the 12 step thing. I once started a support group for alcoholics and drug abusers that wanted some group support without all the religion. Unfortunately I got too sick to keep it going long enough to see if it would get off the ground. Thanks for reminding me I once had a life with purpose and was very active in my own right.
oky
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