![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by zonked on May 29, 2010, at 20:59:39
Sometimes, I feel like this place is the only place I can be understood...
Was thinking a lot today, as I have had a partial response to Marplan and didn't get what I truly felt I needed--a dose increase. Yeah, I've only been on 40mg for almost two weeks; what is frustrating to me is that with Parnate and Nardil (respectively), I could tell whether or not a dose increase had any effect within four days...
I had to move out of county because of an abusive living situation I was in, and do not see my new permanent psychiatrist until June 10...
(In California, Medicaid [called Medi-Cal here] is based on the county you live in, and you can only see doctors in your home county.)
The person who prescribed my Marplan is a NP at the crisis clinic. I went back armed with the dosing info from Marplan's website, which says after 40mg/day, dosage can be increased weekly from 40mg "if needed and tolerated.". As I've said in the Marplan update post, it took very large doses of Nardil and Parnate (respectively) for me to get a robust AD response...
Is an increase needed? I really, really think so. Tolerated? I have had no side effects from this drug.
So, I *know inside* that it's good that, at least sometimes, I can *somewhat* enjoy things like I used to, as opposed to being a suicidal blob 100% of the time who can't decide whether being awake or asleep is worse; but waiting is also painful.
It's like I know I'm 20-30% there, but can't even know if I am going to hit at least 80% until after June 10? Why can't I get the staff there to look at the things I bring them? I know they have to look Marplan up and that they probably are used to patients on more conventional drugs, but I am not being heard.
I can only hope that I don't grow too frustrated with waiting over the next couple weeks--I rather imagine it'd be like someone with severe physical pain only getting partial relief and being told to suffer through it for an equivalent period of time.
I feel embarrassed to even be complaining... I've had the depressive cloud over my head all day, and just drank some coffee because all I have is Klonopin, and it sedates me too much, even at 0.5mg; and I don't want to go to bed early and wake up at 4:30 tomorrow, like I have been doing.
I am in a residential mental health program, and while I am being forced to take basic care of myself, I don't think the staff here have been adequately educated on what treatment resistant depression is like. No amount of walks, deep breathing, eating healthy, or group therapy has done anything but, at best, provide a tiny bit of distraction and at worst make me more frustrated because I am continually told these things will make me feel better when in fact they have not, and believe me, I have kept an open mind about them.
My goal, which I believe reasonable, is remission, not mild symptom reduction. And I cannot get there without medical help. I am repeatedly told by those around me that "it's not just the meds" (DUH, even I know that, even in remissions I still needed therapy and guts to face my issues--the pills are not panacea), but they do provide the foundation upon which I can continue working on myself....
I am sorry if this is random and whiny, but I need an outlet and I know people in here, if nowhere else, can relate.
-z
Posted by Phillipa on May 29, 2010, at 21:37:19
In reply to On partial-response, treatment-resistance, and having to wait.. (rant), posted by zonked on May 29, 2010, at 20:59:39
Yes I do from both a work perspective and as a patient perspective. Those groups are just boring at least the ones I went to fold paper airplanes, paint a figurine? I don't like doing it. I would have rather had l:l talk theraphy. I'm so sorry your not given the increase. Hang in there. Easy to say? I do know. Phillipa
Posted by floatingbridge on May 30, 2010, at 15:09:23
In reply to Re: On partial-response, treatment-resistance, and having to wait.. (rant) » zonked, posted by Phillipa on May 29, 2010, at 21:37:19
Gosh, how can you get around waiting until June 10th to increase? So an NP is in charge at your residence? No access to a doc?
I assume your dx is unipolar depression. Your meds given to you each day.
Zonked, how frustrating to wait! (Argh.) The treatment I received in the hospital was pretty pitiful. Very stock advice like you're receiving...blah, blah, walking, blah, blah, deep
breathing. Yes, the habits of the non-depressed--all true and valid, but...[insert obvious conclusion here].
Posted by zonked on May 30, 2010, at 20:41:11
In reply to Re: On partial-response, treatment-resistance, and, posted by floatingbridge on May 30, 2010, at 15:09:23
> Gosh, how can you get around waiting until June 10th to increase? So an NP is in charge at your residence? No access to a doc?
Well, no. The NP is at the crisis clinic--it takes weeks to see a new regular prescriber after moving into this county, so I must be seen there until then. But yes, where I live now is a "social rehabilitation" program where meds are dispensed for me by staff (no on-site NP or MD.). Lots of group therapy (of limited value), and a lot of dual-diagnosis folks in there, so a lot of the groups do not apply to me.. I am one of two or three in there not dual diagnosis.
I may call my psychotherapist (whom I've seen once, he made the June 10 appointment) and ask if a sooner appointment can possibly be made. Also, there IS another possibility--see below..
> I assume your dx is unipolar depression. Your meds given to you each day.*Currently*, yes. It was changed from Bipolar II+ADD-inattentive at my most recent hospitalization (I found this out later). Honestly, I think my 2004 dxes were closest--cyclothymic disorder + ADD-inattentive. Except that my depressions are WAY more severe than cyclothymic disorder indicates, but any hypomania I've had has been infrequent and mild. Parnate did trigger it, but only after being on it awhile and at a super-high dose. If such a thing as "mild hypomania" exists, Zoloft also made me a bit hypomanic at times in 2001-2002 but what I was experiencing didn't meet DSM-IV criteria for an actual hypomanic episode... Zoloft was the only SSRI that ever worked for me, and only once!
It was like during that year I had relief from depression and anxiety, but once in awhile I had "blips" of hypomania-like elevation that only lasted a day or so at a time.
So, having told her all that during my initial appt. with her perhaps she is concerned with increasing too rapidly due to having had those diagnoses--but--I am still suffering tho, and Nardil *never* triggered hypomania when it still worked...also, I have *no* history of rapid cycling.
Anyhow, on Friday, I received a call from the local (and HIGHLY regarded) medical school's bipolar disorders clinic and told that I was accepted. I told the screener that my DX had changed back to major depression and he said I still may qualify, since I have had bipolar spectrum disorder diagnoses before. I am calling him back tomorrow.
This may be the best option--I might receive MUCH better care from a university medical center psychiatric clinic than from the department of public health...
I will continue to be proactive...today was better than yesterday--I spent the day with my Mom who said I seem much more like myself than the last time I saw her a week ago...
Easier to be me today. Will keep the board updated...
-z
> Zonked, how frustrating to wait! (Argh.) The treatment I received in the hospital was pretty pitiful. Very stock advice like you're receiving...blah, blah, walking, blah, blah, deep
> breathing. Yes, the habits of the non-depressed--all true and
Posted by Leo33 on May 31, 2010, at 21:38:30
In reply to On partial-response, treatment-resistance, and having to wait.. (rant), posted by zonked on May 29, 2010, at 20:59:39
Zonked, you seem pretty good to me, you are able to put together long posts and able to stick up for yourself as well as wanting to get better. Yes, I can relate to you and empathize, most residential places won't even give people coffee or klonopin. Thank god your not being put on anti psychotics. I must be worse off than most people here as I don't even have the energy to do a bunch of posts.
I guess what I'm trying to say is too have some patience, at least your getting some response and on a treatment you want.
My medicaid / welfare has hit my lifetime limit of 5 years and four turn downs by Social security leaves me completely #$*)@@!!
I also suffer from treatment resistant depression and fight for a reason to continue living everyday although not completely suicidal on pristiq.
So hang in there it will get better for you, I have that feeling, take care.
Leo33
Posted by zonked on May 31, 2010, at 22:02:04
In reply to Re: On partial-response, treatment-resistance, and having to wait.. (rant), posted by Leo33 on May 31, 2010, at 21:38:30
Thanks :-)
You have a great point. It's so bleepin hard for me to be patient and thankful for what I *do* have... I am not an ungrateful person...
There have been times in my life where I was so depressed It took tremendous effort for me to even get out of bed to take a piss...and waited until I was sure my bladder really was about to explode. Plus all the times I just couldn't take it anymore and ended up in psych wards to protect myself from myself...
This place I live in now is contracted with the county and MUST follow doctor's orders and have no say in *what* meds I take, but they do dispense them.
Let's go simple and two-dimensional: if zero is "I really do want to kill myself" and 8-10 is the "normal" range in remission, I have been hovering between a 2 and a 6 since starting Marplan. I want to get up to that range...I just hope this isn't rapid cycling but an inadequate AD response!That'd be JUST what I need, sigh, another return to bipolar/mood stabilizer land...Lamictal stopped working for me and was the only one I could tolerate (although I haven't tried Tegretrol or Trileptal)...
See why I want to see a doc sooner? I am scared, man.
I refuse to consider antipsychotics, (I have been infrequently offered them either for sleep or mood stabilization, no history of psychosis--screwing with dopamine like that is NOT something I wanna do.)
Gonna use every last energy molecule in me to keep the depression from putting me in the hospital *again*...
-z
> Zonked, you seem pretty good to me, you are able to put together long posts and able to stick up for yourself as well as wanting to get better. Yes, I can relate to you and empathize, most residential places won't even give people coffee or klonopin. Thank god your not being put on anti psychotics. I must be worse off than most people here as I don't even have the energy to do a bunch of posts.
>
> I guess what I'm trying to say is too have some patience, at least your getting some response and on a treatment you want.
>
> My medicaid / welfare has hit my lifetime limit of 5 years and four turn downs by Social security leaves me completely #$*)@@!!
>
> I also suffer from treatment resistant depression and fight for a reason to continue living everyday although not completely suicidal on pristiq.
>
> So hang in there it will get better for you, I have that feeling, take care.
>
> Leo33
Posted by floatingbridge on May 31, 2010, at 23:23:52
In reply to Re: On partial-response, treatment-resistance, and having to wait.. (rant), posted by Leo33 on May 31, 2010, at 21:38:30
Hey Leo,
Maybe you aren't worse off than some around here (cold comfort). Some folks can put posts together even if they feel like sh*t. Jeez, some can work and be suicidal. We're all so different.
I'm sorry your struggle is so intense. Do you have an anti-psychotic in your cocktail? They can have nasty s/e's.
I'm treatment resistant, too. I'm o.k. right now, but I never can take a day for granted. The effort required is pretty significant, but I've been much worse. A recent assessment put my functioning capacity at 50%. Hard to see that in print. Luckily my pdoc no longer uses ap's with me.I'm currently fortunate in that I have insurance--but someday I'm sure I won't--and I certainly did not always.
Really, what will you do w/o Medicaid coverage? Will your treatment simply be denied? I didn't know there was a cap. And is social security the same as ssi? Well, that really stinks. More than stinks. I'd be angry. Heck, I'm just p*ssed about having depression.
Good luck to you. I really wish you the best and hope you catch a break soon. I'm glad you posted.
Posted by europerep on June 1, 2010, at 15:16:28
In reply to Re: On partial-response, treatment-resistance, and » Leo33, posted by floatingbridge on May 31, 2010, at 23:23:52
it must be the worst feeling in the world (or almost) to suffer from TRD, but still having hope that a certain med might help (value of hope obviously not expressable in money terms), but not being able to access this med (cost of production a couple of bucks) because there is no freakin' healthcare for everyone.. not to turn political here, but it just doesn't go into my head..
zonked, what about the clinic? can you go there? I think I wouldn't have told them on the phone about the diagnosis, once you're in the office they can't throw you out.. but I hope they won't deny you access..
Posted by Leo33 on June 9, 2010, at 21:15:30
In reply to Re: On partial-response, treatment-resistance, and » Leo33, posted by floatingbridge on May 31, 2010, at 23:23:52
Thanks Floatingbridge, I have seroquel in the mix at 25mg, and it helps with sleep, but seems to kill cognition and feel hungover all day. Now I am just taking it PRN. When I was in the county hospital in Dec 2008 it worked well for the phobic anxiety / paranoia I felt in the hospital. It kills what little motivation I have.
I don't know what I am going to do without Insurance, guess go back to self medication with Pot, although that's not the greatest option.
SSDI is a little different than SSI - claim started in Oct 2008 and still pending, probably another year to see the Judge if the lawyer takes the case.
I guess treatment will be denied although treatment is not working real well now. How can you afford the meds with no money.
The USA has a five year limit on welfare/medicaid as that is the only way I can get the coverage, and that is a lifetime limit so no more after they cut off my current exemption.
I wish I could win the lottery, so I could take care of myself.
Posted by zonked on June 9, 2010, at 22:40:34
In reply to Re: On partial-response, treatment-resistance, and, posted by Leo33 on June 9, 2010, at 21:15:30
Leo--
Hang in there, man--my SSI/SSDI attorney thought I'd need multiple appeals and was prepared to "prep" me for talking to the judge, because my intellectual functions are still there, and I present well. We were both pleasantly surprised--I was approved and got my backpay in three months.
I can't stress enough how important it is that you get an attorney. Also, when approved you will get Medicaid immediately, and add-on Medicare within a year. Don't give up.
-z
> Thanks Floatingbridge, I have seroquel in the mix at 25mg, and it helps with sleep, but seems to kill cognition and feel hungover all day. Now I am just taking it PRN. When I was in the county hospital in Dec 2008 it worked well for the phobic anxiety / paranoia I felt in the hospital. It kills what little motivation I have.
>
> I don't know what I am going to do without Insurance, guess go back to self medication with Pot, although that's not the greatest option.
>
> SSDI is a little different than SSI - claim started in Oct 2008 and still pending, probably another year to see the Judge if the lawyer takes the case.
>
> I guess treatment will be denied although treatment is not working real well now. How can you afford the meds with no money.
>
> The USA has a five year limit on welfare/medicaid as that is the only way I can get the coverage, and that is a lifetime limit so no more after they cut off my current exemption.
>
> I wish I could win the lottery, so I could take care of myself.
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.