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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by floatingbridge on May 26, 2011, at 2:27:23
That's today's question.
My pdoc says I don't seem depressed. Rather, I'm sitting on a resivouir (sp) of anger from dealing with cptsd & highly intelligent and challenging child. Yes, true, but what? I am now spun beyond spun
This is so left field. I am flabbergasted.
Here emsam gets me out of bed; this man is sodear and sooooo elliptical. I am stunned. I do not understand.
Yeah, I'm not depressed? Let's party. No wait, I'm a whack job then, right?
He is trying to tell me something, but what? I need my boxtop decoder ring for this.
I wrote a letter, point by point that I will read to him before he even starts next week
Presently, I am flabbergasted. He thinks out loud: maybe I need drugs, maybe I Don't, certainly going forward I do, all said on the same session.
I've decided to ask or find a dbt group.
He said he'd think of an ER med like a high dose xanax for me after chastising me for using 5mg Valium for sleep. I had told him and we both agreed in advance it wasn't optimal. Now he thinks my intractable insomnia is from armor thyroid and the t3 in it
Good lord. I rely on him. I tell him everything.
He even forgot my ptsd trigger at childbirth. Funny because I didn't connect the dots I'm that. He did. He identified it. How could he forget, then act like I googled it? I didn't.
I feel like I desperately need to hear what he has to say and also I feel accused of being a hypochondriac smarty pants. That really hurts My feelings. He's been my doc for three years. I thought he:d be pleased emsam got me out of
bed.I don't understand what He wants and what he thinks of me anymore.
Something had changed :(
Posted by poser938 on May 26, 2011, at 3:01:36
In reply to am I even depressed?, posted by floatingbridge on May 26, 2011, at 2:27:23
im sorry about your doctors ideas. i know i've really taught myself not to listen to psychiatrists about everything. i mean, yes they went to schoolto learn about meds and how to treat people depression and mental disorders, but they're not god. they basically know what the drugs companies tell them.
i do tons and tons of research with reading about the effects of different drugs on the brain, my knowledge isnt as good as some peoples, but im trying to get there. but i do this because i dont trust doctors near as much as i did before i started taking these meds. i believe thats the best way to take control of your mental health, and not by listening to "all" of what doctors have to say. they are right about somethings but with other things they can very well be wrong.
the doc im seeing right doesnt believe what so ever that med side effects can persist after stopping a med, shes wrong.i responded to your post above too :)
Posted by SLS on May 26, 2011, at 5:55:28
In reply to am I even depressed?, posted by floatingbridge on May 26, 2011, at 2:27:23
> That's today's question.
>
> My pdoc says I don't seem depressed. Rather, I'm sitting on a resivouir (sp) of anger from dealing with cptsd & highly intelligent and challenging child. Yes, true, but what? I am now spun beyond spunHaving a depressive disorder and a challenging child are not mutually exclusive.
> This is so left field. I am flabbergasted.
Relax and know that ascertaining your diagnoses is an ongoing project. Be insistent, but cooperative. You have already comprimised by trying Emsam first before moving on to Nardil. My concern is, however, that your doctor is setting you up for him to deny you Nardil.
Make a list of the features of your condition so that you can have something concrete to refer to when assessing symptoms.
> Here emsam gets me out of bed; this man is so
Is all that Emsam does for you is get you out of bed? It could be that the amphetamine metabolites are helping with energy and any ADD that may exist. On the other hand, I find that an increase in mental energy is one of the first things to return when I begin to respond to medication. It seems to me that having difficulties getting out of bed is an indicator of depression rather than ADD.
> Yeah, I'm not depressed? Let's party.
That might be a good idea if the party is limited to people who are depressed.
:-)
> No wait, I'm a whack job then, right?
Yes, but that has nothing to do with your having a depressive disorder.
<humor>
> He is trying to tell me something, but what?
Ask, but have your list.
Reread your letter after a few days have past. You may want to refine it.
When you finish your list, perhap you could post it or send it to someone you trust for feedback.
Hang in there. I would be upset if I were to find myself in your situation. It must feel as if your doctor has given up on you. Until you find therapeutic success, the doctor will tend to refine his diagnosis to make sure he is treating the right illnesses. To be proactive, you need describe to him the symptoms of your mental illness (should there be any). Give him as much information as you can for him to get it right.
- Scott
Posted by SLS on May 26, 2011, at 6:05:00
In reply to am I even depressed?, posted by floatingbridge on May 26, 2011, at 2:27:23
Ativan (lorazepam) is perhaps the most globally useful benzodiazepine. It is good for sleep, anxiety, seizures, and muscle relaxation. I find it very clean. For me, it does not produce extraneous psychiatric side effects. I experience very little hangover.
"Lorazepam (initially marketed under the brand names Ativan and Temesta) is a high-potency short-to-intermediate-acting 3-hydroxy benzodiazepine drug that has all five intrinsic benzodiazepine effects: anxiolytic, amnesic, sedative/hypnotic, anticonvulsant and muscle relaxant.[4][5] Lorazepam is used for the short-term treatment of anxiety, insomnia, acute seizures including status epilepticus and sedation of hospitalised patients, as well as sedation of aggressive patients.[5]["
http://en.wikipedia.org/wiki/Lorazepam#Medical_uses
- Scott
Posted by torrid on May 26, 2011, at 8:31:03
In reply to am I even depressed?, posted by floatingbridge on May 26, 2011, at 2:27:23
please don't look at it this way. anger with no outlet turns into depression, just means that it's not chemical in nature your depression it's emotional in nature.
Posted by Phillipa on May 26, 2011, at 11:14:26
In reply to Re: am I even depressed?, posted by torrid on May 26, 2011, at 8:31:03
Sometimes conflicted emotions can cause all sorts of things. Like getting script yesterday worst nightmare ever. Could it be impending vacation? Didn't the Emsam also lift you mood? Confused Phillipa
Posted by Dinah on May 26, 2011, at 13:19:07
In reply to am I even depressed?, posted by floatingbridge on May 26, 2011, at 2:27:23
Perhaps you aren't. I firmly believe there's a subgroup of people with finely tuned nervous systems. Who respond differently to the sensory inputs. Who need a different kind of treatment than standard antidepressants (which can as often irritate the nervous system as calm it).
Do you get migraines?
Do you have IBS?
Do you fall apart after a crisis?
Do you often feel overwhelmed in a noisy room or someplace with a lot of visual stimulus?
Do your nerves jangle?
I think that's entirely different than a melancholic depression.
Posted by Phillipa on May 26, 2011, at 13:33:00
In reply to Re: am I even depressed? » floatingbridge, posted by Dinah on May 26, 2011, at 13:19:07
Dinah what do you feel this is as that sounds like me also hence the past failures with meds. Also the S spinal curvature and osteo and known cure. Nightmares of death. Thanks Phillipa
Posted by floatingbridge on May 26, 2011, at 18:44:22
In reply to Re: am I even depressed? » floatingbridge, posted by Dinah on May 26, 2011, at 13:19:07
Dinah,
Yes to the checklist, except, thank goodness, no real migraines and no full-blown IBS. I do have fibromyalgia. I've always responded at level ten on the volume scale; I do see lots of folks not register the same event, or if they do, it's not seismic.
So why do you bring this up? I fully admit to personality disorder nos, even if my pdoc hasn't bought it before.
I remember your own emergency med. It's not flying at my pdoc's office--not that yours would be mine.
There is talk about highly sensitive people. I think trying to get into a group therapy like dbt plus meds would be good for me.
And I think I have a week to practice the kindest, most effective way of asking my pdoc, what the f*ck are you wanting to tell me???!!!
Thanks, Dinah
> Perhaps you aren't. I firmly believe there's a subgroup of people with finely tuned nervous systems. Who respond differently to the sensory inputs. Who need a different kind of treatment than standard antidepressants (which can as often irritate the nervous system as calm it).
>
> Do you get migraines?
>
> Do you have IBS?
>
> Do you fall apart after a crisis?
>
> Do you often feel overwhelmed in a noisy room or someplace with a lot of visual stimulus?
>
> Do your nerves jangle?
>
> I think that's entirely different than a melancholic depression.
Posted by floatingbridge on May 26, 2011, at 19:08:02
In reply to Re: am I even depressed? » floatingbridge, posted by SLS on May 26, 2011, at 5:55:28
Scott,
I will reread my letter--let it cool. Very sage advice. You probably remember I can be very reactive and I really (really) work on pausing and developing wise patience.
I feel like, well I thought we were working the same equation with the
same rules, but our working answers are so different. Worse is the sensation that don't understand him any longer. I mean, we still have affection for one another--I started seeing him three years last month, just about when I joined babble. He's helped me tons, so I feel very sad, actually.And I don't understand about maoi's. Yes, they are dangerous. But why is asking for one like asking for crack? If he feels it isn't the right treatment, then explain why. I can't seem to go med-less. I have waited months for treatment. I just threw in the towel on snri's. Twelve years is enough.
Is there something about, say parnate that is truly more harmful than a more selective AD? I really don't know.
The emsam at 6mg is no cure. But I have less vegatative symptoms (is that a real term). I wake up easier, my mind still gets completely over run, but I am sharper. I am quicker to anger, but that's the point of my therapy: feel anger, learn to be skillful, know it won't destroy me.
I hope I can work things out. Three years is alot of observation, knowledge, and just time together.
Thanks for your calm response and perspective--and the jokes, too :-)
Posted by floatingbridge on May 26, 2011, at 19:12:22
In reply to am I even depressed?, posted by floatingbridge on May 26, 2011, at 2:27:23
Just think. It's 12-something a.m. and I can compulsively write a rant/post and wake up the following morning to replies.
Thoughtful, intelligent, caring replies.
That's better than birthday cake.
Thanks :+)
fb
Posted by floatingbridge on May 26, 2011, at 19:32:50
In reply to am I even depressed?, posted by floatingbridge on May 26, 2011, at 2:27:23
Just think. It's 12-something a.m. and I can compulsively write a rant/post and wake up the following morning to replies.
Thoughtful, intelligent, caring replies.
That's better than birthday cake.
Thanks :+)
fb
Posted by Dinah on May 26, 2011, at 19:40:51
In reply to Re: am I even depressed? » Dinah, posted by floatingbridge on May 26, 2011, at 18:44:22
I only meant that there were different types of emotional pain, with different sorts of treatments. And that being told you aren't depressed isn't the same as being told you aren't in pain. Now, if he told you there was nothing wrong with you, that would be different.
What does your pdoc have against as needed meds?
Posted by floatingbridge on May 26, 2011, at 20:12:03
In reply to Re: am I even depressed? » floatingbridge, posted by Dinah on May 26, 2011, at 19:40:51
> I only meant that there were different types of emotional pain, with different sorts of treatments. And that being told you aren't depressed isn't the same as being told you aren't in pain. Now, if he told you there was nothing wrong with you, that would be different.
>Dinah, I don't know of he has anything
against meds as needed. When I had an
adverse reaction to abilify, he and we became wary of AP's (had bad reaction to seroquel, too). I've brought up risperdal as needed, saphris he mused about out loud, but still scripts me for xanax, then worries (outloud, again) about long term effect. Tuesday out the door I said I need a go-to medicine since
xanax doesn't seem to pull it's weight at it's old dose. He then pondered upping my dose, but that seems like really nurturing potential trouble. It's like he cannot decide. And yet, weeks upon weeks of my life go by.
> What does your pdoc have against as
needed meds?Oh, and about your first comment,
I thought you might have a miracle answer like,"...there's two types of people and You dear are this type and therefore have you considered....?"But life couldn't be that simple :P
Though I (most likely mistakenly) took him to mean there wasn't anything wrong with me I couldn't fix if I stopped trying different meds. Like it's a new hobby :(
Posted by Dinah on May 26, 2011, at 21:00:58
In reply to Re: am I even depressed? » Dinah, posted by floatingbridge on May 26, 2011, at 20:12:03
Hmmm... Well, I suppose (and this is purely my own opinion) that when faced with a highly reactive nervous system, it's best to stick with anti-anxiety meds and mood stabilizers. But that may be partly due to how very bad I did on AD's without mood stabilizers added. They did make me a bit nuts. Ok, a lot nuts. I cringe when I think back on it.
Posted by floatingbridge on May 26, 2011, at 22:00:15
In reply to Re: am I even depressed? » floatingbridge, posted by Dinah on May 26, 2011, at 21:00:58
Dinah,
I agree for me that the ssri/snri wasn't a good thing. That's with years of good effort. I tried.
Anti-anxiety, unless benzo, I don't know. Is that like buspar or even risperdal or some other atypicals?
Mood stabilizers are under explored.
Well, this won't be solved tonight (darn it,
though!). Thanks for your opinion
:D
Posted by floatingbridge on May 26, 2011, at 22:04:59
In reply to Re: am I even depressed? » floatingbridge, posted by Dinah on May 26, 2011, at 21:00:58
Dinah,
I agree for me that the ssri/snri wasn't a good thing. That's with years of good effort. I tried.
Anti-anxiety, unless benzo, I don't know. Is that like buspar or even risperdal or some other atypicals?
Mood stabilizers are under explored.
Well, this won't be solved tonight (darn it,
though!). Thanks for your opinion
:D
Posted by floatingbridge on May 26, 2011, at 22:11:08
In reply to Re: am I even depressed? » floatingbridge, posted by SLS on May 26, 2011, at 5:55:28
Why would a/my doctor want to prepare to deny someone/me Nardil?
I missed that comment first time around.
I've only asked for parnate; then took up emsam for a number of what seem excellent reasons--safety and neuroprotection (possibly).
Posted by Phillipa on May 26, 2011, at 22:22:45
In reply to Scott, » SLS, posted by floatingbridge on May 26, 2011, at 22:11:08
FB the emsam is working also isn't it? Phillipa
Posted by SLS on May 27, 2011, at 4:15:56
In reply to Scott, » SLS, posted by floatingbridge on May 26, 2011, at 22:11:08
> Why would a/my doctor want to prepare to deny someone/me Nardil?
My apologies. I confused Nardil with Parnate. Maybe it is me who would prefer Nardil given your levels of anxiety. Has your doctor already consented to prescribing Parnate if Emsam doesn't work?
> I've only asked for parnate; then took up emsam for a number of what seem excellent reasons--safety and neuroprotection (possibly).
Well, lets see what happens. The logic is there, but not the evidence. I tried Emsam and experienced an anxiolytic effect during the first week. I then became dysphoric and stopped taking it immediately. It certainly doesn't affect everyone that way. Just know that you cannot generalize your reaction to Emsam to all other MAOIs.
If I hadn't watched L-deprenyl (selegiline) put through its paces since 1983, I wouldn't have a bias against it for treating depression. The Emsam patch was a great idea to deliver unmetabolized selegiline to the brain. However, even at the higher dosages, it doesn't seem to match Parnate or Nardil in efficacy.
If I were in your position, I would have tried Emsam first. It is logical. I sincerely hope that you have found a good match for your illness(es).
Parnate + lithium had been a favorite combination treatment before the days of Prozac. Lithium is an effective neuroprotective and neurorestorative.
http://www.psycheducation.org/depression/meds/ManjiLithium.htm
N-acetylcysteine (NAC), via glutathione production, is an effective antioxidant that might help prevent stress-induced damage to certain neuron components. If you are looking for a replacement for the neuroprotective properties of selegiline, you might consider adding low dosages of lithium and NAC.
Go for results over theory.
- Scott
Posted by floatingbridge on May 27, 2011, at 7:37:59
In reply to Re: Scott, » floatingbridge, posted by SLS on May 27, 2011, at 4:15:56
Thanks for the link, Scott, and your opinion, too. I am hesitant to ask my doc one more thing (lithium), and that's very odd in itself I think. He would, I imagine, agree to lithium since he had me on 300mg for some time. He hasn't agreed to parnate and is acting oddly about emsam. There is something happening that I am not understanding. Other than that I am a difficult patient :-/
I think the emsam is fine so far. I do get a little cranky, but attribute that to life at this point. Thanks.
Posted by torrid on May 27, 2011, at 8:56:19
In reply to Re: am I even depressed? » floatingbridge, posted by Dinah on May 26, 2011, at 19:40:51
I agree with your thinking. I get depressed but without sadness. it's a very different kind of depression, it's more a feeling of being overwelmed then sad. In my case I believe it related to being premature. middleaged and I'm finnaly catching up with mental and emotional delays, these kind of delays can be made up well into 60's, look at Rain Man's progress today compaired to 25 years ago. Mild autism, ADHD can be out grown. what did you call it, different subtypes? I'd like to hear more about this
Posted by floatingbridge on May 27, 2011, at 9:13:40
In reply to Re: am I even depressed? » Dinah, posted by torrid on May 27, 2011, at 8:56:19
Torrid, I'm curious, too, and not just for myself. Someone in my family is being assessed and is coming up with an audio processing delay. This condition, in theory, doesn't necessarily abate, but can be compensated for in healthy ways. This is one example. The delays of being born premature might be different and could indeed be brought up to one's optimal level of functioning.
I was born before assessments for children became more standard. Now I consider myself as add-inattentive. Easily overwhelmed. However, had I been run through the assessment process as a child, it is possible something like a delay would have presented. Just my on-going thoughts.
May I ask what symptoms you are dealing with, and what you identify as delays?
Posted by torrid on May 27, 2011, at 12:41:23
In reply to Re: am I even depressed? » torrid, posted by floatingbridge on May 27, 2011, at 9:13:40
I was never a normal and was tested, IQ tested foury years ago in the 1st grade, when they saw the I was above normal, 124, they were just stumped. I look back at my childhood and today they would say mild autism or ADHD or both. In my late 20's I was put on ritalin and immediately knew, "OH, this is the way normal people feel like". ADHD and GAD is what my stuggle with but my lack of emotional control is what had the most destructive effect on my life. I've matured emtionaly and things are falling into place in resent years. I think the depression comes from being so overwelmed day after week after month. Not a true depression a people places and things depression. Anxiety is partly habbit at this point, patterns carved into my brain, I've been rapidly covering over the past 3-4 years at a rate that seemed like a developemental milestone
Posted by floatingbridge on May 27, 2011, at 22:39:34
In reply to Re: am I even depressed? » floatingbridge, posted by torrid on May 27, 2011, at 12:41:23
Torrid, what factors figure into the escalation of your improvement?
This is the end of the thread.
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