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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Elizabeth on December 15, 1998, at 11:06:18
(Please excuse my poor grammar!)
I've been reading many of the posts and many strike
a similar chord for me. I've tried almost every
anti-depressant out there, always becoming intolerant
of the side effects within 1-3 weeks. Ten years ago,
it was three weeks, now it's one week or less. My usual
experience is either an intolerable increase in anxiety,
an intolerable feeling of euphoria, insomnia, and a bizarre "finger in an
electrical socket" feeling that I've had with several newer drugs,
or an occasional strong desire to kill myself - oh I
forgot the nausea factor, which has often been quite severe
(I am deathly phobic about becoming ill).
I even had a seizure on Nardil, and "rage" reactions to anti-psychotics.
I've had panic attacks/depression with "ticcing" since puberty (more than
20 years), and became completely agoraphobic since
a very close relative passed away recently. Not diagnosed, but is a signifigant
part of my problem, are the appearance and sudden dissappearance of total rage "attacks" -
a common phenomenon on one side of my family. There is also
a family history of diagnosed bi-polar disorder (more than one member),
drug abuse, suicide and alcoholism.
My present diagnosis is Panic Disorder with Agoraphobia and "Mixed States'
Personality Disorder (my present dr.added OCD).
I have been on Klonopin for 4 years, 1mg daily,
which helped the anxiety at first but my dr. and I both
agree that it's made the anxiety and the depression/agoraphobia
worse - and I cannot for the life of me cut down on this med.
My present Dr.(for over a year) has tried to get me on an anti-depressant,
then taper off the klonopin.
We have tried so many meds, but she is still convinced, despite my bi-polar
backround, that her perscribed regimen is what I need.
I have done some research on individuals like me, and it certaintly
sounds like I fit somewhere on the bi-polar continum - what I've read about
"rapid-cycling" seems to fit the description of how I've reacted to most meds.
I think my Dr.'s standards for meeting this criteria are much higher than mine -
perhaps it really wouldn't help if it were changed. However, I would like to
have the opportunity to at least try some mood-stabilizing drugs.
After years of therapy, I have come to some conclusions regarding my "illness:"
I think that (for me) panic/agoraphobia is ultimately not the problem, I think it is what
the panic/agoraphobia masks, and for me what they mask is total "mood instability."
This is why I don't drink - when I have, I go comletely nuts (I've even been
arrested while intoxicated)!
Cognitive therapies that directly attack the panic backfire for me.
When I've taken some anti-depressants, and the panic is alleviated,
I am often left with a strong desire to commit suicide.
I also believe that personality disorders are in actuality mood disorders.
I am astounded by how clinicians in the area where I live are not up to date
on information regarding this probable "mis-diagnosis." In my experience, once
you are given a diagnosis of a personality disorder, therapists will
treat you in a patronizing and condesending manner.
Once I got a hold of my psychiatric records, my gut feelings regarding
this were more than confirmed.
I have never yelled or behaved inappriopriatly with a therapist or psychiatrist,
but I know that I must be extra careful in my behavior and composure or else I'll
be dropped from treatment. A diagnosis of a personality disorder, IMHO, is an excuse
for negligent and occasional abusive treatment (and do I have some experiences with both!).
Despite my present Dr.s adherence to my diagnosis, she has been the only one
who has actually read the medical information I've gathered and has at least for
a moment considered a change in my treatment. Others have transferred me for much
milder "transgressions," like complaining about the side effects of drugs.
I wish that, in my community, our clinicians were more progressive. I wish
that they would not adversly judge a patient for "using medical jargon" or
obtaining medical information. I wish they would listen when a patient presents
a rational request for a change of treatment. I especially wish that there would not
be a "knew-jerk" response to do the exact opposite of what the patient requests.
And I wish they would be more aware of novel approaches to treatment and
be willing to try them. Any advice or opinions would be greatly appreciated.
Thanks for reading this long rant and good luck on your own path to wellness.
Posted by Elizabeth on December 15, 1998, at 20:36:49
In reply to frustration with treatment, diagnosis and meds, posted by Elizabeth on December 15, 1998, at 11:06:18
Hi there. :-) (Thanks for switching to Liza, BTW; there is also someone who is not me who has posted as elizabeth-with-a-lowercase-e!).
I think it is _very_ possible that you are bipolar or that medications have been giving you manic reactions. Feeling hyper shortly after starting antidepressants may be a sign of this. It might be something to talk to your doctor about.
The increased suicidal urges could be signs of a "mixed state" - where the antidepressants cause mania but you are also still depressed at the same time. (Supposedly the worst feeling in the world.)
(I am not bipolar exactly but I have had manic episodes on antidepressants too. Tricyclics seem to be the most likely to do this, while Wellbutrin and MAOIs are least likely.)
Tegretol is an anticonvulsant that can prevent seizures, manic episodes, and rages (these may be a type of seizure too BTW), and also may (with long-term treatment) cause depressions to occur less frequently. It can be combined safely with most antidepressants. There are other, newer anticonvulsants that may have the same benefits (Lamictal, Neurontin, Topamax) with less sedation and without the need for blood tests. Depakote is another anticonvulsant that is known to be effective for bipolar disorder and also may help with the panic attacks.
As far as panic goes: I suffer from panic disorder too. Unless the panic attacks are related to some specific stimulus (like a phobia or certain interpersonal situations, thoughts, etc.), cognitive therapy is limited in what it can do. The best strategy for panic disorder with agoraphobia is to find a medication that will stop the panic attacks and then use CBT to unlearn the agoraphobia.
Regardless of whether you call it a personality disorder, mood disorder, or anxiety disorder, unstable moods are really hard to deal with. I think it's smart of you to avoid alcohol, and it shows you have a lot of will power and determination to get better.
I'm not sure which personality disorders you were diagnosed with ("mixed personality disorder" means that you have features of more than one) but I agree that this tends to be an excuse for giving incomplete treatment or even being downright nasty. I don't think that personality disorders are exactly mood disorders but most of them seem to be exacerbations of mood or anxiety disorders. (For example, almost everyone diagnosed with borderline personality disorder (which I think is the most common one) also has a mood disorder.)
I sympathize with your complaints about the way patients are treated by clinicians! I get a lot of weird looks for being well-informed.
Anyway I hope this helps. Take care, and stick around.
Posted by racer on December 27, 1998, at 0:24:01
In reply to Re: frustration with treatment, diagnosis and meds, posted by Elizabeth on December 15, 1998, at 20:36:49
I have long thought that 'personality disorders' were cop-outs, too. Admittedly, I haven't read all that much about them, but everything I've read boils down to: "Hopeless case, don't even bother to try to treat." And I have also run into the doctor who doesn't like patients to be informed. (I could see the doctor I'm stuck with right now mentally adding "hypochondria" to my diagnosis when I told her that the medicine she had just prescribed was contraindicated because of pre-existing problems.)
So, here is my considered opinion:
A good doctor will not let a label interfere with good treatment.
A good doctor wants an informed patient who can contribute to the recovery process.
A good doctor who honestly believes that you're not well informed, but have crossed a line into obsession or something of that nature will be honest in telling you that, and will give you a reasonable explanation of why that conclusion was reached.
Too bad there aren't more good doctors, huh?
Realistically, though, many doctors now are so overburdened by the managed care bureaucracy that they can't give adequate care to their patients. County drs, like the one I'm stuck with, have little incentive to be good care givers. Some drs just don't "click" with some patients. And some have their own biases that may interfere with treatment.
If you're not getting good care, look around and call around and ask around for alternatives. See my post down below asking the drs here for advice. There are low impact ways to get ideas.
Good luck to you.
Posted by CindyM on April 25, 1999, at 21:00:50
In reply to I'm sorry no doctors have responded to this yet, posted by racer on December 27, 1998, at 0:24:01
Hi...My name is Cindy and I have been having panic attacks off and on for about two years. Recently they have been getting worse and worse, and so my primary care doc perscribed (generic) Xanax and Paxil. The Xanax started working fine, although we had to cut the dosage. It made me really woozy at a .50 mg dosage. The Paxil, however, wired me, like I was drinking coffee all day. My doc then tried BuSpar, and it made me so sick to my stomach I couldn't even take one half pill in the morning and one half at night. And it's hard for me to shake that nervous, "I know I'm in trouble for something" feeling. My doc sent me to a nurse practictioner, who diagnosed me as bi polar with panic attacks stemming from my mood swings. She told me that my reaction to the Paxil is really what told her that, because Paxil will usually bring people "down" to a calmer mood, unless they are bi-polar or manic. I am usually "up", so I questioned "bi polar", because I thought that meant depressed. After doing more research and looking into things, I realize I am too "hyper" and that's probably what has been the deal. My new nurse put me on Depakote, and so far, I've only had twinges of nervousness, not anything like the "Oh God, I'm going to pass out, throw up, and make a complete fool of myself right HERE!" feeling like I usually have. I still have to try to fight it, though. Without the Xanax I don't know what would happen. I wish more docs would be up to date as to what to do. I wish there weren't 15 different names for what I possibly have. I wish they'd make up their minds as to what I DO have. And I really wish I could feel "normal". Whatever that feels like. I hope you find someone to help. I understand how frustrating it is, to wake up every day and wonder...."what's going to happen today".
Good luck, e-mail me if you like.
This is the end of the thread.
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