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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Racer on June 8, 1999, at 21:32:23
OK, I won't repeat the whole sad saga of the Psy-doc. Let's just say that I finally got a call back today, from a call from Friday saying I was suicidal. She said that anti-depressants weren't going to help me, because my problems were deeper than that. I needed therapy (no s**t!), and since that wasn't possible, well, there wasn't much of anything to be done.
I asked about adding another drug to what I'm taking, she said that no one ever prescribed a second anti-depressant, and since I'd been on Serzone and Effexor XR, there weren't any others to try. Maybe Prozac, but she didn't think so. Now I do go to a support group, and several people there take multiple anti-depressants. What's the reality here?
Here's the reality check from my side: I know that therapy would be good, but since I'm too sick to work, I can't afford to eat, let alone spend money on anything beyond food. I know that anti-depressants should work for me, they have in the past. I know that this one is not fixing the depression, though it is controlling the anxiety. I know that this doctor is less than stellar. I know that my feelings of suicidal ideation are not a real sign that I want to die, just that I need this pain to end. I know how to do research about other options available to me, but there are none right now. I know that President McKinley is doing a great job. (OK, so that last was meant as a joke. I know that my jokes are a little weird, that's got to be a good sign, right?)
So, Doctors, what do you think? Another drug? A higher dose? A call to the medical board? Any suggestions?
Thanks!
Posted by Judy on June 9, 1999, at 19:23:48
In reply to Questions for Doctors... (Toby? Dr Bob?), posted by Racer on June 8, 1999, at 21:32:23
Racer,
Sorry I'm not a doctor, but here's my opinion anyway: your doctor sucks and a call to the Medical Board might be in order to report her calling back a suicidal patient 'when she got around to it.'
Therapy's great for dealing with your issues - but first and foremost, you need the right med so that you don't feel sick all the time. All the therapy in the world cannot change that - therapy's for later when you're feeling better.
Can you get the name of another doctor from one of your support group members? I would definitely ditch the uninformed loser you're trying to deal with now.
By the way, your sense of humor means you are still in there someplace. I've noticed that a lot of posters here have a sense of humor, as do I. I think that's what keeps us from totally coming apart at the seams sometimes. It's a sign of strength - and life - somewhere within us even if we don't always feel that's the case.
My very best wishes,
Judy
Posted by Toby on June 11, 1999, at 12:14:58
In reply to Questions for Doctors... (Toby? Dr Bob?), posted by Racer on June 8, 1999, at 21:32:23
Hello, Ms. Racer...
I remember we talked about your difficulty finding a new doctor because you live in a remote area and also due to finances the MHC is the only thing available to you. I have forgotten, however, whether your MHC offers individual or group therapy (group is sometimes less costly than individual) and it would appear you may derive more benefit from some well-informed therapy than from these ineffective medications. Nevertheless, to answer the question about multiple medications: yes, frequently treatment-resistant depression is treated with 2 or more medications at once. And in some cases, 2 or more antidepressants plus a mood stabilizer and possibly even adding Buspar (an antianxiety med) to boost the effects of the antidepressant. Monotherapy is the ideal, but this is not an ideal world and depression does not always respond in neat, predictable ways and contrary to the pharmaceutical company drug studies, does not always (or even frequently) respond to one medication the first time around.
It's been awhile since I looked at what you responded to in the past, but I wonder if it might be reasonable to try that medication again(even if it quits working, sometimes being off it awhile and then returning to it amkes it work again) and then maximizing the dose as much as possible. If you have tried that without success, there are other meds besides Effexor and Serzone, like Remeron up to 60 mg (or more) per day, Wellbutrin, Celexa, MAOI's, adding Lithium, thyroid replacement (making the lab levels of T4 to be 150% of normal), estrogen, and bright light therapy. If you have Medicaid, you might want to check on getting a bright light box you can use at home each morning.
Posted by Racer on June 11, 1999, at 14:18:37
In reply to Re: Questions for Doctors... , posted by Toby on June 11, 1999, at 12:14:58
I'm glad you remember me. Maybe it's silly, but I am. Thank you.OK, the MHC does not offer any therapy of any kind. The only thing they offer is meds. And they only offer those for a limited time, then they have to kick us out of the program as soon as we are "stabilized" according to their standards. The doctor is now saying that this drug is working effectively for me. She doesn't listen when I try to tell her that I'm feeling suicidal. To me, the fact that I am feeling like killing myself is proof enough that the drugs are not effective. Does that make sense? Does to me, but then I'm the crazy patient, not the sane and competant doctor.
So, the one drug that helped in the past was Paxil. The side effects with that one were constant fatigue and weight gain. The fatigue was barely tolerable, I felt stupid all the time because I never quite felt awake. The weight gain was significant: about 60 pounds in the first few months, though it leveled off after that. And I was anorgasmic (though the doctor who prescribed it said that the anorgasmia was only a side effect for men! What a crock!). I couldn't survive that sort of weight gain now, for a number of reasons. Mostly because when I gained all that weight before, I could afford to get new clothes. Also because I was then in an anorexic state, so needed to gain a bunch of weight. I don't need to gain that way now.
The other drugs that I've been on have also been problematic, so they're out of the question.
Wellbutrin is right out, because of the eating disorder. Because I'm so screwed up about food anyway, I'm not willing to try an MAOI. Maybe that makes me crazy, but I think I really would rather die than make food even more of an issue for me. Does that seem totally crazy?
This is so frustrating, because it's taking all my energy to keep trying to find a way to get help for myself. So far, I've been able to make telephone calls to try to get some help, as a substitute for suicide attempts. Isn't that considered a good thing? Shouldn't there be some response to that? Isn't that a sign that I'm serious about trying to get help? I'm so frightened, because I can feel my energy draining, and I'm afraid that next time or the time after I'll just take the poison to get it over with. All the things that have stopped me in the past are getting weaker and weaker. I used to be so afraid of the pain and agony of death by poison, but now I'm starting to think to myself, "I've been going through hell and pain and agony and despair for a year now, the agony of the poison would only last a short time compared to that." That's really frightening to me. Somewhere out there there must be help. I just can't seem to find it and I do think that the doctor I'm seeing now should be forced to suffer what I'm going through to see how "hwlpful" her comments are. I do wish that she could suffer from her behavior, but then I know that she already does. She must know that she's not competant, and it must be painful for her. I just want revenge. That doesn't feel good, either.
Anyway, with the eating disorder (which is troubling me again), the low blood pressure, the suicidal impulses and all the rest, can you tell me whether you, were I your patient, would keep me on the Effexor XR (which is helping the anxiety if not the depression), add another drug to it, or change it altogether? Also, if you added something, what would you try first? If you changed it, what would you try first?
Thanks for all your time. I realize that you can't prescribe for me, but since I have no trust or faith in this doctor at all now, and because I'm so scared, I hope that you can tell me something that I can try to talk to her about. If I have already looked up the drugs and know something myself, at least then I don't get so scared by her.
Posted by dove on June 12, 1999, at 10:36:37
In reply to Toby, here's more..., posted by Racer on June 11, 1999, at 14:18:37
I'm not a doc nor any kind of professional and I don't know your situation, but you obviously know you need help and your doc isn't listening. Have you tried any old Tricyclic Anti-depressants? Sometimes they can help when other newer AD's don't. I have taken verapamil with a night-to-day change, although my doc said this can be a sign of bipolar rather than unipolar depression. Amytriptyline has been good for me, I've had no weight gain though my appetite seems good. No sexual problems from it and decent nights sleep for the first time in my life. I hope someone will listen to you, my heart goes out to you. I have trouble communicating with docs, some just don't seem to care or listen for some reason. Find someone who will care and listen, and I know that can be harder than it sounds. Good luck!
dove~
Posted by Toby on June 16, 1999, at 11:00:39
In reply to Toby, here's more..., posted by Racer on June 11, 1999, at 14:18:37
I would max out the dose of the Effexor (up to 300-400 mg per day) if you could tolerate it. In addition, I would ask you to do something that you can try on your own: sleep deprivation. I'm not talking about the kind of sleep deprivation you probably already feel from the depression. I mean completely deprive yourself of sleeping for 24 hours by staying up, being active with something where you won't fall asleep even for a few minutes and then seeing you feel the next day. If you actually feel better, then you would want to do this every 3-6 days. The problem with it is that as soon as you go back to sleep, the effect wears off. That's why you have to do it once or twice a week. I works in 50% of depressed patients, so it is worth a try.
After maxing out the Effexor, if no benefit, there are some other things to try that don't require a doctor's prescription such as phenylalanine 500-2000mg given in the morning (not at night), melatonin 3 mg at 11:30 pm, and fish oil (but I am sorry I will have to look that one up again, the name coming to mind is not correct).
Now, what to talk to the doc about: max out the Effexor, then can add Buspar, tegretol, lithium, cylert, or thyroid hormone. Since Paxil worked before, it might be worth a try again, but with a thought to different strategies to prevent or minimize the side effects like Buspar for the anorgasmia, Cylert for the weight gain (or if it's a matter of making you feel hungry just all day long, use Zantac or Pepcid with it) and also for the slowed down feeling.
It's a hard thing to have such poor access to care. Ever consider moving out of state? Although I don't know that eventually all states won't be in the same shape.
Posted by Ann on June 19, 1999, at 8:34:21
In reply to Re: med changes, posted by Toby on June 16, 1999, at 11:00:39
> I would max out the dose of the Effexor (up to 300-400 mg per day) if you could tolerate it. In addition, I would ask you to do something that you can try on your own: sleep deprivation. I'm not talking about the kind of sleep deprivation you probably already feel from the depression. I mean completely deprive yourself of sleeping for 24 hours by staying up, being active with something where you won't fall asleep even for a few minutes and then seeing you feel the next day. If you actually feel better, then you would want to do this every 3-6 days. The problem with it is that as soon as you go back to sleep, the effect wears off. That's why you have to do it once or twice a week. I works in 50% of depressed patients, so it is worth a try.
>
> After maxing out the Effexor, if no benefit, there are some other things to try that don't require a doctor's prescription such as phenylalanine 500-2000mg given in the morning (not at night), melatonin 3 mg at 11:30 pm, and fish oil (but I am sorry I will have to look that one up again, the name coming to mind is not correct).
>
> Now, what to talk to the doc about: max out the Effexor, then can add Buspar, tegretol, lithium, cylert, or thyroid hormone. Since Paxil worked before, it might be worth a try again, but with a thought to different strategies to prevent or minimize the side effects like Buspar for the anorgasmia, Cylert for the weight gain (or if it's a matter of making you feel hungry just all day long, use Zantac or Pepcid with it) and also for the slowed down feeling.
>Everything that Toby recommends is consistent with what my doctor has talked about with me--except my doctor says you can go up as high as 600 mg on Effexor, which I have done successfully. I have chronic treatment resistant depression, have tried just about every drug, and the 600 mg Effexor works best for me. You can definitely mix drugs, it's very common in cases like mine and yours--I've tried the Buspar and the lithium, the lithium helped a lot but I gained a lot of weight on it.
Another thing I've heard about as a temporary measure is to use stimulants, they give you a "boost" while you are waiting for the antidepressants to kick in.
My doctor does clinical trials in addition to seeing private patients like myself, and it might be a way to get yourself some decent treatment. However, you might have to travel to do it.
Good luck getting some decent care, you deserve it!
Posted by Ruth on June 27, 1999, at 20:42:36
In reply to Re: med changes, posted by Ann on June 19, 1999, at 8:34:21
I understand money is a problem for you, but feeling suicidal needs a response asap. It is unfortunate that your current doc isn't being responsive to you.
What I would do is if you live near a medical school I would arrange to see a psychopharmacologist at their teaching hospital. Med school related people, or even just docs who just do pharmacology are up on the latest latest and are often more comfortable trying new combinations of meds until they find the right one. Good luck> > I would max out the dose of the Effexor (up to 300-400 mg per day) if you could tolerate it. In addition, I would ask you to do something that you can try on your own: sleep deprivation. I'm not talking about the kind of sleep deprivation you probably already feel from the depression. I mean completely deprive yourself of sleeping for 24 hours by staying up, being active with something where you won't fall asleep even for a few minutes and then seeing you feel the next day. If you actually feel better, then you would want to do this every 3-6 days. The problem with it is that as soon as you go back to sleep, the effect wears off. That's why you have to do it once or twice a week. I works in 50% of depressed patients, so it is worth a try.
> >
> > After maxing out the Effexor, if no benefit, there are some other things to try that don't require a doctor's prescription such as phenylalanine 500-2000mg given in the morning (not at night), melatonin 3 mg at 11:30 pm, and fish oil (but I am sorry I will have to look that one up again, the name coming to mind is not correct).
> >
> > Now, what to talk to the doc about: max out the Effexor, then can add Buspar, tegretol, lithium, cylert, or thyroid hormone. Since Paxil worked before, it might be worth a try again, but with a thought to different strategies to prevent or minimize the side effects like Buspar for the anorgasmia, Cylert for the weight gain (or if it's a matter of making you feel hungry just all day long, use Zantac or Pepcid with it) and also for the slowed down feeling.
> >
>
> Everything that Toby recommends is consistent with what my doctor has talked about with me--except my doctor says you can go up as high as 600 mg on Effexor, which I have done successfully. I have chronic treatment resistant depression, have tried just about every drug, and the 600 mg Effexor works best for me. You can definitely mix drugs, it's very common in cases like mine and yours--I've tried the Buspar and the lithium, the lithium helped a lot but I gained a lot of weight on it.
> Another thing I've heard about as a temporary measure is to use stimulants, they give you a "boost" while you are waiting for the antidepressants to kick in.
> My doctor does clinical trials in addition to seeing private patients like myself, and it might be a way to get yourself some decent treatment. However, you might have to travel to do it.
> Good luck getting some decent care, you deserve it!
This is the end of the thread.
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