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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Shirley on November 15, 2000, at 20:50:35
Like many of you on this board, I am going through a period right now where I am so tired of the med trials and not being able to enjoy life fully. I am transitioning from Zoloft to Prozac and had gotten off the Zoloft and was at 20mg Prozac. I started having breakthrough agiatation and depression and the only thing that seemed to help was to add in 25mg Zoloft. I'm also taking 30mg Adderall and 15mg Remeron at night.
Psychiatrist thought I should stay with the Prozac and Zoloft since I told him I seemed to have felt the best on a combination of that. After doing reasonably well yesterday in the morning, the same "wonderful" symptoms appeared yesterday afternoon.
I foolishly took an extra 12.5mg Zoloft this morning and the agiation/depression appeared immediately in the morning. PDoc says that I need to stay with 20mg Prozac and 25mg Zoloft for about a month to give everthing time to stabalize.
Based on the posts that I have read on this board, I don't think what my psychiatrist is suggesting is outrageous. He is also flexible and is great about calling me back. So what's wrong with this picture?
I really don't feel he is very experienced in working with difficult cases. It was a neuropsychologist who suggested the Zoloft and Adderall that finally put a stop to my suicidal ideations. When I had extreme foot pain, which was definately a side effect of Zoloft, he said he never heard of it even though the side effect is on the drug manufacturer's web site.
The medicine problems related to my menstrual cycle he didn't have a clue about.I realize that none of this makes him an incompetent or uncaring psychiatrist. But I am getting less confident that he can handle my situation because I seem to have more problems than what he is used to.
The thought of Dr. Jansen is very appealing. John L, how did come to decide that what he is saying makes sense? I have read alot of old posts but have not seen anything about how you decided that he is legitimate.
A former poster from this board told me that he no longer does telephone consultations. Is that correct? To be honest, I couldn't see him working with my current psychiatrist, who told me that doctors have no way of knowing whether a medicine is going to work quickly or not.
As you can see, I am conflicted because I am so tired of this medicine garbage and struggling to get through a day. (I am crying as I write this) But I don't want to fall in the "If it sounds too good to be true, it is" trap. Any clarification would be greatly appreciated.
Finally, another issue in dealing with a psychiatrist is I have a learning disability. I have already told this guy once that he needs to spell out things clearly for me. He said he would try to but I left Monday's appointment feeling very frustrated. Unfortunately, I didn't realize I was frustrated until I had left his office and was in my car.
Anyway, I feel like I am rambling and sorry for such a long post. Got to get up early because I didn't have the energy to do something that I needed to today.
Thanks for your support.
PS-As a clue, when I have eating something light and had a cup of coffee when the breakthrough depression and agiation occur, my symptoms are relieved although I am not 100%. It seems like it would be a good idea to increase the Adderall but when that has been done before, I have had side effects plus depression.
Posted by JohnL on November 16, 2000, at 5:33:39
In reply to Very frustrated + depressed/confused/Dr. Jansen, posted by Shirley on November 15, 2000, at 20:50:35
> The thought of Dr. Jansen is very appealing. John L, how did come to decide that what he is saying makes sense? I have read alot of old posts but have not seen anything about how you decided that he is legitimate.
....First it should be understood that I was definitely convinced he was NOT legitimate. Like many have said, it just sounded too good to be true. I was very pessimistic, yet open minded. I studied his book. I talked with him. He consulted with my GP. He did nothing to convince me of his legitimacy. It was my own research and personal experience that did. The more I learned the more I realized everything he said was right. He frames it in an overly simplistic fashion, but nevertheless, I realized he was right. It took a while for me to swallow ego. Realizing he was legitimate didn't happen overnight.....I should mention that his methods are actually not too good to be true. Ever tried 3 different medications within 2 or 3 weeks? Believe me, it aint no picnic. The end results are well worth it, and much faster than conventional methods. But easier said than done. Not much fun. The longest it took him to find the right drugs was 8 visits. Usually it's about 3. But it aint easy.
....A potential drawback is that not all doctors have a feel for how to read the clues of drug reactions. Unless a doctor knows what he's looking for and knows how to make sense of seemingly senseless clues, then sample trials are useless. Jensen has an uncanny knack for figuring out what this negative reaction means, or that side effect means, or whatever. Every clue seems to make sense to him. Most doctors I think wouldn't even realize there were clues staring them in the face. They aren't trained that way. They don't know what to look for. Studying his book describes a great deal of this clue-finding process. But it aint no picnic and it aint too good to be true.
> A former poster from this board told me that he no longer does telephone consultations. Is that correct? To be honest, I couldn't see him working with my current psychiatrist, who told me that doctors have no way of knowing whether a medicine is going to work quickly or not.
....I don't know if that rumor is true. One could email or call and ask. Jensen gets excellent cooperation from other physicians. He can and will answer any questions your doctor may have. He got cooperation from my GP, which I had thought to be impossible. He's professional, humble and polite.....It's true, there is no way to predict if a medication will work fast or not. But that's not the point. The point is to gather clues, to get a clearer picture of what's going on. During the clue finding process though, the patient usually stumbles onto a medication they really like that does work fast. We don't know ahead of time which drug that might be. But because no stone is left unturned, that drug will be found. Usually within 3 visits, 8 at the most.
....I think a good place to start is to study his book "The Successful Treatment of Brain Chemical Imbalance". You'll have a clear picture of what your options are, why they are, and in what order they should be tried.
> PS-As a clue, when I have eating something light and had a cup of coffee when the breakthrough depression and agiation occur, my symptoms are relieved although I am not 100%. It seems like it would be a good idea to increase the Adderall but when that has been done before, I have had side effects plus depression.
....This reminds me of an case in his book. It goes like this..."Most panic victims got worse with coffee, yet others enjoyed coffee. What was this chemistry?" He shows which drugs got excellent results for what percentage of patients in each group. It's an example of how he uses clues to make sense of the bigger picture. The part I do understand and find very useful is the chart showing which medications worked which percentage of the time. Call it whatever you want, explain it however you want, but what matters to me is what actually worked.....I know I've said it a thousand times, but his book really is excellent reading. Unlike most psychpharm books that are expensive and not all that immediately useful, his is inexpensive and immediately useful.
Hope this helps.
John
Posted by pullmarine on November 16, 2000, at 23:41:51
In reply to Very frustrated + depressed/confused/Dr. Jansen, posted by Shirley on November 15, 2000, at 20:50:35
> Like many of you on this board, I am going through a period right now where I am so tired of the med trials and not being able to enjoy life fully. I am transitioning from Zoloft to Prozac and had gotten off the Zoloft and was at 20mg Prozac. I started having breakthrough agiatation and depression and the only thing that seemed to help was to add in 25mg Zoloft. I'm also taking 30mg Adderall and 15mg Remeron at night.
>
> Psychiatrist thought I should stay with the Prozac and Zoloft since I told him I seemed to have felt the best on a combination of that. After doing reasonably well yesterday in the morning, the same "wonderful" symptoms appeared yesterday afternoon.
>
> I foolishly took an extra 12.5mg Zoloft this morning and the agiation/depression appeared immediately in the morning. PDoc says that I need to stay with 20mg Prozac and 25mg Zoloft for about a month to give everthing time to stabalize.
>
> Based on the posts that I have read on this board, I don't think what my psychiatrist is suggesting is outrageous. He is also flexible and is great about calling me back. So what's wrong with this picture?
>
> I really don't feel he is very experienced in working with difficult cases. It was a neuropsychologist who suggested the Zoloft and Adderall that finally put a stop to my suicidal ideations. When I had extreme foot pain, which was definately a side effect of Zoloft, he said he never heard of it even though the side effect is on the drug manufacturer's web site.
> The medicine problems related to my menstrual cycle he didn't have a clue about.
>
> I realize that none of this makes him an incompetent or uncaring psychiatrist. But I am getting less confident that he can handle my situation because I seem to have more problems than what he is used to.
>
> The thought of Dr. Jansen is very appealing. John L, how did come to decide that what he is saying makes sense? I have read alot of old posts but have not seen anything about how you decided that he is legitimate.
>
> A former poster from this board told me that he no longer does telephone consultations. Is that correct? To be honest, I couldn't see him working with my current psychiatrist, who told me that doctors have no way of knowing whether a medicine is going to work quickly or not.
>
> As you can see, I am conflicted because I am so tired of this medicine garbage and struggling to get through a day. (I am crying as I write this) But I don't want to fall in the "If it sounds too good to be true, it is" trap. Any clarification would be greatly appreciated.
>
> Finally, another issue in dealing with a psychiatrist is I have a learning disability. I have already told this guy once that he needs to spell out things clearly for me. He said he would try to but I left Monday's appointment feeling very frustrated. Unfortunately, I didn't realize I was frustrated until I had left his office and was in my car.
>
> Anyway, I feel like I am rambling and sorry for such a long post. Got to get up early because I didn't have the energy to do something that I needed to today.
>
> Thanks for your support.
>
> PS-As a clue, when I have eating something light and had a cup of coffee when the breakthrough depression and agiation occur, my symptoms are relieved although I am not 100%. It seems like it would be a good idea to increase the Adderall but when that has been done before, I have had side effects plus depression.
Posted by Shirley on November 18, 2000, at 7:14:43
In reply to Re: Is Dr Jensen legitimate? Too good to be true?, posted by JohnL on November 16, 2000, at 5:33:39
John,
Your response is very helpful, especially about a psychiatrist being able to make sense out of clues. Even if mine were to endorse his method, I am not very convinced that he knows what clues to look for.
I do have Dr. Jensen's book but find it very hard to follow due to my learning disability. Sooner or later, I am going to get a scanner for my computer and when I do, I can scan his book onto to my computer and use text to speech software.
Yesterday, I had another day from hell due to my meds. Again, the coffee helped in the am although I felt lousy all day even though I made it to work.
My psychiatrist suggested lowering the prozac dose to 15mg from 20mg but I've decided that I'm going to try splitting the dose. This morning, I took 10mg Prozac along with my usual 10mg Adderall and so far, so good. Keep your fingers crossed for me. If it doesn't work, then I'll ask
you the other questions that I have thought of.Thanks for your wonderful posts.
Shirley
Posted by Shirley on November 18, 2000, at 7:29:42
In reply to Summary of Dr. Jansen's ideas, please!!! (np), posted by pullmarine on November 16, 2000, at 23:41:51
Pullmarine,
I think John L. could a better job than me but I'll take a quick shot at it.
Basically, before doing what traditional psychiatry does with standard 6 week medicine trials, Dr. Jensen will have you compare different medicines from the same class.
For example, based on the clues that you provide in your history, if he thinks that you may respond well to SSRI drugs, he will have you try Zoloft, Pazil, Prozac, Serzone, and Luvoz for three to five days. He will also provide an antidote of a small dose of stelazine or xanax in case of severe side effects. Prozac is used last because it has the longest half life.
You should know when a match is found because you will feel good instantly. If you find a drug before trying all of them, Dr. Jensen will have you then engage in a full trial for the standard 6 weeks. If none of the SSRI's work, he will move on to a different class of drugs, based on the clues that you provide him.
According to the abstracts that I have seen in Medline, there seem to be other psychiatrists who are doing similar work. But unfortunately, there don't seem to be too many.
My psychiatrist feels that someone can feel well pretty quickly on an antidepressant and says that person will do the best in treatment. He does not attribute it to a placebo effect because he says the good feeling continues. But what's interesting is he says there is no way of knowing which medicines will provide quick relief. I was afraid of mentioning Dr. Jensen but I am going to at my next visit and see what happens.
I wasn't as quick as I thought I would be. Hope this helps.
Shirley
Posted by Shirley on November 18, 2000, at 8:36:53
In reply to Re: Is Dr Jensen legitimate? Too good to be true?, posted by Shirley on November 18, 2000, at 7:14:43
John,
Since I started feeling lousy this morning on 10mg Prozac although not as bad as yesterday, I decided to another shot at Dr. Jansen's book. I happened to catch the part where he said that coffee may raise Noriprenephrine. As a result, I started thinking some more about my medical history.
I was on Effexor for about a year. It wasn't great although it was decent. But at the time, I wasn't on a stimulant along with it so I'm wondering if the combination might work since I definately seem to always do better when a stimulant is added to the mix? Wellbutrin just caused mild agiation although I wonder if I really got a true sense of it due to taking Zoloft at the same time.
But then again, when I was put on Zoloft and Adderall, that worked fantastic for about a year until the Adderall started becoming less effective. Raising the dose and switching to ritalin and dexedrine didn't work and because of the weight gain from zoloft, that's why the switch was made to prozac.
Bear with me, I am thinking out loud here. As I think about the prozac and the bit about the coffee getting me out of a bad medicine reaction, I am wondering if I might do well on your combination since I think too much prozac and adderall might be bad news.
I am definately going to mention Dr. Jensen at my next appointment on 11/28. But I also want some help sorting this all out in case my p-doc doesn't buy any of this and is only willing to prescribe certain medications.
Sorry for the long winded post but I am so confused. Also, I am just so damm sick of this and want to start living my life.
Shirley
Posted by S Howard on November 19, 2000, at 0:34:49
In reply to Very frustrated + depressed/confused/Dr. Jansen, posted by Shirley on November 15, 2000, at 20:50:35
Okay this is how I relate to your story: I worked in an orthopedic office for many years. The older doctors were afraid to try anything new, which is sad. If two children of the same age came into the office at the same time with identical torus (buckle) fractures of the wrist, and one of them saw the "old" doctor and one of them saw the "new" doctor, the patient who saw the old doctor would leave our office in a heavy, ugly white plaster cast. The patient who saw the "new" doctor would leave in a lightweight fiberglass cast in various colors or patterns. If the child in plaster got his cast wet, he had to return to the office to have his cast cut off and a new one applied. If the child in fiberglass got his cast wet, he could dry it with a hairdryer.
Mind you, these two doctors work in the same office. The older doctor is used to plaster, plaster has worked for him since medical school, and he's not about to change now. Still this is unfair to the patient. The question is, how do you find a doctor, no matter what kind of doctor, who is willing to research and change along with medical advancement? How do you know your doctor is up-to-date? How do you know that you are getting the very best treatment available? I would be interested to know if Dr. Bob has ideas on the subject.
-Gracie
Posted by Shirley on November 19, 2000, at 7:12:13
In reply to Re: John L. or anybody else -More Questions Please, posted by Shirley on November 18, 2000, at 8:36:53
Yesterday, the splitting of the Prozac dose worked wonders as around 6:00pm, all that energy I had two weeks ago returned. Noa, my apartment must have looked exactly like yours and immediately, I make it cleaner without too much effort.
Unfortunately, taking a Prozac dose at lunch along with my usual three times a day Adderall caused insomnia and I don't feel so great this morning. Since I like the effect I get by taking 15mg Remeron for sleep, this morning, I tried 15mg Prozac in the morning to see what would happen.
Anyway, I know this has been mentioned in posts before but it bears repeating-if you have side effects from a drug, split the dose to see if it goes away. It didn't totally work for me but the agiation did disappear mostly. Also, when I previously split the dose of the Zoloft to eliminate insomnia, it worked.
And the beat goes on.
Shirley
Posted by tenuous on November 29, 2000, at 3:33:46
In reply to Re: Update on my situation-Good News/Bad News, posted by Shirley on November 19, 2000, at 7:12:13
When you say "split the dose" do you mean cut the total daily dose in half or do you mean take half of the dose in the morning and the other half later in the day? I've been experimenting with the timing of my meds also, so I'm interested in what is working for others.
thanks
This is the end of the thread.
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