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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 utopizen on July 20, 2003, at 16:37:48
In April, I started on Klonopin at 1mg 3x/day and Nalodol (all-day beta blocker) 40mg in AM, both for social anxiety disorder.
(it was heaven, first thing I got my from psychopharmacologist after seeing him for the first time and explaining how my previous p-doc tried everything from Visatril to Gabitril to Abilify to Risperdal to Effexor to Celexa to Wellbutrin to Neurontin to Buspar to Paxil to Atarax to no avail).
Unfortunately, last month or so I've noticed 2mg basically has the same effect 1mg use to have on me, if that sometimes. Is there hope augumenting with something like Straterra (never tried before, but doc wants to tried it down the road for possible help with my social anxiety and ADD).
I take Desoxyn now, but I don't take it on the weekends, so I know it's not that. I'm switching to Dexedrine Spansules (generic) if my out-of-state p-doc here finally agrees to follow what my doc at home suggested I advise her to give me.
So I was thinking, I'll probably have to take some stimulant for my ADD (my neuropsychological exam came back with off-the-charts inattentiveness basically), but augumenting with Straterra might let me lower my dose on a stimulant and maybe even Klonopin?
I might try Abilify again. It was cute, I didn't notice effects from it. But I was only on it for 2 weeks, at 15mg, and stopped because of akathasia. I think that I might give it another shot now that I have Klonopin (that might help athkasia, right?
At any rate, I was wondering that even though I failed to help my social anxiety so much with anything but Klonopin, maybe going back to those take-three-weeks-and-find-out-it-doesn't-do anything things that didn't give me any relief at all for my social anxiety might let me reduce my dose for Klonopin in a synergistic way. Anyone notice this happen??
I don't want to increase my dose of Klonopin, I think 1mg 3x/day is all I'm comfortable with. It offers some great relief, just not the same extent of relief (like 100% symptomatic relief) I felt when I first took it for a few months.
And what's up with stims and me? I tried Ritalin, made me anxious, but after a few months also made me depressed when I wore off. Same thing with Adderall after several months, and now Desoxyn is doing it after not having any problems with it since I started in April. Why do I feel depressed for an hour at the end of the day when it's wearing off? I realize it's common in a short-acting stimulant, but I didn't feel this way for the first months I took it. It's still effective when I take it. Does this indicate a hidden bipolar or something?
Not that I care, I took Seroquel recently and my childhood speech impediment came back and immediately quite that. I'm sick of my current out-of-state doctor, I complained of insomnia and feeling down at the end of the day when I took my Desoxyn for ADD. She automatically goes "bipolar!" and gives me seroquel, only telling me it's for "sleep" until revealing to me the second appt. it's for "more than just that."
She also keeps telling me how Klonopin's "not the best for social anxiety" even though I explained to her I worked on every possible avenue for 2 years with Harvard Med psychopharmacologists before taking it. What ticks me off the most is she'll complain about how my doctor at home prescribed this to me (and I have to refills left, so I don't care what she thinks) but not bother to speak with him about working with my meds. And whenever I mention my doc suggested I tell her to have me switch from Desoxyn (which I had to spell for her) to a long-acting stim, she refuses, gives me a bad look like I'm a junkie, and tells me to take Wellbutrin at 400mg (I told her I tried it at 300mg, so the chances of 400mg magically working are zero).
And I had a consult with a Harvard Med Psych. Professor/psychopharma, who told me to tell my psychohparma to give me Klonopin.
Of course, being out-of-state for the summer also means I don't have much time, so I can't keep up going to these appts. and leaving without the treatments that will actually help me, and can't switch to a different doc just for the next month at this point. She's very dismissive and firm when I suggest I switch to a long-acting stimulant.
My doctor at home prescribed the Desoxyn, so I don't think she realizes by not switching me to a different stimulant she's still responsible for keeping me on one that is giving me adverse effects.
My doc at home is great in person, but is terrible at returning my calls, and I've lost patience with him a long time ago, that's why I'm seeing this doc while I'm out of state before I see him in the fall.
I don't know what to do. I feel so weakened and humiliated when she ignores my request to switch to a long-acting stim that won't make me feel depressed for two hours at the end of the day, like I hate everything then. She interprets this as bipolar or depression, so she gives me Seroquel.
But that didn't help anyway. If I tell her it's not working, her answer is to up the dose. No single study has ever claimed an antypical antipsychotic can kill the depression effect of short-acting stims, and it seems so obvious and simple to just switch me to a longer-acting one, doesn't it? I initially came to her with insomnia, and she automatically assumes this means I have depression (which I don't, I'm happy) and I'm really really frustrated. I feel like I have no willpower, either. I tell her what my doctor told me to tell her each appt., she dismisses it, ups my Seroquel, and asks me when I want to see her again. I wish I could believe I would have the will power to just stand in that chair until someone had to drag me out of it, or tell her it's insurance fraud to diagnose me for disorders that aren't consistent with the symptoms the DSM spells out (that depression must be isolated from substance-induced problems, that insomnia is not the only symptom for a depression diagnosis, that bipolar has to be isolated from a drug's effects).
Clearly there's billing codes she must report to the insurance co. to prove I have a disorder that requires treatment, so if those disorders are falsely reported, then that's fraud as far as I'm concerned.
Yeah, 300mg of Wellbutrin didn't work on my ADD. It's really, really realistic to expect that 400 will suddenly help. I have inattentive ADD only, and it's very serious.
Yeah, let's keep me on a drug you can't spell, and never heard of, that'll make you feel more conservative somehow because you didn't prescribe it, right?
Posted by jay beck on July 20, 2003, at 18:00:52
In reply to Klonopin less effective at same dose, posted by utopizen on July 20, 2003, at 16:37:48
honestly, most of the people on this forum are very informed about diffrent diagnoseses and meds. most of us know what we would like to try but thanks to the fda/dea we cant do this alone. we have to convince a docter to write a peice of paper saying its ok. this is insane i should be able to put in my body any med i wanted to with only my permission. not only does "big brother" harass the populous he also harasses the p-docs to not write scripts for abusable meds. i know none of this will help, im kinda just venting. but really, the fda/dea are responable for your trouble.
Posted by utopizen on July 20, 2003, at 18:18:32
In reply to Re: Klonopin less effective at same dose, posted by jay beck on July 20, 2003, at 18:00:52
My roommate said after I was complaining about my psychiatrist, "look, this is how you deal with psychiatrists: you say: I want this. I want this a x dose, x times a day." They respond by their line "but x drug will get you addicted, you don't want that, right?" Then you said, "I don't care, I want that" And they said "Fine, here, and get the * out of my office."
My p-doc, she's running late by about 40 min. each appt. She tried to argue with me all the time, and when she doesn't do that, she tries to shut me up by asking when I want to see her again (so I can repeat the same stupid hopeless process). This time, I'm going to try to just say, "we're not scheduling a thing until you decide to start properly treating me. It's your fault by the third appt. you haven't called my doc at home, not mine, so don't claim you have to be cautious about prescribing a damn thing. I told you the first appt. for you to call my doc, and I shouldn't have to suffer because you failed to do that."
Posted by River1924 on July 21, 2003, at 0:21:59
In reply to Re: Klonopin less effective at same dose, posted by utopizen on July 20, 2003, at 18:18:32
I found your original message kinda hard to follow. You may have a seaonal aspect to your mental state. In the summer, I tend to be a bit more wired and take more klonipin. (Actually, my doc goes with the flow now and rotates my drugs on a seaonal basis.) Unless, you have a history of drug abuse, it is unlikely you will become an addict to any of these meds: an intelligent doctor should know this. Also, a good doctor will listen and experiment with you and see what works. Your doctor may be unwilling however since you won't be with her long. You original message does seem a little "all over the place." Maybe instead of or in addition to stimulants, you do need something for bipolar disorder. If so, I can't beleive any doctor's first choice would be seroquel: lithium or lamictal would be more conservative and sensible.
This is the end of the thread.
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