Psycho-Babble Medication Thread 418891

Shown: posts 1 to 20 of 20. This is the beginning of the thread.

 

Best choice SP med in the UK? MAOIs?

Posted by jclint on November 22, 2004, at 8:13:43

Hi guys I feel the need to let off a bit of steam here. For the past 6/7 months I have been geared towards getting effective help for my SP. Its really getting me down about how slow progress is, to the point where I end up more depressed after a doc's appointment then before hand. Also I'm withdrawing from 2 years off efexor and I'm sure that's not exactly helping my situation.

I'm in a bit of a rut at the moment, I really don't know what to do - I want to do what my doctor thinks best, yet I really feel he is not knowledgable about progressive SP meds etc. He wants to try a tri-cyclic, but I have very little faith in this helping, as I have never seen any clinical or anecdotal reports of this working for SP. Of course, correct me if I'm wrong!

I wrote a letter to him concerning things I was interested in - pregabalin, amisulphide, clonazepam, MAOIs - but I don't think he took my suggestions very seriously. He is reluctant to use amisulphide but hasn't ruled it out, although I feel I would have to go through months of benign drugs before he prescribes it, so that is out for the forseeable future. Ditto for benzos, and he is typical of UK docs in that he prescribes very short term valium only, and I would want something more long-term. Pregabalin we didn't really talk about, but I don't think he's the type that would prescribe something so new off-label.

The main point of this post (sorry for the life story) is that he would be willing to prescribe an MAOI instead of a tricyclic. I feel in a bit of a catch 22 situation. I think that Nardil would have, out of all the drugs, possibly the best effect for my symptoms (atypical depression, social anxiety, mild ADD), yet I have a difficult time deciding if I could cope with the extras it brings. The thing is, I am 18 years old, and fear that the restrictions and side effects might prevent me from doing things people my age do, which kind of undermines the purpose of treating SP. I'm not too bothered about weight gain, but the anorgasmia is discouraging. I have something of an over-active libido, do you think this would counter-act nardil's sexual effects to a degree? And do you think that the fact I had no sexual impairment on efexor suggests would suggest they wouldn't be too much of a prob on nardil?

I think I'm fine with the diet, apart from alcohol. Obviously I will have to forget about narcotics - XTC, coke etc (not that I've done them). I'm not a heavy drinker but it forms the basis of most my social occassions, in England the age limit is 18 so that's what myself and my peers are into. I'm very confused as to the danger of this - some people say everything's fine apart from tap beer and aged spirits, others (like my doctor) say alcohol is out, period. I was wondering what people's opinions on semi regualar, social drinking would be. Although I know he is ignorant about the revised diets, I can't help feeling reluctant to go against his advice. I haven't yet discussed this with him, and am reluctant, as I fear my liberal attitude might clash with his old-fashioned MAOI attitude.

Sorry for the rant people. I think 50% of the purpose of this was to get some opinions, but 50% to just get stuff off my chest.

Thanks for reading, John :)

 

Re: Best choice SP med in the UK? MAOIs?

Posted by crazychickuk on November 22, 2004, at 9:10:48

In reply to Best choice SP med in the UK? MAOIs?, posted by jclint on November 22, 2004, at 8:13:43

May i ask why u r tapering of the effexor?

I know what you mean about the uk docs very reluctant to give out benzo's .. do you see a physciatrist ? If you were hospilized u would beable to get a benzo pretty much right away..

 

Re: Best choice SP med in the UK? MAOIs? » jclint

Posted by King Vultan on November 22, 2004, at 9:46:46

In reply to Best choice SP med in the UK? MAOIs?, posted by jclint on November 22, 2004, at 8:13:43

>
> I'm in a bit of a rut at the moment, I really don't know what to do - I want to do what my doctor thinks best, yet I really feel he is not knowledgable about progressive SP meds etc. He wants to try a tri-cyclic, but I have very little faith in this helping, as I have never seen any clinical or anecdotal reports of this working for SP. Of course, correct me if I'm wrong!
>


I found tricyclics helpful for my SP (80% effectiveness vs. SSRIs and Effexor at about 50%), but the relief came about because tricyclics were much better at reducing my panic attack like symptoms that I experience in certain social situations. In general, I have no great fear of people; my fear is of the runaway, profuse sweating that will sometimes strike me while I'm talking to someone or standing in a line at a store--situations where I tend to feel "trapped."



> The main point of this post (sorry for the life story) is that he would be willing to prescribe an MAOI instead of a tricyclic. I feel in a bit of a catch 22 situation. I think that Nardil would have, out of all the drugs, possibly the best effect for my symptoms (atypical depression, social anxiety, mild ADD), yet I have a difficult time deciding if I could cope with the extras it brings. The thing is, I am 18 years old, and fear that the restrictions and side effects might prevent me from doing things people my age do, which kind of undermines the purpose of treating SP. I'm not too bothered about weight gain, but the anorgasmia is discouraging. I have something of an over-active libido, do you think this would counter-act nardil's sexual effects to a degree? And do you think that the fact I had no sexual impairment on efexor suggests would suggest they wouldn't be too much of a prob on nardil?
>

Your experience with Effexor is encouraging. Nardil doesn't cause orgasm difficulties for 100% of patients, but I'm guessing it's somewhere in the range of 20-50%. That still leaves a fair number who won't experience much of a problem.


> I think I'm fine with the diet, apart from alcohol. Obviously I will have to forget about narcotics - XTC, coke etc (not that I've done them). I'm not a heavy drinker but it forms the basis of most my social occassions, in England the age limit is 18 so that's what myself and my peers are into. I'm very confused as to the danger of this - some people say everything's fine apart from tap beer and aged spirits, others (like my doctor) say alcohol is out, period. I was wondering what people's opinions on semi regualar, social drinking would be. Although I know he is ignorant about the revised diets, I can't help feeling reluctant to go against his advice. I haven't yet discussed this with him, and am reluctant, as I fear my liberal attitude might clash with his old-fashioned MAOI attitude.
>

I think you have it right that as long as you avoid tap beer and aged spirits, you would probably be fine. Nardil is also substantially more forgiving than Parnate is. I have some information on this that goes into the subject in excruciating detail but don't really have any way of e-mailing it. If you have a really strong interest, I could perhaps send it via post.

Todd

 

Re: Best choice SP med in the UK? MAOIs?

Posted by jclint on November 22, 2004, at 10:05:34

In reply to Re: Best choice SP med in the UK? MAOIs?, posted by crazychickuk on November 22, 2004, at 9:10:48

> May i ask why u r tapering of the effexor?

I was chronically tired, and very depressed, so not much point in taking it. It didn't help my SP at all. I need 2 come off it before another antidepressant, which realistically is the only thing I'm going to be prescribed in the near future.

> I know what you mean about the uk docs very reluctant to give out benzo's .. do you see a physciatrist ? If you were hospilized u would beable to get a benzo pretty much right away..

Yes I see a psychiatrist. He's private, but I'm going to go on the NHS asap. I really can't imagine any advantages of me seeing this guy over a NHS one, he's not very liberal.

It sucks so much, I wouldn't choose to go down this MAOI route but I'm not being given any effective options. It seems like the only things given for anxiety here are antidepressants.

:(

 

Re: Best choice SP med in the UK? MAOIs? » King Vultan

Posted by jclint on November 22, 2004, at 10:16:38

In reply to Re: Best choice SP med in the UK? MAOIs? » jclint, posted by King Vultan on November 22, 2004, at 9:46:46

> I found tricyclics helpful for my SP (80% effectiveness vs. SSRIs and Effexor at about 50%), but the relief came about because tricyclics were much better at reducing my panic attack like symptoms that I experience in certain social situations. In general, I have no great fear of people; my fear is of the runaway, profuse sweating that will sometimes strike me while I'm talking to someone or standing in a line at a store--situations where I tend to feel "trapped."
>

That's interesting. There's something about that class of drug that seems a bit blah though... I think if I'm going to do the antidepressant thing I want one with the best track record for my symptoms, and it seems nardil has that accolade.

> Your experience with Effexor is encouraging. Nardil doesn't cause orgasm difficulties for 100% of patients, but I'm guessing it's somewhere in the range of 20-50%. That still leaves a fair number who won't experience much of a problem.
>

I guess its easy to forget the ones who don't have such side effects when you're on somewhere like here. I'm probably asking a bit much to be even in a situation where I'll need to 'perform', but the thought of being an 18 year old asexual male is not appealing :p

> I think you have it right that as long as you avoid tap beer and aged spirits, you would probably be fine. Nardil is also substantially more forgiving than Parnate is. I have some information on this that goes into the subject in excruciating detail but don't really have any way of e-mailing it. If you have a really strong interest, I could perhaps send it via post.
>
> Todd

I appreciate that Todd. Don't worry about it for now, but I'll keep that in mind, it might be very useful. I've been encouraged by the fact that on here, people seem to report crises from a small amount of *unsafe* drinks like tap beer, but none from people who had them after accumulating several *safer* drinks. It seems one can tell pretty quickly if something is dangerous or not. Not planning on going over the top though, obviously.

 

Re: Best choice SP med in the UK?-jclint

Posted by crazychickuk on November 22, 2004, at 10:30:02

In reply to Re: Best choice SP med in the UK? MAOIs? » King Vultan, posted by jclint on November 22, 2004, at 10:16:38

How did u go about seeing a private physc ? did u have to be refered via your gp ?

good luck with the nhs physcs ...

 

Re: Best choice SP med in the UK?-jclint » crazychickuk

Posted by jclint on November 22, 2004, at 10:36:37

In reply to Re: Best choice SP med in the UK?-jclint, posted by crazychickuk on November 22, 2004, at 10:30:02

> How did u go about seeing a private physc ? did u have to be refered via your gp ?
>
> good luck with the nhs physcs ...

Yes my family asked for me to be referred. I realised that most private docs work on the NHS also - the one I'm seeing now only comes into the private hospital a couple of times a week, for the majority he's on the NHS. So in that respect, there really is not much difference :) It seems the only thing my family have been paying for (and paying a LOT) is flexibility in appointment times and abundant wildlife outside the windows.

 

Re: Best choice SP med in the UK? MAOIs?

Posted by ed_uk on November 22, 2004, at 10:38:24

In reply to Re: Best choice SP med in the UK? MAOIs?, posted by jclint on November 22, 2004, at 10:05:34

To John,

I wouldn't worry too much about the restrictions that an MAOI may bring. They're unlikely to be as bad as the restrictions that SP brings! As far as the sexual side effects go, if you did get them on Nardil you could always try Parnate instead. I don't think that you should let this get in the way of trying a potentially effective treatment.

Info..........

Nardil=phenelzine
Parnate=tranylcypromine
Manerix=moclobemide
Hypotension=low blood pressure
Hypertension=high BP
Syncope=fainting (you probably know all this anyway but I decided to mention it anyway just in case you didn't, please don't be offended!!!)

Monoamine oxidase inhibitors (MAOIs) + Tyramine-rich drinks

Patients taking the older MAOI (tranylcypromine, phenelzine, nialamide, pargyline, etc.) can suffer a serious hypertensive reaction if they drink some tyramine-rich drinks (some beers, lagers or wines), but no serious interaction is likely with the newer reversible and selective MAOIs (moclobemide, etc.). The hypotensive side-effects of the MAOIs may be exaggerated in a few patients by alcohol and they may experience dizziness and faintness after drinking relatively modest amounts.

Clinical evidence, mechanism, importance and management
(a) Hypertensive reactions
A severe and potentially life-threatening hypertensive reaction can occur in patients on MAOIs if they take alcoholic drinks containing significant amounts of tyramine. A dose of 10–25 mg tyramine is believed to be required before a serious rise in blood pressure takes place.

Remember: All alcoholic drinks are the end-product of a biological fermentation process and no two batches are ever absolutely identical. For example there may be a 50-fold difference even between wines from the same grape stock. There is no way of knowing for certain the tyramine-content of a particular drink without a detailed analysis.

(i) Ales, Beers and Lagers
Some ales, beers and lagers in ‘social’ amounts contain enough tyramine to reach the 10–25 mg threshold dosage, for example a litre (a little under two pints) of some samples of Canadian ale or beer. A man on phenelzine developed a typical hypertensive reaction after drinking only 15 oz. (a little less than 0.5 L) of Upper Canada lager beer on tap (containing about 45 mg tyramine/l). Alcohol-free beer and lager may have a tyramine-content which is equal to ordinary beer and lager. One patient on tranylcypromine suffered an acute cerebral haemorrhage after drinking a de-alcoholised Irish beer, and hypertensive reactions occurred in four other patients after drinking no more than 375 ml (&#8532; pint) of alcohol-free beer or lager. A very extensive study of 79 different brands of beer (from Canada, England, France, Holland, Ireland, Scotland, USA) found that the tyramine content of the bottled and canned beers examined was generally too low to matter (<10 mg/l), but four beers (all identified as being on tap) contained more than enough tyramine (26–112 mg/l) to cause a hypertensive reaction. It was concluded in this report that the consumption of canned or bottled beer, including de-alcoholised beer, in moderation (fewer than four bottles, 1.5 L in a four-hour period) was safe, but ales, beers and lagers on tap should be avoided. However the safety of all de-alcoholised beers is clearly still uncertain.

(ii) Spirits
Gin, whiskey, vodka and other spirits do not contain significant amounts of tyramine because they are distilled and the volumes drunk are relatively small. There seem to be no reports of hypertensive reactions in patients taking MAOIs after drinking spirits and none would be expected.

(iii) Wines
In the context of adverse interactions with MAOIs, Chianti has developed a sinister reputation because 400 ml of one early sample of Italian Chianti wine contained enough tyramine to reach the 10–25 mg threshold dosage. However, it is claimed by the Chianti producers and others that the newer methods which have replaced the ancient ‘governo alla toscana’ process result in negligible amounts of tyramine in today’s Chianti. This seems to be borne out by the results of recent analyses two of which failed to find any tyramine at all in some samples. In conclusion, small or moderate amounts (1–2 glasses) are unlikely to be hazardous.

(b) Hypotensive reactions
Some degree of hypotension can occur in patients on MAOIs (therapeutically exploited in the case of pargyline) and this may be exaggerated by the vasodilation and reduced cardiac output caused by alcohol. Patients should therefore be warned of the possibility of orthostatic hypotension and syncope if they drink. They should be advised not to stand up too quickly, and to remain sitting or lying if they feel faint or begin to ‘black out’.

(c) Other reactions
In addition to the hypertensive and hypotensive reactions described in (a) and (b), the possibility that the alcohol-induced deterioration in psychomotor skills (i.e. those associated with safe driving) might be increased by the MAOIs has also been studied. Moclobemide appears to have only a minor and clinically unimportant effect and brofaromine and befloxatone do not interact with alcohol.

Regards,
Ed

 

Re: Best choice SP med in the UK? MAOIs? » ed_uk

Posted by jclint on November 22, 2004, at 10:51:13

In reply to Re: Best choice SP med in the UK? MAOIs?, posted by ed_uk on November 22, 2004, at 10:38:24

Ed, that's extremely helpful. You are a great asset to this board.

I agree that I will probably be more than happy to accept some side effects in exchange for my SP, but I get hesitant some times. I guess my main worry is the lack of hard facts about alcohol interaction, I am angry at the neglect these old meds get dispite the clear advantages for some conditions. The fact that after 50 years, a lot of patients (like myself) are being told ALL cheese and alcohol (amoungst other things) are off limits seems pretty poor.

I need to think on a day by day basic, rather than a long term one... I think I'm just going to go for the nardil and weigh up the pros and cons once I actually know what they are.

Thanks again ed.

PS I wonder if Ace will be around to add his 2 cents? :)

 

Re: Best choice SP med in the UK? MAOIs? » jclint

Posted by ed_uk on November 22, 2004, at 11:38:12

In reply to Re: Best choice SP med in the UK? MAOIs? » ed_uk, posted by jclint on November 22, 2004, at 10:51:13

John, you're more than welcome!

Personally, I only really drink stuff with vodka in it so I'd probably be OK if I was on an MAOI!
Fainting isn't as bad as having a hypertensive crisis and anyway only some people get low blood pressure on alcohol.

All the best...
Ed

 

Re: Best choice SP med in the UK? MAOIs?

Posted by Ted Brosnan on November 22, 2004, at 12:07:18

In reply to Best choice SP med in the UK? MAOIs?, posted by jclint on November 22, 2004, at 8:13:43

Hello ed_uk! and all the nice ppl here:)

Today I got a letter from a psychiatrist who says that he would love to help me and he can rx a MAOI after examination.

I won't get appointment before february but that is fine with me.

Looks like he has more experience with Nardil than with Parnate.

I understand that the sexual side effects would go away after 2-4 months. But would they really go away completely?!

Would Parnate be more helpful for ADD than Nardil?

I need first to get a diagnosis of ADHD. If I get it then I would have the right to ask for dextroamphetamine. This is thought to help both SA and ADHD. Any thoughts ?!

Best wishes,
Ted.

 

Re: Best choice SP med in the UK? MAOIs?

Posted by TheOutsider on November 22, 2004, at 17:08:54

In reply to Best choice SP med in the UK? MAOIs?, posted by jclint on November 22, 2004, at 8:13:43

> Hi guys I feel the need to let off a bit of steam here. For the past 6/7 months I have been geared towards getting effective help for my SP. Its really getting me down about how slow progress is, to the point where I end up more depressed after a doc's appointment then before hand. Also I'm withdrawing from 2 years off efexor and I'm sure that's not exactly helping my situation.
>
> I'm in a bit of a rut at the moment, I really don't know what to do - I want to do what my doctor thinks best, yet I really feel he is not knowledgable about progressive SP meds etc. He wants to try a tri-cyclic, but I have very little faith in this helping, as I have never seen any clinical or anecdotal reports of this working for SP. Of course, correct me if I'm wrong!
>
I can completely sympathise with your predicament, I am also finding it very difficult to get decent social anxiety treatment in the UK.
At the moment I am really feeling down about it.

You are quite right to be wary of trying tri-cylics, I was on Clomipramine for three months and it did very little for my Social Anxiety.
If your being offered the chance to try MAOIs I would take it.

 

Re: Best choice SP med in the UK? MAOIs?

Posted by ed_uk on November 23, 2004, at 6:30:49

In reply to Re: Best choice SP med in the UK? MAOIs?, posted by Ted Brosnan on November 22, 2004, at 12:07:18

Hi Ted!

I'm glad to hear that you'll be getting an appointment. Unfortunately, no one will be able to tell you for sure whether the sexual side effects would go away after 2-4 months, the only way to find out would be to try the MAOI and see what happens!!

To be fair, neither Nardil nor Parnate has been well studied in ADHD but theoretically Parnate (tranylcypromine) might be better.

Here is a little study...


Arch Gen Psychiatry. 1985 Oct;42(10):962-6. Related Articles, Links


Treatment of hyperactive children with monoamine oxidase inhibitors. I. Clinical efficacy.

Zametkin A, Rapoport JL, Murphy DL, Linnoila M, Ismond D.

Fourteen boys (mean age, 9.2 +/- 1.5 years) with Attention Deficit Disorder (ADD) With Hyperactivity were treated with dextroamphetamine sulfate or a monoamine oxidase inhibitor (MAOI) (six received clorgyline, eight received tranylcypromine sulfate) for four weeks each in a double-blind, cross-over study that included a two-week placebo washout between active drug periods. The MAOIs had immediate, clinically significant benefit and were clinically indistinguishable from dextroamphetamine. Most children responded to both stimulant and MAOI. These findings of equivalent efficacy of MAOIs in ADD are in contrast to our previous studies with neurotransmitter system selective agents, which showed only weak effects, and suggest that multiple neurotransmitter alterations may be required for stimulant drug effects in ADD. The immediate response to MAOIs indicates a different mechanism from that mediating antidepressant effect. The MAOIs may be useful alternate treatments in selected cases of ADD.


All the best...
Ed.

 

Re: Best choice SP med in the UK? MAOIs? » Ted Brosnan

Posted by King Vultan on November 23, 2004, at 12:30:47

In reply to Re: Best choice SP med in the UK? MAOIs?, posted by Ted Brosnan on November 22, 2004, at 12:07:18

> Hello ed_uk! and all the nice ppl here:)
>
> Today I got a letter from a psychiatrist who says that he would love to help me and he can rx a MAOI after examination.
>
> I won't get appointment before february but that is fine with me.
>
> Looks like he has more experience with Nardil than with Parnate.
>
> I understand that the sexual side effects would go away after 2-4 months. But would they really go away completely?!
>
> Would Parnate be more helpful for ADD than Nardil?
>
> I need first to get a diagnosis of ADHD. If I get it then I would have the right to ask for dextroamphetamine. This is thought to help both SA and ADHD. Any thoughts ?!
>
> Best wishes,
> Ted.


I have some ADD symptoms related to distractibility, poor concentration, and lack of motivation. My own experience with Nardil and Parnate is that Parnate is dramatically superior for my symptoms. However, I did at least find Nardil far superior to Zoloft or Effexor for the ADD symptoms in my case.

Todd

 

SP please?

Posted by Clarinette on November 24, 2004, at 1:53:01

In reply to Best choice SP med in the UK? MAOIs?, posted by jclint on November 22, 2004, at 8:13:43

John,

I'm very interested in what's going on in the UK, my sister lives there. Sorry, but I've been living in France too long and I can't work out all of the abbreviations, what's SP? Then I may be able to make some sense of your post!

Bises,
Clara

 

Re: SP please? » Clarinette

Posted by jclint on November 24, 2004, at 3:50:06

In reply to SP please?, posted by Clarinette on November 24, 2004, at 1:53:01

Hi Clara.

Sorry for not being specific. I meant SP as in Social Phobia, or Social Anxiety.

:)

 

Re: Best choice SP med in the UK? MAOIs? » jclint

Posted by Tepiaca on November 25, 2004, at 20:38:36

In reply to Best choice SP med in the UK? MAOIs?, posted by jclint on November 22, 2004, at 8:13:43


> The main point of this post (sorry for the life story) is that he would be willing to prescribe an MAOI instead of a tricyclic. I feel in a bit of a catch 22 situation. I think that Nardil would have, out of all the drugs, possibly the best effect for my symptoms (atypical depression, social anxiety, mild ADD), yet I have a difficult time deciding if I could cope with the extras it brings. The thing is, I am 18 years old, and fear that the restrictions and side effects might prevent me from doing things people my age do, which kind of undermines the purpose of treating SP. I'm not too bothered about weight gain, but the anorgasmia is discouraging. I have something of an over-active libido, do you think this would counter-act nardil's sexual effects to a degree? And do you think that the fact I had no sexual impairment on efexor suggests would suggest they wouldn't be too much of a prob on nardil?
>

Don let this stop you from trying Nardil . You can be one of the lucky ones that does not suffer anorgasmia . Besides , time help to overcome this problem. In my case , now on 45mg I dont have it . When I was on 60mg I spent more time to have and orgasm , but it was still possible and the orgasm was more pleasant . 75mg was the dose in wich I couldn´t have an orgasm


> I think I'm fine with the diet, apart from alcohol. Obviously I will have to forget about narcotics - XTC, coke etc (not that I've done them). I'm not a heavy drinker but it forms the basis of most my social occassions, in England the age limit is 18 so that's what myself and my peers are into. I'm very confused as to the danger of this - some people say everything's fine apart from tap beer and aged spirits, others (like my doctor) say alcohol is out, period. I was wondering what people's opinions on semi regualar, social drinking would be. Although I know he is ignorant about the revised diets, I can't help feeling reluctant to go against his advice. I haven't yet discussed this with him, and am reluctant, as I fear my liberal attitude might clash with his old-fashioned MAOI attitude.
>
I have drink all many kinds of wines and get drunk on nardil . Although this is not something I recommend you . Everyone is different . Besides depression become stronger.
I have drink , whisky , vodka , beer(no tap beer), ron , and many more


Good luck in your decisition
Tep

 

UK health care

Posted by Clarinette on November 29, 2004, at 8:56:54

In reply to Best choice SP med in the UK? MAOIs?, posted by jclint on November 22, 2004, at 8:13:43

Hello John, and thanks for the SP precision ( I ought to have guessed the doc diagnosed me as suffering from social phobia along with BPII1/2 and cylothymic ) .

I don't really know much about what you're taking as my drugs are all geared to bipolar. I take three mood regulaters; Lamictal which works against depression, Depakine which works against the highs which I'm phasing out, and Rivotril ahainst the highs. However, if all of this helps with the BP, maybe the SP will get better too!

I can relate to your questions about social drinking, I can remember being a twenty year old student (I'm now a 33 year old hôtesse de l'air! ) . Just this weekend I was at a family get together ( in-laws), where the wine never stops flowing. Well I just drank sparkling water and a small glass of champagne. Ok, I'm sure it's easier for me, it's not at all the same social situation. But I don't know these meds very well yet, and I'm a bit concerned about the interaction with alcohol. Step by step. Also, I'm a pretty heavy grass smoker, so I have that to consider too.

I agree that the british system is somewhat en retard, running behind the rest of the world, concerning mental health care at least. I live in France and benefit from treatment from the top specialists in Paris, paid for by the social security and my work health insurance. My sister lives in the uk. I have worked out that she is BPI, but the only diagnostic she as ever had was maniaco depressive, about 14 years ago! Her psychiatrist was so stupid that he encouraged her to come off lithium because she hadn't had a manic episode for 10 years! Eight months later, predictably, she had a manic episode that ended with her being arrested and sectioned. Five months after being out of hospital, she has an appointment in one months time to see if it is necessary to put her on a waiting list to see a psychologist!

In the mean time she is being treated by her GP, who has prescribed her antidepresseurs, without giving a moments thought to the fact that she's just come out of a manic episode, and anti depresseurs are reknown for inducing manic episodes ...

Anyway, all that ranting and raving ( sorry ) to say that I empathize with your probleme with the British health care systeme, it really is below the mark.

Best wishes, bises,
Clara

 

Re: Diagnosis in the UK

Posted by ed_uk on November 29, 2004, at 9:51:27

In reply to UK health care, posted by Clarinette on November 29, 2004, at 8:56:54

Hi,

Some UK psychiatrists use the ICD rather than the DSM. They have many similarities though. There seems to be much more emphasis on the DSM in the US than there is in England.

In the UK, 'bipolar disorder' isn't really an everyday term. Most people are familiar with the concept of manic depression though. Also, there's less emphasis on whether people are bipolar I or bipolar II, people are often just diagnosed with 'bipolar affective disorder.'

I'm hardly the world's greatest fan of the DSM! I'm rather glad that it isn't taken so seriously here.

Ed.

 

the importance of correct bp diagnosis

Posted by Clarinette on November 30, 2004, at 4:43:31

In reply to Re: Diagnosis in the UK, posted by ed_uk on November 29, 2004, at 9:51:27

Salut Ed,

Whilst I agree that looking for and sticking too closely to a diagnostic (especially as in the bipolar spectre, we can move fairly easily from one to another )is not a good idea, I feel that the right diagnostic is essential for finding the right treatment.If the shrinks are vague or unsure of their diagnostic, you can be assured the treatement will be of the same level!

Here is a link to a page which gives two principal bp defenitions:

http://www.psycom.net/depression.central.lieber.html

The diagnostic proposed by the specialist that I see comes from Akiskals schema. Its all fairly well explained.

Bonne journée à toi,
Bises,
Clara


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[dr. bob] Dr. Bob is Robert Hsiung, MD, dr-bob@uchicago.edu

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