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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by jealibeanz on May 16, 2006, at 11:21:08
Sorry, this is a long one... send me a bill!
OK, I have one more chance to get some help before my grad school is supposed to start a week from today. I still haven't signed a lease because I'm not sure if I'll go yet.
I don't know how to clearly explain the gravity of my situation and to get someone to take me seriously, not making their own weird assumptions.
OK, I have social anxiety. That is true. I believe I can show that with a survey that I filled out (Leibowitz I believe). I'm fairly comfortable with giving him that. I haven't found a good survey that I can fill out for general anxiety and depression. Some are too vague. I'm not even sure if I have ADHD. That complicates things. I think alot of my concentration problems are caused by anxiety and depression, but maybe ADHD also plays a part.
I would like a benzo (maybe not good if I have ADHD and am going to a medical school, however, maybe I'm not cut out for the field and should do something easy where I can just be mildy drugged and relaxed!). I realize that it is not a magical cure, but it does help to some extent. I'm too nervous around such large groups of people, especially such a competitive and professional group, to go to this new school without something to relax me! It's the truth. I want the opportunity to take this chance and at least give this school and profession a shot. A little medication can at least get me to drive to the school and sit down!
I'm not always terrrible socially anxious. I went to London last year for study abroad. I was outgoing, for me, and happy. I interviewed and toured for grad school. I was able to impress them. However, for the most part, I am socially anxious and introverted. Right now I am. I basically always have been. Does that fact mean I don't mean medication to help because it's a part of my personality? What are most docs view on this?
I am beginning to get depressed now. I don't want to do anything. I want to sleep most of the time! I don't want to work out, which is something I usually love love love to do! (I do it anyway still). I could care less about school right now. I have a paper due on Wednesday and a final tomorrow. I barely feel like going. (I will force myself to put in a half-*ss effort, just for the sake of not screwing myself over) If I don't, I won't graduate! I don't care about going to the ceremony, not that I don't want to, but I am somewhat numb right now. Talk about apathy! I am taking Straterra and Provigil right now. They are considered antidepressants. I can't imagine how I'd be without them.
So, what are docs stance on medication for depression? More likely if it's caused by outside factors, or biological factors? If I've failed on several drugs before, will most think I'm hopeless? Certainly the ones I've talked to so far have. I don't even feel like I've had fair trials anyway. Both Paxil and Buspar were stopped after 2 weeks for weight gain. Wellbutrin, may have stopped depression, not sure, but not anxiety, well, it's not supposed to. Effexor actually did help at first. I played doctor at first and significantly increased my dosage the first two weeks, I felt great. However, my doc didn't like that of course. We went back down to the normal dosage. Eventually, I became severly apathetic (too high?) and stopped. Plus, the weight gain would have led me to stop it anyway.
Many of my depressions start in the fall, I realize that's a little different than most depressions, but still, they're real. Sometimes they're caused by stress, sometimes nothing identifiable. Right now, in my life, I have a lot of stress from school. I have a lot of anxiety about trying to figure out my life. If I want to go more toward the route of outside factors (beside my own inflictions), my grandparents in town have been in a out of the hospital constantly over the past month. They are deteriorating severely mentally and physically. My great aunt has now been hospitalized for a broken hip. My other grandfather has cancer, which he refuses to treat, because he wants to be well enough to take care of my other ailing grandmother. So, if I want to give some outside causes, I can. I've never been terribly happy. Does this mean I am unchangeable through medication? I thought dysthymia is treatable. The last few docs I've talked to just think I'm doomed to be slightly unhappy, anxious, and uncomfortable.
So, I want to give evidence of dehabilitating anxiety and depression, worthy and attention and medication. As I've said before, I want a daily, not "as needed", benzo, at least for the short term. I refuse to take another SSRI. I'd like to consider EMSAM. I just read that MAOI's aren't likely to be effective if Effexor was already tried. I wouldn't say Effexor didn't help, but I didn't like all the side effects. Actually, it did pull me out of the deep depression I was in, just left my unemtional, along with other effetcs, so I stopped. I am still weary of weight gain and fear that it will not help, but I feel it's worth a try. Do you know if docs are afraid of trying this medication since it's an MAOI and not "first line treatment"? (I'm not new to this game though, have had several antidepressants and a few benzo trials. I suppose this qualifies me as treatment resistant.) I don't want any other MAOI's because of the weight issue.
I don't know if I should ask to continue the Straterra or not. I think it does help with concentration. I only have a few more tablets of Provigil left. I'm scared now! I have always been one to take multiple naps a day, and always groggy, no matter how well I sleep and how healthy I am. Isn't that a common feature of anxiety and depression? I can't imagine trying to get through a day productively without it. I've been this way since college.
I think I just will tell him that I was from a doc years ago for depression related fatigue. I can't inidcate that it's from my current doctor, since he could tell me to go back there and get refills if he does not approve of its use for me. I had saved a large supply and have been taking it for months. This is the first time in years I can remember feeling normal in terms of wakefullness throughout the day. This is all true, very true. I'm just afraid he doesn't approve of the drug and will say no. I'm not telling him about Lunesta. I can get more on my own. That issue just complicates things.
I realize that I'm asking for a lot at an initial appointment. I don't want to come off as too desperate and drug seeking. That probably shows signs of my so called "personality problem" than run of the mill anxiety and depression. However, I need to make him understand that he is my last hope to get myself a stepping stone to graduate school. I need to be aggressive enough to show him that. I don't know if I should let him know that I've seen my regular GP (although it's been ongoing for years now), a psychiatrist, and two new GP's all within the last month, and have not gotten what I want. That indicates some sort of problem with me and I realize that.
I'm afraid the benzo fatigue won't go away. Whenever I take my tiny Xanax .25mg, I want to sleep, and take an hour long nap. That's barely enough to put a dent in my anxiety too. I do feel that's it's slightly depressing, but the depression probably comes from the hopelessness that I'm sleeping my life away. I like to be productive. It may have to do with timing of the drug. I've taken it after very long intense workouts, where I'm likely to be tired anyway. Do docs usually shy away from augmenting benzos with Provigil?
I appologize for the incredibly long post. I'd truely appreciate any advice you can give!
Posted by JaclinHyde on May 16, 2006, at 12:14:34
In reply to Help! Extreme Anxiety... seeing a new pdoc soon., posted by jealibeanz on May 16, 2006, at 11:21:08
I can answer a few of your questions regarding MAOI's having taken them for over 25 years for extreme panic attacks and depression. First of all I don't know where you heard that if Effexor (or 'side-effexor' as my pdoc likes to call it ;-) doesn't work then the MAOI's won't because that couldn't be further from the truth. The MAOI's are in their own class and very different from any other AD. As for the weight issue I am the same way having had a gastric bypass back in '99 and absolutely refuse to take any med that will pack on weight. Weightloss on the MAOI Parnate is the norm, not weight gain. Marplan, another MAOI and the one I take seems to fall in the middle. For some people it causes weightloss and for some weight gain. Others still do not see any effect on their weight at all. Nardil is known for it's weight gain properties so that is the one to stay away from if weight is an issue.
If you have any more questions about the MAOI's feel free to ask! :-)
JH
Posted by lymom3 on May 16, 2006, at 12:17:15
In reply to Help! Extreme Anxiety... seeing a new pdoc soon., posted by jealibeanz on May 16, 2006, at 11:21:08
Of course I managed to not post my last post but the bottom line is that I think you are pushing yourself hard in a direction that you are not even sure that you want to go. You have the added stressors of your family. It sounds like they are all elderly and unfortunately it can happen for all of them to get sick at once. My grandmother was one of 13 children and there were some really horrible times when they were all sick at the same times.
I don't know that there is a medication in the world that can fix the fact that you are pulled in so many different directions. Grad school will still be there next year. I have a stepdaughter that is 1 year away from her PhD, so I know how big (and maybe ridiculous sounding) statement that might be but I really think you need some down time for you. It is great that you have ambitions for yourself and want to give school a shot..but at what cost to yourself?
Finding a good doc is so hard. I think questionnaires are a good tool. You have such limited time that anything consolidated that you can give a doc to look at is a good thing IMO. The best thing to tell the pdoc and the easiest thing to remember is the truth. If you feel a need to lie or bend the truth to get the meds that you want, then maybe that in and of itself is worth a second look?
Best of luck to you no matter what you decide..
Posted by jealibeanz on May 16, 2006, at 12:18:21
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc soon., posted by JaclinHyde on May 16, 2006, at 12:14:34
Would it be unreasonable to suggest an MAOI from a new doc? What's your diagnosis?
Posted by jealibeanz on May 16, 2006, at 15:36:36
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc soon., posted by lymom3 on May 16, 2006, at 12:17:15
I know I'm definitely not at a point in my life where I want to be going to school, however, putting it off would be a life changing decision. It's a medical program. Admission is tough. Applications are a nightmare. Interviews are required. A sudden remission from life after previously being accepted is tough to explain. Recommendations would be very difficult to obtain after being away from the college setting.
Posted by lymom3 on May 16, 2006, at 15:50:44
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc soon., posted by jealibeanz on May 16, 2006, at 15:36:36
No doubt...I know that. It's just a tough call. How much can you handle without breaking if you don't find a med that works...You have the rest of your life ahead of you, no matter what you choose to do with it. How many more years of med school and residency with ungodly expectations from you? The mom in me is kicking in, I guess.
I don't know how you catch a break there. With the limited time they ever give you for appointments, write down everything you can ahead of time. I do that because the doc can read along the bullet points and ask me questions as needed. Less time with him taking notes and fishing for questions. Listing out the meds you've tried already is a time saver too. If these are things you've already done, I apologize in advance.
I also find that if there is any meds I do want to ask about or try, or ones that I don't , the bullet points are helpful there too. He can readily see your concerns in a concise format and you also look somewhat prepared and at least have some intelligent thoughts and questions for him.
Good luck!!!
Posted by Jost on May 16, 2006, at 20:29:31
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc soon., posted by lymom3 on May 16, 2006, at 15:50:44
What particular aspect of the situation are you most concerned about?
Is it how to present yourself to a new doctor so as to get something helpful? Something that, perhaps, you have an idea about, which you're afraid whoever it is won't go along with--?
This is a scenario that I often struggle with--not trusting others -to have the skills, patience, empathy or respect for me that I think would lead to their actually figuring out what would help.
I don't have any great answers for how to deal with this, except to try to have a little more faith in other people, and yourself. Other people to want to be helpful if they can, and yourself to take seriously your right to be helped, and to look further if the first or second person isn't helping--not to blame yourself, or give up hope.
It's hard, but it's all I've come up with--
Jost
Posted by RobertDavid on May 16, 2006, at 20:53:29
In reply to Help! Extreme Anxiety... seeing a new pdoc soon., posted by jealibeanz on May 16, 2006, at 11:21:08
Wow, lots going on for sure! I'll just give you my take on meds that I'd go straight to for your Social Anxiety (I have it too).
Klonopin. It's long acting and I'd take it at night as it has a long half life and could last through the next day. I've done that for 12 years. It was the only thing that knocked out my social anxiety. Key with it is taking enough to be effective. Most with social anxiety land somewhere between 1 and 4 mgs though some get away with less and a few need more. The sedation side effects go away, but not the anxiety relief. It will also help you sleep particularly for the first few weeks.
You mention depression as well. It's my take that many that have SAD as a primary disorter also have to deal with depression. Probably klonopin will need to be augmented with something to help with your energy and depression. You mentioned your having luck with Provigil. Provigil is a mild stimulant that may also help mood. It can blend well with klonopin. That was that second best combo I did before blending klonopin with EMSAM.
I'd go with klonopin at bedtime and keep taking Provigil in the morning. Find the doses that work best and I think you'll feel much better and better quick. If Provigil doesn't do the job, then you'll need to find another med/anti depressant to go with klonopin.
Social Anxiety stinks. In my opinion the best meds to treat it are klonopin and or an MAOI. Since you don't want the weight issue Nardil might be a problem, but helps many with social anxiety and depression.
If it were me, I'd try klonopin. Unlike other meds you'll know in a short period of time if your getting relief and if you like it. It's safe and effective and lots of people take it. You need to have a doctor that's not benzo phobic.
Just my take on it. I hope things work out for you. Rob
Posted by jealibeanz on May 16, 2006, at 21:06:32
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc soon. » jealibeanz, posted by RobertDavid on May 16, 2006, at 20:53:29
I've used Klonopin before. It caused major depression when combined with Adderall, so I was taken off. By itself, it's so sedating! Combinded with Straterra and Provigil, it's ok, still a little sedating, maybe mildly depressive. I need probably 1 or 1.5 mg Klonopin a day, but it's too sedating. How much Provigil can one take? I have used 400 will not ill side effects, but it's not quite enough to combact Klonopin fatigue. Rob, what kind of work do you do? I'm wondering how limited people are in their careers from SA
Posted by RobertDavid on May 16, 2006, at 21:30:01
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc soon., posted by jealibeanz on May 16, 2006, at 21:06:32
Wow, 400mgs Provigil. I could only take 50, 100mgs max! Klonopin will blend with provigil even at the high dose. EMSAM by far was the best blend with klonopin, it "woke me up" and is probably giving me additional social anxiety relief. All I know is I feel great, it's probably the blend. If you take klonopin long enough a lot of the tiredness, sedation should go away.
Even if a little remains it's better than living a life of hell. I think the key is to find something to offset the sedation you don't like. I think if you find the right dose, it will work for you. Did you try taking it the full dose at night? That helps
15 years ago I could harldy leave the house. Things like standing in lines at a bank, grocery store or going to a restaurant were hell. Without alcohol I couldn't go to a party. I left high paying jobs because I couldn't sit in the meetings, when the door closed I started to panic.
But when I landed on klonopin I opened a mortgage company and now have 25 people working for me. It's soley due to klonopin or I'd still be at home.
Once I wanted off klonopin so I tapered off. But all the old anxiety returned. I FORGOT how bad it felt, how disabling it was. So I went back on it and got relief. My doctor just told me to keep taking it and I probably will the rest of my life unless EMSAM or something else comes along that can replace it. Either way life is incredibly better for me.
Posted by jealibeanz on May 16, 2006, at 21:38:33
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc soon. » jealibeanz, posted by RobertDavid on May 16, 2006, at 21:30:01
Glad to hear you're doing so well! What an inspiration to all of is. How long did it take for the EMSAM to take hold? Is it energizing? I'd love to get rid of the anxiety. Plus, feel even the slightest amount of happiness would be nice, since I never really have before. I'm hoping something can help. I'm wondering if 600 mg Provigil would be unheard of?
Posted by RobertDavid on May 16, 2006, at 21:46:14
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc soon., posted by jealibeanz on May 16, 2006, at 21:38:33
I don't know that provigil will provide the happiness you're looking for, but should give you more energy.
I've been on EMSAM 6 weeks. I was begining to really think nothing would work for my mood, mental fog, energy. EMSAM was the gap that was missing. I felt good right away, within a week I really could notice a change. At 4 weeks it was better. I sometimes really wonder who I am as
I've never participated in life, had this good of an outlook before. I hope it's the "real me" and not an imposter! My doctor was very optimistic that EMSAM would do for me just what it did.
Nothing else worked, though I had never tried an MAOI before. Seems they work good for those that don't respond well to other anti depressants, at least it did for me. I thought about going to Nardil, but waited it out for EMSAM as I figured if it worked I won't have to contend with the food issues at the 20mg dose. And I work hard to keep my weight down and EMSAM wasn't supposed have weight gain as a side effect which has been the case with me.
In fact, I've probably dropped a few pounds as I have more energy and my gym workouts are longer. It's certainly not for everyone, but it has been for me. Just hope it never poops out! Rob
Posted by jealibeanz on May 16, 2006, at 21:50:49
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc soon. » jealibeanz, posted by RobertDavid on May 16, 2006, at 21:46:14
Sounds great! I just question whether a new doc to me would be receptive to an MAOI. Plus benzos and Provigil. It's a lot to ask for.
Posted by RobertDavid on May 16, 2006, at 21:53:33
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc soon., posted by jealibeanz on May 16, 2006, at 21:50:49
If you're interested in EMSAM you can go to emsam.com and print info for your doctor. If you do go to it I don't think you'll need or should keep taking provigil. Good luck!
Posted by jealibeanz on May 16, 2006, at 22:00:48
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc soon. » jealibeanz, posted by RobertDavid on May 16, 2006, at 21:53:33
No? what about straterra? i hope for an increase in concentration and energy!
Posted by RobertDavid on May 16, 2006, at 22:12:35
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc soon., posted by jealibeanz on May 16, 2006, at 22:00:48
> No? what about straterra? i hope for an increase in concentration and energy!
That's what I got from EMSAM. You may not need anything else besides klonopin. I don't really have experience with straterra. That said, you may be able to blend provigil with emsam, but I'd check for possible drug interactions.
Posted by Phillipa on May 16, 2006, at 22:30:48
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc soon. » jealibeanz, posted by RobertDavid on May 16, 2006, at 22:12:35
See the pdoc on Monday. John please let the EMSAM keep working following all the posts . I want to try it. Love Phillipa
Posted by Emily Elizabeth on May 16, 2006, at 22:37:06
In reply to Help! Extreme Anxiety... seeing a new pdoc soon., posted by jealibeanz on May 16, 2006, at 11:21:08
I haven't read the other replies, so forgive me if others have made the same comments.
Have you considered deferring med school admission for 1 yr? I know that this can sometimes be done. That way you wouldn't lose your spot and you'd have some time to sort these things out before you take the plunge into a pressure cooker of stress (sorry for the mixed metaphors).
If you aren't willing to do that...how far away is your med school? If it is only 1 hr or so away, maybe you could see a pdoc that is local to the school. That way you could keep seeing her once you start there. I'd imagine that one of the reasons that you can't get a doc to go along w/ what you want is that they know that they won't be able to follow up w/ you long term. (Right?)
Have the docs given you any other reasons for not wanting to go along w/ your plan? One thing I think you want to be careful is coming off as arrogant or stubborn. Physicians often have fragile egos and doing anything that suggests that you think that you are smarter than they are is the kiss of death. (Not saying that you are doing this, just a general warning). Make sure to ask for their ideas and make it clear that you are interested in their answers. Present your own thoughts as concerns and hesitations rather than absolute refusals (even if in your mind they sorta are).
Hope this helps.
Best,
EE
Posted by RobertDavid on May 16, 2006, at 22:37:31
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc soon. » RobertDavid, posted by Phillipa on May 16, 2006, at 22:30:48
Hang in there Phillipa. If your really anxious right now why don't you take a little extra valium? Good luck at your appointment!
Posted by Jost on May 16, 2006, at 22:57:40
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc soon. » Phillipa, posted by RobertDavid on May 16, 2006, at 22:37:31
When's your appointment, Philippa?
Jost
Posted by Jost on May 16, 2006, at 23:06:13
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc so, posted by Jost on May 16, 2006, at 22:57:40
Sorry, Phillipa, I misspelled your name.
Jost
Posted by Phillipa on May 16, 2006, at 23:33:45
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc so, posted by Jost on May 16, 2006, at 23:06:13
No problem it's Monday. And David I just e-mailed you. Love Phillipa
Posted by fiftylager on May 18, 2006, at 13:53:40
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc so, posted by Jost on May 16, 2006, at 22:57:40
I'm sorry you are feeling so horrible. Please don't give up on school. I did that because of my anxiety and depression and regret it very much.
I don't want to freak you out but have you ever looked at the symptoms for bipolar disorder? I had never thought of it and I had bad anxiety with depression often. The depression was worst in the winter. I never had obvious mania but when I was happy my symptoms did point to hypomania. Also I get mixed episodes and dysphoric mania which many people don't think of with bipolar. It was actually someone on here who suggested it to me and I looked it up and was very shocked. I have since been diagnosed and put on the mood stabilizer lamotrigine and it is really helping, especially with my anxiety. It is very common for bipolar to have an initial response to antidepressants and then to stop working or an extreme reaction to them.
I'm not a dr. but it's worth checking out. Take care and good luck.
Crissi
Posted by jealibeanz on May 22, 2006, at 18:19:39
In reply to Re: Help! Extreme Anxiety... seeing a new pdoc so, posted by fiftylager on May 18, 2006, at 13:53:40
I don't quite understand what dysphoric mania is. Depressive symptoms? I definitely don't have any euphoric mania of any degree. Just low level depression, sometimes very high seasonal depression, and chronic general anxiety. I don't rule anything out though. I've never had great responses toward medications, so a more in depth diagnosis (rather than just run of the mill depression/anxiety) may be in order. It's so hard to get someone to recognize these things!
This is the end of the thread.
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