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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 37. Go back in thread:
Posted by Think1234 on June 16, 2006, at 14:54:54
In reply to re: finding good pdoc; Groupthink. » Think1234, posted by pulse on June 16, 2006, at 4:14:11
My bad, I read through your post very superficially. 14 seemed peculiarly high. It was the first line "as far as finding a good pdoc, i've seen 14 in 26 yrs." That threw me. Yes 14, goes against common sense and would imply that you must have met a ton of Pdocs.
Its bipolar "mania" its seems for a lot of psychiatristics. So does that mean everyones' "manic" or are they the ones who are "manic"?
I wonder if its possible to arrange to have a good Pdoc by scheduling long distance phone calls. And having them send the prescription by phone. I'm sure its been done before, but I wonder how easy it is.
> NO! i found only TWO good pdocs - 20 years apart - out of the FOURTEEN that i've seen, in coming up on THIRTY years.
>
> i'd call that: VERY discouraging!
>
> i lived in a rural area for the first 15 years of this, then out of state - also rural, then back here to the business district of my original home town, then, lastly, in a suburban area near said town - all an hour or more's drive from a major city.
>
> i have no clue what 'they' are doing now with bipolar and the whole spectrum deal - nor why. earlier, i thought of the bipolar spectrum concept as novel, exciting, and with much promise; now i see it as just too much...an ever-increasing hodge-podge, to explain the unexplainable, with great promise for yet more garbage can diagnosing. bpII is the (current) dx du jour.
>
> i don't doubt you have a point re: liability.
>
> pulse
Posted by gardenergirl on June 16, 2006, at 20:25:27
In reply to re: finding good pdoc; Groupthink. » Think1234, posted by pulse on June 16, 2006, at 4:14:11
Pulse,
If you are in need of a new pdoc, email me or babblemail me, and I might be able to help. I love mine, although she's closer to downtown than she is to your neck of the woods. But I've also worked with some in our area, and I have opinions (of course!) about some of them.gg
Posted by linkadge on June 17, 2006, at 1:47:35
In reply to PDocs aren't greedy, Just too much Groupthink., posted by Think1234 on June 13, 2006, at 20:10:33
I agree with what you said. The worst thing for a psychiatrist is insult of the drugs. The drugs are seen as flawless. If there is a problem with somebody who takes a drug, it is the fault of the patient and not the drug.
This leads patients down the garden path. More drugs, more disability.
Linakdge
Posted by linkadge on June 17, 2006, at 1:58:54
In reply to re: finding good pdoc; Groupthink. » pulse, posted by gardenergirl on June 16, 2006, at 20:25:27
I don't understand it. Cocaine was once prescribed for nervous depression. The negitive effects were probably eventually less deniable due to its short half life and such.
Anyhow, back then, did we start to think that all of these people were latently psychotic, and that cocaine was just lifting it to the surface?
What is the principle action of cocaine? It's a serotonin reuptake inhibtor.
Some studies that are arising now are showing that SSRI's can activate some of the genes that are switched on in mania and by stimulants. PKC, CLOCK, GRK, etc. Theres enough people wondering about these substances that millions of dollers are put into studies to determine whether they can induce mania / rapid cycling etc.
I think they are a failure as a whole. Without the SSRI's though, psychiatry would fall to the ground. That is why every attempt is made to sweep all the dust under the carpet, and keep things all looking clean on the surface.
Linkadge
Posted by fuchsia on June 17, 2006, at 7:38:18
In reply to re: finding good pdoc; Groupthink., posted by linkadge on June 17, 2006, at 1:58:54
> I don't understand it. Cocaine was once prescribed for nervous depression. The negitive effects were probably eventually less deniable due to its short half life and such.
>
> Anyhow, back then, did we start to think that all of these people were latently psychotic, and that cocaine was just lifting it to the surface?
>
> What is the principle action of cocaine? It's a serotonin reuptake inhibtor.
>
> Some studies that are arising now are showing that SSRI's can activate some of the genes that are switched on in mania and by stimulants. PKC, CLOCK, GRK, etc. Theres enough people wondering about these substances that millions of dollers are put into studies to determine whether they can induce mania / rapid cycling etc.Sigh. My first second and third mixed episodes correlated exactly with antidepressant treatment. Now I'm bipolar II, rapid cycling. I haven't exactly been out of the house much these last 5 years.
Who is spending these millions of dollars? I wouldn't think that pharmaceutical companies would be keen to show that SSRIs caused a bipolar epidemic.
Posted by pulse on June 17, 2006, at 8:03:53
In reply to re: finding good pdoc; Groupthink. » pulse, posted by gardenergirl on June 16, 2006, at 20:25:27
thanks much, gg!
i may EMAIL you at some time, possibly soon. today, however, i have a bad sinus headache that i have no solution for.
i already have a great therapist with 2 nursing degrees (she whips out her latest copy of the nursing version of the pdr and we peruse together.) she is also a mentor. also, i have a great gp who has 300 psych patients, and who did volunteer work at a transitional living place for the severely menatlly ill. he knows more than than all but the 2 GOOD pdocs i mentioned i've ever had.
i WOULD love to hear some of your opinions.....perhaps more than anything else.
again, thanks. very kind of you.
pulse
Posted by pulse on June 17, 2006, at 8:20:46
In reply to Getting a good Pdoc by phone appointment? » pulse, posted by Think1234 on June 16, 2006, at 14:54:54
no biggie. i figured as much. i *think* i can see how my wording could have been read 2 different ways in that one line.
re: pdocs are the ones who are bipolar? dunno/ could be. do know that i call my gp tripolar and he loves it. he's a real card, and an old man, being that he's exactly 4 days older than me. we have alot in common, and i strongly suspect he's a 'work -cure' depressive. please see my above post to garden girl - if you feel like not reading it superficially, of course - for abit more about why my gp is my 'pdoc' solution of choice.
don' know about pdocs, but my therapist has already agreed to consult with me by phone, in the event that i move 3,000 miles away.
Posted by pulse on June 17, 2006, at 10:06:53
In reply to re: finding good pdoc; Groupthink., posted by linkadge on June 17, 2006, at 1:58:54
> I don't understand it. Cocaine was once prescribed for nervous depression. The negitive effects were probably eventually less deniable due to its short half life and such.
>
> What is the principle action of cocaine? It's a serotonin reuptake inhibtor.linkage, i had NO idea of this - cocaine's principle action is as a serotonin reuptake inhibitor???!!!
reason i ask is that i now believe i do have the nervous type of mdd - always have - just wrote my therapist email about this 2 days ago. what a timely post your's is.
my 'drug of choice' was cocaine. sorry, perhaps you'll view this as disgressing, but i'm now forced to go on yet another rant about rehab tx centers. you'll see why:
so often, they suggest/ PUSH wellbutrin as the best bet for ALL types of depressive cocaine 'addicts.' i do have a friend for whom it worked well, but alcohol is actually his 1st-line 'drug of choice,' that, then, inevitably (although that time frame varies) leads him in pursuit of cocaine. he only has dysthymia, compare to my mdd, and i now suspect, he has alot of sp, which is SO very common for those that self-medicate with alcohol, then unfortunately usually either become binge or daily drinkers. in contrast, i have no sp, whatsoever.
i've never craved alcohol, nor liked it's effects. also, quite simply, it makes no sense whatsoever, since alcohol is such a well-known depressant.
***so, so much for the gene theory, since alcoholism runs on both sides of my family*** (yes, i realize that it's been proven, but i simply don't believe this so-called proof. the studies have to be flawed).
my foremost point is - this tx center disease model/ 'thinking' led me directly down the dopamine ADs seeking trail. i feel so hood-winked, now, and yet again. one wonders how often CAN they believe the total opposite of what is truth/ what WILL work!
i know you hate the ssris, but for me, prozac was fabulous, and for many, many years, until i could no longer take the gi side-effects, that now never diminish - this being 'fairly' recently. so, this surely tends to strongly support your assertion re: cocaine being a serotonin reuptake inhibitor.
btw, ssris have never once induced one iota of mania/ nor hypomania in me. now, i wouldn't suggest putting anyone on prozac when they are 2 days off crack!, but that's a substantially different matter. the original paxil would be the best one, at that point, then a switch to prozac - in my opinion, backed up directly by my own experience.
thank you,
pulse
Posted by heaven help me on June 17, 2006, at 11:39:08
In reply to bear with me... » linkadge, posted by pulse on June 17, 2006, at 10:06:53
nm
Posted by linkadge on June 17, 2006, at 21:46:50
In reply to bear with me... » linkadge, posted by pulse on June 17, 2006, at 10:06:53
Yeah, I believe cocaine inhibits the uptake of all three monoamines, serotonin norepinephrine and dopamine.
But, I do believe it is a slightly stronger serotonin uptake inhibitor than dopamine or norepinephrine reuptake inhibitor.
Wellbutrin, otoh is really only a very weak dopamine uptake inhibitor, that is why it probably lacks abuse potential.
To kick cocaine, you might do well on prozac and methyphenidate. (Even methylphenidate is not as reinforcing/rewarding as cocaine, since it has minimal serotonin uptake inhibition). Methylphenidate does not consistently or readily substitiute for cocaine.
It is seeming that the rewarding properties of cocaine are a combination of its serotonin and dopamine uptake inhibition.
Linkadge
Posted by pulse on June 17, 2006, at 21:58:33
In reply to Ive been DX BP2 and its meds work for me, am I?nm, posted by heaven help me on June 17, 2006, at 11:39:08
not sure if you meant in subject line >> it's << ...or 'if.'
sure, you can have BPII. it's just so often over-dxed these days. that's all i meant by my 'dx du jour' comment. it can STILL be borderline personality disorder only, instead.
some may have both.
i believe it's far too often happening, as a result of a payback pdocs are getting throttled with by their borderline only clients. then, said pdocs finally say, 'enough - UNCLE.'
it's gotten so bad, it's likely that the new dsm will re-name borderline pd - get this - 'emotional dsyregulation syndrome.' medicalizing a behavioral disorder, with all the negative ramifications to safety/ other for our society that this change will have, is sure to end up - a big step...backwards.
when there are hundreds of net sites FOR bpds, but only a couple for their victims or targets, any rational person would have to conclude things are sorely out of balance.
if meds do work for you, don''t fix what's not broken.
pulse
Posted by Deneb on June 17, 2006, at 22:08:53
In reply to Re: Ive been DX BP2 and its meds work for me, am I » heaven help me, posted by pulse on June 17, 2006, at 21:58:33
Posted by Caedmon on June 18, 2006, at 9:29:23
In reply to Re: PDocs aren't greedy, Just too much Groupthink., posted by Deneb on June 13, 2006, at 21:03:56
> Am I naive to think that pdocs aren't money-hungry pseudo-scientists? >
No, I don't think this is naive at all. I've had good experiences with pdocs, although my n is only 3. When I read some of what "online" pdocs write, I'm impressed by their thoughtfulness.
Believe me there are some cruddy PCPs out there too.
Part of the problem is the generalizations here.
- Chris
Posted by Think1234 on June 18, 2006, at 12:34:16
In reply to re: finding good pdoc; Groupthink. » gardenergirl, posted by pulse on June 17, 2006, at 8:03:53
The PDR is not a reliable source of information when it comes to side effects or interactions. Its the same book that reported that SSRI's had sexual side effects for 2% of the population. Far far, lower than what it was in actuality.
> thanks much, gg!
>
> i may EMAIL you at some time, possibly soon. today, however, i have a bad sinus headache that i have no solution for.
>
> i already have a great therapist with 2 nursing degrees (she whips out her latest copy of the nursing version of the pdr and we peruse together.) she is also a mentor. also, i have a great gp who has 300 psych patients, and who did volunteer work at a transitional living place for the severely menatlly ill. he knows more than than all but the 2 GOOD pdocs i mentioned i've ever had.
>
> i WOULD love to hear some of your opinions.....perhaps more than anything else.
>
> again, thanks. very kind of you.
>
> pulse
Posted by linkadge on June 18, 2006, at 19:05:12
In reply to About the PDR, posted by Think1234 on June 18, 2006, at 12:34:16
I suppose why many of these assumptions have been extended to psychiatrists in general, is that there seems to be no collective effort to try and reduce the number of unnecessary prescriptions. It just seems like there is so much varience from office to office.
There was only one psychiatrst I saw that I knew was genuine. She told me that most of the time these drugs just act as placebo's. Thats how I knew she was genuine.
Linkadge
Posted by pulse on June 18, 2006, at 19:14:04
In reply to Victims? Targets? :-( (nm), posted by Deneb on June 17, 2006, at 22:08:53
:~( NOT :-(
two of the many, many examples, of which i know to be true:
VICTIM:
me - almost killed; charge: attempted murder. crime was completed premeditated by this bpd woman, with whom i was not in an intimate relationship. perpetrator: all 9 bpd criteria, and to a high degree.
i was deemed the victim from outset, by responding officers. my life-threatening experience, and the resulting extreme injuries to my person, were cited as the most obvious - and clearly undeniable - reasons.my 'crime': saying something kind and respectful of her boundaries. could not have been misinterpreted by anyone. period.
TARGET:
my current therapist in another state. bpd client stalked her for over a year. police finally had to be brought in.
fyi: i'm often asked to be a special consultant re: this subject. 5 years, now. more often than not, i accept.
i will not debate this.
Posted by cecilia on June 18, 2006, at 19:17:40
In reply to About the PDR, posted by Think1234 on June 18, 2006, at 12:34:16
Re the PDR as an "objective" source of drug info-it's written by the drug manufacturers-need I say more?! Cecilia
Posted by Think1234 on June 18, 2006, at 19:18:41
In reply to Re: About the PDR, posted by linkadge on June 18, 2006, at 19:05:12
Can you email me the the number of that psychiatrist? I'm looking for a real psychiatrist or doctor with psychiatric knowledge. And I don't care if I have to cross the country to find one. But if I could do appointments by phone that would be even better. Anyhow a real doctor wouldn't necessarily care for sit in appointments.
Its sort of a dogma.My email is [xxx]
> I suppose why many of these assumptions have been extended to psychiatrists in general, is that there seems to be no collective effort to try and reduce the number of unnecessary prescriptions. It just seems like there is so much varience from office to office.
>
> There was only one psychiatrst I saw that I knew was genuine. She told me that most of the time these drugs just act as placebo's. Thats how I knew she was genuine.
>
>
>
>
> Linkadge
>
>
Posted by Think1234 on June 18, 2006, at 19:26:56
In reply to Re: About the PDR, posted by cecilia on June 18, 2006, at 19:17:40
Exactly right. Its for all practical purposes its an exact reiteration of the drug manufacturers line.
How is it that as one becomes more educated, the more gullible one becomes? Particularly psychiatrists, literary theorists, and economists. (of course not all psychiatrists, literary theorists, and economists are gullible, or worse:liars)
"written by the drug manufacturers-need I say more?! Cecilia"
Posted by pulse on June 18, 2006, at 20:26:07
In reply to Re: bear with me... » pulse, posted by linkadge on June 17, 2006, at 21:46:50
thanks for your further clarification re: all 3 nts involved. glad you reiterate that there's more serotonin involved, however. that's really been an education for me.
re: ritalin. it took my being 7 yrs. clean, out of my now 9, to get any pdoc to prescribe it. then, only because this last pdoc - who thinks of himself as highly knowledgeable, and even runs a separate program for 'substance abuse' - yes, he's one of the buyers ($$$) into that national disaster - didn't ever ask if i'd formerly ever self-medicated with anything. ha! guess i don't have the 'proper' look that all crack 'addicts' are supposed to have. what an arrogant, self-aggrandizing NPD idiot he was - and an inveterate SNOB ta-boot!
my therapist offered to accompany me to that first 1 1/2 hr. consult. both of us were shocked at his failure to ask this - in his otherwise thorough questioning. we were also smugly gratified. i did then try ritalin for 2 months. i did not escalate my dosage, but found the crashes so terrible, that i chose to discontinue it myself.
at that point, then, he agreed with me on this: if you don't have add or adhd (which i don't), ritalin - (even though, it feels a little bit like cocaine, as it's said to) - is still speed. i loved cocaine but HATED speed - only took it 2 times, 35 yrs. ago. ritalin felt in no way like a true augmentor for depression. from all the augmenting with other ADs/ other i've done, i well know the difference. (i don't care for for provigil either, for the fairly similar way it feels - for me.)
next, with him, came desipramine, but monotherapy - made sense for 'drive' - but killed my stomach far more than even ritalin, even at 1/2 norm start dosage.
next came my termination of this pdoc.
pulse
Posted by 10derHeart on June 18, 2006, at 21:34:13
In reply to Re: Victims? Targets? :-(, posted by pulse on June 18, 2006, at 19:14:04
...consider whether part of your post was in keeping with the need to be sensitive to the feelings of others reading here? In particular those dx'd with bpd?
First, I want to say that it must have been terrible to go through what you did - terrifying and traumatic, to say the least, and I am so sorry you had to experience being victimized in that way. I've also been hurt mentally and physically by someone who was suffering from a psychiatric problem (nothing to do with bpd) and it was truly scary and awful. No wonder you have lasting effects and a very strong opinion about this particular subject. But...
Having said that, the civility rules here, set by Dr. Bob, require we not post anything that, "could lead others to feel accused or put down" and also that we not overgeneralize. (See the FAQ at:
http://www.dr-bob.org/babble/faq.html#civil)The main idea here is *always* support, despite what we each have experienced in the past. Sometimes, this may mean we have to refrain from stating all our beliefs, in order to stay within the guidelines.
I believe what Deneb was reacting to in your previous post was the sense you were implying that all those dx w/bpd have "targets" and "victimize" others. That is also how I read it. But perhaps both she and I misunderstood?
Anyway, I can see how Deneb, who has posted on other boards about doubts/questions she struggles with re: her own pprior dx of bpd, could feel hurt by part of your previous post.
I like to try and help promote civility and harmony here. I hope any awkwardness in expression on my part doesn't blur the message too much, or sound like an attack - I definitely don't mean to attack you.
Respectfully,
-- 10derHeart (posting as myself, NOT as a deputy for Dr. Bob)
Posted by linkadge on June 19, 2006, at 18:03:07
In reply to Re: bear with me... » linkadge, posted by pulse on June 18, 2006, at 20:26:07
Were you augmenting an SSRI with methyphenidate ?
I did notice some crashing, but it wasn't too bad for me.
Although ritalin is compared to cocaine, it isn't completely like it.
You can go to:
to look up compounds activities at certain targets. Lower Ki values mean greater affinity for the target.
Ie. Cocaine, 5-ht transporter ~150
DAT transporter ~300Ritalin, 5-ht transporter ~5000
DAT transporter ~100So, some authors speculate that the greater euphoria of cocaine is a combination of serotonin and dopamine transporter blockade.
Linkadge
Posted by pulse on June 19, 2006, at 19:58:32
In reply to Re: bear with me... » pulse, posted by linkadge on June 19, 2006, at 18:03:07
yes, i was trying to boost prozac with ritalin.
i'd only taken one 5 or 10 mg. ritalin ever before, during my druggie days, 'recreationally.' quotes because i got nothing out of it then but a stoamch ache; i can tell you that i DO know it's not - completely - like cocaine! ha.
thanks for the link, and making it so easy by telling me exactly what to look up. i've read you here for years. you are so much more knowledgeable than i in the science end of all this.
however, i don't know your history. ONLY if you don't mind saying: are or were you a pharmacist, on your way to becoming one.... or does this knowledge come because you're naturally so inclined, but, also, unfortunately, have HAD to learn ALL these things? (in a way similar to my having HAD to learn pscyhology and criminolgy, areas where i'm naturally inclined, being an artist first. (that's quite common, btw. i know very few that don't have both abilities, but one or the other is usually a secondary pursuit).
now don't get me wrong. i, too, believe one must be as informed a client as one possibly can, and be responsible for one's own mental health. to do otherwise, has proven to be sheer folie for most here.
thanks again - you go to the mat to help others, even when you are struggling mightily yourself.
pulse
Posted by naughtypuppy on June 20, 2006, at 16:15:05
In reply to Re: About the PDR » cecilia, posted by Think1234 on June 18, 2006, at 19:26:56
I used to get a copy of the electronic version of the PDR from a warez site, now I couldn't even bother to pirate the useless thing!
Posted by linkadge on June 20, 2006, at 17:03:40
In reply to Re: bear with me... » linkadge, posted by pulse on June 19, 2006, at 19:58:32
I'm no professional by any means. I have had no formal education in this feild. I started to read books about the brain when I was young as my mother was very sick with bipolar disorder, and then it grew. But, don't anyone stop questioning what I post.
Linkadge
This is the end of the thread.
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