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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by saturn on December 14, 2006, at 12:00:13
Is it standard (or necessary) for pdocs (or any doc)to get for example B12, thyroid studies, before starting antidepressants?I know several people who have just been straight given AD's without any of these kind of tests. There's just a typical "Do you have any medical problems" or "when was your last physical" and that's it.
Posted by Phillipa on December 14, 2006, at 12:03:30
In reply to Ruling out medical causes of depression, posted by saturn on December 14, 2006, at 12:00:13
Definitely rule them out as if my old pdoc hadn't done blood work I'd never have known I had chronic lymes and gotten IV and oral antibiotics. And he watched my thyroid as it's hasimotos thyroiditits and my pdoc now says yes thryroid problems with mental disorders. Love phillipa
Posted by Quintal on December 14, 2006, at 12:06:47
In reply to Ruling out medical causes of depression, posted by saturn on December 14, 2006, at 12:00:13
>Is it standard (or necessary) for pdocs (or any doc)to get for example B12, thyroid studies, before starting antidepressants?
I've tried nearly all the meds available and have yet to have a pdoc request a blood test/physical of any kind! The only time I've had blood work done was in hospital when I had cellulitis and the pdoc never enquired about that.
Q
Posted by Emme on December 14, 2006, at 12:47:06
In reply to Ruling out medical causes of depression, posted by saturn on December 14, 2006, at 12:00:13
>
> Is it standard (or necessary) for pdocs (or any doc)to get for example B12, thyroid studies, before starting antidepressants?
>
> I know several people who have just been straight given AD's without any of these kind of tests. There's just a typical "Do you have any medical problems" or "when was your last physical" and that's it.Mine is thorough and has had me tested for everything under the sun, including B12, folate, TIBC, Lyme, thyroid, and more. She makes sure to order bloodowork if it's been a while just to make sure nothing's changed.
Posted by stargazer on December 14, 2006, at 12:53:42
In reply to Ruling out medical causes of depression, posted by saturn on December 14, 2006, at 12:00:13
Most pdocs will ask about your general health and if you had any thyroid testing recently but it is not as thorough as it should be.
I recently saw a neurologist, my own request not my pdoc's, and had the whole battery of tests (B-12, Lymes, sed rate, thyroid) only to find out everything is perfect and my symptoms were probably due to the Lamictal, which should have been an obvious conclusion, but neither my pdoc or myself, who is usually so vigilant about the meds, could figure out why I was falling and not thinking clearly. My mind was obviously not seeing connection but neither was my pdoc.
So basically, we are on our own to make sure our medical status is normal, even if our doctor doesn't suggest it. You primary MD should be aware of your depression history and be testing for these things.
Which reminds me I should get those results for my records.SG
Posted by fca on December 14, 2006, at 15:13:17
In reply to Re: Ruling out medical causes of depression, posted by stargazer on December 14, 2006, at 12:53:42
It is a good practice but nor done on a routine basis. If you have any doubt you should feel free to request a thryoid work up. fca
Posted by blueberry1 on December 14, 2006, at 15:22:27
In reply to Ruling out medical causes of depression, posted by saturn on December 14, 2006, at 12:00:13
Yeah, I think they fail quite a bit in terms of testing. Testing could give some clues before even beginning treatment. And even if there was nothing abnormal found, at least they would have some baseline numbers to compare to at some point in the future. And by addressing any abnormalities at the beginning of treatment, medication doses could potentially be kept lower.
I think there should be a system in the whole scheme of things to have the patient go the very next day to have things like thyroid (TSH and free T3 and free T4), things like magnesium, calcium and selenium, toxic things like mercury, cadmium, lead, too much copper, B and D vitamins, is the person over-methylated or undermethylated, histimine high or low, cortisol, prolactin. It would obviously be expensive, but has the potential to be a huge benefit to the patient and possibly save years of suffering through trial and error. But of course, then the doctor would actually have to think. Not to say they don't, but I believe they have the scientific ability to make much more educated guesses than they presently do.
Posted by Jimmyboy on December 14, 2006, at 15:37:27
In reply to Re: Ruling out medical causes of depression, posted by blueberry1 on December 14, 2006, at 15:22:27
I agree that it is a good idea to rule all of those things out.. it may be expensive, but if it ends up being one of those things that is the problem then it could save years and years of sadness and frustration ..plus in the long run it will cost more having to keep paying for a psychiatrist all the time.
But, in my experience.. when you go in to see a certain doctor .. say you see a psychiatrist , he only sees your problem as a apsychiatry problem .. or see an allergist and he interprets it as an allergy problem. The way doctors are trained that is just how it goes .. it would be great to be able to talk with someone who would not have their mind made up before you finished your list of problems.
JB
Posted by stargazer on December 14, 2006, at 18:42:54
In reply to Re: Ruling out medical causes of depression, posted by Jimmyboy on December 14, 2006, at 15:37:27
it takes time and we know there isn't enough of that and they would say they aren't getting paid enough to do case mgmt besides do the obvious diagnosis and treatment of the current problem.
The pdoc barely keep up with all the information out there and the patients know more than many of them with all the info available on the internet. We have to ask them to do what we read or hear should be done. My pdoc just expects this kind of imput from me now, but sometimes I wish he had more answers than he does. I am resigned to the fact that we have to direct our own care...we may have more time than them to do this research, understanding it is another story.
The blind leading the blind sometimes.
SG
Posted by stargazer on December 14, 2006, at 18:43:11
In reply to Re: Ruling out medical causes of depression, posted by Jimmyboy on December 14, 2006, at 15:37:27
it takes time and we know there isn't enough of that and they would say they aren't getting paid enough to do case mgmt besides do the obvious diagnosis and treatment of the current problem.
The pdoc barely keep up with all the information out there and the patients know more than many of them with all the info available on the internet. We have to ask them to do what we read or hear should be done. My pdoc just expects this kind of imput from me now, but sometimes I wish he had more answers than he does. I am resigned to the fact that we have to direct our own care...we may have more time than them to do this research, understanding it is another story.
The blind leading the blind sometimes.
SG
Posted by stargazer on December 14, 2006, at 18:44:17
In reply to Case management/ Primary MD should do but..., posted by stargazer on December 14, 2006, at 18:43:11
Posted by saturn on December 14, 2006, at 19:22:17
In reply to Why does that appear twice? Keeps happening (nm), posted by stargazer on December 14, 2006, at 18:44:17
it's a glitch in the matrix ;)
This is the end of the thread.
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