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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by TexasSP59 on November 4, 2007, at 10:52:39
I'm new to this board, so excuse me if this is something covered in a FAQ. I'm a lifetime sufferer of PS that wants to find a prescriber for Nardil. I've been bouncing around with a shrink from my HMO for the last year. I'd taken 40mg Prozac for the last few years but the relief that it offered wasn't really worth the trouble. My HMO shrink explained his 'standard of care' was: SSRI, SNRI, and, if both those failed, going to an "older" antidepressant (Tricyclics, I came to find out.) He is opposed to the Sertraline patch as well. Perhaps one member of this online community could give me some advice on finding a prescriber.
I'm about 100 miles North of Austin, 100 miles from Abilene, and 100 miles from Waco. I'm sure that somewhere in those 3 cities there are shrinks that see MAOI's in a more realistic light, but I don't know how to find one. Any help would be greatly appreciated.
Posted by Phillipa on November 4, 2007, at 11:29:06
In reply to Finding a shrink, posted by TexasSP59 on November 4, 2007, at 10:52:39
Well you could start by googling pdoc in your area and then some have e-mails . But tedious work would be calling. Hope someone here can help. Are you already on one as that may help? Phillipa
Posted by Racer on November 4, 2007, at 11:34:45
In reply to Finding a shrink, posted by TexasSP59 on November 4, 2007, at 10:52:39
Welcome to Babble. I hope you like it here, and decide to stick around.
First of all, your HMO's psychopharmacologist is pretty much stating standard of care. There are a lot of good reasons for this, so I hope you won't hold it against him. MAOIs can be excellent choices for some people, but they carry certain risks that other, newer drugs do not. The same is true for the tricyclics, but those risks are less immediately hazardous.
If your current pdoc won't discuss Nardil, and you are set on that drug and no other, my advice is to call around to all the pdocs on your HMO's list, and ask if they would consider Nardil. That's the only sure way to find out if they're amenable to the option.
If your current pdoc is not adamantly opposed to Nardil, but wants to consider other options first, it might be worth trying to work it out with him. There are a couple of ways you can approach this. The first is to ask him why he is opposed, and what would influence his decision to try it? If you choose this route, I urge you to give him a fair hearing. One suggestion for this discussion is to keep a food record for the five week washout period you'll need between Prozac and Nardil, showing that you can follow the diet consistently and diligently. A poster here, Gardenergirl, did this as part of her treatment with Nardil. You may find that the diet is not something you can live with, and choose to go a different route instead.
You could also lay out all of your reasons for wanting to try Nardil, and ask him to discuss them with you. If you approach him respectfully, it doesn't seem like too much to ask that he would listen to you respectfully.
Another option, by far the least attractive, is to try the other drugs your doctor is more willing to prescribe, and then ask for Nardil if none of them work adequately. Believe me, I recognize that this is by far the least attractive, and it's not something I recommend.
The other option I can think of with your current doctor is to tell him flat out that you are looking only towards Nardil, lay out your reasons, and tell him that if he won't prescribe it, you'll find someone who will. If you go this way, be prepared to walk. I don't know many doctors who would respond positively to that one.
I realize that there are a lot of people who are highly enthusiastic about MAOIs in general, and Nardil in particular. Do you mind if I ask why that drug is the one you've chosen as most likely to help you?
Posted by brooke484 on November 4, 2007, at 11:58:36
In reply to Finding a shrink, posted by TexasSP59 on November 4, 2007, at 10:52:39
Use this form http://www.ascpp.org/?q=contact
to email ASCPP (American Society of Clinical Psychopharmacology). Tell them where you live and they will send you a list of psychopharmacologists near you.Good luck!
Posted by TexasSP59 on November 4, 2007, at 14:02:21
In reply to Re: Finding a shrink » TexasSP59, posted by Phillipa on November 4, 2007, at 11:29:06
Thanks to all of you who replied to my previous post. I decided long ago(15-20 years) that Nardil was the drug that had the best track record-- the only drug that I had ever heard effecting a "cure".
I don't think I"ll be able to switch shrinks within my HMO (Scott & White). And I've met with this one's immediate superior (in my shrink's office) and am convinced that this "hard line" stance comes from the top down.
I am currently taking Nortriptylene at near the top dose, having gone from Effexor to that drug, along with Hydroxyzine (an antihistamine that helps with some of the physical symptoms) I'm feeling almost as bad as I would feel taking nothing.
Posted by Lonely on November 8, 2007, at 0:10:16
In reply to Re: Finding a shrink, posted by TexasSP59 on November 4, 2007, at 14:02:21
Can you go to another major city in your state? Bigger cities have more docs and more choices. Some insurance plans allow for it with the same rate of reimbursement and some require that you pay more.
If the treatment is totally unacceptable it might be worth it to pay for a psychiatrist a couple times out of your own pocket. Sometimes it's easier to then convince a psychiatrist in your own network or your own geographic area that you are on successful treatment and it should be continued.
> Thanks to all of you who replied to my previous post. I decided long ago(15-20 years) that Nardil was the drug that had the best track record-- the only drug that I had ever heard effecting a "cure".
> I don't think I"ll be able to switch shrinks within my HMO (Scott & White). And I've met with this one's immediate superior (in my shrink's office) and am convinced that this "hard line" stance comes from the top down.
> I am currently taking Nortriptylene at near the top dose, having gone from Effexor to that drug, along with Hydroxyzine (an antihistamine that helps with some of the physical symptoms) I'm feeling almost as bad as I would feel taking nothing.
Posted by florence on November 13, 2007, at 18:12:17
In reply to Finding a shrink, posted by TexasSP59 on November 4, 2007, at 10:52:39
You can also call around to different pharmacies to see if they will give you names of drs that prescribe it........I am so fatigued from undiagnosed thyroid disease that it is imperative for me to save time and physical energy- not to mention money by finding a dr by a patient on-line (like us guys here) who recommends a certain dr.
I even call the drs in my plan to see if they ever prescribe the med I want. (In my case, I wanted to know if they treat thyroid disease by the lab numbers OR by how a patient FEELS, ie. symptom relief not numbers.)
It's getting very challenging: endocrinologists who SHOULD know all about thyroid disease often go into more profitable practices-- reproductive health (infertility) and diabetes.
I am finding the same thing true with psychiatrists; more are in psycho-therapy...frustrating in my case since I don't need a pdoc- but she was the one who rxed Klonopin and psych meds to help with my fatigue SO even the ER isolated me when I went cuz I ran out of Klonopin......never told it was an epilepsy drug. But when the nurse asked what type of dr rxed it, well, off I went to the back room to be evauated to see if I was a danger to myself or others.....
In 1988 I think- I was seeing a headache specialist at the cleveland clinic who gave me prozac to prevent migraines. He told me I was one of the first people in the country to try it. And I was impressed.
Not anymore.... it helped a bit- then he tried zoloft, etc........So I have a huge problem convincing any dr that I have no psych problems or history.
Do your homework. Maybe you already have. Just trying to save you time and money. I think an older pdoc would be more open to something like Nardil; new drs think new drugs are better....But I think the new drugs are safer; And drug companies don't like to pay for expensive drugs. And insurance companies dictate alot to drs:
Nardil is probably cheaper than the newer drugs BUT too many risks so they don't want a lawsuit.
Lots of info here!! Read and Persevere.
Sorry you have had this all your life. Come back here often: loving and intelligent people that know how you feel.......florence
Posted by Phillipa on November 13, 2007, at 20:55:35
In reply to Re: Finding a shrink, posted by florence on November 13, 2007, at 18:12:17
Just what's happening to me with the endo. Numbers and not how I feel which is horrible. Trying a new one in December. Phillipa
Posted by florence on November 15, 2007, at 1:21:27
In reply to Re: Finding a shrink » florence, posted by Phillipa on November 13, 2007, at 20:55:35
Have you checked out these sites: Stop the Thyroid Madness. (the best: consolidated from info on Natural Thyroid Hormone- Yahoo Group) They taught me SO MUCH..... Mary Shoman's "About" site is good but hard to navigate...
Dr Derry from Canada (retired) has best interview on Mary's site. Also Dr Whybrow, Dr "Doug"???can't remember but he is from South Bend, Indiana AND also Dr Ken Blanchard's book is good.
Endos have a BAD reputation......Do you know about high cholesterol, FREE T3 and FREE T4- antibodies: thyroglobulin, thyroid peroxidase (TPO), microsomal??? etc. I could GAG on all the info I know about thyroid........and I still can't find a dr. to help me.
It took decades to just get diagnosed. ....florence
+++++++++++++++++++++++++++++++++++++++
Just what's happening to me with the endo. Numbers and not how I feel which is horrible. Trying a new one in December. Phillipa
Posted by Phillipa on November 15, 2007, at 18:45:41
In reply to For Phillippa..., posted by florence on November 15, 2007, at 1:21:27
Florence was diagnosed right away with the high anxiety. Didn't know it was hasimotos til hospitalized. Did okay with stable thyroid for nine years and then it got wacked out. Yes I do know of those things and even at one point tried adding cytomel. I will have to check out those sites. Thanks so much. Just had bloodwork we'll see what it is now last was .4. Phillipa ps that's the TSH.
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