![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 38. Go back in thread:
Posted by Phillipa on June 7, 2008, at 16:06:33
In reply to Re: Any doctors in UK prescribe dexedrine?? » dbc, posted by Horned One on June 7, 2008, at 15:43:36
Followed the thread and what you all say is true about the USA no opiods here unless just had surgery. Phillipa
Posted by West on June 7, 2008, at 17:06:34
In reply to Re: Any doctors in UK prescribe dexedrine?? » dbc, posted by Horned One on June 7, 2008, at 15:43:36
>>CBT is the preferred treatment for social anxiety and depression here, with medication usually being a short-term measure.
There's a fantacial puritanism in 'proving' you are a legitimate candidate for drug prescription. Like it's a test. Actually CBT was useless to me since my problem is primarily anhedonic not melancholic. Both my brother and I suffer from a biological low mood which, hard as it is for doctors to believe, has no environmental basis.
I'm still being pestered to have therapy. Actually I had a referral in January, but I still haven't heard anything back from that. It took over a year to get an assessment interview from my CBT therapist.
This is unbelievable. We are arguably at a higher risk of losing our lives than cancer patients.
> >Hey parnate is an awsome drug for depression and the anhedonia you describe but its not something to be taken lightly. It can be dangerous if a doctor doesnt understand what they're doing with an MAOI or a patient doesnt know about some of the dangers (ie you can die from eating types of cheese)
Parnate is i think discontinued here. I don't know why, tried googling it but got nothing. Nardil hits GABA which I need. Strangely, half a zopiclone got me out of the flat for a run in the park the other day (At 10pm)
>
> On balance, Dexedrine isn't a drug to be taken lightly either. I think the dietary restrictions are pretty much notorious, but I didn't have a problem with them myself.
>
> >The same goes for dexedrine except its amazingly and brutally addictive. During the 60s and 70s it was prescribed pretty openly along with valium and both became a problem of epidemic proportions and so prescribe it very infrequently in the US compared to ritalin or adderal. The only drug with more negative stigma attached to it is Desoxyn (methamphetamine).
>
> From the 50s through to the 70s there was an epidemic of barbiturate/amphetamine (Purple Hearts, Dexamyl etc) and benzo addiction here.My neighbour used to take these with his mates back when 'to get more drunk'. right. Sounds like the phenobarbital/d-amphetmine combo would probably would have been very effective for atypical, someone reported taking it as a student in the 70s as an effective study aid. She is diagnosed with adult ADD today.
One of the reasons my pdoc is willing to give me zopiclone is because he did his training in that era, and thinks that 'the pendulum has swung too far in this country'.
>This made me hmmm and nod and stroke my chin. Too true. Too true. We are at a very crude level with anxiolytics certainly. In the future they will have greater specificity, less amnesia/cognitive dulling and zero dependance (we can hope). That said i've never been under the thumb of real benzodiazepine dependance except for last summer when i had a rebound anxiety after taking one lorazepam everyday for a month.
What about Modafinil? I've taken it on its own and with escitalopram. Modalert is gritty. Modiodal is better but uber expensive unfortunately (£56 for 30) And sometimes frankly you just want a nap, which is obviously impossible (i found).
GaryLee- do you have the details of the harley street docs you mentionef. I am hoping a prescription for concerta will help if the Nardil plan doesn't come through
Posted by Horned One on June 7, 2008, at 18:16:57
In reply to Re: Any doctors in UK prescribe dexedrine??, posted by West on June 7, 2008, at 17:06:34
>This is unbelievable. We are arguably at a higher risk of losing our lives than cancer patients.
I know. It's ridiculous that prescriptions are witheld in preference for psychological therapies, especially when they take so long. CBT was useless for me too.
>Parnate is i think discontinued here. I don't know why, tried googling it but got nothing. Nardil hits GABA which I need.
Parnate is still available here (as generic tranylcypromine) http://www.bnf.org/bnf/bnf/55/3346.htm?q=%22tranylcypromine%22#_hit. There are studies showing that it actually lowers GABA, in contrast to Nardil. I did find it useful (in combination with clonazepam) for my mood and anxiety. Nardil is the only MAOI I haven't taken, and that's because of the side effect profile. I think the combination of Parnate and a benzo is 'cleaner' and more tolerable than Nardil.
>Strangely, half a zopiclone got me out of the flat for a run in the park the other day (At 10pm)
I sometimes take a little bit of zopiclone during the day for the same reason. Benzos usually have an activating effect in me.
>That said i've never been under the thumb of real benzodiazepine dependance except for last summer when i had a rebound anxiety after taking one lorazepam everyday for a month.
I was addicted to clonazepam for years, but the docs just stopped my prescriptions one day, and I went to hell. The whole argument about benzo addiction is that they have a hellish withdrawal syndrome, so why deliberately cause such suffering?! I wasn't given a Valium taper, and I was even refused a Librium taper by the drug addiction unit I went to. Had I been a Heroin addict though, I'd have got a script for methadone and application form for benefits no messing. As it was, my doctor expected me to be fit for work after two weeks.
Posted by dbc on June 7, 2008, at 18:37:46
In reply to Re: Any doctors in UK prescribe dexedrine?? » dbc, posted by Horned One on June 7, 2008, at 15:43:36
> Sounds like an awful lot of posters in the US are taking medication (particularly benzos) for social anxiety. I thought the craze for CBT was pretty much a UK thing - CBT is the preferred treatment for social anxiety and depression here,
>Im an exception not the rule. I dont take benzos for social anxiety i take them because im a neurotic mess of a human being with a panic disorder most doctors have never even heard of an agoraphobia. Social anxiety is the least of my worries.
Usually whats considered minor anxiety disorders in the US are treated with SSRIs and therapy in combination. This is everything from social anxiety to even major cases of GAD.
Some of the older doctors dont fall for the benzo hysteria so much and are more relaxed about their use because they have practical real life experience with the drugs. Theres a big movement right now in psychiatry in the US to move from benzos to this 2nd (more like 3rd) generation anti-psychotics because of their supposed safety. Seroquel is the drug of choice in this crap and i almost suspected a lot of this is perpetuated by drug companies because this Atypical are expensive as hell compared to a $5 bottle of generic valium (were talking hundreds for seroquel and its the cheapest).
Posted by West on June 7, 2008, at 19:34:15
In reply to Re: Any doctors in UK prescribe dexedrine??, posted by Horned One on June 7, 2008, at 18:16:57
> I know. It's ridiculous that prescriptions are witheld in preference for psychological therapies, especially when they take so long. CBT was useless for me too.Going to be tedious very briefly and say what about the cost of arranging cbt seesions and therapists vs largely generic ADs
>
> Parnate is still available here (as generic tranylcypromine) http://www.bnf.org/bnf/bnf/55/3346.htm?q=%22tranylcypromine%22#_hit. There are studies showing that it actually lowers GABA, in contrast to Nardil. I did find it useful (in combination with clonazepam) for my mood and anxiety. Nardil is the only MAOI I haven't taken, and that's because of the side effect profile. I think the combination of Parnate and a benzo is 'cleaner' and more tolerable than Nardil.Really? That's brilliant news. Questions 1) can you describe the effects (positive and negative)and 2)what is the likelihood of getting prescribed it WITH clonazepam (i assume it's quite
activating) - is relatively exotic stuff like this the preserve of the 'progressive' psychiatrist? Maybe you could even mention your pdoc - did you say youwere in Leeds?
> >Strangely, half a zopiclone got me out of the flat for a run in the park the other day (At 10pm)
>
> I sometimes take a little bit of zopiclone during the day for the same reason. Benzos usually have an activating effect in me.
>
Fat. Will give that one a try- who would have thought zopiclone would make it as an anxiolytic? The only forseeable problem with that would be balance + generally looking a bit 'mid-sleep'. If you ever need more I use u**tedph****cies (.co.uk) for imovane at very reasonable pricesAnd what of amilsulpride ?
Posted by undopaminergic on June 7, 2008, at 20:19:09
In reply to Re: Any doctors in UK prescribe dexedrine??, posted by West on June 7, 2008, at 13:12:30
> I am intersted in amilsupride which i understand is an asti-psychotic, but at low doses a partial dopamine agonist which sounds very interesting.
>It's not a partial dopamine agonist, but a pure antagonist. The good thing is that it preferentially blocks presynaptic dopamine receptors that function as autoreceptors. Since these autoreceptors reduce or inhibit dopamine release, blocking them with amisulpride results in enhanced dopamine release, and as long as the dose of amisulpride is low enough not to negate the effect of increased neurotransmitter release by too extensive blockade of postsynaptic dopamine receptors, the result is a stimulant effect.
A good cheaper alternative to amisulpride is sulpiride.
> Will it produce a ritalin-style lift and focus?
>Yes, in my experience. Unfortunately, as with Ritalin, tolerance can develop and greatly diminish the effects.
Amisulpride/sulpiride and Ritalin can be used in combination, sometimes resulting in a stronger effect than with either drug alone.
Posted by undopaminergic on June 7, 2008, at 20:42:04
In reply to Re: Any doctors in UK prescribe dexedrine??, posted by dbc on June 7, 2008, at 14:58:25
> > Thanks for your thoughts >> dbc- i think you're absolutely right about p'docs being conservative here. I just saw an on call GP here who was running an out of hours surgery in Northallerton and she agreed to give me a prescription for 3 diazepam 'just to tide me over' until i could see my real GP on monday. She hinted strongly that she was doing me a favour and that this was not normal practice.
> >
>
> Thats insane, i receive 60 10mg diazepam a month.
>I never had any trouble getting benzos either, here in the drug-restrictive Northern Europe.
> i try to maintain a more moderate dose unless were trying out a new psych med that i cant tolerate (seroquel anyone?) and then i get the green light to take however many is needed.
>I don't see why you would need more benzos while trying out such a sedative medication as Seroquel. Or did you find Seroquel to give you paradoxical agitation or insomnia?
Posted by West on June 7, 2008, at 20:43:49
In reply to Re: Any doctors in UK prescribe dexedrine??, posted by West on June 7, 2008, at 19:34:15
>
> >>>>>> I know. It's ridiculous that prescriptions are witheld in preference for psychological therapies, especially when they take so long. CBT was useless for me too.
>
>>>>>> Going to be tedious very briefly and say what about the cost of arranging cbt seesions and therapists vs largely generic ADs
Sorry this wasn't clear. As in the human and financial cost of employing therapists and arranging sessions all over the place must grossly outweigh that of generic medecines>
Posted by West on June 7, 2008, at 20:49:25
In reply to Re: Any doctors in UK prescribe dexedrine??, posted by undopaminergic on June 7, 2008, at 20:19:09
Sulpride- essentially a dopamine reuptake inhibitor then via bloacking of presynaptic dopamine. Sounds good. Will a british Pdoc be familiar with this do you think?
Posted by undopaminergic on June 7, 2008, at 21:01:48
In reply to Re: Any doctors in UK prescribe dexedrine??, posted by West on June 7, 2008, at 20:49:25
> Sulpride- essentially a dopamine reuptake inhibitor then via bloacking of presynaptic dopamine. Sounds good. Will a british Pdoc be familiar with this do you think?
>Yes, except possibly some younger ones. Sulpiride is a pretty old drug, and hasn't been actively marketed for a long time.
Posted by dbc on June 7, 2008, at 23:27:49
In reply to Re: Any doctors in UK prescribe dexedrine??, posted by undopaminergic on June 7, 2008, at 20:42:04
>
> I don't see why you would need more benzos while trying out such a sedative medication as Seroquel. Or did you find Seroquel to give you paradoxical agitation or insomnia?
>I didnt quite explain the situation. Lamictal was causing minor psychotic features with me and seroquel kicked off worse hallucinations. I have some really strange neurochemistry apparently.
Posted by Horned One on June 8, 2008, at 10:20:38
In reply to Re: Any doctors in UK prescribe dexedrine??, posted by West on June 7, 2008, at 19:34:15
>Really? That's brilliant news. Questions 1) can you describe the effects (positive and negative)and 2)what is the likelihood of getting prescribed it WITH clonazepam (i assume it's quite
activating) - is relatively exotic stuff like this the preserve of the 'progressive' psychiatrist? Maybe you could even mention your pdoc - did you say youwere in Leeds?At high doses, Parnate was the most powerful stimulant I've ever taken (out of Ritalin, cocaine, amphetamine, phentermine, bupropion). So how does it help anxiety? One person described it as making him feel like a boxer getting psyched up for the fight. He found it gave him the energy and the oomph to tackle situations he would normally be afraid of and enjoy them. I found it gave me a 'buzzing' feeling and just generally made me feel more alive and productive.
On the downside, in the first week I felt like killing myself (but I've had this from other antidepressants too). This went away when I increased the dose to 40mg, and I started to like it very much. The stimulant effect tended to wear off in the afternoon - a phenomenon known among users as 'the Parnate slump'. I used to take an extra 20-30mg in the afternoon to overcome this effect. In the end I was taking 80-120mg a day, even though I was only prescribed 30mg. My pdoc took me off it after three months because he wasn't prepared to raise the dose beyond 30mg (higher doses are routinely used in the US). He was a horrible man and I wouldn't wish him on my worst enemy. Maybe he was progressive in the way he thought medication would play no part in the treatment of psychiatric disorders in the future (does this mean he thinks psychiatrists are becoming redundant?!) - I had to persuade him to give me anything, but I've had various MAOIs from two different pdocs. I've found them fairly reluctant to prescribe MAOIs, but because I've tried nearly everything else they were willing to relent. My old pdoc was Dr. Walker, and my new one is Dr. Burton. They are both based at West Park Hospital in Darlington. According to Google Earth it's just up the A167 from Northallerton.
It might be especially hard to get prescriptions for clonazepam because it's not licensed as an anxiolytic here. I did manage to get a GP to prescribe it off-label, but in time the other doctors put a stop to that. By the time I was taking Parnate I was getting my supply of clonazepam entirely from online pharmacies...
Amisulpride doesn't have any noradrenergic activity AFAIK, so it isn't as good for focus as Ritalin. I thought it felt more like a small dose of an opiate in the beginning. I was prescribed 200mg in hospital (for psychosis), but I managed to get that reduced to 50mg p.r.n as an outpatient. I've stopped taking it over the last few days because I don't think it's doing anything any more. I've been on it about six months now.
Any more questions just ask.
-Horny
Posted by West on June 8, 2008, at 12:39:34
In reply to Re: Any doctors in UK prescribe dexedrine??, posted by Horned One on June 8, 2008, at 10:20:38
Just wrote a long reply and lost it to the old delete/page back trap. Practically in tears.
To summarise I am sorry to hear you had such a rough run with your doc over the parnate. My brother seemed to think it had been discontinued for lack of interest here, mysterious. Someone who's never experienced the kind of suffering associated with biological depression can't begin to understand how to correctly deal with it. It actually sounds as if he thought you needed disciplining, a probable cure, and that you were simply being self-indulgent. It's blood boiling stuff.
>>>On the downside, in the first week I felt like killing myself (but I've had this from other antidepressants too). This went away when I increased the dose to 40mg, and I started to like it very much. The stimulant effect tended to wear off in the afternoon - a phenomenon known among users as 'the Parnate slump'.Perhaps a fiercer cousin of what my brother calls the 'nardil nod'?
>>>> My old pdoc was Dr. Walker, and my new one is Dr. Burton. They are both based at West Park Hospital in Darlington. According to Google Earth it's just up the A167 from Northallerton.
So I take it Dr. Walker is the one to avoid? Thank you for the details - We sort of have a family doc who diagnosed my older sister with schizophrenia (7 years ago) and brother with atypical/BP 2 (he takes thyroid hormone, phenelzine, lamotrigine, hoodia, 5htp, rhodiola...i lose count). He is at the Friarage. I'm hoping to get in touch tomorrow and explain that the guy i saw, his understudy, thought me 'unengaged', 'describing myself as if i were a fictional character in a novel', generally in need of a good kick up the *rs* and fundementally well despite going into a dysphoric rage later that day until 4am, struggling to surpress my desire to put my fist through every door and window in my house. I am going to ask for some clonazepam until i can get an MAOI but odds are, as you say, they'll give me diazepam at the most.
>>> I was prescribed 200mg in hospital (for psychosis), but I managed to get that reduced to 50mg p.r.n as an outpatient. I've stopped taking it over the last few days because I don't think it's doing anything any more. I've been on it about six months now.
>
Psychosis is the one symptom i've never had. What is your diagnosis if you don't mind me asking?A fine day on the north york moors today, pity I couldn't enjoy it - but everyone else seemed to be
enjoying the good weather -West
Posted by dbc on June 8, 2008, at 13:09:19
In reply to Re: Any doctors in UK prescribe dexedrine??, posted by West on June 8, 2008, at 12:39:34
Why do you want klonopin over valium? I've tried about every benzo in the book thats mainstream in the US and really diazepam is my preferred one because its low risk of getting strung out like with xanax. Good god i wouldnt wish xanax withdrawal on anyone.
Klonopin is pretty close to diazepam but the diazepan has an even longer half life.
Posted by West on June 8, 2008, at 15:59:12
In reply to Re: Any doctors in UK prescribe dexedrine??, posted by dbc on June 8, 2008, at 13:09:19
>>> Why do you want klonopin over valium? I've tried about every benzo in the book thats mainstream in the US and really diazepam is my preferred one because its low risk of getting strung out like with xanax.
Well i don't know about xanax but Clonazepam feels less dulling/depressing than d'pam. In my (extremely) limited experience I would wager clonazepam is a better anxiolytic too. Perhaps you could elaborate on the getting strung out thing?
Posted by dbc on June 8, 2008, at 16:50:41
In reply to Re: Any doctors in UK prescribe dexedrine??, posted by West on June 8, 2008, at 15:59:12
Physical addiction = strung out
Sometimes doctors are just ignorant or sometimes a patient is manipulative and sometimes its just nessecary but either way you end up on moderate to high doses of benzos daily and what this means in the end is addiction management.
Certain benzos are much easier to deal with in this department, diazepam being the easiest and xanax being the opposite.
Posted by Amigan on June 8, 2008, at 17:26:16
In reply to Re: Any doctors in UK prescribe dexedrine??, posted by undopaminergic on June 7, 2008, at 21:01:48
> > Sulpride- essentially a dopamine reuptake inhibitor then via bloacking of presynaptic dopamine. Sounds good. Will a british Pdoc be familiar with this do you think?
> >
>
> Yes, except possibly some younger ones. Sulpiride is a pretty old drug, and hasn't been actively marketed for a long time.Amisulpride and Sulpiride are not DARIs to be precise. They block the presynaptic Dopamine autoreceptors. The final result is almost the same for both class of drugs, anyway, but Am-Sulp tends to "poop out" quickly in an almost predictable manner and their action is weak. It's close to placebo for me.
Posted by West on June 9, 2008, at 16:18:50
In reply to Re: Any doctors in UK prescribe dexedrine??, posted by Amigan on June 8, 2008, at 17:26:16
Saw GP and said i would like some diazepam for my dysphoria (playing devil's advocate by asking me to explain the meaning of dysphoria) for short as-and-when relief before i am put on an antidepressant by the psychiatrist (if i manage to actually get put on one.) He e-mailed ahead to the Pdoc
just to say he had given me the 7 diazepam. He asked why i didn't get out there and do stuff instead of reading about and asking for drugs. That was pretty hurtful.He didn't like my using psychiatric terms to describe my symptoms either. What they really want is someone who comes in complaining of back ache and poor sleep - 'it's okay you've got depression, it's a disease' - they love to explain in their most professionally calm middle-class tones before sending patients off with a bag of fluoxetine and a CBT leaflet.
In particular he couldn't understand why i make my depression worse by reading about it and sharing anecdotal information with fellow sufferers when i should be out there trying to make things better- 'there are things you can do.'He also said i should read about cbt instead and that there's an online service- which i would have taken as fair advice if cbt hadn't been shown to be predominantly ineffective in biological depression.
I ended up telling him that i didn't expect him to get it if he didn't have depression himself and that researching an illness hardly makes it worse but is in fact a form of positive action.
Also extra suspicious since i mentioned to another GP in leeds that i'd ordered tianeptine from the internet which, along with the ssri's didn't help a great deal i.e he didn't respond to antidepressants = not depressed. Add to that being 23 + candidly admitting past substance use- nothing out of the ordinary for university students however- just regular grass/periodic pills/coke for a time).As for amilsulpride- 'why do you want to take an antipsychotic?' he visibly winced. Somewhere between pit and contempt. Not a pleasant experience. For a doctor he was surprisingly anti-medication: his encompassing argument being that we don't know how they they work (he certainly didn't demonstrate any knowledge of their mechanisms but reassured me he was 'interested' in mental health)
Anything to smooth the passage if you ask me. Why not actually TRY and HELP make people's live's worth living ?
Actually i don't know if i am really depressed and now i'm starting to think maybe he's right. Hold on though, difficulty in decision-making, classic depressive symptom. Damn this knowledge.
Posted by West on June 9, 2008, at 16:22:05
In reply to Doc thinks there's nothing wrong with me, posted by West on June 9, 2008, at 16:18:50
Not going to touch the diazepam. He has actually made me guilty about it. Right now though ranting is
providing good relief. My apologies to anyone kind enough to be reading this. God Bless.
Posted by Horned One on June 9, 2008, at 17:41:35
In reply to Doc thinks there's nothing wrong with me, posted by West on June 9, 2008, at 16:18:50
>He asked why i didn't get out there and do stuff instead of reading about and asking for drugs. That was pretty hurtful.
I know, they don't seem to realise that we spend most of our days researching, then hoping and praying we'll get what we need at the next appointment. I stand accused of having 'an unhealthy obsession with psychopharmacology' by Dr. Walker, and just last week my social worker asked if 'thought I had a medication addiction' because 'whenever there's a dip in your mood you immediately think of a pharmocalogical solution'. I don't, but over the last few weeks my mood just went into freefall, so I asked very urgently for the antidepressant I've been waiting for since January. I know what you mean about '*if* you get an antidepressant when you see the pdoc. I've been waiting for six months for an antidepressant (so not exactly demanding an quick fix here), and I think the problem is I've just lost all hope of getting one. I'm crying out for help and just keep getting doors slammed in my face. Maybe I'll get one this time next year, but who know's what state I'll be in then? Maybe I'll be manic? If so I'll just have to stockpile it for when I need it next. There's no guaruntee of getting the treatment you need when you need it on the NHS. It needn't be this way though.
>Why not actually TRY and HELP make people's live's worth living ?
Do you ever wonder why they went in for that career? I'm getting cynical that the majority really want to help people. It's all about power and control. That comes before suffering.
>Actually i don't know if i am really depressed and now i'm starting to think maybe he's right
Dr. Walker discharged me from secondary psychiatric services in 2006, claiming that 'I had an unhealthy obsession with psychopharmacology' i.e. I'm a hypochondriac and a malingerer. I sort of began to accept that over time, but last December I was sectioned under the mental health act for a manic episode, which I thought proved for all time that I had a real mental illness, but no. By rights my diagnosis should be Bipolar I, or even Schizoaffective Disorder, but I don't know if I actualy have a diagnosis. They're playing this trendy, progressive 'I don't want to label you with an illness' game here. He had no qualms about labelling me with borderline personality disorder though.
Trust your own instincts. You live with your illness, and you almost certainly know more about it than your doctor does.
-Horny
Posted by West on June 10, 2008, at 6:57:57
In reply to Re: Doc thinks there's nothing wrong with me, posted by Horned One on June 9, 2008, at 17:41:35
>>>Dr. Walker discharged me from secondary psychiatric services in 2006, claiming that 'I had an unhealthy obsession with psychopharmacology' i.e. I'm a hypochondriac and a malingerer. I sort of began to accept that over time
I'm primed and ready to receive this accusation - it seems the combination of being unwell and being articulate, intelligent + taking initiative doesn't wash with the NHS. Drugs cost money after all. The reason patients in the US have some relative freedom of choice respected by the pdocs in what they put pop in their mouths every day is presumably that they are paying top dollar for it.
>>I'm crying out for help and just keep getting doors slammed in my face.
This is more than you should stand for. Can you/family afford to see someone better privately?
>>but last December I was sectioned under the mental health act for a manic episode, which I thought proved for all time that I had a real mental illness, but no. By rights my diagnosis should be Bipolar I, or even Schizoaffective Disorder
Could anyone have a manic episode if, say, they were going through a highly stressful situation alone, or under the influence of a drug which didn't agree with them. What actually defines a manic episode?
Oh and I'm taking roaccutane (at half the recommended dose) to clear up persistent minor acne which MIGHT be a trigger. I have been diagnosed with depression previous to going on it though and certainly had low periods since adolescence. Only recently came off a 3 year SSRI
waltz (5 weeks ago) which i predict will raise an eyebrow.Horny what med are you pushing for. An MAOI?
Posted by West on June 10, 2008, at 10:17:55
In reply to Re: Any doctors in UK prescribe dexedrine??, posted by garylee on June 6, 2008, at 23:24:41
Would be a great help if you could give me a name of someone who can find out if i have thisBest
West
Posted by Horned One on June 10, 2008, at 11:08:08
In reply to Re: Doc thinks there's nothing wrong with me, posted by West on June 10, 2008, at 6:57:57
>I'm primed and ready to receive this accusation - it seems the combination of being unwell and being articulate, intelligent + taking initiative doesn't wash with the NHS. Drugs cost money after all. The reason patients in the US have some relative freedom of choice respected by the pdocs in what they put pop in their mouths every day is presumably that they are paying top dollar for it.
Yep, that's pretty much it.
>This is more than you should stand for. Can you/family afford to see someone better privately?
No, I was looking at private psychiatrists recently and they were charging £250/hour, with rates going as high as £2800 a day if you needed a written report. That's way out of my league.
>Could anyone have a manic episode if, say, they were going through a highly stressful situation alone, or under the influence of a drug which didn't agree with them. What actually defines a manic episode?
It's not easily distinguished from Schizophrenia, in fact it may be the same thing. For me it involved delusions of persecution, hallucinations, the classic 'hearing voices' thing. Thought I was God. Ran around the garden naked. That sort of thing.
>Oh and I'm taking roaccutane (at half the recommended dose) to clear up persistent minor acne which MIGHT be a trigger.
Yeah, it might be aggravating your depression.
>Horny what med are you pushing for. An MAOI?
I've just put in a request for Parnate today. I also mentioned buprenorphine and methadone, but I don't hold much hope for those. I'd been asking for lofepramine over the last few months because at that point I didn't think my depression was anywhere near severe enough for the dietary restrictions of Parnate to be worth it. If they'd just given me it then, when I first needed it, then most likely I wouldn't be needing Parnate now (wether I actually get anything at all is another matter).
-Horny
Posted by West on June 10, 2008, at 11:17:42
In reply to Re: Doc thinks there's nothing wrong with me, posted by Horned One on June 10, 2008, at 11:08:08
Hope you do get it! Again, if the worst does come to the worst there's always unitedpharms who stock a Parnate generic and are cheapish + reliable. Are you taking anything now for relief?
Best of Luck Amigo
Posted by Horned One on June 10, 2008, at 11:56:40
In reply to Re: Doc thinks there's nothing wrong with me, posted by Horned One on June 10, 2008, at 11:08:08
Just found this:
__________________________________________________What a carry on doctor! A newly qualified GP reveals what really happens behind surgery walls
By DR JONATHAN GOLDBERG
Last updated at 12:14 AM on 10th June 2008The work of a modern GP involves more than mere medicine and demands careful negotiation through a veritable minefield of pushy drug reps, bolshy patients, and fellow practitioners out to make a quick buck. Here, JONATHAN GOLDBERG, who has been practising as a doctor for two years, reveals what really goes on in a GP's surgery. It makes for hilarious, but also sometimes unsettling, reading.
Annie is nine years old and about 13st. She waddles into my room and then Mum waddles in after her. My room suddenly feels very small.
'It's her ankles, doctor. They hurt when she runs at school. She needs a note to say that she can sit out games.'
'Did you fall over or twist your ankle, Janine?' I ask. Janine looks at the floor and then shakes her head.
'How long have they been sore?' Eyes still to the floor, though this time I get a shrug.
'Let's have a look then.' I give her my best ' smiley doctor' face and prod and poke at her ankles.
Being a new qualified GP isn't all fun and games as one doctor reveals
My examination is a bit of a show; one look at Janine walking into my room revealed it wasn't her ankles that were the problem.
But still, I try to make my prodding and poking look like it has purpose: I want Janine and her mum to think I am taking them seriously.
'Right, well, I can't find any swelling or tenderness in those ankles, and she's walking OK.'
This was the make-or-break moment - how was I going to put this tactfully? I was standing at the top of the diving board: I could just write the note, prescribe some paracetamol and climb quietly down the ladder . . . but as a doctor, it's my duty to say something. Right, here goes.
'Some children find that. . . erm.. . that being a bit . . . erm (say it, just say it!) overweight can make their joints hurt sometimes.'
I did it, I jumped! Janine's mum's face suddenly looks like a pitbull slowly chewing a wasp.
'It's got nothing to do with her weight,' she says. 'Janine's cousin is as skinny as a rake and she has problems with her ankles, too. It's hereditary.'
Mum stares hard at me. I blink first. 'She can still do swimming,' I shout encouragingly as they waddle away, sick note and paracetamol prescription tucked into Mum's handbag.
I picture Janine sitting in the changing rooms, munching on some crisps, while the rest of her class run around outside.
Beneath the many layers of abdominal fat, her pancreas is slowly preparing itself for a lifetime of insulin resistance and the debilitating symptoms of diabetes that will occur as a result.
Meanwhile, her joints will be straining under her excess weight and she'll develop early onset arthritis.
Would a few well-placed words of advice really have breached deeply entrenched lifestyle and diet habits?
'Hold on, kids, no more soft drinks and Turkey Twizzlers. Dr Goldberg thinks we are overweight and thank goodness he pointed it out or we'd never have noticed.
He's given me a wonderful recipe for an organic celery and sunflower seed bake and we're swimming the Channel at the weekend.'
Lucy, the practice manager, pops her head around the door: 'I've put you down for a visit to see Mrs Tucker. She's had a funny turn and fallen over. Perhaps-you could diagnose her as having had a stroke?'
It is January and our surgery targets are due in April. None of our patients has had a stroke in the past nine months.
This should, of course, be a cause for celebration, but Lucy was not happy.
If no one has a stroke before April, we'll miss out on our 'stroke target'. The Government tells us that if a patient has a stroke, we need to refer them to the stroke specialist and then we'll get five points.
But if no one has a stroke, we miss out on the points and the money that comes with them.
This money has already been earmarked for a skiing holiday for the partner of the surgery and a nice little Easter bonus for the practice manager.
In the world of general practice, points really do mean prizes.
The role of a modern doctor involves more than just medicine
Mrs Tucker is 96 and lives in a nursing home. She is severely demented and doesn't know her own name. In her confusion, she wanders around the nursing home and frequently falls.
She had fallen over again today and could well have had a mini-stroke. She could just as easily have tripped.
She is fine now and common sense tells me that this lady would not benefit from a load of tests and new medications that, in the long run, would probably make her only more confused and more likely to fall over.
I can't help but feel that financial incentives to follow certain guidelines are tempting us to make clinical decisions that make us money rather than benefit the patient. I don't diagnose stroke.
Another day, another dilemma. I'd been asked to go on a home visit to see a patient I'd never met. Mr Tipton was in his 50s and complaining of a viral infection.
As I skimmed through his notes, one item stood out. In between entries for a slightly high blood pressure reading and a chesty cough, one read 'six years' imprisonment for child sex offences'.
Mr Tipton was a paedophile and had only recently been released.
He lives in a 17-storey tower block as grey and intimidating on the inside as it is on the outside.
After several minutes of knocking on the door, Mr Tipton answers.
Walking unsteadily with the aid of a Zimmer frame, he led me into the flat. It was like nothing I had ever seen, with beer cans and cigarette butts in their hundreds, and a brown, sticky floor.
I try desperately to manoeuvre myself down the corridor without touching anything. I don some gloves and half-heartedly prod his belly. I make a few token comments about letting viruses take their course and then I flee.
When I call social services, I make it very clear I didn't think any more medical input was needed.
I could have done more both as a tor and as a human. But as I red the squalor that was Mr Tips life, I had just two thoughts.
The first was: 'Serves you right, you filthyy paedo,' closely followed by: 'How quickly can I get out of here and dump this problem on someone else?'
The Hippocratic Oath tells us that it not our place to judge patients, but to treat each one as we would any other.
I agree with this in principle, but offering compassion to a paedophile covered in his own mess isn't easy.
We're all influenced by appearances, of course. Take drug companies, for example.
They are very good at overcharging us for medicine. Millions of pounds are wasted by the NHS because doctors prescribe expensive drugs when they could choose a much cheaper version of the same thing.
Hoodwinking
How do the pharmaceutical companies hoodwink us into doing that? Young and attractive drug reps buy us lunch or even take us out for dinner at posh restaurants, then feed us biased information on why we should use their more expensive medicine and give us free pens sporting their brand.
In the U.S., pharmaceutical companies employ former American football players and cheerleaders to do this.
Like everyone else, doctors are suckers for a pretty face. The attractive female reps are sent to sell their products to the predominantly male surgical consultants, while the pretty-boy male reps sell to the more female-dominated obstetric and paediatric departments.
Fortunately, in this country our retired sports stars tend to fall ungracefully into alcoholism and gambling addiction rather than trying to sell us over-priced medicines.
At one dispensing practice I worked for, I was shocked when the partners passed round a list of the medications that we were 'encouraged' to prescribe.One of these was the antidepressant Seroxat, which has recently had a huge amount of justifiably bad press.
The manufacturer was accused of hiding evidence that its use has been linked with higher suicide rates in young people.
Despite this, the partners were encouraging us to prescribe it over safer, cheaper and equally effective anti-depressant alternatives.
When I questioned this, I was told the dispensary (i.e. the partners), make only a penny on every prescription of Prozac they dispense, but £1 profit on every Seroxat prescription.
As well as constant pressure from drug reps, GPs also face resistance from patients when trying to change medication.
Whenever I can, I try to switch my patients from the more expensive medicines to cheaper equivalents. One elderly lady once stormed into my surgery furious that I had changed her medicine:
'You told me that the new medicine was the same as the old one!'
'Yes, that's right, Mrs Goodson - same medicine, different name.'
'Well, I know that's nonsense because when I try to flush these tablets down the toilet, they don't float like the old ones did!'
A good doctor
So what makes a good doctor? At my medical school interview, the panel yawned as I spouted some naive nonsense about being caring and good at working in a team.
During my training year after medical school, I saw a middle-aged woman with stomach pains.
I referred her urgently to the hospital because I thought she might have stomach cancer. She was seen within a week and turned out to have bad indigestion.
The consultant sent me a snotty letter suggesting I'd made an inappropriate (and expensive) referral, causing unnecessary anxiety to the patient.
The patient and her husband, however, think I am a saint ('That wonderful Dr Goldberg arranged for me to be seen so quickly').
Most of us have an idea when we're being good or bad doctors. On a Friday afternoon, when I'm drained and focused on the weekend, I'm a rubbish doctor.
I prescribe antibiotics for colds. I sign inappropriate sick certificates and dish out sleeping pills as if they were sweets. I'll usually give my patients anything they want if it helps me get to home on time.
As GPs, we are supposed to be the 'gatekeepers of the NHS', but it is much easier to leave the gate permanently ajar rather than carefully defend the NHS waiting lists by fending off the worried well.
I'm very popular with my patients on a Friday afternoon because they are getting what they want, but I'm certainly not practising good medicine.
But good medicine can come in many forms - and not all of them in a foil-backed pill packet. Sometimes, kindness is the best doctor.
Like parents, doctors are not supposed to have favourites, but I am rather fond of Mrs Peacock. She is well into her 80s and her memory has been deteriorating over the past few years.
Most weeks she develops a medical problem and calls up the surgery, requesting me to visit.
When I arrive, the problem has been resolved or at least forgotten, and I end up changing the fuse on the washing machine or helping her to find her address book which we eventually locate in the fridge.
Social support
I imagine the grumbling taxpayer wouldn't be too pleased to know that having forked out more than £250,000 to put me through my medical school training, they are now paying my wages of £70 an hour for me to try ineptly to recall which coloured wire is earth in Mrs Peacock's ageing plug.
What she needs a bit of social support - much more than she needs a doctor - so when I return to the surgery I spend 30 minutes trying to get through to social services on the phone.
When I finally do, I am told that due to her dementia, Mrs Peacock needs a psychiatric assessment before they can offer any assistance.
The psychiatrist is off sick with depression and the waiting list to see the stand-in psychiatrist is three months.
I'm also reminded that she'll need to have had a long list of expensive tests to exclude a medical cause for her memory loss.
Three months and many normal test results later, Mrs Peacock forgot to go to her appointment and had to return to the back of the queue.
Through no fault of her own, Mrs Peacock has cost the NHS a small fortune. Her heart scan, blood tests and hospital appointments all cost money and we GPs don't come cheap, either.
She does have mild dementia but, more importantly, she is lonely. She needs someone to pop in for a cup of tea from time to time and remind her to feed her long-suffering cat.
Meanwhile, I'll continue to visit and provide practical support. I guess this is what is called Vocation.
http://www.mailonsunday.co.uk/health/article-1025354/What-carry-doctor-A-newly-qualified-GP-reveals-really-goes-surgery.html
__________________________________________________-Horny
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.