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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 39. This is the beginning of the thread.
Posted by Deneb on June 19, 2008, at 18:01:40
There is nothing wrong with me except for a touch of social anxiety now.
My pdoc says I don't meet criteria for borderline personality disorder anymore.
I used to OD and want to kill myself all the time, but these days, I'm afraid of suicide.
I've been well for a long time now, I think a year or more.
I also don't have bulimia anymore.
I'm not depressed at all either.
I'm happy now.
Is it possible I was misdiagnosed as borderline?
Right now I'm on 40 mg Celexa, 40 mg Prozac and 0.75 mg Risperdal. The first thing my pdoc is lowering is the Risperdal. After another week of my new job, it'll be 0.50 mg Risperdal. I had a feeling my pdoc didn't like the Risperdal. She wasn't even the one who originally prescribed it for me, but since I was on it, she just kept me on it.
Posted by dbc on June 19, 2008, at 18:35:08
In reply to I'm slowing going off my meds, posted by Deneb on June 19, 2008, at 18:01:40
You feel better after taking your medication so now you dont want to take it?
I dont know about anti psychotics and BPD so i cant really comment.
Posted by Deneb on June 19, 2008, at 19:23:25
In reply to Re: I'm slowing going off my meds, posted by dbc on June 19, 2008, at 18:35:08
No, I don't care if I'm on meds or not. They don't give me side effects and I have insurance that covers then 100%.
My pdoc was the one who suggested I decrease my medications.
Posted by Midnightblue on June 19, 2008, at 20:02:44
In reply to I'm slowing going off my meds, posted by Deneb on June 19, 2008, at 18:01:40
Deneb,
You are doing MUCH better and it doesn't matter what your dx is or was. Why are you going off the meds? Is this your doctor's idea or yours? In the past when you have tried to stop taking meds you had a relapse. There is nothing wrong with taking meds.
MB
Posted by Deneb on June 19, 2008, at 20:09:33
In reply to Re: I'm slowing going off my meds » Deneb, posted by Midnightblue on June 19, 2008, at 20:02:44
I already said, my pdoc suggested I wean off my meds.
She thinks I'm doing really well right now.
I really don't care if I'm on them or not since I don't get side effects and they are covered under my insurance.
I think we are going to go off them really slowly though. If I get worse, we'll probably stop.
I think my pdoc doesn't think taking meds for long periods is a good idea. She believes more in psychotherapy.
Posted by Deneb on June 19, 2008, at 20:14:27
In reply to Re: I'm slowing going off my meds, posted by Deneb on June 19, 2008, at 20:09:33
I'm a little afraid to decrease my meds, but my pdoc seems to think it's ok. I trust her.
Posted by bleauberry on June 19, 2008, at 20:46:30
In reply to I'm slowing going off my meds, posted by Deneb on June 19, 2008, at 18:01:40
It's easy and natural to fall into the trap of saying I'm all better now and these meds are longer needed. The reason you are better is because of the meds. Take them away, you won't be better any more. Just a matter of time. And when you finally give in and go back to them, they won't work like they used to.
Though I don't disagree with the above, I do not mean to make it sound like it is my opinion or my lecturing. It is instead a very common outcome, almost guaranteed, that I have seen happen over and over and over again.
Posted by Deneb on June 19, 2008, at 21:39:44
In reply to Re: I'm slowing going off my meds, posted by bleauberry on June 19, 2008, at 20:46:30
OK, now I'm scared.
I really really don't want to go back to the way I was, it was horrible. I wanted to die all the time, I was ODing and even ended up in the hospital a couple of times.
I was losing control and purging several times a day.
Posted by Phillipa on June 19, 2008, at 22:41:15
In reply to Re: I'm slowing going off my meds, posted by Deneb on June 19, 2008, at 20:14:27
Deneb that is wonderful that your pdoc thinks you are well enough to start weaning down as they don't have to be a life long thing. See how you do sure you doc will be working with you and you'll probably be able to tell it it's right or wrong. And work on that T stuff it will help. Phillipa
Posted by gardenergirl on June 19, 2008, at 23:29:58
In reply to Re: I'm slowing going off my meds, posted by bleauberry on June 19, 2008, at 20:46:30
> And when you finally give in and go back to them, they won't work like they used to.
That's not true for all drugs for all people. For those that it is, it sucks surely.
But it sounds like deneb is doing this with very good supervision and guidance.
gg
Posted by SLS on June 20, 2008, at 4:43:16
In reply to Re: I'm slowing going off my meds, posted by Deneb on June 19, 2008, at 19:23:25
With every drug you completely discontinue, you are running the risk of becoming resistant to responding to it in the future.
You feel good? I wonder why. Be careful. You might feel particularly well due to the administration of one or more of the drugs you are taking. It might be best were you to attempt to discontinue one drug at a time to determine which drugs you still need to be taking.
Good luck.
- Scott
Posted by SLS on June 20, 2008, at 4:48:11
In reply to Re: I'm slowing going off my meds, posted by gardenergirl on June 19, 2008, at 23:29:58
> > And when you finally give in and go back to them, they won't work like they used to.
>
> That's not true for all drugs for all people. For those that it is, it sucks surely.
>
> But it sounds like deneb is doing this with very good supervision and guidance.Possibly. However, there are many practicing physicians whom are unenlightened to this phenomenon. That's why I would exercise caution and attempt to remove only one drug at a time. It may be, though, that this doctor has a great "feel" for treatment using these drugs. I think this issue should be discussed with the doctor.
- Scott
Posted by Justherself54 on June 20, 2008, at 10:08:39
In reply to I'm slowing going off my meds, posted by Deneb on June 19, 2008, at 18:01:40
From your first post it sounds like your doc is taking you off one drug at a time which is a good thing. If it's really freaking you out about the risks of the same meds not working again I would talk this over with your doctor. Your doctor knows your full history and obviously feels you are ready to try being med free.
You are an intelligent young woman and I know you'll monitor yourself closely for any signs of relapse and do what is necessary if that happens...
My friends and family always pick up right away when I'm not doing well. You have many friends at babble who will be gently watching over you. Good luck Deneb!
Posted by Phillipa on June 20, 2008, at 12:06:50
In reply to Re: I'm slowing going off my meds, posted by SLS on June 20, 2008, at 4:48:11
I feel that is the message a lot of us have tried to convey to Deneb. She's now working feeling good about self-esteem. Her Doc said Cut Down and ultimately he is the expert and Deneb feels well. Meds arent always for life for people. For some it's for grief, life changes, and brain chemistry changing as we age like menopause for women. Wow what a change that is speaking from very personal experience. Best luck to you Deneb and I know will keep us posted. I think it's great!!!!! Love Phillipa
Posted by bleauberry on June 20, 2008, at 17:17:23
In reply to I'm slowing going off my meds, posted by Deneb on June 19, 2008, at 18:01:40
Millions of people have health conditions that are completely improved with medications and require lifetime consumption to stay well. Heart disease, blood pressure, diabetes, cancer, organ transplants, on and on. I wonder why we tend to think the central nervous system or the brain are different?
Just wanted to followup and say I agree with the wisdom of SLS. If it must be done, do it one drug at a time. I would add, do it very slowly in very tiny increments. If at any time you notice worsening that is instinctively different than withdrawals, get back to your regular dose immediately.
The phenomenon has been noted here hundreds of times in the last decade, and is well documented at other places such askapatient.com or revolution health. The mysterious phenomenon. A drug that previously worked very well without notable side effects becomes a poison with strong side effects that either doesn't work, works only a fraction of how it used to, or actually makes you feel worse than ever. Almost like your immune system recognizes it and says no no no. And there is a certain aspect of treatment resistance that was not there previously, which makes the whole process harder and more complex in followup efforts.
There are indeed people who take a drug, get well, stop the drug and stay well. There are indeed people who take a drug, get well, stop the drug, relapse, start the drug again and it works just as good as ever. No scientific evidence to back it up, but my guess is the bad outcomes outnumber the the good ones. Any way you look at it, one is taking a situation of very low risk and purposely voluntarily entering a realm of high risk.
Personally I think the time to think about changing meds is when they are obviously not working like they used to, for whatever reason. Poopout, aggravation of underlying biology, whatever. That's a time to maybe change. But when perfectly well? Hmmm.
I guess what I am saying is, you've heard it before, "if it aint broke, don't fix it". It's too easy to accidentally mess it up even with perfectly honorable good intentions and skill.
So you decide to stay on the meds. You have to put a pill or two in your mouth everyday, someone else is paying for most of it, you feel pretty good. I dunno, I would trade you a million dollars for that.
Posted by seldomseen on June 20, 2008, at 18:09:08
In reply to I'm slowing going off my meds, posted by Deneb on June 19, 2008, at 18:01:40
oooooooo - everytime I do that I get into trouble.
And I am the queen of doing that.
I'm lucky because thus far everytime I restarted Prozac it has worked for me. It's just I forget what the start up is like (it sucks) and I'm always like "Why did I quit this med again?"
I would approach this decision with much much caution. If I can vow to stay on my meds, then anyone can.
Seldom
Posted by Deneb on June 20, 2008, at 18:14:36
In reply to Re: I'm slowing going off my meds, posted by Justherself54 on June 20, 2008, at 10:08:39
Thanks dbc, Midnightblue, bleauberry, Phillipa, gg, SLS, Justherself,
I really feel you all care about me. Thanks for caring. It seems like the majority vote is to not fix something that isn't broken. i.e. don't mess around with what works.
In the past, I have expressed an interest in becoming med free and perhaps my pdoc is just trying to make that happen for me.
The thing is, my pdoc mostly gives me psychotherapy. Perhaps I feel good because of psychotherapy?
No, that is too simple. Why would she increase my meds sometimes if she didn't think it was doing something?
I think my pdoc doesn't like the Risperdal. She never did anything to its dose, it was always increasing the SSRI. I think she likes SSRIs a whole lot. I'm on two of them.
She also doesn't like benzos. She's only given me 3 0.5mg instant dissolve tablets and that was for a very specific circumstance.
I think what I'll do is follow her instructions and see if I get worse.
Posted by Justherself54 on June 20, 2008, at 18:52:41
In reply to Re: I'm slowing going off my meds, posted by Deneb on June 20, 2008, at 18:14:36
I'm glad to hear that you are going to follow your doctor's directions Deneb. As I said before she knows your history. The decision to go off your meds should be made between you and your doctor.
Just go slow to try to counter the effects of coming off them and keep in touch with your doctor during the titration. Keep us posted on your progress!
Posted by Phillipa on June 20, 2008, at 20:43:10
In reply to Re: I'm slowing going off my meds, posted by Justherself54 on June 20, 2008, at 18:52:41
Deneb definitely agree with above posts and not all are treatment resistant. Your doc decided with you that you no longer needed that dose and that is great. And I know you are very responsisble now. Good Luck!!! Love Phillipa
Posted by Racer on June 21, 2008, at 1:34:26
In reply to Re: I'm slowing going off my meds, posted by bleauberry on June 20, 2008, at 17:17:23
>
>> The phenomenon has been noted here hundreds of times in the last decade, and is well documented at other places such askapatient.com or revolution health. The mysterious phenomenon. A drug that previously worked very well without notable side effects becomes a poison with strong side effects that either doesn't work, works only a fraction of how it used to, or actually makes you feel worse than ever.
>
> There are indeed people who take a drug, get well, stop the drug and stay well. There are indeed people who take a drug, get well, stop the drug, relapse, start the drug again and it works just as good as ever. No scientific evidence to back it up, but my guess is the bad outcomes outnumber the the good ones. Any way you look at it, one is taking a situation of very low risk and purposely voluntarily entering a realm of high risk.
>I respectfully disagree, and would suggest that the specific population posting on sites such as this one and others where that phenomenon is reported may be a causal factor of this belief.
Last year, I tried EMSAM, with lousy results, and went back onto my trusty Wellbutrin/Concerta cocktail. And felt miserable, because it didn't seem to be working very well. I started to think, "Oh, it's because I went off it and now it won't work as well anymore..." Only one problem with that theory -- if it had been working well in the first place, we'd never have tried something else. My combination is working about as well as it ever has -- but I remembered it working better than in fact it had been. I don't think my experience is all that unusual, and I think that skewed view of how well a medication worked is behind that belief that drugs don't work as well on subsequent trials.
Furthermore, as SeldomSeen pointed out, often times start up effects are a problem when restarting a medication. Also, restarting at too high a dose can cause problems.
Personally, I believe that for many people -- in fact, the vast majority of people who do not experience treatment resistance of any sort and simply improve on the first medication they take -- stopping a medication and later restarting it probably poses no significant challenges. I think it's worth remembering that the people who post here are a distinct, though heterogeneous, population.
I also think it's wonderful that Deneb has worked so hard and improved so much that her doctor thinks she will do well off medications. I hope that it turns out well, and that this thread does not cause too much anxiety for her.
Posted by SLS on June 21, 2008, at 5:15:10
In reply to I have a very different view » bleauberry, posted by Racer on June 21, 2008, at 1:34:26
To Deneb:
It sounds to me like your doctor is doing the right thing for you. Don't let the rest of this post influence your decisions. You are smart enough to be cautious, as is your doctor.
*************************************************************
The phenomenon of antidepressant-induced-treatment refractoriness has not been formally studied. All we have is compelling anecdotes with no statistics.
If this is indeed a "special" population where this phenomenon occurs at a rate greater than that seen in the majority of people treated pharmacologically, then, the chances of any one person experiencing post-treatment TRD is greater.
Of course, this might not true of Deneb. It just sounds like it is a warranted precaution to treat her as such.
The decision to attempt the discontuation of treatment might be exactly what is right and justified. Much of this decision is dependant on Deneb's history of depression. Is it recurrent? Is it chronic? Is it biological or psychological or both? Has she had a previous episode of depression for which treatment was discontinued successfully? How long would such a remission last for? Family history? Etc. These are the type of things a good doctor will use to make treatment decisions by.
Obviously, I cannot, and would not, assess someone's absolute risk of any sequale to discontinuing treatment.
And.
The doctor might be happy to remove the Risperdal only, and assess the consequences, only to make small adjustments in the rest of her treatment regime. I don't know.
Yes, a huge number of people can discontinue their treatment for depression once psychosocial issues are resolved. Even if the depression be totally biological, maintaining a stable remission for even 6 months can allow for discontinuation. It really depends on case history and clinical assessment.
For Deneb, I have no idea of her case history to be able to submit anything more as a suggestion.
- Scott
Posted by Racer on June 21, 2008, at 9:04:41
In reply to Re: I have a very different view, posted by SLS on June 21, 2008, at 5:15:10
>
> The phenomenon of antidepressant-induced-treatment refractoriness has not been formally studied. All we have is compelling anecdotes with no statistics.
>
> If this is indeed a "special" population where this phenomenon occurs at a rate greater than that seen in the majority of people treated pharmacologically, then, the chances of any one person experiencing post-treatment TRD is greater.
>
>Actually, I had a slightly different point I was hoping I'd made -- not so much that people here are more prone to develop TRD if we stopped a medication and then restarted it, but that since so many of us already are experiencing TRD, that scenario may lead us to over-estimate how much a medication benefited us in the first place. Like my view that Wellbutrin/Concerta wasn't working as well when I restarted it, when it fact it hadn't been working all that well in the first place, which is WHY we'd stopped it. Does that make more sense? That I inaccurately attributed to it much greater efficacy than it, in fact, had, and that lead me to believe it was less effective after the hiatus?
And it could be that you're right and I'm -- not right. I think, though, that in the absence of formal studies, it's worth considering that we might be a special population, and that the phenomenon may be illusory.
By the way, I really hope you'll let me know what I've done.
Posted by bleauberry on June 21, 2008, at 13:35:47
In reply to I'm slowing going off my meds, posted by Deneb on June 19, 2008, at 18:01:40
Bottom line, Deneb will benefit by knowing every angle of this decision. So I'm glad the thread was started and I am glad everyone who contributed an opinion did so. It arms Deneb with a great deal of wisdom that would not have been found any other way except at psychobabble.
Posted by Phillipa on June 21, 2008, at 19:00:04
In reply to Re: I'm slowing going off my meds, posted by bleauberry on June 21, 2008, at 13:35:47
I feel Deneb will do very well going down or off the resperidol as she has worked very hard in theraphy and now is making rational decisions. And remember she has now become an adult and is working. And has attende what three babble conventions on her own and had a great time. Congrats again to you Deneb. Love Phillipa
Posted by SLS on June 21, 2008, at 22:32:13
In reply to Re: I have a very different view » SLS, posted by Racer on June 21, 2008, at 9:04:41
Hi Racer.
> By the way, I really hope you'll let me know what I've done.
That's easy. You've done good!
;-)
- Scott
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