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Dr. Bob is Robert Hsiung, MD,
dr-bob@uchicago.eduShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Quintal on December 31, 2008, at 13:36:07
Pdoc gave me Zyprexa and nitrazepam for severe insomnia yesterday. He insists on the full 10mg Zyprexa and warned me in no uncertain terms I may be hospitalized if I don't take my medication. I think he's over reacting. A few months ago I had an episode of severe insomnia and psychosis - I was almost begging for Seroquel, but he just left to get on with it. He says he can't give me Seroquel this time either because it's only available as extended release version and he isn't impressed with it as an antipsychotic.
He gave me enough nitrazepam for two tablets a night, but wants me to start out with one. I haven't taken any Zyprexa yet and don't intend to unless things get badly out of control. I took 5mg nitro last night and it was the worst sleep I've had so far. The only other time I've had nightmares like that was when I was on Zyprexa. The whole idea behind this combo is to give me restful sleep, so I'm stuck in a bind.
I also don't think it's safe to drive on 10mg Zyprexa, no matter what they say - especially when combined with a long acting benzo. I have to be able to drive (and even do some higher math over the next month), and I don't think it's managable on that amount of medication. I just can't afford to lose that much of my already deteriorating cognitive function.
He said he wants me to stay on Zyprexa for at least a month, posssibly longer "but I'm not suggesting you take it for 10 years or anything". I'm worried that his mind even wanders that far 'cos for me it's a strictly p.r.n med. He made a vague reference to Parstelin (an old combo of Parnate and Stelazine), which makes me wonder if he's thinking of adding Parnate to it next month. He was going to give me a script for Parnate last month, but with my recent sleep problems that idea has been scrapped. I'm thinking that with Zyprexa on board he might relent with a little persuasion, and with a powerful stimulant on board I might even consider taking a little bit of Zyprexa :-)
I don't want to be a 'difficult' patient, but I have a really bad feeling about this. I don't think I'd be able to work normally on that combo.
My current cocktail:
75mg lamotrigine
7.5mg zopiclone
37.5mg tianeptine
5mg nitrazepam
Posted by Maxime on December 31, 2008, at 20:21:08
In reply to Zyprexa for insomnia, posted by Quintal on December 31, 2008, at 13:36:07
It really angers me when doctors prescribe anti-psychotics for slept. They can do more harm than good. Surely there is something better to try for sleep? Maybe if you come up with some suggestions for him he would be willing to change his mind?
Posted by Phillipa on December 31, 2008, at 21:48:23
In reply to Zyprexa for insomnia, posted by Quintal on December 31, 2008, at 13:36:07
Q you say psychosis I remember what happened. I think you should follow instructions. Better safe than sorry and don't drive till you see how it affects you. Not suicidal? Love Phillipa
Posted by bleauberry on January 2, 2009, at 17:17:58
In reply to Zyprexa for insomnia, posted by Quintal on December 31, 2008, at 13:36:07
In my opinion, antipsychotics are for: Treatment resistant depression when combined with SSRIs; Boosting a partial response to SSRIs; schizo-affective disorders; Silencing violent prisoners; sometimes things like Autism. For sleep? Not.
I would make one exception. I see no harm in 25mg Seroquel for sleep. Sure Zyprexa can be good for sleep. But I mean, if sleep is the issue, Seroquel has more of a knockout punch. And its halflife is short. Zyprexa is there 24 hours.
Now if he were giving you Prozac+Zyprexa, I would say excellent idea. But Zyprexa alone, well, it's still a great med, but I hesitate a little bit.
There are better choices for sleep, such as Trazodone, Lunesta, Seroquel, Restoril.
If you are in a place where you feel inferior to your doctor, as in being as you called a "difficult patient", then I can't help but see a bad doctor/patient relationship there. I know of no details other than what you wrote, so I could be way wrong and overly judgemental. But based on what I see with limited information, either this doctor is undeservingly egotistical (thinks he knows it all and has all the answers and is not to be questioned), or maybe he is fine but you are not standing up for yourself. Either way, a middle ground of compromise has to be found that is agreeable with both of you. After all, it is you that is getting him paid, and it is you that has to swallow powerful mystery pills. You are the paying customer. He has no business and no paycheck without you. You are the boss in that regard. There is nothing wrong with discussing alternatives with a doctor that are different than his best choice. Just do it respectfully and tactfully, but boldly, and it helps to have scientific evidence on paper laid on his desk to back up your opinions.
And so what if that is a difficult patient? So what? That difficult patient sounds like he is taking a responsible stand in his own wellbeing, and not subordinating his life to the role of guinea pig at someone else's whim. I have had doctors like yours. Right now I have two that respect that I am involved, researching, and sparking ideas. They admit right up front medicine leaves a lot to be desired, and they encourage patient involvement in decision making. Actually, it makes their job easier. So a difficult patient can actually be an easier patient.
This is the end of the thread.
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