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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by Phil on May 5, 2012, at 12:29:49
I talked to my pdoc briefly at the end of my appt Thursday about the anti-psychiatry "movement." He said there is a lot of problems with psychiatry and a big one is over-prescribing.
Now, my shortcoming and the results. He started me on Concerta a while back. I didn't like it. When he started me on stims I had to fill out an ADD 1 page questionnaire before I saw him. Anyone can manipulate that document and I did even though I'm honest with him 99.9 % of the time.
Fact is, I did well on Adderall years ago but he was avoiding it. I thought, well, I'll slightly skew this test and get Adderall. He compared the results and said, you're worse now than before I prescribed anything.
He switches me to Vyvanse solely on that paper and started me at 50mg and go to 100mg after two weeks. At 100mg, rapid breathing was too much. I did a search and it's very common. One lady said her 6yo panted like her dog but didn't seem concerned. I'm a grown up but if I had a sixyo panting on a psych med I'm be strangling the prescribing doc. People, many people are taking this problem as the price of admission for better focus. Anyone heard of heart attack, stroke, etc?
So Thursday, when filling out the paper I was completely honest. My intention was to ask him to drop my dose to 70mg from 100.
He saw the test and said, this is great! I think we should go to 120mg. (I like my doc and usually he tries to find a way to drop dosages and this shocked me)I just stared off in the distance thinking of how my experiment was backfiring. He said something like it's only 10 more mg(I think) of amphetamine than the 100mg and this is working. Honestly, stims do work for me and I did not want to get pulled off of them. I just wanted a lower dose but didn't say why.
He wrote it for 120mg and I'm not about to take it, I'm just taking 60mg with good results. Next appt I'm going to tell him why.
As others have said here, this is a blind spot in their profession. Well, the paper says it, so, it is true. I think a 10th grader could manipulate an ADD test.
I did something wrong hoping to get a right outcome and then made things worse. But when I wanted to drop the dose to correct the situation, I couldn't come up, on the spot, with why. But I'll spill the beans in a month.
I've never been close to perfect but instead of pushing for what I knew worked, I tried to be clever.
On the upside, I now had a one month script that will last two.
Comments welcome.
Posted by Phillipa on May 5, 2012, at 12:37:19
In reply to Me and my doc...stims, posted by Phil on May 5, 2012, at 12:29:49
Phil if you wanted the dose lowered wouldn't it lower it without a test first? And it's more than scarey what children are put through. I'm surprised your doc wishe and did raise the dose. Wow. Phillipa
Posted by Phil on May 5, 2012, at 13:49:59
In reply to Re: Me and my doc...stims » Phil, posted by Phillipa on May 5, 2012, at 12:37:19
Kind of hard for my doc to make a decision with me not being straightforward and assertive with him. I did it out of an unfounded fear of being pulled off stims when I knew that they work.
I almost fell out of my chair when he said we need to up it although I had been to my pcp the day before who said my vitals were fine but I only took 50mg that day.
I haven't searched all stims but there are probably many thousands of people with breathing issues on vyvance when the package insert says it's a very serious side effect. Yes psychiatry has a long ways to go.
Posted by Christ_empowered on May 5, 2012, at 15:00:05
In reply to Re: Me and my doc...stims » Phillipa, posted by Phil on May 5, 2012, at 13:49:59
Vyvanse is just Dexedrine 2.0. All the old problems still apply, its just shiny, new, expensive, and has a better delivery system.
I wouldn't talk about breathing problems (fear of litigation might make your doc drop the amphetamine completely), but you shouldn't have a problem getting him to lower a Schedule II medication unless he's got some kind of power issue with always having to set the dosage.
You could also explain that you don't take them every day, or some days you benefit from a lower dosage. I don't know if your doc would understand that, but one of my ex-shrinks--an old school shrink if ever I saw one--was cool with that approach. My Rx'd dose was the max allowed, basically. Then again, she referred to Adderall as an "upper," so she's probably not your typical pdoc.
Posted by Phil on May 5, 2012, at 15:30:19
In reply to Re: Me and my doc...stims, posted by Christ_empowered on May 5, 2012, at 15:00:05
He's been out of character, in my eyes, on his view of stims. I don't think he'll have a problem lowering the dose. 60mg today has been fine but I'm thinking 70-80 may be better. I need to give it more time.
A couple of things surprised me. I told him that some people take days off or maybe weekends off of stims. He said why would anyone do that?
Secondly, after I took the test and he said, this is great! So, then why bump the dose again?
I really like my doc and I've seen him for years and this is the first time I'm kind of puzzled.
I've struggled a lot over the years and I think he's trying to maximize something that shows major promise. I think we're both dysfunctional on this subject.
Posted by Christ_empowered on May 5, 2012, at 15:50:59
In reply to Re: Me and my doc...stims » Christ_empowered, posted by Phil on May 5, 2012, at 15:30:19
I've never heard of a shrink who would do anything but rejoice upon hearing that someone wanted to low-dose a controlled substance or take breaks. Maybe he thinks you're being too cautious, given all the problems you've had?
He might just think stims are the magic ticket to getting you to be happier, more productive, better adjusted, etc. The higher doses just might be a way of him expressing his enthusiasm. Just a guess.
Anyway, I've also noticed that male psychiatrists high dose things more often than females. Its weird. I think men really want to feel like "real doctors" with real treatments, so they sometimes go a bit apesh!t with doses, at least more often than women. Just something I've observed through personal experience.
Posted by Phil on May 5, 2012, at 16:15:35
In reply to weird, posted by Christ_empowered on May 5, 2012, at 15:50:59
I saw a woman doc before him and she had no problem with higher doses. I guess there are always exceptions.
Let me see, I recently brought up raising the dose on something and he said more is not necessarily better. He also talked about going prn on Clonazepam and dropping Seroquel from 300 to 150. I'm unemployed and super stressed and said I can't do that right now though I'm thinking about the Seroquel option.
My therapist, who my doc recommended and is right down the hall, has been feeding him info on where I'm at. He's funny and seems to enjoy messing with psychiatrist's heads. So, the stim issue may be partly because of what my therapist sees. Plus we have more time to talk and a lot is med related. hmmm
Posted by Alexei on May 6, 2012, at 11:27:17
In reply to Re: weird, posted by Phil on May 5, 2012, at 16:15:35
I have not heard of too many people on 120mg vyvanse, although I might ask for that if abilify keeps jacking with me ... lolz.
In a way, it's almost better to have a pdoc who is prone to rx'ng too much than too little. You can always dial it back to whatever you think is best.
I know lots of people cannot wrangle any benzos or stims from their pdoc even when badly needed. Ridiculous.
Phil, may I ask your opinion on seroquel? Is it helpful for anxiety and depression at 300mg? How are you doing on it?
Alexei
> I saw a woman doc before him and she had no problem with higher doses. I guess there are always exceptions.
>
> Let me see, I recently brought up raising the dose on something and he said more is not necessarily better. He also talked about going prn on Clonazepam and dropping Seroquel from 300 to 150. I'm unemployed and super stressed and said I can't do that right now though I'm thinking about the Seroquel option.
>
> My therapist, who my doc recommended and is right down the hall, has been feeding him info on where I'm at. He's funny and seems to enjoy messing with psychiatrist's heads. So, the stim issue may be partly because of what my therapist sees. Plus we have more time to talk and a lot is med related. hmmm
Posted by Phil on May 6, 2012, at 11:50:37
In reply to Re: weird » Phil, posted by Alexei on May 6, 2012, at 11:27:17
First my doc waited years before introducing stims. First he tried Nu and Provigil which I think are useless. I think my therapist talked to him about my desire to get back on stims and a social worker that I did group with faxed him a copy of a report that I had slowed thought processes. I was also sleeping all day, etc.
Gotta tell you Alexei, I've been cycled through so many meds that I'm not sure what's doing what. When I'm on Lamictal, Lithium and others, I'm not sure. My guess is that it's helping some. It and Zyprexa before it have added #'s.
Most days I do OK. But as I told my doc, three weeks ago I had two days of 'I can't take it anymore suicidal ideation.' I think that had more to do with bipolar than medication failure.
If I was asked I would say talk to your doc about Seroquel.
My life circumstances suck and 99 days out of 100 I think I'm OK. I know that's a convoluted answer but it's the best I can do.
Bottom line. Though things aren't perfect and for a few exceptions, I haven't been in a seriously deep depression in a long time.
Posted by policebox on May 6, 2012, at 18:11:53
In reply to Me and my doc...stims, posted by Phil on May 5, 2012, at 12:29:49
Must be nice. My psychiatrist is at a university, so he isn't allowed to prescribe stimulants without the permission of the director (who isn't even a psychiatrist). So after waiting 1 month to see the director for an ADHD assessment, I completed the questionaire. I was completely honest. Based upon my symptoms, the results of my questionaire, and my history he said it sounded like I had ADHD. Then I had to wait 6 months to be given a TOVA test. Based upon the results of that, I was ruled not to have ADHD, despite my clinical history, symptoms, and failure to respond to several classes of antidepressants.
I'm not a typical college student, as I'm 36 years old. The reason I'm a 36 year old college student is because of difficulties with concentration, getting motivated to get things done, problems with interpersonal relationships, holding down jobs, etc.
So, you're lucky you can be dishonest and get the drugs you need to help you. I chose to be upfront and honest and told that all my problems would go away if I just excersized more often.
Posted by phidippus on May 6, 2012, at 21:41:38
In reply to Me and my doc...stims, posted by Phil on May 5, 2012, at 12:29:49
Whyy do you think stims do it for you?
Eric
Posted by Phil on May 7, 2012, at 6:25:31
In reply to Re: Me and my doc...stims » Phil, posted by phidippus on May 6, 2012, at 21:41:38
Short story..my stepfather had little education, lived in a small town and was a farmer. He retired a millionaire. I observed him a lot and wondered what made him so successful. Besides hard work etc, he had curiosity about everything.
As a depressed person, sometimes I have curiosity about nothing. Stims help there. Also focus and as a mood brightener.
Also I'm a drummer but had not even looked at my drums in 10 years. When I started on Concerta, I ordered new heads, etc and I'm playing again. I've had trouble exercising because of a ligament problem in my left leg. So, I ordered a recumbent exercise bike(a decision I could never make)and I'm exercising.
And I'm curious. I listen to Ted Talks. I go to Google Scholar to read things and try to learn. I could go on.
On the other hand, I think more and more about trying to get off meds. I don't think that experiment would have a good outcome but I'd give almost anything to live without medication.
Posted by Phillipa on May 7, 2012, at 19:42:33
In reply to Re: Me and my doc...stims » phidippus, posted by Phil on May 7, 2012, at 6:25:31
Nor do I stick with them for now. Phillipa
Posted by Alexei on May 8, 2012, at 8:00:09
In reply to Re: weird » Alexei, posted by Phil on May 6, 2012, at 11:50:37
Thanks Phil ... Sounds like the stims have done wonders for you ... yet it took years for your pdoc to cooperate. And docs throw AAP's around like candy. Unbelievable.
Do you mind if I ask what you're taking now? Do any of your meds interfere with your vyvanse? No doubt in my mind that abilify is throttling my vyvanse. I could easily go higher than 70mg right now.
Have you had any experience with abilify?
Alexei
> First my doc waited years before introducing stims. First he tried Nu and Provigil which I think are useless. I think my therapist talked to him about my desire to get back on stims and a social worker that I did group with faxed him a copy of a report that I had slowed thought processes. I was also sleeping all day, etc.
>
> Gotta tell you Alexei, I've been cycled through so many meds that I'm not sure what's doing what. When I'm on Lamictal, Lithium and others, I'm not sure. My guess is that it's helping some. It and Zyprexa before it have added #'s.
> Most days I do OK. But as I told my doc, three weeks ago I had two days of 'I can't take it anymore suicidal ideation.' I think that had more to do with bipolar than medication failure.
> If I was asked I would say talk to your doc about Seroquel.
> My life circumstances suck and 99 days out of 100 I think I'm OK. I know that's a convoluted answer but it's the best I can do.
> Bottom line. Though things aren't perfect and for a few exceptions, I haven't been in a seriously deep depression in a long time.
Posted by Phil on May 8, 2012, at 19:15:06
In reply to Re: weird » Phil, posted by Alexei on May 8, 2012, at 8:00:09
So 100mg had me buzzing. He ups the dose to 120mg. I take 60mg and, day by day, break open one cap and put in water and gradually go up. Today I said screw it and took 120. I'm totally chilled almost like I've taken nothing. No rapid breathing or the like. Focus is OK. Full 'speed' ahead.
Posted by Alexei on May 9, 2012, at 6:32:23
In reply to Re: weird, posted by Phil on May 8, 2012, at 19:15:06
Sounds good. What time did it wear off? ... any crash or trouble sleeping?
> So 100mg had me buzzing. He ups the dose to 120mg. I take 60mg and, day by day, break open one cap and put in water and gradually go up. Today I said screw it and took 120. I'm totally chilled almost like I've taken nothing. No rapid breathing or the like. Focus is OK. Full 'speed' ahead.
Posted by Phil on May 9, 2012, at 8:14:18
In reply to Re: weird » Phil, posted by Alexei on May 9, 2012, at 6:32:23
Uh-oh, was it supposed to wear off?!! j/k Went to bed at 10 but took Seroquel 3 hours earlier. When Seroquel says bed time, it's bed time. I always sleep well. Thanks!
Posted by Alexei on May 9, 2012, at 8:30:04
In reply to Re: weird » Alexei, posted by Phil on May 9, 2012, at 8:14:18
Haha ... seroquel is a great med, no doubt! Makes me question my choice of abilify over Quel. I thought it would be better for depression..
300mg does you justice?
> Uh-oh, was it supposed to wear off?!! j/k Went to bed at 10 but took Seroquel 3 hours earlier. When Seroquel says bed time, it's bed time. I always sleep well. Thanks!
Posted by Phil on May 9, 2012, at 8:59:50
In reply to Re: weird » Phil, posted by Alexei on May 9, 2012, at 8:30:04
Yeah it does but I wouldn't mind trying 150. We shall see.
On the student doctor site I go to one person there said something lie, Seroquel sucks as a AAP. Something like that.
One thing I've learned there is that med students, residents, attending doctors have their bias' and I wonder sometimes if they know as much as we do. Their trick is memorize / regurgitate.
One doc said polypharmacy is just wrong. At a certain point it is but sometimes people with Bipolar 1 with psychosis are just not going to get by with Lithium alone.
They will grow up, hopefully.
Posted by Alexei on May 9, 2012, at 11:31:39
In reply to Re: weird » Alexei, posted by Phil on May 9, 2012, at 8:59:50
Yes I looked at that site, thread, and post. That was an extremely arrogant post... I'd hate to be his patient. Seroquel is pretty effective for anxiety/depression problems. Screw that guy. Maybe he prefers Haldol or moban, lolz..
Hey Phil, have a question for you. Does seroquel interfere with your vyvanse? I'm going to d/c abilify for that reason, plus it's making me MORE depressed! I just started a thread on that fiasco.
Have you tried abilify?
> Yeah it does but I wouldn't mind trying 150. We shall see.
>
> On the student doctor site I go to one person there said something lie, Seroquel sucks as a AAP. Something like that.
>
> One thing I've learned there is that med students, residents, attending doctors have their bias' and I wonder sometimes if they know as much as we do. Their trick is memorize / regurgitate.
>
> One doc said polypharmacy is just wrong. At a certain point it is but sometimes people with Bipolar 1 with psychosis are just not going to get by with Lithium alone.
>
> They will grow up, hopefully.
Posted by Phil on May 9, 2012, at 13:20:45
In reply to Re: weird » Phil, posted by Alexei on May 9, 2012, at 11:31:39
Abilify triggered a mixed states episode. I wasn't on it very long.
One of the reasons I was put on Vyvanse was lack of focus, maybe a bit dumb, and I slept all the time. I guess that's 3 reasons. I can still take a nap if I need to but no I can't say that it interfered, more like enhanced.
Although sometimes at night when it's wearing off I can get really pissed at my cat but knowing that I can control it. :)
Posted by phidippus on May 9, 2012, at 21:47:20
In reply to Re: Me and my doc...stims » phidippus, posted by Phil on May 7, 2012, at 6:25:31
Has anyone diagnosed you with ADHD?
Eric
Posted by Phil on May 9, 2012, at 22:19:19
In reply to Re: Me and my doc...stims » Phil, posted by phidippus on May 9, 2012, at 21:47:20
Yep. Before a doctor did my older brother read an article on it, called me and said this is you.
Certified.
Posted by Phil on May 9, 2012, at 22:27:57
In reply to Re: Me and my doc...stims » Phil, posted by phidippus on May 9, 2012, at 21:47:20
Actually three psychiatrists in a row have no disagreement on it. Ask my mother, my brothers, and my schoolmates. Nobody knew what it was back then but they knew I was 'special.'
I also had depression at a very young age. My family had their own problems, mine weren't noticed.
I came from a malignant home and I'm still paying.
Posted by phidippus on May 10, 2012, at 19:48:46
In reply to Re: Me and my doc...stims » phidippus, posted by Phil on May 9, 2012, at 22:27:57
So you need a good stim/AD combo?
Eric
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