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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 26 to 50 of 52. Go back in thread:
Posted by SLS on April 11, 2006, at 6:31:54
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 10, 2006, at 21:00:16
> How long is a fair trial to give paxil while it is greatly increasing my anxiety/derealization?
> Plus depression is back since im not on the trileptal, now i don't look forward to teaching/tutoring, whereas before i was loving it.I found that Trileptal 900mg produced a significant antidpressant effect. However, I was taking it with antidepressants. My main reasons for stopping it were that the degree of improvement was inadequate and it produced excema like lesions on my hands.
> Morning anxiety is killing me.
Have mornings always been your worst time?
> Gentlemen (women close your eyes), has it ever occured that the anxiety from a med is/was so bad, that your genital shrink up (adreneline rush), almost to receed in to your stomach? This happens non stop.
This can be the result of a phenomenon called "dysautonomia". I too have found that there is a tendency towards testicular ascension, especially upon orgasm. It is a sort of exaggerated cremaster reflex. It should abate once the depression remits.
Have you ever tried a tricyclic antidepressant?
- Scott
Posted by Racer on April 11, 2006, at 10:30:03
In reply to Re: Would you listen to this doctor? Help please!!!!!! » qbsbrown, posted by Phillipa on April 10, 2006, at 21:57:43
Posted by Phillipa on April 11, 2006, at 10:52:20
In reply to Re: Would you listen to this doctor? Help please!!!!!! » qbsbrown, posted by Phillipa on April 10, 2006, at 21:57:43
I said if his doc in the US prescribed the other to him to call him and ask his advise. Since what he had prescribed worked for him. Not prescribe for himself two pdocs heads are better than one. And maybe the trileptal isn't available in China and his old Doc may know this. Too many circumstances for mere peers to know of. Just my take. Love Phillipa
Posted by Phillipa on April 11, 2006, at 10:58:06
In reply to Re: Would you listen to this doctor? Help please!!!!!! » qbsbrown, posted by ed_uk on April 10, 2006, at 13:50:20
And I am not the only one suggestioning that this may or may not be the correct or right med for this person. I feel another opinion should be sought. Why suffer for six weeks if he can resolve the med issue sooner with info from his old doc or another and I do understand it is few and far between to find a pdoc in China according to the poster who started the thread. Just like you or I we have to weigh all the options available to us. Love Phillipa
Posted by Phillipa on April 11, 2006, at 11:13:33
In reply to Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 6, 2006, at 20:05:20
I reread your opening thread I would see your GP then and maybe they could talk together. Love Phillipa
Posted by ed_uk on April 11, 2006, at 15:32:49
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 10, 2006, at 19:39:53
Hi B :)
>she seems not to believe me that it was working
Doctors believe what they want to believe........the influence of expectation.
>that would be with higher dosage
600mg is not especially low. Even in epilepsy, 600mg can sometimes be adequate.
>I agree. I felt great the first 2 days on 10mgs paxil, and i still took my last doses of trileptal. Best i had felt in years. 20mgs threw me for an acid trip. I am on day 10 of 20mgs,so should just push through right? My anxiety/derealization is still way worse.
I would go back to 10mg if I were you. You can increase to 20mg in a few weeks time *if necessary*. I would never let anyone force me to take a higher dose than I was comfortable with. It's my body!
>Oh yeah, im not supposed to look anything up on the internet regarding mental health.
Some doctors prefer that their patients lack knowledge RE medications. This way, the doctor can assume the role of the expert. It's got a lot to do with ego.
Regards
Ed
Posted by ed_uk on April 11, 2006, at 15:43:57
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 10, 2006, at 21:00:16
Hi Brian
>How long is a fair trial to give paxil while it is greatly increasing my anxiety/derealization?
Decrease the dose to 5-10mg. 20mg was clearly much too high a starting dose.
>Gentlemen (women close your eyes), has it ever occured that the anxiety from a med is/was so bad, that your genital shrink up (adreneline rush), almost to receed in to your stomach? This happens non stop.
Anxiety causes the testes to be brought closer to the body. The scrotum may appear 'tight'. The size of the penis at any one time is related to the amount of blood that it contains. Your penis can be many different sizes throughout the day! An erection occurs when the erectile tissue of the penis fills with blood. During the flaccid state, the penis is smaller because it contains less blood. Anything which decreases the blood flow to the penis (eg. very cold weather) will cause a temporary decrease in size. Anxiety can affect the blood flow to the penis, causing a *temporary* shrinkadge - which *immediately* reverses when the anxiety is relieved. Anxiety related to sex is particularly likely to cause these symptoms.
Regards
Ed
Posted by Racer on April 11, 2006, at 18:05:50
In reply to Re: Would you listen to this doctor? Help please!!!!!! » qbsbrown, posted by ed_uk on April 11, 2006, at 15:32:49
>
> >Oh yeah, im not supposed to look anything up on the internet regarding mental health.
>
> Some doctors prefer that their patients lack knowledge RE medications. This way, the doctor can assume the role of the expert. It's got a lot to do with ego.
>
>I didn't read it this way. Brian said that he tends to obsess about things, and I kinda figured his doctor was trying to minimize his obsessing about meds and mental health. Not that she was trying to stop him from being an informed consumer, just that she didn't want him to be an obsessing consumer, you know?
Then again, could be I'm wrong...
Posted by Phillipa on April 11, 2006, at 18:40:45
In reply to I guess I got a different reading on this » ed_uk, posted by Racer on April 11, 2006, at 18:05:50
Ahhh Racer don't feel bad we all make mistakes. I do it all the time myself. Such is life. Love Phillipa
Posted by gardenergirl on April 11, 2006, at 19:32:00
In reply to Re: I guess I got a different reading on this » Racer, posted by Phillipa on April 11, 2006, at 18:40:45
I think she was saying she interpreted the comment differently than Ed did.
Of course I may be wrong.
gg
Posted by Phillipa on April 11, 2006, at 19:38:55
In reply to Re: I guess I got a different reading on this » Phillipa, posted by gardenergirl on April 11, 2006, at 19:32:00
Well that's what makes us individuals with different opinions and different diagnoses and different career choices, different locations to live and on and on. Love Phillipa
Posted by qbsbrown on April 11, 2006, at 19:51:03
In reply to Re: I guess I got a different reading on this ?Racer, posted by Phillipa on April 11, 2006, at 18:40:45
Great news! She came through with flying colors. I could not be more satisfied with her email. Thanks for your support. Enjoy reading.
"First of all, this is not a fight of egos. Not at all. I acknowledge the amount of information you have regarding mental health and medication effects/side effects. And yes, it is true that every person is an individual, meaning we are not supposed to generalize.
?/div>
But, in your case, I believed it was best to follow the "guidelines" to treat your anxiety and OCD. You have tried almost everything, with different timing and combinations; and your feelings, sometimes not only affected by the chemicals, are too subjective to be reliable. Please, understand me, I do not mean you are making up anything. I truly believe what you tell me is exactly how you felt. But I am somewhat skeptical due to the way your psyche works. That is why I preferred to follow the guidelines.
?/div>
SSRI is the first line treatment for anxiety, depression and OCD. After that, almost everything else is considered adjunctive treatment, working together with SSRI. (another treatment could be another antidepressant, such as the old tricyclic ones with many many side effects). My plan is using the paroxetine for as long as needed, 20 to 40 mg, initially together with benzodiacepines, for 3 to 4 weeks and then decrease and eventually stop benzodiacepine.
An hypnotic such as Ambion could do the trick to help you sleep better. And I do believe sleeping well is important for a good recovery.But continuing with the guideline:
1. SSRI for 4-5 weeks with benzo and then decrease/stop benzo,
2. increase SSRI,
3. change SSRI or add adjuvant treatment such as (I prefer the last, if not it is a waste of time)?
?. another antidepressant
?. antipsychotic
? mood stabilizer
?/div>
I decided to wear you off Trileptal because you were already complaining about its side effects (mostly those terrible headaches) and in order not to interfere with a "proper" treatment. Trileptal was not really bothering me, it was bothering you. You were taking Trileptal as a treatment for benzodiazepine withdrawal, and we know that's not the case. Also, I sincerely believe antidepressants will help you more in improving your symptoms than Trileptal, but with time. Antidepressants need 2 to 6 weeks to work, it depends on the individual. A 3 week trial of paroxetine as you did before is not enough to know if it is beneficial for you or not.?
?/div>
Having said all that I really do not want to discuss further this issue about taking or not taking Trileptal (there is not such an important reason against it) and as it will not do harm (apart from side effects) I let you restart it as you wish. If it helps, we shouldn't care if it is due to the placebo effect or due to its antidepressant-like effect, we should just be grateful it helps. ?/div>
?/div>
On the other hand, I understand your derealization as an anxiety symptom. Anxiety symptoms are many and respond differently to SSRI. Some respond quicker than others. The slowest ones could take one and a half or two months to disappear or to become better. Some might be resistant to an SSRI and need further treatment (another antidepressant, an antipsychotic...). We will need to give paroxetine a chance to improve this particular symptom. At the beginning of the treatment with SSRI there is a chance of worsening of symptoms, that is one of the reasons why, I am sure you already know about that, FDA imposed the drug companies a black box warning to SSRI saying at the beginning of the treatment it could increase suicidality.
Posted by Phillipa on April 11, 2006, at 20:04:45
In reply to she came through better than i could have imagined, posted by qbsbrown on April 11, 2006, at 19:51:03
Wonderful that sounds like great news to me. You are working together as a team and if I read it correctly correct me if I'm wrong . She's letting have the trileptal back too? Love Phillipa
Posted by Racer on April 11, 2006, at 21:45:58
In reply to she came through better than i could have imagined, posted by qbsbrown on April 11, 2006, at 19:51:03
I'm so glad for you!
For what it's worth, Paxil is known to be good for anxiety, once you get past any adjustment phase effects. I know it's hard -- in the past, I've gone through periods of having trouble sticking with drugs for more than a few weeks myself -- but if you can get through it, there's a good chance that the one drug will help all your symptoms.
And I'm very glad you talked to your doctor. And that she took the time to explain her thinking to you so clearly.
Good luck!
Posted by Deneb on April 11, 2006, at 21:56:13
In reply to she came through better than i could have imagined, posted by qbsbrown on April 11, 2006, at 19:51:03
Wow! Your pdoc is great! She spends lots of time with you and writes e-mails to you! And you know she really does listen!
Deneb*
Posted by qbsbrown on April 11, 2006, at 22:50:19
In reply to Re: she came through better than i could have imagined ?qbsbrown, posted by Deneb on April 11, 2006, at 21:56:13
It's a tough descision for me to add trileptal again or not. If i do reinstate it, i won't know if it is from the trileptal or the paxil. But on the other hand, i could always remove the trileptal at any time, and see if there are any bad effects from removing it.
Today is only day 12 of paxil. I have noticed some improvements w/ anxiety, but not so much depression, that's where trileptal was working.
I think i'll weigh the descision with my psychotherapist, and i'd love to hear your feedback.
And yes, i know you guys aren't prescribing anything for me. This will be a personal choice.Thanks so much for your help and interest.
Brian
Posted by qbsbrown on April 11, 2006, at 22:53:05
In reply to I guess I got a different reading on this ?ed_uk, posted by Racer on April 11, 2006, at 18:05:50
> I didn't read it this way. Brian said that he tends to obsess about things, and I kinda figured his doctor was trying to minimize his obsessing about meds and mental health. Not that she was trying to stop him from being an informed consumer, just that she didn't want him to be an obsessing consumer, you know?
>
> Then again, could be I'm wrong...You're right Racer, and my therapist agrees.
Posted by Caedmon on April 11, 2006, at 23:34:34
In reply to Re: she came through better than i could have imagined, posted by qbsbrown on April 11, 2006, at 22:50:19
Ahh, tricky.
> It's a tough descision for me to add trileptal again or not. If i do reinstate it, i won't know if it is from the trileptal or the paxil. But on the other hand, i could always remove the trileptal at any time, and see if there are any bad effects from removing it. >
If it were me I would go with the Paxil. Give it a full trial, and if it's tolerable but not sufficient, try adding the Trileptal. If it's intolerable, I might ask about going with Trileptal once again but by itself. Switching around with benzos might complicate that, I'm not sure. I'm still very impressed with your level of communication btw. At my pdoc appointment today, I just got handed a Parnate script and it was a quickie appointment, kind of surprised me. (Maybe he just trusts me a lot, heh.)
- C
Posted by Racer on April 12, 2006, at 0:42:39
In reply to Re: I guess I got a different reading on this, posted by qbsbrown on April 11, 2006, at 22:53:05
Brian, let me say again -- I am very, very glad that you and your pdoc can communicate about these things. And I'm very glad she came through for you.
As for whether or not to add Trileptal back in, I'm cringing but have to say I wouldn't. The reason I wouldn't has already been said: you'll get a cleaner picture of Paxil if you minimize the other drugs you're taking. Changing more than one med at a time makes it awfully hard to say what's actually going on.
Good luck, whatever you choose to do.
Posted by ed_uk on April 12, 2006, at 9:56:48
In reply to I guess I got a different reading on this » ed_uk, posted by Racer on April 11, 2006, at 18:05:50
>Then again, could be I'm wrong...
....or you could be right Racie :)
Ed x
Posted by qbsbrown on April 12, 2006, at 22:12:18
In reply to Re: I guess I got a different reading on this, posted by ed_uk on April 12, 2006, at 9:56:48
Well now the obvious dilema is to add trileptal or not.
I believe that i will lift depression w/ in one week, which has gotten bad. I will have to deal w/ the SEs (headaches, sleep, and hunger probs).
I could always drop it in a month and see what the paxil is doing alone.Or i could continue on with this worse anxiety and depression, and try to gut it through a couple more weeks.
It's a tough call. hard to turn down the depression lifting.
on the same hand, i would like to give this paxil a shot, although i could drop trileptal at any time and see how it is.What do you guys think?
Thanks so much.
Brian
Posted by MidnightBlue on April 13, 2006, at 0:11:22
In reply to my final descision, advice/comments appreciated, posted by qbsbrown on April 12, 2006, at 22:12:18
Honestly, I think headaches, sleep and hunger problems are pretty big negatives! Maybe you should stay off the trileptal for a bit. Didn't you also say it was causing a rash?
MB
Posted by qbsbrown on April 13, 2006, at 0:16:22
In reply to Re: my final descision, advice/comments appreciated » qbsbrown, posted by MidnightBlue on April 13, 2006, at 0:11:22
Sleep; she wants me on ambien anyway. I wonder if headaches might be lessened by the paxil. I'm sure the hunger would remain.
I think i'd rather have those than not wanting to get outta bed and do any work, or play on weekends.But should i wait for the paxil?
Obviously if only lamictal and trileptal has worked for my depression, there seems to be some connection, closely related.I could always take trileptal for a month, drop it and see how paxil is working.
Brian
Posted by Phillipa on April 13, 2006, at 0:21:03
In reply to Re: my final descision, advice/comments appreciated, posted by qbsbrown on April 13, 2006, at 0:16:22
I thought the decision was made no more trileptal and give the paxil a chance. I think I now know why she is being strict with you. No i'm not scolding you I do the same thing but it doesn't make it right. Love Phillipa
Posted by MidnightBlue on April 13, 2006, at 0:49:26
In reply to Re: my final descision, advice/comments appreciated, posted by qbsbrown on April 13, 2006, at 0:16:22
I hate to tell you this, but too high a dose of Ambien or Paxil can give me a headache! I think you should just try what your doctor suggested. Give the trileptal a rest.
And headaches, lack of sleep, and hunger MAKE me depressed!
MB
> Sleep; she wants me on ambien anyway. I wonder if headaches might be lessened by the paxil. I'm sure the hunger would remain.
> I think i'd rather have those than not wanting to get outta bed and do any work, or play on weekends.
>
> But should i wait for the paxil?
> Obviously if only lamictal and trileptal has worked for my depression, there seems to be some connection, closely related.
>
> I could always take trileptal for a month, drop it and see how paxil is working.
>
> Brian
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Dr. Bob is Robert Hsiung, MD,
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Script revised: February 4, 2008
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