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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Refractory depression has ruined my life on October 18, 1999, at 1:25:56
I am a 30 year old guy in Greensboro, NC with treatment resistant depression. I have been on the following meds. Remeron up to 45 mg, Zoloft up to 200 mg, Effexor XR up to 375 mg and Wellbutrin SR up to 400 mg. I have also tried lithium augmentation with 300 mg Effexor XR...the lithium made me worse actually. I also recently completed a clinical trial of the new rTMS magnet therapy...two weeks of it. It did not help much. I need a GOOD psychopharmacologist in North Carolina. If you know of a good psychopharmacologist in the Raleigh/Durham/Chapel Hill area, Greensboro, Charlotte...or ANYWHERE in NC, please let me know. Feel free to E-mail me directly. I hate to say this but I would really prefer male doctors as I have sort of a gruff personality a little and have been advised by former psychiatrists to use only male doctors for this reason.
I also want a doctor who is good with the older meds like the Tricyclics and the MAOIs as I intend to try these soon.Also, if you know of a good neuropsychiatrist in NC please let me know. But not one whose main specialty is working with children. I have been advised I might wanna see a neuropsychiatrist but have had a ton of trouble finding one in NC. I know a lot of them specialize in working with children, which is not what I need.
Thank you
Posted by JohnL on October 18, 1999, at 3:27:24
In reply to Need a good Psychiatrist in NC, posted by Refractory depression has ruined my life on October 18, 1999, at 1:25:56
Sorry to hear your struggles. Certainly sounds like you've made some valiant efforts. MAOIs, MAOI+TCA, ECT would all be warranted at this time I think. Also mood stabilizers. Maybe Naltrexone. Not to worry, there are still many chioces for you. One of them will work. MAOIs and TCAs especially can work wonders when nothing else did. Also, if you've been misdiagnosed and you are actually bipolar (can be even if manic episodes aren't evident), then ADs would be the wrong approach altogether, explaining your failures so far.
There is a site called Ivan Goldberg's Depression Central. In it he lists the top psychiatric hospitals in the USA. One is Duke University Medical Center in Durham, NC.
He also lists top psychiatrists in the country. Here are the three in NC:
Janowsky, David S., M.D.
University of NC School of Medicine
Chapel Hill, NC 27599
919-966-0167Prange Jr, Arthur J., M.D.
same as aboveDavidson, Jonathan R.T., M.D.
637 Totten Place
Chapel Hill, NC 27514
919-684-2880There are also good questions to ask in determining the expertise of a doctor. For example, what's the highest dose of Prozac you've prescribed? A poor answer is 80mg. An expert answer is 160mg. Another example, are you comfortable prescribing a TCA with an MAOI? Bad answer is no, that could be very dangerous. Expert answer is Yes, I've found that very helpful in certain patients.
So whether you use the addresses above or use specific questions to screen your own prospective list of doctors, there is plenty of hope here! Go get em! :)
Posted by Refractory on October 18, 1999, at 12:22:13
In reply to Re: Need a good Psychiatrist in NC, posted by JohnL on October 18, 1999, at 3:27:24
No, I am not bipolar at all...have been screened for that by several doctors. I have never had mania or hypomania. I had to get screened thoroughly to rule out bipolar or schizophrenia, etc. just to get into that rTMS clinical trial. Besides, I just came off lithium augmentation with Effexor XR and the lithium made me MUCH worse. Ive tried mood stabilizers like neurontin and they dont help they make it worse in fact. Yes, I have read all that stuff on Depression Central. I definitely have plans to try TCAs and MAOIs very, very soon. In fact I am currently tapering off my Effexor XR now so I can go on Pamelor soon. I really should have been tried on a TCA a long time ago...kinda makes me mad a little. I have even read on the net that the "definition" of treatment resistant depression is the failure of a TCA, probably Tofranil, at an adequate dose. I am not totally treatment resistant. I get a partial response from the meds. I feel around oh, 40% the majority of the time. I have not worked now in about a year and a half!! I am trying to avoid ECT for obvious reasons...have YOU had ECT? Ive had my thyroid checked and all the blood work, blah, blah, blah.
I am all for TCAs and MAOIs and any other drug which would help me though. I dont know, maybe ECT is what I will end up having to get though, who knows? I am very cooperative with my Pdoc, take my drugs religously at the doses I am supposed to take them, etc. I also even force myself to work out aerobically on a consistent basis. I force myself to swim laps most days. Of course I cant swim at the intensity or speed I used to before depression, but I force myself to swim a 650 meters 5 or 6 days a week most of the time. Of course a lot of times I am so dead from depression it takes every bit of strength I have to discipline myself to do it but I do it. Guess that is a carryover from my predepression days when I was kind of athletic and an exercise buff...good habits carried over a little. My depression was largely steroid induced(prednisone) and it was especially nasty before I got on meds. But the meds just dont bring me back very much, just enough to somehow barely function.Ive been advised I might wanna see a specialist in treatment resistant depression but kind of get the run around when I call Duke or Chapel Hill. They always say, "well, ALL of our psychiatrists should be capable of treating treatment resistant depression." Nobody bothers to try to refer me to anybody good. I did get referred to this one good psychiatrist at Duke...but he was not accepting new patients...bummer cause I think that guy was an excellent med guy.
Nobody has wracked their brains to try to help me find a good psychiatrist, if I died tomorrow I think the only people who would even care at all would be my immediate family.The best medical care I have gotten so far was when I went to the Medical University of South Carolina at Charleston for rTMS trial. They were very professional and very competent I thought. And hell, that was free...I was not even paying for it! Cause it was a research thing. But I received super high quality care there but when it was over I was no longer in the research program there so I cannot go there anymore. But I though MUSC was the greatest for psychiatric care. Much better than Duke, which I think is oftentimes kind of overrated.
That being said, I need a good psychomed person, preferably a male doctor cause of my gruff personality type. I dont care where they come from or where they are at in NC, as long as they are within an hour and a half drive from me which puts Duke, Chapel Hill, Wake Forest, Charlotte all in my target range.
If any doctors are reading this and you are good and need new patients, please drop me a direct E-mail.
Posted by JohnL on October 19, 1999, at 3:42:17
In reply to Re: Need a good Psychiatrist in NC, posted by Refractory on October 18, 1999, at 12:22:13
Sorry. Was just trying to help. I know nothing about the things I suggested except they are from a reputable source. But since you live in NC you probably have a better perspective.
I am better aware now of your frustration. I can relate. The old cliche, been there done that. Here's what worked for me. I got every name from the yellow pages. I called every clinic and hospital and asked, "Who would you suggest for your own family member?" Many answers were reserved, but I did get a few recommendations of trusted names. A couple came up more than once. That was a good sign.
I also sent a brief letter, shotgun style, to all names in the yellow pages. Described concisely (one page) my situation, treatment history, and asked if they felt confident of taking on my case. I got a 50% response rate. I was looking for someone in love with their work. They tend to perform better when they absolutely love what they do. After getting responses, I followed up with phone calls. If I couldn't get the doc on the phone, I scratched them off the list. I want accessiblity. If I did get them on the phone, I then screened with intuition, gut feeling, chemistry, and specific questions.
Out of a universe of about 30 names at the start, I ended up with three excellent ones to choose from. I then used age as my final criteria. I wanted an old guy who was around when MAOIs were the only choice. Someone who's seen it all. He's been wonderful. He's accessible, highly experienced, and willing to try any suggestion I have.
Anyway, there really is no easy answer here. My approach took serious effort, time, stamps, and calls. But my situation was serious, so my efforts were warranted. And it was a distraction from dwelling on my condition for a while. You know, you might want to just call everyone you can and say, "I want to try an MAOI and possibly add a TCA later, I need a doc who will go along with my desire and monitor my progress. Would you be willing to do that?" You can screen them based on how they answer your straight-forward simple question. If you get some kind of politically correct balogne answer, scratch em off. You will know the right doc with the right answer when you talk to them. The more you talk to the better. You will likely find psychiatrists actually recommending to you other psychiatrists more qualified for your case. No easy way. Just gotta get out there and bang on doors. One of them will be the right one. But they're not gonna come to you. You gotta go find them. On your terms.
Posted by JohnB on October 25, 1999, at 21:42:05
In reply to Need a good Psychiatrist in NC, posted by Refractory depression has ruined my life on October 18, 1999, at 1:25:56
Refractory:
I live in Raleigh NC and would recommend two very experienced MD's in treating depression:
Dr.Jim Wells/Center For Creative Balance
Hillsborough, NCDr.Richard Weisler
Raleigh, NCI've been seeing Dr.Wells for many years. Dr.Weisler has a reputation as one of the most knowledgable psychopharmacologists in the country.
When you contact either of them, simply state that you're dealing with some tough depression, haven't been able to find a good MD in your area, and would like to make an appointment. Remember. There many options still available to treat your depression.Also, there is a North Carolina Depression/Manic Depression organization in Raleigh that should certainly be able to make recommendations for other MDs to see.
Good luck,
JohnB
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