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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 10 to 34 of 34. Go back in thread:
Posted by Dinah on February 25, 2005, at 16:20:26
In reply to Re: Pdoc ruled out treating me with what works., posted by gardenergirl on February 25, 2005, at 16:00:03
That's what I had read here too. But perhaps he's had a malpractice suit over it or something. (Am I cynical or what?)
Posted by Dinah on February 25, 2005, at 16:22:32
In reply to Re: Pdoc ruled it out » Dinah, posted by TamaraJ on February 25, 2005, at 14:48:10
Hmmm. I'll have to look into that. They're in the same class as nortryptiline? It didn't work too well for me.
But I recognize those names as drugs they used to use to treat OCD, and that's my primary diagnosis (I think - who knows anymore).
Posted by TamaraJ on February 25, 2005, at 16:27:11
In reply to Re: Pdoc ruled it out » TamaraJ, posted by Dinah on February 25, 2005, at 16:22:32
Yes, nort is a TCA, but I think the beauty of TCAs (if I am remembering correctly) is that they all work differently. So, if you can't tolerate nort, you may well be able to tolerate Tofranil.
Dinah, do you think your pdoc may be concerned about prescribing a MAOI because of your diabetes and the diet you have to follow for that? He no doubt has your best interests at heart.
Tamara
> Hmmm. I'll have to look into that. They're in the same class as nortryptiline? It didn't work too well for me.
>
> But I recognize those names as drugs they used to use to treat OCD, and that's my primary diagnosis (I think - who knows anymore).
Posted by Dinah on February 25, 2005, at 16:43:53
In reply to Re: Pdoc ruled it out » Dinah, posted by TamaraJ on February 25, 2005, at 16:27:11
If I remember correctly, he said that he doesn't prescribe it, not that he didn't want to prescribe it for me. It sounded like a global thing.
I'm sure he does have my best interests at heart. I'm just a bit discouraged.
Posted by TamaraJ on February 25, 2005, at 16:45:07
In reply to Re: Pdoc ruled it out » TamaraJ, posted by Dinah on February 25, 2005, at 16:43:53
Posted by Phillipa on February 25, 2005, at 17:47:48
In reply to I don't blame you :-( (nm) » Dinah, posted by TamaraJ on February 25, 2005, at 16:45:07
If it's OCD what about Luvox? There's a good Thread on the Board now about it. Hope this helps. Fondly, Phillipa
Posted by jay on February 25, 2005, at 21:21:56
In reply to Pdoc ruled it out, posted by Dinah on February 25, 2005, at 14:37:16
> He says he doesn't prescribe it because it's too dangerous. He offered me Cymbalta, but I refused because my research showed me it's pretty much Effexor, and I did horribly on Effexor (and nortriptyline and Wellbutrin).
>
> Since the SSRI's just add feeling bad onto feeling sad, I'm just out of luck A-D wise.
>
> Thanks anyway, guys.How is this for a combo? Prozac +Nortrip+Risperdal+Depakote(and maybe clonazepam)? I recall you talking about most of these drugs except for the Prozac. Thoughts?
Best,
Jay
Posted by Dinah on February 26, 2005, at 0:26:40
In reply to Re: Pdoc ruled it out...what about this? » Dinah, posted by jay on February 25, 2005, at 21:21:56
Nortriptyline disagreed with me, even with Depakote and Klonopin on board. It made me itchy jumpy. Norepinephrine is poison to me. I'm guessing Prozac would be similar to Luvox. And I generally take Risperdal as needed because I worry about tardive dyskenesia. A couple of my relatives have it, and it's no fun. It's a great drug as needed though.
It seems to just be antidepressants that I can't tolerate easily. I even eventually got used to Provigil on an as needed basis.
Thanks Jay. I think I'm just up a creek on this one.
Posted by Phillipa on February 26, 2005, at 0:30:52
In reply to Re: Pdoc ruled it out...what about this? » jay, posted by Dinah on February 26, 2005, at 0:26:40
Prozac is very stimulating and has a very long half-life. Luvox has a short half-life, and is not stimulating. It helps OCD as well as depression. Fondly, Phillipa
Posted by Dinah on February 26, 2005, at 0:32:01
In reply to Re: I don't blame you :-(, posted by Phillipa on February 25, 2005, at 17:47:48
Thanks Phillipa.
I was on Luvox for four years, and it certainly wasn't the worst drug I've been on. If I get desparate enough that I think it's death or Luvox, I'll take it.
But I don't like the increased migraines, IBS, GERD, ear ringing, head buzzing, stupids, apathy, anorgasmia, etc. Not to mention withdrawal. Especially withdrawal. I did it once and it's hard to imagine it's worth doing again.
I think I'm just going to have to gut it out without an AD.
Posted by SLS on February 26, 2005, at 6:46:32
In reply to Re: I don't blame you :-( » Phillipa, posted by Dinah on February 26, 2005, at 0:32:01
Hi Dinah.
> I think I'm just going to have to gut it out without an AD.
Anafranil?
Zyprexa?
Pull yourself up by your bootstraps?
Out of curiosity, do you have OCPD? Maybe some of your difficulties can be addressed with more specific psychotherapeutics.
(I'm just reaching for sh*t)
What was it about nortriptyline that you found disagreeable?
To what degree does you OCD interfere with your day-to-day functioning?
- Scott
Posted by Dinah on February 26, 2005, at 8:56:37
In reply to Re: I don't blame you :-( » Dinah, posted by SLS on February 26, 2005, at 6:46:32
> Hi Dinah.
>
> > I think I'm just going to have to gut it out without an AD.
>
> Anafranil?
>
> Zyprexa?
>
> Pull yourself up by your bootstraps?Hope the depression will pass? I've only had extended periods of major depression two or three times in my life. My therapist thinks this is time four, but I think it might be too early to judge that.
>
> Out of curiosity, do you have OCPD? Maybe some of your difficulties can be addressed with more specific psychotherapeutics.No, I'm pretty sure my husband has that, and I soooo do not. :)
>
> (I'm just reaching for sh*t)
>
> What was it about nortriptyline that you found disagreeable?
>
Same as Effexor and to a greater degree Wellbutrin. Akasthesia (sp?) and the nasty sort of hypomania.> To what degree does you OCD interfere with your day-to-day functioning?
>
Not so much really. It's largely under control. It was my initial diagnosis, but responded well to cognitive behavior therapy.I'm not sure DSM-IV has a good category for me. In general, I just have a highly reactive nervous system, and I have problems with mood regulation and lots of anxiety. But right now, I am depressed. At least I think I might be. Suicidal thinking, not grooming myself, having trouble concentrating on work or anything else, sleeping too much, or sometimes too little. Still, it's hard to pull the strands of everything going on. Grief at my father's death, physical reactions to diabetes and food, and disgust at myself for not accomplishing my work for whichever reason is accurate. There are alternate explanations to depression, I think.
>
> - Scott
>
Thanks Scott. I appreciate it. But I'm pretty sure I'm hopeless in the medication area. My therapist is pushing me to get an AD, and every once in a while I get excited about a new possibility. But every new drug looks like a repackage of a prior one. I haven't seen any truly new ones in a while. I can't bear another norepinephrine induced agitation. Not even as a trial. If things are bad enough long enough, I might break down and take the Luvox. But it's hard to look down the road and say I might feel better in six to eight weeks, when I know that right now I just feel lousy on top of whatever I felt before.I'm really not a general pain in the rear about meds. I'm happy with my mood stabilizer and anti-anxiety drug. And I don't mind taking antipsychotics (for agitation) and Provigil (a stimulant?) as needed. They just need to do some improvements in the antidepressant drug arena.
Posted by Phillipa on February 26, 2005, at 11:07:05
In reply to Re: I don't blame you :-(, posted by Dinah on February 26, 2005, at 8:56:37
Scott, What is OCPD? Fondly, Phillipa
Posted by SLS on February 26, 2005, at 14:06:17
In reply to Re: I don't blame you :-(, posted by Phillipa on February 26, 2005, at 11:07:05
> Scott, What is OCPD? Fondly, Phillipa
It stands for obsessive compulsive personality disorder. I believe it is an Axis II diagnosis in the DSM.
"A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts"
- Scott
Posted by TamaraJ on February 26, 2005, at 17:03:43
In reply to Re: I don't blame you :-(, posted by Dinah on February 26, 2005, at 8:56:37
Dinah,
I know of another poster (Jas)) who has a sensitivity to ADs and her pdoc has prescribed L-Tryptophan (works on serotonin) for her. She has been having good results with it without the side effects. Some trial and error getting the right dose, but we go through that with ADs as well.
Tamara
Posted by Phillipa on February 26, 2005, at 17:08:06
In reply to Re: I don't blame you :-( » Dinah, posted by TamaraJ on February 26, 2005, at 17:03:43
Thanks Scott, That's what I thought it meant. I didn't know they had added the P though. Fondly, Phillipa
Posted by Dinah on February 27, 2005, at 0:43:43
In reply to Re: I don't blame you :-( » Dinah, posted by TamaraJ on February 26, 2005, at 17:03:43
This may sound silly, but I'm afraid to ask for a prescription for anything else. My pdoc really sounded annoyed that my therapist had suggested a specific type of medication. I probably shouldn't have mentioned the source of the idea. And even more annoyed that I knew what Cymbalta was, and how similar it was to Effexor in what it targeted. He asked how I knew what Cymbalta was, and didn't sound happy that I was active on an internet bulletin board.
If I were feeling stronger, I might feel up to facing his irritation again, but I don't feel that strong. I think I'd rather look for a new doctor, but I rather like this one in a lot of ways, and the pickings aren't good. I've already fled the two that are considered the best psychopharmacologists in the area because they were rotten matches for me, personality-wise.
So many people are mad at me right now... That's the trouble with depression. You're least willing to be proactive when you most need to be.
Posted by TamaraJ on February 27, 2005, at 8:24:11
In reply to Re: I don't blame you :-( » TamaraJ, posted by Dinah on February 27, 2005, at 0:43:43
It's not silly at all! I am the same way with my pdoc - almost shaking in my boots when I have to tell him a med isn't working and put forward my own suggestion. And, he takes it the same way as yours :-( but eventually (sometimes) comes around :-). Anyay, what I did the last two times I had to ask for a new med was I told him I knew some people who had taken a particular med and had done very well on it or that some people had suggested that such in such a med would be a good match for me. I now leave the internet out of it, unless it is to say that I did look up some basic info on what people had recommended.
Actually, if you are in the U.S. you wouldn't need a prescription for L-Tryptophan. It is sold over the counter in there. It would mean dosing yourself, but, if you decided to pursue it, both Larry Hoover and Jas (because she has been through a dosing schedule) could help guide you I'm sure. At least it is an option that is available.
As for the people who are mad, they will get over it (I'm sorry if that sounds harsh). You need to think of you and getting your depression under control and getting through this. That is the most important thing IMO. And, until they have been through what you are going through, they can't begin to understand the toll it takes on a person, including their self-esteem.
Strength to you Dinah. You are in my thoughts.
Tamara
P.S. My proactivity is a very recent phenomanon. After bad responses to a number of meds, I started trying to be a bit more proactive and assertive. And, my new found assertiveness in other areas of my life, well . . . time will tell if I can continue down that road (I hope so, but I know me only too well!).
> This may sound silly, but I'm afraid to ask for a prescription for anything else. My pdoc really sounded annoyed that my therapist had suggested a specific type of medication. I probably shouldn't have mentioned the source of the idea. And even more annoyed that I knew what Cymbalta was, and how similar it was to Effexor in what it targeted. He asked how I knew what Cymbalta was, and didn't sound happy that I was active on an internet bulletin board.
>
> If I were feeling stronger, I might feel up to facing his irritation again, but I don't feel that strong. I think I'd rather look for a new doctor, but I rather like this one in a lot of ways, and the pickings aren't good. I've already fled the two that are considered the best psychopharmacologists in the area because they were rotten matches for me, personality-wise.
>
> So many people are mad at me right now... That's the trouble with depression. You're least willing to be proactive when you most need to be.
Posted by SLS on February 27, 2005, at 8:40:07
In reply to Re: I don't blame you :-( » TamaraJ, posted by Dinah on February 27, 2005, at 0:43:43
> That's the trouble with depression. You're least willing to be proactive when you most need to be.
Ain't that the truth.
Maybe you could apologize for knowing so much. Really. Tell him that your case has been so difficult to treat, that you were forced to learn something about your illness. Tell him that you would be happier being totally ignorant and just take whatever a doctor prescribes and have it work.
- Scott
Posted by Dinah on February 27, 2005, at 19:44:15
In reply to Re: I don't blame you :-( » Dinah, posted by SLS on February 27, 2005, at 8:40:07
Doctors are a pain, aren't they? I didn't realize that this one was until this time. Usually my biggest complaint is that my fifteen minute med checks last about five minutes, tops.
Maybe he was in a particularly bad mood.
Posted by Racer on February 28, 2005, at 11:22:27
In reply to Pdoc ruled it out, posted by Dinah on February 25, 2005, at 14:37:16
> He offered me Cymbalta, but I refused because my research showed me it's pretty much Effexor, and I did horribly on Effexor (and nortriptyline and Wellbutrin).
>Actually, I've taken both Effexor and Cymbalta, and they're different. I thought at first that Cymbalta would be too much like Effexor, and wanted to stop it right away. Nope, turns out that it behaves differently, feels different, and the molecular structure is quite different. What they have in common is their method of action. Everything else is different.
I'm sorry that you're not doing all that well. Hope it improves soonest.
Posted by Dinah on March 1, 2005, at 1:58:36
In reply to Re: Pdoc ruled it out » Dinah, posted by Racer on February 28, 2005, at 11:22:27
Thanks Racer. I suppose it's all for the best. The time for med trials is probably not when the hounds of h*ll are nipping at my heels. I'm not functioning great now, but a nice agitated hypomania would really play havoc with what productivity I have left.
And I'm still not convinced it's not diabetes related.
I haven't seen much of you lately. I hope you're doing well?
Posted by up'n'down on March 1, 2005, at 2:48:14
In reply to Pdoc ruled it out, posted by Dinah on February 25, 2005, at 14:37:16
> He says he doesn't prescribe it because it's too dangerous. He offered me Cymbalta, but I refused because my research showed me it's pretty much Effexor, and I did horribly on Effexor (and nortriptyline and Wellbutrin).
>
> Since the SSRI's just add feeling bad onto feeling sad, I'm just out of luck A-D wise.
>
> Thanks anyway, guys.
After reading all the posts that your problems engendered, I am left with three observations.
#1. A lot of physicians hate MAO inhibitors because of previous predjudice against them and the carefulness required because of the interactions with other meds.
#2. The statement about Verapamil making you less work-productive really staggers me. It is a calcium channel blocker and is used for chest pain, cardiac irregularities and high blood pressure, as well as incidentally helping to prevent migraine headaches. My mother has been on it for years, and she is very work-productive;it has been very effective in blocking her migraines.
#3. I though l-tryptophan had been taken of the market in the U.S. because of causing blood dyscrasias?? Am I wrong??
It does seem that your pdoc isn't as cooperative as we hope he would be. We feel for you in your distress, and hope a medication and/or doc can be found to help you, Dinah. U'D
Posted by Dinah on March 1, 2005, at 10:38:28
In reply to Beleaguered Dinah, posted by up'n'down on March 1, 2005, at 2:48:14
I must confess that I'm considering the difficult task of finding a new psychiatrist. But I'm not up to it right now.
It should be better this time, because I can hold on to this one while I'm looking for another.
Posted by Phillipa on March 1, 2005, at 15:05:57
In reply to Re: I don't blame you :-(, posted by Phillipa on February 26, 2005, at 11:07:05
You're right it will be. Look for a pdoc that is older, has a good reputation, look them up on the Internet[found out my new one has published numerous articles for JAMA, and reviews for The American Psychiatric Society], and this way he/she will be familiar with the old drugs as well. When I brought up Nardil and Parnate she said she still had a few pts on them. Fondly, Phillipa
This is the end of the thread.
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