![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by ronaldo on December 19, 2006, at 13:25:14
I am curious. Just how much does it cost the average American to experiment with so many different drugs? Do the insurance companies pick up the whole tab? or does the average babbler dip into his/her own pocket to supply the large variety of drugs that the average babbler seems to try? How many different psychotropic drugs has the average babbler tried in his/her life? Your sensible reply might be there is no such thing as the average babbler.
How many anti-psychotics, anti-depressants, stimulants, mood-stabilizers, anxiolytics, neuroleptics and the list goes on and on...?
Your immediate reply might be well it really is none of my business. You are probably right but my curiosity has burnt a hole in my discretion. I would also like to know, if you will indulge me a little further, what is the contents of the average babblers medicine chest? How many different types of psychiatric medicines lurk in the dark recesses of your bathrooms?
In my own cabinet I have: Tegretol, Largactil, Amitriptyline, Risperdal, Lithium, Seroquel, Trazodone, and last my own favourite, Zyprexa. These are just what I have collected over the last 5 years or so. Most are still within date. I expect I should take them back to the chemist to be destroyed. Most of them I will not use though Trazodone might be good for sleep, so might Amitriptyline.
I reckon my medicine cabinet is pretty empty with comparison to most.
My main question is how many different types of pills does the average babbler get through in a three month period? Again it may be none of my business but one reads in the posts on this board of so many suggestions to add a bit of this or add a bit of that. Whence comes the money to pay for all this? How much does it cost to be a fully fledged acceptor of all the suggestions for medication?
Someone tell me to go and get knotted if I have been too indiscreet. But my curiosity still burns at more than a 1000 watts.
....ronaldo
P.S. I don't know whether a trigger should be applied to this post. Maybe it is not so good to embark on a trip down memory lane via an excursion through your medicine cupboard. Perhaps we all have far too many medicines, and memories, in our possession. We should not be tempted to abuse them.
Posted by MidnightBlue on December 19, 2006, at 14:00:53
In reply to I'm curious....$$$....£££....$$$.....trigger.., posted by ronaldo on December 19, 2006, at 13:25:14
If you have insurance, many "new" or name brand drugs are $50 per prescription per month. And there can be limits on the amount of drugs issued each month. So if it takes two strengths of a med to equal your prescribed dose then that is two $50 co-pays per month. And if your doc wants you to take something twice a day and the drug company says you only need to take it once a day you only get the once a day dose for the $50.
Assuming you are on more than one or two meds that can add up rather quickly. And don't forget you are paying insurance premiums, too.
MB
Posted by Phillipa on December 19, 2006, at 14:30:34
In reply to Re: I'm curious....$$$....£££....$$$.....trigger.. » ronaldo, posted by MidnightBlue on December 19, 2006, at 14:00:53
I pay out of pocket as medicaire doesn't pick-up benzos or most of my psych meds. I just paid $l99 for luvox. And far as what's in my medicine chest I keep a box and have prozac,trileptal, seroquel,pamelar,cymbalta, different strenghts of synthroid,theophylline,EMSAM,lexapro,zoloft. Maybe a few more oh lamictal and remeron too. None of which worked. I get $825 of Disability. love Phillipa ps also the valium, xanax
Posted by Meri-Tuuli on December 19, 2006, at 14:48:46
In reply to Re: I'm curious....$$$....£££....$$$.....trigger.., posted by Phillipa on December 19, 2006, at 14:30:34
For those of us in the UK, we only pay about $10 for each medication regardless of quantity, type of drug, etc. However, thats when you see a doc using the NHS, which I think nearly all of us babblers do. Sometimes we go privately, and then we pay out of pocket, but I don't know how common that really is. I just try to find a GP that will be amenable to my drug suggestions and therefore we pay peanuts for all our meds.
That being said, a GP rarely presribes benzos/ritain/MAOIs etc or 'exotic' combinations. So it has its downside too! Pdocs are more likely to prescribe something 'exotic' but its a push.
Of course, some babblers in the UK also order from online pharmacies, but that'll be much the same as in the US I imagine and they do so to get stuff their GP/pdoc wouldn't/couldn't prescribe them, stuff like provigil, MAOIs etc etc.
Yeah before I started using babble, I took our dirt cheap meds totally for granted. At the time, I was taking effexor and that cost me the 10 bucks standard prescription fee-I was shocked to find out that it costs something like 100 bucks if you were to buy it privately! I guess the NHS is alright at something!
Posted by lymom3 on December 19, 2006, at 15:52:09
In reply to I'm curious....$$$....£££....$$$.....trigger.., posted by ronaldo on December 19, 2006, at 13:25:14
You've really depressed me now. I have 3 tiers of copay. $8 for generic of which 2 of the meds I'm going to list cost, the middle tier is $25 which 14 were that copay, the top tier is $45 of which 7 were that copay... here's my list from the last 18 months; had to go online to check and see if I forgot anything:
Daytrana, Emsam, Focalin XR, Lexapro, Tofranil PM, Cymbalta, Restoril, Ambien, AmbienCR, Ritalin LA, Seroquel, Topamax, Lamictal, Cogentin, Abilify, Geodon, Nortriptyline, hctz, Inderal LA, Provigil, Imitrex, Neurontin and Wellbutrin.
No wonder I'm a mess....The copay's for the meds are only a part of it. You still have to see the pdoc to get prescriptions every once in a while too.
Posted by Quintal on December 19, 2006, at 16:43:30
In reply to I'm curious....$$$....£££....$$$.....trigger.., posted by ronaldo on December 19, 2006, at 13:25:14
Well here's my list of tried and failed treatments over a seven year period:
SSRIs: Paroxetine, fluoxetine, fluvoxamine, sertraline, citalopram, escitalopram.
TCAs: Dothiepin, imipramine, melitracen.
RIMAs: Moclobemide.
MAOIs: Tranylcypromine, isocarboxazid.
SSNRIs: Venlafaxine, mirtazapine.
Other: Trazodone, tianeptine, reboxetine, bupropion.
Benzos: Diazepam, lorazepam, alprazolam, nitrazepam, bromazepam, clonazepam, temazepam, estazolam, triazolam.
Other GABAergic: Zolpidem, zopiclone, gabapentin, phenobarbital.
Antipsychotic: Olanzapine, quetiapine, amisulpride, aripiprazole, flupentixol.
Anticonvulsant: Lamotrigine.
Opiate: Tramadol, codeine, diamorphine.
Miscelaneous: Sibutramine, sulbutiamine, levothyroxine, ephedra, buspirone, phentermine, domperidone, oxandralone, nandralone, tamoxifen, clomiphene.
There are probably more that I've forgotten, but anyway that's one hell of a lot of money spent on psychoactive substances and nearly all of it funded by the British NHS except for a few online purchases of my own.
Q
Posted by Quintal on December 19, 2006, at 16:53:56
In reply to I'm curious....$$$....£££....$$$.....trigger.., posted by ronaldo on December 19, 2006, at 13:25:14
Yes, there's more that I've just remembered:
Selegiline, adrafinil, piracetam, levitiracetam, picamilon, propranolol, pindolol, glucophage.
Probably more where they came from, and that's only psych meds. I've had just as many again for other conditions.
I got most of my meds free becuase I was either a student or unemployed while I was taking most of them and that makes us exempt from prescription charges in the UK.
Q
Posted by stargazer on December 19, 2006, at 18:41:07
In reply to Re: I'm curious....$$$....£££....$$$.....trigger.. » ronaldo, posted by Quintal on December 19, 2006, at 16:53:56
Wow, half of those meds I've never heard of here in the U.S.
My stash is not anywhere near as plentiful...let's see, right now I have the following in my drug storage bin...
Wellbutrin
Celexa
Adderall
Risperdal
Geodon
Seroquel
Zyprexa (samples)
Lamictal
Marplan (Nifedipine to counteract hypertnesion)
Lexapro
Lorazepam (Ativan)
Amphetamine
Cymbalta
Emsam (currently on)All covered by my insuror at $10 generic, $25 brand, $35 non-label.
Right now I'm paying $600 month for insurance, since I left my job in the summer. I have continued insurance through my former employer and hopefully will find another job with health insurance which is becoming more and more difficult, especially if you can't work full time.
Between insurance and copays, I am spending around $1000/month during drug trials. Once I'm stable an hopefully employed, the costs are usually only one to three copays a month, about $100.
Luckily, other than TRD, I'm basically very healthy and have no other meds that are for long term health conditions.
SG
Posted by rosa63 on December 19, 2006, at 18:45:49
In reply to I'm curious....$$$....£££....$$$.....trigger.., posted by ronaldo on December 19, 2006, at 13:25:14
> I am curious. Just how much does it cost the average American to experiment with so many different drugs?
I am on Medicaid (aka Welfare) and I pay $1 for generic and $2 for brand drugs. I wish I could stay on Medicaid indefinitely because meds and office visits are free to CHEAP; however, I will be finishing college in May and so thereafter, when I land a job, I will be disqualified for Medicaid. :(
The drugs I have in my medicine cabinet are:
Cymbalta, Trazodone, Paxil, Wellbutrin XL, Abilify, Lexapro, Effexor XR, Xanax, Klonopin, Inderal, and Provigil....YIKES, it's time for me to clean!!!
Posted by blueberry1 on December 19, 2006, at 18:47:18
In reply to Re: I'm curious....$$$....£££....$$$.....trigger.. » ronaldo, posted by Quintal on December 19, 2006, at 16:43:30
That's one heck of a list.Are there any on the list that you got a tiny bit of response from?
I wonder if it is something besides brain chemistry? Is your thyroid borderline between high normal and hyperthyroid? If not, that's where you want it. Some doctors just ignore the tests and prescribe natural T3+T4 enhancement to see what happens. Or you can mailorder it yourself. Tests are not always helpful or accurate and their results can be debated. Genetics vary so much.
Ever tried just a plain ole tyrosine supplement to see what happens? I don't think it makes a good longterm treatment, but I think it is an excellent way of pinpointing if you want to focus on dopamine or not. You'll know in just a couple hours if yes or no.
Maybe it's not a primary neurotransmitter but instead a secondary messenger. You could try high dose insositol 10g - 12g for a few days and see what it feels like. If nothing, forget it.
And phosphatidyl serene.
Pyroluria? Do you have any little white spots on your fingernails? Do a search on pyroluria to see the symtoms. Do they fit you? If yes, all it takes is megadose vitamin B6 and zinc.
Ever had mercury and lead levels checked?
Were your omega-3 oils high when you tried all those meds? Do you eat fish 3 to 6 times a week? Do you, or did you, take fish oil?
Ever tried high dose SAMe? If you are undermethylated, nothing is going to work very well until that is addressed.
I wonder what else it could be? If none of those drugs helped you even a little bit, that is a clue that it is not brain chemistry. Or if it is, then it is by a mechanism you haven't tried yet, such as neurotransmitter releasers instead of reuptake inhibitors. Such as adderall and cousins. And dopamine helpers like requip or pramipexole. And of course lithium and depakote should not be ignored.
Anyway, I sure feel for you. Not to mention the money and time spent, that was a ton of suffering in terms of start-up side effects and withdrawals.
If these ideas are junk, please just ignore.
Sorry, it seems I just accidentally may have introduced new things to make your list even longer. But hopefully, success in knowing what's going on.
Posted by Phillipa on December 19, 2006, at 19:58:25
In reply to Re: I'm curious....$$$....£££....$$$.....trigger.. » Quintal, posted by blueberry1 on December 19, 2006, at 18:47:18
Blueberry what is undermethalated? Love Phillipa
Posted by Quintal on December 19, 2006, at 20:46:38
In reply to Re: I'm curious....$$$....£££....$$$.....trigger.. » Quintal, posted by blueberry1 on December 19, 2006, at 18:47:18
>Are there any on the list that you got a tiny bit of response from?
Yes, I got a response from most of them but they either pooped out or I couldn't tolerate the side effects. With Parnate my pdoc refused to raise the dose above 30mg and I only responded to the 80-120mg range. Low doses made me feel worse. Benzos worked very well, but they are not a long term option in the UK and I can't afford to buy them online any longer.
>I wonder if it is something besides brain chemistry? Is your thyroid borderline between high normal and hyperthyroid? If not, that's where you want it. Some doctors just ignore the tests and prescribe natural T3+T4 enhancement to see what happens. Or you can mailorder it yourself. Tests are not always helpful or accurate and their results can be debated. Genetics vary so much.
The last time I was in hospital the thyroid test came back low. They said I didn't need any medication though. This was after I'd been experimenting with levothyroxine though and I wonder if I may have damaged my thyroid as the results were always normal before I did this - or just coincidence?
>Maybe it's not a primary neurotransmitter but instead a secondary messenger. You could try high dose insositol 10g - 12g for a few days and see what it feels like. If nothing, forget it.
I'll look in to that. My multivitamin contains insositol. I don't know how much - very little I suspect.
>And phosphatidyl serene.
I tried that a while ago - nothing.
>Pyroluria? Do you have any little white spots on your fingernails? Do a search on pyroluria to see the symtoms. Do they fit you? If yes, all it takes is megadose vitamin B6 and zinc.
I have a tiny white speck on my little finger nail - I don't suppose that counts? The thing about having skin that doesn't tan applies to me and the stress, depression noise sensitivity etc. I've been taking a multivitamin that contains high levels of vitamin B6 and zinc for a few years. It's also low in copper, but I haven't been to find a multivitamin/mineral that does not contain copper in the UK.
I'm thinking of having a complete overhaul by one of those naturopathic doctors if I can find one in my area since the NHS has just about given up on me.
>Were your omega-3 oils high when you tried all those meds? Do you eat fish 3 to 6 times a week? Do you, or did you, take fish oil?
Yes, I've been taking between 1-2g of omega-3 fish oil for about two years. It does seem to help quite a bit as a mood stabilizer and antidepressant. May not help my mercury levels though as it's not purified as far as I know.
>Ever tried high dose SAMe? If you are undermethylated, nothing is going to work very well until that is addressed.
No, but I've tried high dose TMG which is supposed to be converted to SAMe have a similar effect but with no result as far as I could tell.
>I wonder what else it could be? If none of those drugs helped you even a little bit, that is a clue that it is not brain chemistry. Or if it is, then it is by a mechanism you haven't tried yet, such as neurotransmitter releasers instead of reuptake inhibitors. Such as adderall and cousins. And dopamine helpers like requip or pramipexole. And of course lithium and depakote should not be ignored.
>
Adderall is *not* an option in the UK (!) my GP looked at me as if I'd just asked her for a gram of crack when I innocently requested dexedrine a few years ago. I've tried illicit Ritalin, street amphetamine paste and cocaine, and they didn't help much. With amphetamine I mamnged to clean my kitchen cupboards out and stack everything up tidily, but I rubbed all the skin off my fingers because I was rubbing so hard (obsessively) with a cloth for hours at a time. I don't think stimulants really suit me and there's no chance of getting a doctor to prescribe them unfortunately.Depakote is one I forgot to add to my 'anticonvulsants' list earlier. It was one of the first drugs I tried and I didn't like it much - seemed to make me feel flat and empty, then the hair loss started. I was advised against lithium in the beginning by my pdoc so I've never tried it. Lamictal was very effective but only when taken with benzos - it made me too agitated and irritable otherwise.
I had a good response to low dose amisulpride which is supposed to be a dopamine helper. Don't know why I'm not taking it now........
I identify strongly with Asperger's Syndrome. I think I'm definitely on the autistic spectrum anyway - my grandmother once told me 'they' (doctors I presume) once thought I was mildly autistic as a child. Not sure if UK GPs were familiar with Asperger's Syndrome back then. Borderline Personality Disorder also feels familiar but is it possible to have both?
>If these ideas are junk, please just ignore.
I think they're very good. I'll look into the insositol and probably give it a go. Thank you for taking the time to write it.
Q
Posted by yxibow on December 19, 2006, at 20:57:00
In reply to I'm curious....$$$....£££....$$$.....trigger.., posted by ronaldo on December 19, 2006, at 13:25:14
You would not want to know how much my health costs are. For obvious reasons I will not mention the name of the company and I don't think anyone should mention either.
I am lucky that Clinton (however you like or hate what he does with his willy) passed HIPAA because as I exhausted COBRA and am now on what we will refer to as Company X PPO under HIPAA.
Company X PPO allows me to go to any doctor I want to but their tier doctors pay more. Company X pays a paltry amount for certain tests done during a physical and even worse outside of.
PPO -- payer provider organization is different from an HMO in that you have higher upfront costs but you can waltz into anywhere and get some coverage. They love their own choice clinics because they pay most for emergency clinics
Company X costs many thousands a year in deductibles and expenses.
Drug Y can cost as much as 100+ for a copay.
Generic Drug Z may only cost 15 to 30.
Basically the insurance is there if someone runs me down because then Company X will pay for most of a hospital visit especially at whatever hospital they don't have a p*ing contest with (that goes for HMOs and PPOs in the US, contract costs from the bean counters at all companies, not just company X). But that's what it is most important for, stopgap disastrous intensive care coverage with N million lifetime cap.
NHS is more like an HMO and has from what I know cranky doctors who hate benzodiazepines. Other than that, England regulates drug costs like Canada and I think some other Commonwealth nations so you will get drug Z at 7 quid unless its something esoteric/private.
Its remarkable the system even partially works and politically I wish we had some sort of a system -- it could be public-private, but more regulations on medical care, especially mental health care which with some HMOs is contracted out to other organizations and have nasty small caps placed on the amount they will pay out for mental hospitalization.
I like the way Canada manages their health care, though I know very much about triage, I used to have a relative in Canada, and I know it wasn't perfect and had to take out American insurance to do certain waitlist procedures.
Now from this I'm sure we'll get donkey and elephant arguments, but I think its neither, its the dignity of people with the stigma of mental health care somehow put on a different tier even though the vast majority of all of it are biological, born causalities, just like diabetes I, or MS, or any life illness. [end soapbox]-- tidings
Posted by Simcha on December 20, 2006, at 0:00:29
In reply to I'm curious....$$$....£££....$$$.....trigger.., posted by ronaldo on December 19, 2006, at 13:25:14
Ronaldo,
It's pretty depressing even with good insurance here in the good ol' US of A, IMHO.
I have a PPO. That means that I can choose my doctors and specialists. If I choose doctors and specialists on my PPO's list (in-network) I pay one set of co-pays. If I choose docs and specialists not on the list (out of network) I pay higher co-pays.
So, here's the breakdown for what it costs to get my meds on my plan. The rest of it is complicated and isn't on topic.
I'm actually pretty fortunate compared to most Americans...
First, I pay $75 per month in premiums. My employer pays $300 per month.
For drugs on the PPO's Formulary:
$10 co-pay for generic drugs
$20 co-pay for brand name drugs (drugs whose patent has not expired)Non-Formulary drugs:
$35 co-payA formulary is a list of drugs that the insurance company has approved for reimbursement. Anything that is not on the company's formulary is a non-formulary drug.
It seems rather arbitrary what is and what is not on the formulary. When you look at my formulary you notice that drugs that are more expensive that do close to the same thing as other drugs are not on the formulary. So, it's not just doctors deciding what is covered and what isn't, it's accountants too.
So, currently my monthly prescription costs:
$10 Gabapentin (generic Neurontin on formulary)
$20 Wellbutrin XL (Brand on formulary)
+$35 Cymbalta (Brand not on formulary)
--------------
$65 total monthly on medsNot bad, but add:
$75 for monthly premiums
-----------------------
$140 per month (meds + premium)Then consider that I have a $15 co-pay when I see the pdoc every quarter and I pay my therapist $75 per hour for therapy every other week and treating my depression is quite costly. Therapy is not covered under my plan. Thus I cannot afford weekly therapy.
($75 X 26 sessions per year = $1950 per year in therapy)
$1950/12 months = $162.50 per month in therapyGrand Total:
$140.00 per month (meds + premium)
+$162.50 per month in therapy
------------------------------
$302.50 monthly personal cost to treat my depressionAnd that's without considering however many times per year I need to see the pdoc at $15 a pop after a $250 deductible
As you can see, these costs add up quickly.
I've been pretty lucky. I've responded to almost every med I've been on. I have asthma and fibromyalgia too though. Perusing through my medicine chest you will find:
Wellbutrin SR, Effexor XR, Klonopin, Alburterol, Q-Var, Prednisone, Advair, Singulair, Flonase, Nasorel, Vicodin, Tylenol 3
Simcha
Posted by Sebastian on December 22, 2006, at 12:18:39
In reply to I'm curious....$$$....£££....$$$.....trigger.., posted by ronaldo on December 19, 2006, at 13:25:14
I have a six month supply of 10mg zyprexa, thats one a day, plus I have an open bottle, and I can order more right now. I said zyprexa is addictive in one of my posts, that can't be true, I have a six+ month supply, for emergency. Ok and I have 500 x 60mg geodon's which I don't take anymore. 2 90 day bottles of 3 a day 100mg wellbutrin sr(genaric), 2 90 day bottles of 1.5 x 40mg celexa genaric. insurance pays most of the cost. For 90 x10mg zyprexa I pay a $40 co-pay and insurance pays $700. The 2 genarics have a $20 co-pay and insurance pays about $200. Geodon, $100 co-pay for 3 months and insurance payed $1500 for the 4 a day 60 mgs. Then the cost of my insurance is $400 month, which my job pays. And I have 6 sample packs of abilify, 2 and 5 mg, paid for by the drug company, given to me from my doctor. When that runs out I problbly have another $100 co-pay. My current co-pays are probably a little low for the U.S.. Others charge $125 and $75 for 3 month supplys. Or you can go to the pharmacy and pay a lot more co-pay and the insurance pays a lot more. Insurance tells you to use mail order. Not to mention these are just the psychotropics. I also have blood pressure and cholesteral meds and diabeties test strips. A lot of these are as a result of the psychotropics. Yes I have a whole drawer of pills which is running out of space, and not all are in it.
Posted by jedi on December 24, 2006, at 3:23:39
In reply to I'm curious....$$$....£££....$$$.....trigger.., posted by ronaldo on December 19, 2006, at 13:25:14
Hi,
I've been on at least forty different combinations of medications for my chronic atypical depression and social anxiety. My insurance costs about $600 per month for my three person family. It is not the deluxe plan and has high deductables, but it has pretty good med coverage. The generic meds are $5, middle of the road are $15, and the new designer drugs are $30 per month.Currently I am taking 75mg of Nardil($15), 80mg of Geodon($15), 1mg of clonazepam($5). A visit to the doctor is a $35 copay. Then I take 1800mg of EPA and 1500mg of DHA, a couple of multi-vitimins(so I can have expensive urine), and one of the nasal cortisones($5) for sinusitis.
Depression is expensive, but probably not as bad as heart disease.
Take care,
Jedi
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
[email protected]
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.