![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by Jeroen on July 6, 2009, at 15:20:38
so when you're psychotic .. heart racing, loss control
i have pannick attacks, can they prolong the QTc interval?
Posted by bleauberry on July 7, 2009, at 9:31:31
In reply to so when you're psychotic .. heart racing, loss con, posted by Jeroen on July 6, 2009, at 15:20:38
That doesn't sound like psychosis. You wouldn't be able to sit here at a computer and converse with other people with psychosis. It wouldn't even enter your mind.
If I put all of your posts of the last 12 months together, I don't see psychosis. I see a full-blown out-of-control variant of anxiety. Not the common kind of anxiety, but one that is so profound it looks like something psychotic or delusional. It is not the Klonopin or Xanax kind of anxiety. It is the kind having to do with runaway adrenaline and low serotoin. Both of which would call for a TCA+SSRI combo to stop it dead in its tracks and say bye-bye misdiagnosed psychosis.
I've been there so I know.
That particular brand of anxiety does not respond well to antipsychotics. That would explain a lot, including the temporary goodness you felt on seroquel from its super potent antihistamine effect. Of course we all know, tolerance to antihistamine develops rapidly, and no wonder it pooped out quickly.
I am tempted to say your doctors know more than we do, they see you and we don't, and they know your whole clinical presentation and we don't. But I can't say that. Because their track record with you is so dismal they should be ashamed to call themselves doctors of medicine.
I know you are so narrowly focused on the antipsychotic thing that you can't seen anything else. Just for today, one day, consider that this is something different than psychosis and that this is something that obviously...quite obviously...profoundly obviously...does not do well with antipsychotics.
Misdiagnosis. Psychosis...no. Anxiety+depression...yes.
Liquid lexapro, 2 drops per day, increase by 1 drop every 4 days for a target range of 1mg to 5mg. Nortriptyline start at 1/2 capsule of 10mg per night, increasing by 5mg per week, for a target range of 20mg to 50mg.
For reference, 2 drops of lexapro is 1/10th of 1mg.
How can I possibly play doctor and write a prescription? Because yours have proven worthless. It would do zero harm to listen to someone else for a change. No one could possibly do more harm even if they tried than your own doctors have already done and continue to do. By listening to me, you are actually listening indirectly through me to one of the most profoundly successful doctors in the USA.
See your symptoms increase somewhat for about 5 days, then miraculously subside rather quickly day by day from that point on. Lexapro alone equals failure. Nortriptyline alone equals failure. Antipsychotics equals failure, but you already know that. A benzo can be used in emergency panic attacks during the first 5 days. But with such careful dosing, it is unlikely.
Posted by yxibow on July 14, 2009, at 11:09:26
In reply to Re: so when you're psychotic .. heart racing, loss con, posted by bleauberry on July 7, 2009, at 9:31:31
> That doesn't sound like psychosis. You wouldn't be able to sit here at a computer and converse with other people with psychosis. It wouldn't even enter your mind.
That's patently false.
Psychosis / psychotic spectrum disorders are just a DSM-IV-TR diagnosis.
I'm sitting here conversing with Psychosis NOS.. Does that make me any less intelligent than I was -- maybe the medications and the disorder make my memory and word recall cloudy.
People are diagnosed with psychotic depression -- medication certainly makes it easier to live and converse as I am doing.
I think what you're referring to is that it is a different conversation that one would be having with someone with untreated strong schizophrenia -- it would be a dialogue of sorts but yes, a completely different conversation, I'll give you that.
> That particular brand of anxiety does not respond well to antipsychotics. That would explain a lot, including the temporary goodness you felt on seroquel from its super potent antihistamine effect. Of course we all know, tolerance to antihistamine develops rapidly, and no wonder it pooped out quickly.I also beg to differ....
The initial very strong antihistamine effect of antipsychotics that have it may not stay as strong but it can be useful for quite a lot longer, as people take it for sleep.
It's true, I don't get the heavy sedation 15 minutes after taking Seroquel, but there's some always present.
Seroquel and APs in general are not a short window medication -- maximum benefit may not be seen for 3 months.
> I am tempted to say your doctors know more than we do, they see you and we don't, and they know your whole clinical presentation and we don't. But I can't say that. Because their track record with you is so dismal they should be ashamed to call themselves doctors of medicine.
Well... I'll just leave that one there... I think there has been a merry-go-round of medication, I can't say where in the doctor-patient relationship(s), but a medication shouldn't be dumped in the first few weeks unless it has imminent /bad/ effects.
> Misdiagnosis. Psychosis...no. Anxiety+depression...yes.I'll leave that one.. for the doctors.
> Liquid lexapro, 2 drops per day, increase by 1 drop
There is no need for micromedicating with expensive liquid prescriptions unless the person is a minor/child, someone with very little tolerance to medication, and possibly the elderly.
> How can I possibly play doctor and write a prescription? Because yours have proven worthless.
ditto...
-- Jay
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.