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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 3 to 27 of 27. Go back in thread:
Posted by linkadge on November 29, 2010, at 19:19:21
In reply to Re: Need help approaching pdoc, posted by MissThang on November 29, 2010, at 18:48:33
Its *your* body. You do *not* need to be told to **put any more drug in your body that you feel like doing**.
Taking 2.5 is worth a shot. I would personally, just do it. Its generally difficult to find what works best for you, if you wait for the "approval" for every little change.
If 2.5mg doesn't work, you can always go back up, or off it entirely.
The drug companies have no idea what the true theraputic "threshold dose" for these medications are. They just find the smallest dose which gives people significant withdrawl symptoms and make that the "theraputic dose".
Linkadge
Posted by merpmerp on November 29, 2010, at 20:14:56
In reply to Re: Need help approaching pdoc, posted by linkadge on November 29, 2010, at 19:19:21
Thank you both for your kind posts, MissThang and linkadge. I think perhaps I will reduce the dose, but I will at least shoot my pdoc an email telling her what's up so she knows I'm doing it. My reluctance to do it on my own comes from my mom, who's addicted to and misuses all kinds of substances, medicinal and nonmedicinal, so I have always been scrupulous about following my docs' advice. However, you're both right in that if I *reduce* the dose I don't see how that could cause harm. And I woke up this morning and thought to myself, "[Name], this is effing ridiculous. This med is supposed to make me feel *better* and it's making me *worse* so it's basically a poison... what am I doing??"
Miss Thang, thanks for your thoughts about Wellbutrin. It's one I am considering. I will try Lex at a lower dose, then if that does not help I will try a different SSRI, then I may talk to my doc about Wellbutrin. The fact that I did FANTASTIC on a low dose of Prozac some years ago suggests to me that it may be a dopaminergic problem. Conundrum on this board said that at low doses Prozac touches dopamine and norepinephrine and not serotonin so much. So this all is slowly making some sense and at least I have a plan to proceed.
Will post back here or in my other thread occasionally about how the lowered dose is going. I have lurked this board a long time before joining and I feel this is a place full of supportive, knowledgeable people.
Posted by Conundrum on November 29, 2010, at 20:15:52
In reply to Need help approaching pdoc, posted by merpmerp on November 29, 2010, at 17:18:07
Frankly it sounds like SSRIs are not for you. Feeling thoughts of self harm are classic SSRI side effects. SO classic that Eli Lilly had to cover them up in the clinical trials before prozac was on the market and give ppl valium to calm them down. Apathy is common with lexapro as well. It really sounds like SSRIs are not for you and you need to let your doctor know that you don't like the way you feel on them. Fortunately there are other drugs that work via different mechanisms and might have positive effect for you.
All your side effects scream of too much serotonin. You should make your pdoc aware of this. I'm not sure what you are being treated for, but if its lethargic type of depression you should consider perhaps wellbutrin, remeron, tricyclics, or maybe even stimulants. If its anxiety, wellbutrin might help, but don't forget about benzos, also St. John's Wort might help if its a good brand, it probably won't push serotonin as hard as the SSRIs.
> As I expected, my doc does not want to let me decrease to 2.5 mg Lexapro. However, I would really, really like to give it a try. (Currently at 5 mg, have been on 10 mg in the past.) The doc says 2.5 mg is subtheraputic.
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> ***Possible trigger, also maybe TMI***
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> At 10 mg, I have experienced very frequent, violent, intrusive OCD-ish thoughts, images of self-harm etc. I had that at 20 mg Prozac too. I had never had anything like that in my life prior to the meds. The doc says it's from the meds. These thoughts diminish but don't entirely disappear on 5 mg. Both Lex and Prozac also give me dose-dependent diarrhea. This never goes away unless I reduce the dose, and can be quite severe. I have been medically checked for any other cause; there seems to be none. 5 mg also gives me extreme apathy, lethargy, and extremely fuzzy brain which is not good for a grad student. I was on 5 mg for 4 months and this never went away.
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> So I'm about ready to kick Lex to the curb and try something else, but before I do that, it seems that a trial of 2.5 mg is the less drastic thing to do. (I am all for making small changes and waiting a long time to see how that goes, I would rather do that than try something riskier.)
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> How can I talk to her about this? Should I bring in any medical literature I can find on the subject of lower doses, or should I just repeatedly tell her what *I* feel and my symptoms? (I have, repeatedly and in writing, given her my list of symptoms along with a corresponding med chronology.)
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> What I do not want to do is just do a 2.5 mg trial without her consent, but I will consider this if I can't convince her.
Posted by merpmerp on November 29, 2010, at 20:17:01
In reply to Re: Need help approaching pdoc, posted by merpmerp on November 29, 2010, at 20:14:56
Would like to amend my above post to say the med is "ACTING like a poison"... I do not believe all SSRIs, or this one, are actually poison, just in this case it's not agreeing with me.
Posted by merpmerp on November 29, 2010, at 20:23:22
In reply to Re: Need help approaching pdoc, posted by Conundrum on November 29, 2010, at 20:15:52
***Possible trigger***
Thank you Conundrum. What I'm being treated for: I had a severe depression, but no anxiety, some years ago and was treated very successfully with low doze Prozac. This time my depression had a lot of anxiety mixed in. I was put on what I believe is too high a dose of Prozac for me and it made me flip out with the thoughts of self harm - I have had ideation before, but in the form of escape fantasies, not these constant intrusive alien horrible images. Doc said it was the med and switched me to Lex. At 10 mg the Lex did the same thing, we went to 5 mg, it was better but put me in a muddled state all day, so I want to try 2.5 mg.
I would not say my depression has ever been lethargic or apathetic. More like crying spells, insomnia/early morning awakening, anhedonia, and a serious feeling of "something is not right". (I would call it melancholic instead of atypical, if you want to use those terms.) But I have functioned every single day, gotten up and done my schoolwork, no matter how bad I felt. This cognitive fuzziness and need to sleep 12 hours a day has never been a part of my depression.
Posted by Conundrum on November 29, 2010, at 20:24:43
In reply to Re: Need help approaching pdoc, posted by merpmerp on November 29, 2010, at 20:17:01
> Would like to amend my above post to say the med is "ACTING like a poison"... I do not believe all SSRIs, or this one, are actually poison, just in this case it's not agreeing with me.
Time to give it the boot then, or at very least decrease it.
Posted by merpmerp on November 29, 2010, at 20:27:40
In reply to Re: Need help approaching pdoc, posted by Conundrum on November 29, 2010, at 20:24:43
Couldn't agree more. I think I will decrease to 2.5 mg and shoot my doc an email just so she knows what I'm up to.
I am thinking of asking to return to Prozac if this doesn't work, but at a very, very low dose. That worked well for me before. If that doesn't work I'll consider discussing Wellbutrin with her.
> > Would like to amend my above post to say the med is "ACTING like a poison"... I do not believe all SSRIs, or this one, are actually poison, just in this case it's not agreeing with me.
>
> Time to give it the boot then, or at very least decrease it.
Posted by Conundrum on November 29, 2010, at 20:35:32
In reply to Re: Need help approaching pdoc, posted by merpmerp on November 29, 2010, at 20:27:40
I know someone who was prescribed wellbutrin first for anxiety, I think this is because she had diarrhea with Crohn's disease and the doctor must have realized trying an SSRI would be a bad idea, so if these don't work wellbutrin might be helpful and keep you from running to the toilet all the time.
> Couldn't agree more. I think I will decrease to 2.5 mg and shoot my doc an email just so she knows what I'm up to.
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> I am thinking of asking to return to Prozac if this doesn't work, but at a very, very low dose. That worked well for me before. If that doesn't work I'll consider discussing Wellbutrin with her.
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> > > Would like to amend my above post to say the med is "ACTING like a poison"... I do not believe all SSRIs, or this one, are actually poison, just in this case it's not agreeing with me.
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> > Time to give it the boot then, or at very least decrease it.
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Posted by merpmerp on November 29, 2010, at 20:50:49
In reply to Re: Need help approaching pdoc, posted by Conundrum on November 29, 2010, at 20:35:32
Thanks Conundrum. When the diarrhea first started I thought I was dying - it was, like my brother said, almost as if I had some mysterious 17th century wasting disease. I was completely checked out and the docs said absolutely everything was completely fine - so basically I was completely healthy except that I could not keep any nutrition in me. I slowly made the connection to my meds and am glad I did, so I know I'm not dying (well, any more than entropy is making me!)
I am curious that wellbutrin was given for anxiety. I thought it would make that worse because of its effects on norepinephrine?
Thank you very much for your kind post.
Posted by Conundrum on November 29, 2010, at 23:26:58
In reply to Re: Need help approaching pdoc » Conundrum, posted by merpmerp on November 29, 2010, at 20:50:49
Well for this person it helped. I think it can make some people nervous, but then again SSRIs can cause terrible start up anxiety and cause akastesia! Its all roulette really.
> Thanks Conundrum. When the diarrhea first started I thought I was dying - it was, like my brother said, almost as if I had some mysterious 17th century wasting disease. I was completely checked out and the docs said absolutely everything was completely fine - so basically I was completely healthy except that I could not keep any nutrition in me. I slowly made the connection to my meds and am glad I did, so I know I'm not dying (well, any more than entropy is making me!)
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> I am curious that wellbutrin was given for anxiety. I thought it would make that worse because of its effects on norepinephrine?
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> Thank you very much for your kind post.
Posted by Phillipa on November 30, 2010, at 0:11:09
In reply to Re: Need help approaching pdoc, posted by Conundrum on November 29, 2010, at 23:26:58
I also must use low doses of ad's. I'm one who tried wellbutrin at 150mg and anxiety was horrible. If the prozac at a low dose worked well before you might want to return to it. Are you sleeping now? If not maybe a benzos short term? But agree with others either drop the dose on the lex on your own or try another med. I know my pdoc gives me permission to "play" with doses of meds. So I personally would not send the email just do it. Now only if you would not feel guilty about changing the dose as I often feel guilty if don't do exactly as told but it's your mind and body. Good luck with your decision and please let us know personally would like to know as almost doing same thing. Phillipa
Posted by Dr. Bob on November 30, 2010, at 13:02:35
In reply to Re: Need help approaching pdoc, posted by merpmerp on November 29, 2010, at 20:17:01
Posted by merpmerp on November 30, 2010, at 14:03:31
In reply to Re: Need help approaching pdoc, posted by Phillipa on November 30, 2010, at 0:11:09
This is a bit of a rant, I apologize but I am feeling sooo angry at the moment.
I am sleeping okay, except for last night (because I was very hungry for some odd reason, nothing to do with anxiety).
I do have benzos (Klonopin), which I use rarely, but I'm glad they're there for emergencies.
However it's irritating because I never in life had a panic attack before this whole SSRI mess started a year and a half ago, and instead of listening to me saying that the med is the problem, the doc threw more meds at me (also wanted to give me beta blockers, I said no) and then when I complained of the apathy and inability to focus, wanted to give me Ritalin despite the fact that I have never in life had the apathy as a problem either, before this mess.
She believes that this is all my anxiety, getting worse, and she thinks I need a higher dose of Lex to counteract that despite the fact that I never had panic like this EVER before this med go round. Like a idiot I believed her and believed I must be getting worse, that I must be a truly hopeless case. But with each time we've decreased the dose of Lexapro (previously Prozac) I've felt better, and each time we've increased it I've felt worse. I'm a Ph.D. student, I can figure out the trend here from the data points.
It's taken me far too long to connect the dots and be assertive but the more I think about it the more infuriated I become. I've been living in a drug-addled haze for a year and a half because I tried to do the right thing and obey my doctor exactly, instead I am not improving and my doc is adding more meds to counter the side effects of this med. I barely made it through my qualifying exams last year because I was on 10 mg/day of Lex and so sick I literally could barely study. I barely remember anything of that.
I have reduced the dose to 2.5 mg/day and I'm pretty determined not to go back up again for any reason. I am gathering some medical papers to show her and explain what I think is going on and why.
One thing to clarify: I do not believe now that I am depressed. I believe that if I came off the Lex right now, I'd be fine. However, I have had three depressive episodes with increasing severity over the last 8 years (~2 years apart each time), and what I am looking for is a low maintenance dose of something to help act as a preventative measure, which I could quickly increase if my doc and I saw that I was slipping. I have a much older brother and sister who have suffered episodes of unipolar depression/anxiety throughout their lives, I am trying to prevent myself from having any more severe episodes.
There has been a stress trigger for each of my episodes, they don't just come entirely out of no where, but my reaction to stressful events seems exaggerated and I do believe that I need meds to calm it. (I am also in CBT therapy.)
So I feel that I definitely do not need a high dose of anything at this point. I just wasn't sure if it was clear, but I do not believe that there is any underlying depression at this time to treat.
Posted by bleauberry on November 30, 2010, at 19:35:35
In reply to Need help approaching pdoc, posted by merpmerp on November 29, 2010, at 17:18:07
Ask the doc..."subtherapeuthic in who's definition?" A medical journal? The pharm company? Show me a bible that says only such and such a dose will work.
Ask him, "Why does Dr C in New Hampshire have repeated success treating difficult cases with 1mg lexapro, starting at a mere drop per day (that's 1/10th mg). ???
A better option to consider....
Lower the dose to 2.5mg as your gut instincts tell you...TRUST your instincts, not a psychiatrist. Honestly, everything they do is a mere guessing experiment in which they cannot in any way predict the outcome. But lowering the dose is not the end of the story. Add to it 10mg of nortriptyline.
Keep in mind, the whole ssri strategy itself could be very wrong with you. You are already half way there to discovering whether it is or not. The final move to 2.5mg should tell you. Also keep in mind, no single ssri can compare to the magic that can happen when a tca such as nortriptyline is added. This is an old school trick that used to work very well.
Go to psychotropical.com and read all the stuff there. You will have your eyes opened to a lot of stuff that will strongly prepare you to have a solid productive dialogue with your doctor.
In the process of going from 5mg to 2.5mg, this could explode in your face if done wrong. You'll need to buy some single edged razor blades because you are going to need them to cut tiny pieces off the 5mg....4.9mg, 4.6mg, 4.5mg, 4.2mg, and so on....very gradually in tiny steps work down to 2.5mg over about a month. Do it too fast and it will almost surely go sour, in which case he will say told ya so and then you'll be stuck. Or better, ask for the liquid lex, so you can measure it as accurate as 1/10th of a milligram which is one drop.
Some things to remember...
There is no hard science in psychiatry.
Every prescription is a guess.
SSRI monotherapy is highly over-rated. (IMO)
Trust your instincts.
Make changes in very tiny steps.
Posted by merpmerp on November 30, 2010, at 20:47:24
In reply to Re: Need help approaching pdoc, posted by bleauberry on November 30, 2010, at 19:35:35
Bleauberry, thank you very much for your kind post. I am very grateful for all the support you Babblers have given me - it's helping to calm the fire in my brain and keep me sane as I figure out what to do. (No, I am not in a crisis. I have been living with these feelings to one degree or another for a year and half, since this whole mess began, and I'm very sick of it but I can handle it.)
I will definitely look at the site you mentioned as I am trying to gather resources to get my doc's attention and make her listen (not in a combative manner, but in a "HEY! I'm really suffering here!" manner). I had a long talk with my brother tonight and we talked about my pdoc and he said, "She's not listening to you and not listening to you and not listening to you." and that sums up how I'm feeling with her.
As for decreasing to 2.5 mg, I did so just today. I think it will be okay. I have been making steps in 2.5 mg all along and it's been okay. 5 mg is not okay, that makes me go loopy. The effects of a step up or down by 2.5 mg have consistently come like clockwork 48 hours after making the change. So in a couple of days I'll report back.
I expect to have a headache as that's happened each time I've decreased the dose. (I started having migraines when I started hormonal birth control, before I knew that was a bad idea, and I've since learned that some birth control formulations can lower serotonin, and migraines are thought to possibly be linked to low serotonin, which also explains why the pill made me cry all the time and finally made me depressed. So I expect a headache as my serotonin activity decreases.) I also expect/hope to be feeling better.
I'll let you all know, and thank you all very much for your help.
Posted by merpmerp on November 30, 2010, at 21:13:55
In reply to Re: Need help approaching pdoc, posted by bleauberry on November 30, 2010, at 19:35:35
> SSRI monotherapy is highly over-rated. (IMO)
I am thinking this point over a lot. Personally as I've written elsewhere, the first time I was on Prozac, it was an out-of-the-park smashing success. (I did not go manic or anything, but I felt... healthy, like the "real" me.) I was on a moderately low dose and I believe that the generic formulation I was on was a weak formulation, lowering it further. From reading on here and then delving into the matter elsewhere on the 'net, I think that this is because Prozac at low doses gets in some dopamine and norepinephrine effects without being drowned by the flood of serotonin. I think that is why it was a success for me and it's actually something I'd like to try again. I think you've got a point about pure serotoninergic drugs not being good.
If this with the low dose Lex doesn't work, that (low dose Prozac) is what I'm going to push hard for with my doc. However, no further changes will be made for at least a month as I am about to go out of the country for several weeks.
Sorry for the flood of posts I've been making, I hope that's okay. I'm finding all this fascinating and am glad to have a good place to work all this out. I've been suffering in silence with this for a year and a half (I know that is not very long compared with some of you - and I feel deeply for you.)
Posted by Phillipa on November 30, 2010, at 21:26:22
In reply to Re: Need help approaching pdoc, posted by merpmerp on November 30, 2010, at 21:13:55
Sounds like a sound plan. Best wishes. And have a safe trip Phillipa
Posted by bleauberry on December 1, 2010, at 19:56:34
In reply to Re: Need help approaching pdoc » bleauberry, posted by merpmerp on November 30, 2010, at 20:47:24
I performed guitar at a gig for 1500 people a couple months ago. (I am going somewhere with this). The audience was first year university medical students on their way to becoming doctors. During the ceremony they had to take an oath. It was about a ten minute oath but is pretty much summed up like this:
1. Number one priority is to listen to the patient.
2. Do not argue with a patient.
3. Do not embarrass a patient.
4. Work hard to gain the patient's trust.Basically, the whole idea before healing can even start is to have a trusting open relationship.
It sounds to me like your doctor would have flunked out of this university.
Here is an interesting fact. 50% of doctors graduated in the bottom half of their class.
Always remember....who pays who? You are the paying customer. It is your life. it is your money. You are the one who is ultimately in charge of making all decisions related to your health and life. You pay other people to help you do that. You don't pay them to fight you on it. You don't pay them to ignore you or belittle you.
Posted by merpmerp on December 1, 2010, at 21:53:49
In reply to Re: Need help approaching pdoc, posted by bleauberry on December 1, 2010, at 19:56:34
Thank you bleauberry :)
I met with my counselor today (not my pdoc) and told him what was going on with my pdoc. He said that studies have shown that one of THE most important variables in whether a patient improves is *whether they feel listened to*. He said, direct quote, "We had *better* listen to our patients!" because it is such an important thing.
He also told me that it might be a good thing if I tell my pdoc directly that I'm frustrated with her, because this frustration is building and she really needs to take notice.
***Possible trigger***
I mean I have been suffering with these vivid, traumatic, terrifying violent intrusive images of self harm for almost a year now, in varying degrees (sometimes they're barely noticeable, but they've almost always been there). It's actually a complete mystery to me how I have been able to never act on them or even make any type of attempt. I will never understand how I held that at bay. But enough is enough and it's clearly related to the meds and this nonsense has to stop. The pdoc thinks it's my own anxiety and panic. Horse****. Had plenty of anxiety throughout 23 years of life prior to this 2-year-long mess and never once had symptoms like that.
I will post back in a couple days how the 2.5 mg dose is going. And I am finding the psychotropical site to be a good resource.
Posted by merpmerp on December 3, 2010, at 9:04:42
In reply to Need help approaching pdoc, posted by merpmerp on November 29, 2010, at 17:18:07
It's been a few days now at the 2.5 mg dose. This is the lowest dose I've ever been on.
Physical symptoms: shakiness and muscle stiffness, dry mouth and throat, chills, mild insomnia, headache, diarrhea but not as bad (I am going to buy some probiotics to try and help as I'm sure my poor GI tract is just out of whack now.) Also stuffy nose (I may be catching my officemate's cold). These symptoms are about equivalent in severity to a low-grade flu, I think.
Mental outlook: fantastic. The physical symptoms are not really bothering me much, since I feel so much better mentally. It's like someone flipped a switch in my brain. For the first time in over a year, I feel alert, motivated to get stuff done, satisfied in my accomplishments, and capable of feeling happy. I have an excellent short term memory again. I can look forward to things instead of dreading them or being neutral. I feel rekindled interest in my hobbies. I have some anxiety, but it's the good kind, the kind that motivates me and doesn't overwhelm me.
This doesn't mean I think that I want to be on Lex, at this dose, forever. I need to take a month or so and re-evaluate. But it means my pdoc had really better listen to me when I tell her, "Your prescribed doses were too high" because now I feel that I basically have proof.
Posted by Phillipa on December 3, 2010, at 21:15:17
In reply to Re: Need help approaching pdoc, posted by merpmerp on December 3, 2010, at 9:04:42
So basically you are saying that 2.5mg is better than the recommended dose? Will you continue on it know you said reevaluate. Is that between lex and prozac? Phillipa
Posted by merpmerp on December 4, 2010, at 9:00:57
In reply to Re: Need help approaching pdoc » merpmerp, posted by Phillipa on December 3, 2010, at 21:15:17
Yes, it is much better than the recommended (5 mg) dose! Suddenly it's like my brain woke up and said, "Hi, where were you all this time?"
I will continue on it for at least a month, because like I said I'm about to go out of the country (I'm in the States and going to Asia, so quite a trip) and I don't want to be messing with my brain any more when I'm dealing with serious jet lag and a completely different culture.
Yes, the reevaluation will be between Lex and Prozac. My reasons for considering a switch back to (low dose) Prozac are that I like that apparently Proz has some effects on dopamine and norep at low doses, and I feel like Lex is too selective, and I also like Proz's long half life. All along, I do feel like I can tell a daily shift in my moods and symptoms depending on where my body is in metabolizing Lex, and I don't like that. It's distracting and weird.
However..... if 2.5 mg continues to work for me, one thing I think I've learned from my med experience is if it's working, don't upset the apple cart!
Good news - I emailed my pdoc, told her what I was doing, and emailed her a few articles and resources I found (felt like I was giving her homework... weird!) and she said thank you and she'd take a look. I see her Monday so will update after that!
> So basically you are saying that 2.5mg is better than the recommended dose? Will you continue on it know you said reevaluate. Is that between lex and prozac? Phillipa
Posted by creepy on December 9, 2010, at 12:19:15
In reply to Re: Need help approaching pdoc, posted by merpmerp on December 3, 2010, at 9:04:42
This is more complex than you might think since
SSRI discontinuation can include hypomania. You dont necessarily have hypomania.. but you might be feeling improved as a result of the discontinuation process, not so much the dose itself.
Give it a few weeks and see. This happened to me when I went down on lex and it was temporary =(
Posted by Phillipa on December 9, 2010, at 20:10:02
In reply to Re: Need help approaching pdoc, posted by creepy on December 9, 2010, at 12:19:15
It can? Never heard of that before thanks Phillipa
Posted by merpmerp on December 11, 2010, at 14:41:52
In reply to Re: Need help approaching pdoc, posted by creepy on December 9, 2010, at 12:19:15
Leaving tomorrow, feeling okay on the Lex so far (been 2 weeks), the daily up-down is annoying but it may be leveling off.
This is the end of the thread.
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