Posted by bleauberry on January 2, 2009, at 17:17:58
In reply to Zyprexa for insomnia, posted by Quintal on December 31, 2008, at 13:36:07
In my opinion, antipsychotics are for: Treatment resistant depression when combined with SSRIs; Boosting a partial response to SSRIs; schizo-affective disorders; Silencing violent prisoners; sometimes things like Autism. For sleep? Not.
I would make one exception. I see no harm in 25mg Seroquel for sleep. Sure Zyprexa can be good for sleep. But I mean, if sleep is the issue, Seroquel has more of a knockout punch. And its halflife is short. Zyprexa is there 24 hours.
Now if he were giving you Prozac+Zyprexa, I would say excellent idea. But Zyprexa alone, well, it's still a great med, but I hesitate a little bit.
There are better choices for sleep, such as Trazodone, Lunesta, Seroquel, Restoril.
If you are in a place where you feel inferior to your doctor, as in being as you called a "difficult patient", then I can't help but see a bad doctor/patient relationship there. I know of no details other than what you wrote, so I could be way wrong and overly judgemental. But based on what I see with limited information, either this doctor is undeservingly egotistical (thinks he knows it all and has all the answers and is not to be questioned), or maybe he is fine but you are not standing up for yourself. Either way, a middle ground of compromise has to be found that is agreeable with both of you. After all, it is you that is getting him paid, and it is you that has to swallow powerful mystery pills. You are the paying customer. He has no business and no paycheck without you. You are the boss in that regard. There is nothing wrong with discussing alternatives with a doctor that are different than his best choice. Just do it respectfully and tactfully, but boldly, and it helps to have scientific evidence on paper laid on his desk to back up your opinions.
And so what if that is a difficult patient? So what? That difficult patient sounds like he is taking a responsible stand in his own wellbeing, and not subordinating his life to the role of guinea pig at someone else's whim. I have had doctors like yours. Right now I have two that respect that I am involved, researching, and sparking ideas. They admit right up front medicine leaves a lot to be desired, and they encourage patient involvement in decision making. Actually, it makes their job easier. So a difficult patient can actually be an easier patient.
poster:bleauberry
thread:871638
URL: http://www.dr-bob.org/babble/20081223/msgs/871970.html