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Dr. Bob is Robert Hsiung, MD,
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Posted by morgan miller on August 10, 2010, at 21:07:15
In reply to Re: Off Lexapro? - apathy syndrome //Help! » morgan miller, posted by violette on August 10, 2010, at 20:11:45
> No, I agree with you Morgan-the effect of the situation is similar. I was emphasizing lack of addressing psychological issues-and just dispensing pills rather than correct/incorrect dx.
>
> I think the issue I was pointing out is more of a systematic problem.I see, maybe you are right. I was taking psychology courses and on my way to going to grad school to get a Master's in Social Work(I felt like I was getting too old to go for a PhD in clinical psychology), so I will be the first one to acknowledge the need for therapy and issues with lack of participation. I think medications are necessary in some circumstances, but, I agree that they are handed out like candy without any emphasis being put on the need for therapy.
Violette, people just flat out do NOT want to deal with their issues. I do believe this is the majority of people. Everyone wants to stay in denial and move forward and take a little pill that makes them feel better. And ya know what, I can't really blame them, therapy is not easy at all. You actually almost always have to go through a period of sadness and depression and anger before you start really getting better in therapy. Most people have the misconception that they are just going to go to therapy and continue to feel better and better after day one. This just is not the case. If it were, then there wouldn't be any real work being done. There wouldn't be any dealing and coping. There wouldn't be any digging deep and analyzing for a better understanding so that one can be more empathetic and compassionate for one self.
Morgan
Posted by violette on August 10, 2010, at 21:50:22
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by morgan miller on August 10, 2010, at 21:07:15
I see...My T also told me some people who enter therapy drop out because it's too painful.
Considering I spent almost a decade feeling miserable with drugs, I'd trade a few years of therapy pain to get back that time in a hearbeat. And it's not all painful-there are many good feelings that go with having someone who believes in you...the relationship..the support..in your life.
It's worth it in the long run. But it is difficult finding the right therapist, as you said.
People in my family who deny their psychological issues are the unhealthiest.
Posted by morgan miller on August 10, 2010, at 22:28:49
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by violette on August 10, 2010, at 21:50:22
>And it's not all painful-there are many good feelings that go with having someone who believes in you...the relationship..the support..in your life.
This is very true also. I've had wonderful therapists and enjoyed most of my experience in therapy, even the rough times. But that's just me, psychology is a major interest of mine. Hopefully one day I will be functioning at a very high level and have grown and matured so that I will be capable of going back to school and eventually practice therapy. Right now my brain is a dysfunctional mess and I am not as mature and developed emotionally as I would need to be.
>People in my family who deny their psychological issues are the unhealthiest.
This is true for many. And, if one is in denial, but appears to be fairly happy and successful in life and career, eventually the psychological issues deep seated in their psyche will catch up with them and negatively affect their lives in one way or another-usually impacting relationships and not as much careers.
Morgan
Posted by Phillipa on August 10, 2010, at 23:43:32
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by violette on August 10, 2010, at 21:50:22
I tried so many and can't find a good fit any tips? Phillipa
Posted by orbital on August 11, 2010, at 12:20:42
In reply to Re: Off Lexapro? - apathy syndrome //Help! » orbital, posted by Phillipa on August 9, 2010, at 20:00:38
Phillipa, Paxil worked great for me. Like you, I was switched to Celexa, which I dropped after a few weeks, as it turned me into a zombie. Went back to Paxil, but it had quit working.
> Orbital well this get interesting as the next I took after quite a few years was paxil l0mg had to add lopressor 25mg pluse the benzos to tolerate. For three months was a zoombie and then was okay. Went back to working and took for two years then idiot doc took me off for celexa which did me in. Now I'm also sensitive or just nothing with meds. Strange isn't it? Phillipa
Posted by orbital on August 11, 2010, at 12:45:57
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by violette on August 10, 2010, at 21:50:22
Violette, I've been doing psychodynamic therapy for over 15 years. I also do CBT, on and off. I agree with you, the psychological component of depression is extremely important, crucial in fact, at least in my case it stopped me from going off the deep end.
It was my therapist's suggestion that I try medication, as certain symptoms were not responding to treatment. That's how I ended up seeing a psychiatrist in the first place.
I think it's important to realize the difference between apathy being caused by psych. issues such as melancholia or dysthymia, and other causes such as SSRI "overload". I feel that the latter explains my current situation more accurately. I quit taking my excitalopram five days ago, and the fog I'm in is slowly lifting.
I think I neglected to mention in my initial post that this is the precise reason I quit my first Lexapro run about two years ago. It worked extremely well for many months, then I quite suddenly slid into a state of complete apathy and despondency. My doctor at the time decided to up my dosage, which of course made matters much worse.
This time around, I was aware of the possibility that this might happen - I figured I'd ask to lower the dose if it did. That didn't work, so I'm cutting my losses before I wind up wasting an indefinite amount of time in a blurry haze.
> I see...My T also told me some people who enter therapy drop out because it's too painful.
>
> Considering I spent almost a decade feeling miserable with drugs, I'd trade a few years of therapy pain to get back that time in a hearbeat. And it's not all painful-there are many good feelings that go with having someone who believes in you...the relationship..the support..in your life.
>
> It's worth it in the long run. But it is difficult finding the right therapist, as you said.
>
> People in my family who deny their psychological issues are the unhealthiest.
Posted by violette on August 11, 2010, at 15:51:51
In reply to Re: Off Lexapro? - apathy syndrome //Help! » violette, posted by Phillipa on August 10, 2010, at 23:43:32
Hi Phillipa,
Personal preferences sometimes dictate what patients find helpful or not helpful; for anyone whose been in the mental health system for a long time...I'd first try psychodynamic therapists. For people with really walled off emotions, I think conventional psychoanalyis might be a better place to start...
I found webites that offer advice on choosing a therapist to be kind of useless, but you might want to Google that if you've never read them. Some of the lists I've seen of 'good vs. bad' traits of therapists are sometimes unrealistic or much too black and white..
This is probably most useful information I've seen in one place:
http://website.lineone.net/~ve...erapists%20Abuse.htm
That's basically what you don't want in a therapist...
I think a therapist who has been in her own therapy is important...someone who does not let herself become intertwined with your issues. You can get really stuck if the therapist 'becomes who you want them to be'. It happens all the time, but I think it becomes a major problem if it's consistent/undiscovered rather than worked out.
For me, I don't work well with Ts who are directive/give advice. Someone with dependency issues may prefer that, but that will get you nowhere and keep you stuck. Psychodynamic therapists are usually ones who do not do this-instead, they will help you arrive at your own advice through insights.
Gender can be an issue...I have 'mother issues' and found that after working with several female Ts in the past, that working with a male is much better for me.
I always recommend starting here:
http://www.apsa.org/Find_an_Analyst.aspx
Some of the best Ts in my city are a member of that org.; my T is in the database though he was referred to me... Word of mouth is best. I don't trust any of those websites where therapist advertise-though some people may find good matches that way. In my experience, choosing someone with lots of experience and who gets referrals through colleagues made a difference...Ts on the list of that link generally will refer you to a colleague if they are not the best match for you as they usually know preferences of the Ts, who they work best with,etc. I think starting there is the best way to go.
Hope that helps.
:)
Posted by violette on August 11, 2010, at 16:03:36
In reply to Re: Off Lexapro? - apathy syndrome //Help! » violette, posted by orbital on August 11, 2010, at 12:45:57
15 years is a long time in therapy. I've only been in (psychodynamic therapy) it for a year, and it's really been the most help for those symtpoms you describe. I expect to remain in it for a long time too, hopefully not that long..
The last couple times I tried ADs, it made those symptoms much, much worse..like EdUK said, the brain is not a pot of soup! Anyway, I think you're making a wise decision. If you still have problems you could consider getting neuropsychological testing done, if you already haven't, as apathy is a commen symptom of neurological disorders too.
Posted by Phillipa on August 11, 2010, at 20:29:32
In reply to Re: Off Lexapro? - apathy syndrome //Help! » Phillipa, posted by violette on August 11, 2010, at 15:51:51
Violette thank you kindly I appreciate this as google area and did pick therapists from the advertised list. Those where the ones who didn't listen, tried to tell me what to do and then the next week forgot what they had said. Will read your lists. Phillipa
Posted by emmanuel98 on August 11, 2010, at 20:57:36
In reply to Re: Off Lexapro? - apathy syndrome //Help! » violette, posted by Phillipa on August 11, 2010, at 20:29:32
lucky for me that when I was looking for a p-doc, I really liked him and asked him if he would also do therapy with me, and he agreed. This is the ideal. A p-doc who really knows you, knows the difference between when you are in a severe biological depression and when you are just unhappy or despairing over emotional stuff.
Sadly, most p-docs don't do much therapy today (though they are trained in it) because they can make more money doing 3 med consults in an hour than doing an hour of therapy (the insurance payment and my copay nets my p-doc $115 an hour, which isn't much to maintain an office, several phones, malpractice insurance and the rest). If he did 3-4 med consults he could make from 180-240 an hour.
But having your p-doc as a therapist is the ideal situation. For me it has been a "good fit." As he said once, we make a "good team." This isn't always the case, unfortunately.
Posted by Phillipa on August 11, 2010, at 21:25:26
In reply to Re: Off Lexapro? - apathy syndrome //Help! » violette, posted by Phillipa on August 11, 2010, at 20:29:32
Violette can you believe there is 0 none in my city and it's large? Amazing. Phillipa
Posted by violette on August 11, 2010, at 21:58:44
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by Phillipa on August 11, 2010, at 21:25:26
Phillipa, don't use the zip code feature.
I live in a small city and there are over 40...try just entering your city; if that doesn't work, enter the state only...if you get none, sorry to hear that. :(
Posted by violette on August 11, 2010, at 22:05:38
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by emmanuel98 on August 11, 2010, at 20:57:36
Emmanuel-that is lucky for you! I never thought of doing that, of asking a PDoc to do therapy. My former PDocs saw me for 5-15 minutes once a month or every 2 months. Come to think of it, I'm not sure I liked most enough to do therapy with them. They really were not 'people persons..'
My T is a also a psychiatrist; many of those on that list in my area are as well. Yes, it makes a big difference for me too and I am very grateful to have found him.
He prefers providing therapy, despite less income. though he does get more than $115/hr...He also told me he usually spends 1/2 hour with those who see him for meds only anyway. He's really dedicated to his patients. And it makes a great difference.
Posted by morgan miller on August 12, 2010, at 0:53:34
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by emmanuel98 on August 11, 2010, at 20:57:36
> lucky for me that when I was looking for a p-doc, I really liked him and asked him if he would also do therapy with me, and he agreed. This is the ideal. A p-doc who really knows you, knows the difference between when you are in a severe biological depression and when you are just unhappy or despairing over emotional stuff.
>
> Sadly, most p-docs don't do much therapy today (though they are trained in it) because they can make more money doing 3 med consults in an hour than doing an hour of therapy (the insurance payment and my copay nets my p-doc $115 an hour, which isn't much to maintain an office, several phones, malpractice insurance and the rest). If he did 3-4 med consults he could make from 180-240 an hour.
>
> But having your p-doc as a therapist is the ideal situation. For me it has been a "good fit." As he said once, we make a "good team." This isn't always the case, unfortunately.I find that p-docs usually do not make the greatest therapists as they tend to lack the capacity of empathy and compassion that a really good psychodynamic therapist has. I also prefer my therapists to be down to earth and easy to talk to, this is rare amongst psychiatrists.
Posted by violette on August 12, 2010, at 8:47:58
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by morgan miller on August 12, 2010, at 0:53:34
There are still a few psychiatrists left who do psychodynamic therapy (mine for one). It is truly sad that it is becoming more and more uncommon.
I think it depends upon where you live too. There seem to be many in New York city for example.
Finding one has really has made a huge difference in my life.
Posted by morgan miller on August 12, 2010, at 9:30:13
In reply to Re: Off Lexapro? - apathy syndrome //Help! » morgan miller, posted by violette on August 12, 2010, at 8:47:58
I know there are some that practice both psychiatry and psychotherapy in my area, I've seen a few of them. I'm just very skeptical as to whether they have the same capacity for genuine empathy and compassion that some of the really good highly educated psychotherapists have. And, again, I also think it is much harder to find a psychiatrist that acts like a normal everyday down to earth person. Maybe I have been very lucky and found these traits in the 2 therapists I've seen.
Posted by orbital on August 12, 2010, at 10:22:46
In reply to Re: Off Lexapro? - apathy syndrome //Help! » orbital, posted by violette on August 11, 2010, at 16:03:36
Violette, I was in a critical state when I first started therapy. That's no longer the case, needless to say, these days I continue to do therapy mostly out of habit. 15 years is a long time, I suppose it's fair to say that it's part of my lifestyle. It continues to be very helpful, of course.
I resisted taking medication for a very long time and -lucky me- my first med was 20mg Prozac, no titration, which caused severe panic and anxiety.
Anyway, a combined approach is what seems to work best for me. I guess that's not the case for everyone, though :)
> 15 years is a long time in therapy. I've only been in (psychodynamic therapy) it for a year, and it's really been the most help for those symtpoms you describe. I expect to remain in it for a long time too, hopefully not that long..
>
> The last couple times I tried ADs, it made those symptoms much, much worse..like EdUK said, the brain is not a pot of soup! Anyway, I think you're making a wise decision. If you still have problems you could consider getting neuropsychological testing done, if you already haven't, as apathy is a commen symptom of neurological disorders too.
Posted by Phillipa on August 12, 2010, at 19:35:43
In reply to Re: Off Lexapro? - apathy syndrome //Help! » Phillipa, posted by violette on August 11, 2010, at 21:58:44
Didn't use zip code just city. Nearest is about three hours away. I used to have a pdoc that was an osteopath and he did theraphy also, employed massage therapists also. It was great then. Phillipa
Posted by emmanuel98 on August 12, 2010, at 19:41:07
In reply to Re: Off Lexapro? - apathy syndrome //Help! » violette, posted by orbital on August 12, 2010, at 10:22:46
I think people have better luck with older p-docs, who were all trained in dynamic therapy back in the day, and have years and years of experience with really difficult patients. My p-doc is in his early 70s and studied for three years under this world famous therapist and p-doc
Posted by violette on August 13, 2010, at 8:47:02
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by emmanuel98 on August 12, 2010, at 19:41:07
> I think people have better luck with older p-docs, who were all trained in dynamic therapy back in the day, and have years and years of experience with really difficult patients.
I agree Emmanuel! It took me a long time to find this out...
Posted by morgan miller on August 13, 2010, at 9:11:50
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by violette on August 13, 2010, at 8:47:02
I like my pdocs between the ages of 40 and 70, they are still very sharp, lively, and fully connected with their emotions(I feel after 70 people begin to grow a bit numb), while also having plenty of valuable experience. Someone who is very alive and still has a large capacity for empathy and compassion is just too important for me when seeing a therapist. I just think a therapist in their 70s and 80s is less likely to still have everything they once had. The reality is, the brain ages as we age, and with this, we also begin to lose certain emotional components that were once much stronger. JMHO.
Posted by morgan miller on August 13, 2010, at 9:13:31
In reply to Re: Off Lexapro? - apathy syndrome //Help! » violette, posted by morgan miller on August 13, 2010, at 9:11:50
> I like my pdocs between the ages of 40 and 70, they are still very sharp, lively, and fully connected with their emotions(I feel after 70 people begin to grow a bit numb), while also having plenty of valuable experience. Someone who is very alive and still has a large capacity for empathy and compassion is just too important for me when seeing a therapist. I just think a therapist in their 70s and 80s is less likely to still have everything they once had. The reality is, the brain ages as we age, and with this, we also begin to lose certain emotional components that were once much stronger. JMHO.
OOps, didn't mean to say pdoc. I was only talking about therapists.
Posted by emmanuel98 on August 13, 2010, at 20:52:13
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by morgan miller on August 13, 2010, at 9:13:31
Well my therapist (also a p-doc) is 71 and sharp as a tack, compassionate, kind, empathic, but also inclines to push me to work and not just look to therapy as a shoulder to cry on. Now maybe once he hits 75 things will change, but he is semi-retired and would probably retire completely if he felt he wasn't doing as good a job as he once did.
Posted by morgan miller on August 13, 2010, at 21:50:19
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by emmanuel98 on August 13, 2010, at 20:52:13
That's great! Yeah there are some people that tend to hold it together much longer than others.
Posted by orbital on August 14, 2010, at 5:58:21
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by morgan miller on August 13, 2010, at 21:50:19
I quit taking the escitalopram on Monday, with my doctor's approval. So far so good. The fog is definitely lifting, my feelings are returning, I'm starting to feel like myself again. Gradually.
I visited my brother yesterday, I didn't tell him about the withdrawal, he just doesn't keep up with that stuff. Anyway, he was surprised, he told me that something had changed, he said that my sense of humor was back and that I seemed less depressed (gotta love the irony!). I actually felt good.
When I called my doc, she told me that wants me to take a small dose of sertraline, as she thinks that I might still need a boost and quitting SSRIs so abruptly after long term use might cause problems. I asked for Savella instead but she shot it down, at least initially, she feels that it's too activating for someone who suffers from anxiety.
I'll be seeing her in a couple of days, finally, I'm not sure about the Zoloft, but I'm glad she's willing to work with me.
Bye bye escitalopram. It did help me a lot for a long time, but the eventual poop out/emotional blunting was horrendous.
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