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Dr. Bob is Robert Hsiung, MD,
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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.
Posted by morgan miller on August 14, 2010, at 22:41:26
In reply to Update - off Lex, posted by orbital on August 14, 2010, at 5:58:21
I think Zoloft is a great drug, but I am biased. I would insist on taking name brand though. I don't think you will have to be concerned about lethargy on Zoloft.
Glad to hear you are feeling better. I think starting Zoloft at a low dose is a good idea, you might not be feeling so great in a week or so without it.
Posted by ed_uk2010 on August 15, 2010, at 7:10:24
In reply to Update - off Lex, posted by orbital on August 14, 2010, at 5:58:21
>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.
So why does your doctor want you to take sertraline (Zoloft)? It sounds like you are doing well without medication. Sertraline can cause all of the typical SSRI adverse effects. It's a decent medication - but is it what you need right now?
Posted by morgan miller on August 15, 2010, at 10:06:34
In reply to Re: Update - off Lex » orbital, posted by ed_uk2010 on August 15, 2010, at 7:10:24
> >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.
>
> So why does your doctor want you to take sertraline (Zoloft)? It sounds like you are doing well without medication. Sertraline can cause all of the typical SSRI adverse effects. It's a decent medication - but is it what you need right now?
>
>I agree that orbital may want to wait a good month to see how he feels.
The doc wants to start Zoloft because they are concerned that in a week or so, when any therapeutic effects of Lexapro wear off, orbital may not be feeling so good. It is quite common to come off a drug and initially feel better. But then a little time passes and the person finds themselves feeling worse in some ways than when they were on the drug-very very common.
Posted by ed_uk2010 on August 15, 2010, at 13:39:03
In reply to Re: Update - off Lex, posted by morgan miller on August 15, 2010, at 10:06:34
Hi Morgan,
>It is quite common to come off a drug and initially feel better. But then a little time passes and the person finds themselves feeling worse in some ways than when they were on the drug-very very common.
Oh I agree, I just thought that orbital wanted to try without SSRIs for a while. All SSRIs have the potential to cause emotional numbness - which seems to have become such a problem for orbital.
Posted by orbital on August 15, 2010, at 13:47:29
In reply to Re: Update - off Lex, posted by morgan miller on August 15, 2010, at 10:06:34
I'll be seeing my doctor tomorrow, I'm quite unsure as to what to do next. Right now I'm tempted to ask for a short course of Prozac to /hopefully/ ward off rebound depression, and reassess my situation further on. I feel so much better now but I agree with Morgan, it might be too soon to tell.
Im not complaining of course, if push comes to shove, it's reassuring to know I have options :)) Maybe this beast is in remission.
Posted by ed_uk2010 on August 15, 2010, at 14:41:11
In reply to Re: Update - off Lex, posted by orbital on August 15, 2010, at 13:47:29
>I'll be seeing my doctor tomorrow, I'm quite unsure as to what to do next. Right now I'm tempted to ask for a short course of Prozac to /hopefully/ ward off rebound depression, and reassess my situation further on. I feel so much better now but I agree with Morgan, it might be too soon to tell.
You could ask your doctor if she would be willing to prescribe a small amount of Prozac. You don't have to take it immediately, but you could keep it on standby. If you notice any signs of your depression returning, you can start taking it. If you continue to do well, you might decide not to take it at all.
Posted by Huxley on August 15, 2010, at 19:21:36
In reply to Re: Update - off Lex » orbital, posted by ed_uk2010 on August 15, 2010, at 14:41:11
I have been doing alot of research on SSRI withdrawal and from ancedotal reports, a big problem that alot of people run into is Anhedonia
http://en.wikipedia.org/wiki/Anhedonia
From what I have read this can last for months and years after discontinuation.
I personally think that alot of people seem to get into a helpless state from long term SSRI use. They continue to take them long after the drugs have stopped working because discontinuing them is almost impossible because of the withdrawal. The negative effects of long term SSRI use is diagnosed as another mental illness and additional medications are added to your reigme.
Slow and steady is the way to go, discontinue it over a year or two.Sudden SSRI withdrawl is a disaster in my books. Even once you get over the 2-4 weeks of horrible physical withdrawal you will be in emotional turmoil for a long time.
Posted by orbital on August 15, 2010, at 21:44:48
In reply to Re: Update - off Lex » orbital, posted by ed_uk2010 on August 15, 2010, at 14:41:11
> You could ask your doctor if she would be willing to prescribe a small amount of Prozac. You don't have to take it immediately, but you could keep it on standby. If you notice any signs of your depression returning, you can start taking it. If you continue to do well, you might decide not to take it at all.
>
Well, at this point, my reasoning for taking Prozac is to keep any possible post-SRRI rebound depression at bay. Do you think I'm being overly cautious?FWIW, I don't seem to be suffering from any major W/D symptoms, mentally I feel fine, physically... I'm a bit tired, my sleep is somewhat bit restless, and I have some nausea, but that's about it. I'd slowly weaned myself down to 5mg of escitalopram during the past few weeks before quitting, though.
Posted by morgan miller on August 16, 2010, at 0:55:54
In reply to Re: Update - off Lex, posted by orbital on August 15, 2010, at 13:47:29
> I'll be seeing my doctor tomorrow, I'm quite unsure as to what to do next. Right now I'm tempted to ask for a short course of Prozac to /hopefully/ ward off rebound depression, and reassess my situation further on. I feel so much better now but I agree with Morgan, it might be too soon to tell.
>
> Im not complaining of course, if push comes to shove, it's reassuring to know I have options :)) Maybe this beast is in remission.If you do feel the need to try Zoloft, I believe that with time and with the right dose, it is less likely to give you the unwanted effects you have experienced with other SSRIs.
Good luck and hope you continue to feel well!
Morgan
Posted by morgan miller on August 16, 2010, at 1:00:03
In reply to Re: Update - off Lex, posted by Huxley on August 15, 2010, at 19:21:36
> I have been doing alot of research on SSRI withdrawal and from ancedotal reports, a big problem that alot of people run into is Anhedonia
>
> http://en.wikipedia.org/wiki/Anhedonia
>
> From what I have read this can last for months and years after discontinuation.
>
> I personally think that alot of people seem to get into a helpless state from long term SSRI use. They continue to take them long after the drugs have stopped working because discontinuing them is almost impossible because of the withdrawal. The negative effects of long term SSRI use is diagnosed as another mental illness and additional medications are added to your reigme.
>
>
> Slow and steady is the way to go, discontinue it over a year or two.
>
> Sudden SSRI withdrawl is a disaster in my books. Even once you get over the 2-4 weeks of horrible physical withdrawal you will be in emotional turmoil for a long time.
>I don't necessarily agree with this. Does it happen with some people, sure, but I believe those are the people who you are reading reports on such things happening. What you don't read about or find on the internet, are those thousands of people that have discontinued SSRIs and are doing just fine. I have 3 friends that have discontinued SSRIs without any long term withdrawal syndrome or emotional/mental issues.
Posted by ed_uk2010 on August 16, 2010, at 15:04:15
In reply to Re: Update - off Lex, posted by orbital on August 15, 2010, at 21:44:48
>Well, at this point, my reasoning for taking Prozac is to keep any possible post-SSRI rebound depression at bay. Do you think I'm being overly cautious?
How long were you planning on taking Prozac for, and at what dose?
>I'd slowly weaned myself down to 5mg of escitalopram during the past few weeks before quitting....
>I don't seem to be suffering from any major W/D symptoms.....Given that you tapered fairly slowly, I don't think you're likely to experience rebound depression ie. depression as a withdrawal symptom. If your depression starts to return in a few weeks' time, that would be a relapse, not a rebound. Rebound depression normally refers to a depressive episode which occurs quite quickly after stopping an antidepressant, and is often accompanied by pronounced withdrawal symptoms. Gradual tapering can prevent rebound depression, but it can't prevent a relapse from occuring several weeks or months later.
Before you decide whether or not to take Prozac, I think you need to be clear in your mind about what you are actually taking it for.
A short course of Prozac at a low dose (eg. 5mg/day) might reduce your withdrawal symptoms. A very low dose of Lexapro (eg. 2.5mg) for a couple of weeks would probably have a similar effect. Since you're not experiencing much in the way of withdrawal symptoms anyway, I'm not sure that this would be worthwhile. If you're finding the nausea and disturbed sleep to be a problem, it might help.
A short course of Prozac isn't likely to affect your long term risk of relapse. Only if you take Prozac on a long term basis will it achieve this.
If I were you I'd probably ask for a small amount of Prozac and put it away in a drawer. If you notice any signs of your depression returning, you can start the Prozac straight away. Otherwise, you might not need it. The thing about Prozac is that it can cause all of the typical SSRI side effects. All SSRIs have the potential to cause emotional numbness, even though some may be worse than others. I think it makes sense to have Prozac on standby rather than Zoloft, since you mentioned above that you had to stop taking Zoloft due to weight loss. You didn't mention any problems with Prozac.
Take care.
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