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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Vesper on February 17, 2000, at 0:48:07
I have had bad experiences with SSRIs, and I told my Pdoc(this happened last year) that I wouldn't take SSRIs. He recommended Effexor. I asked if it was an SSRI and he said no. Of course I got the same side effects as the SSRIs and when I looked it up I discovered it is not an SSRI, but it IS an SRI. In other words, almost the same thing, with roughly the same side-effect profile, it just isn't selective in its inhibition of the reuptake of seratonin(or something like that.) This seems to be a common thing with psychiatrists, they think they can just say anything they want as long as it is *technically* true. Now they say if I don't do certain things they won't treat me anymore at UCLA, but I'm not sure I can do these things, and if they won't see me anymore, there's nothing else I can do. Anyway my therapist is leaving for several months at least anyway, I don't know what I'm trying to say, sorry for the ramble.
Hey, does anyone know how many stories one must fall to be certain of death?
Posted by torchgrl on February 17, 2000, at 1:47:29
In reply to Patronizing Psychiatrists, posted by Vesper on February 17, 2000, at 0:48:07
Vesper, in defense of your doctor, Effexor *is* considered to be in a different class than the SSRIs like Prozac, Paxil etc., and does act differently in a lot of ways. But he/she probably should have been more cognizant of the problems you've had that were probably related to seratonin, and steered towards something completely different. Effexor does seem to be considered an incredibly effective drug in some circles, so that may be why your doctor wanted you to try it. I agree that it's frustrating when psychiatrists assume that you know absolutely nothing about the different medications available, even when you try to discuss. Although I've been pretty fortunate with this for the most part, I recently had an encounter with one who seemed to just want to ignore everything I said that indicated that I knew more than just what I saw on TV. I guess some of them aren't real "people" people, are more inclined towards the research side, so don't feel comfortable discussing meds to that degree. And many of them are probably used to most people not being involved in their treatment to that level. Still, it's not encouraging when you come up against that resistance...
As far as your therapist leaving, can you get them to refer you to someone else before they go? My therapist had to leave town suddenly last autumn due to her father's illness, which was real blow to me at the time, but she did give me a couple of referrals that she'd put some thought into. It was kind of hard to motivate to call, but I finally did, and I almost like my current therapist better than the original one. It's a lot easier to cope with this stuff when you're not trying to do it alone!
Posted by Paul S. on February 17, 2000, at 2:41:10
In reply to Patronizing Psychiatrists, posted by Vesper on February 17, 2000, at 0:48:07
Let's face it...psychs take courses in being patronizing to patients...especially patients who don't respond quickly to their magic healing powers. As to them not going to treat you unless you do certain things, what things do they want you to do? I've jumped through hoops of fire to try for the docs to try and get rid of my chronic depression and then been labelled an "uncooperative patient" when I refused to keep jumping at their command.
Psychs don't mind us asking them questions but will not tolerate hostility from patients who are (rightly) questioning why none of their prescribed crap is working. One must always remember who is #1. (Hint: it isn't the patient)
Somehow I have found a doc who will let me rant about my constant, extreme, low mood. None of the meds (and I've been on nearly 15 types)work but he doesn't go putting arbritrary demands on me. I hate psych docs but this one I can somehow tolerate.
As an aside....have you considered trying a group like Emotions Anonymous or Recovery Inc.?
Occassionally I go to them and at least can talk with like-minded people who are having a hell of a time coping also.Paul S.
Posted by vesper on February 17, 2000, at 3:04:52
In reply to Re: Patronizing Psychiatrists, posted by torchgrl on February 17, 2000, at 1:47:29
Oh, I'm not slamming effexor. I don't have this pdoc any more anyway. He KNEW that the effexor was likely to have the same effect on me I could not deal with in SSRIs, yet tried it anyway. He is a well known, highly respected researcher and clinician at UCLA, hence his arrogance, probably. My current team I like better, they seem more willing to discuss things rather than presenting ultimatums re meds. It doesn't matter much anyway,I am close to just killing myself. I already did some cutting yesterday, and it makes me want to do more, it felt so good.
Posted by Noa on February 17, 2000, at 4:30:24
In reply to Re: Patronizing Psychiatrists, posted by vesper on February 17, 2000, at 3:04:52
I don't know what happened to my earlier post to you...here is the gist:
1. It IS hard when a therapist leaves. Some of your rage right now is probably about that. It would help to have another therapist to talk to about the loss.
2. What are the things UCLA is asking of you in order to continue treatment there?
3. Your suicidal talk scares me big time. Since you are having trouble refraining from acting on the impulses to cut yourself, and you are clearly thinking about killing yourself, I believe you need to be in the hospital to be safe. There, you can let others who are thinking more flexibly keep you safe until you can think flexibly enough to work on a plan to help you get well.
Posted by saint james on February 17, 2000, at 9:46:50
In reply to Re: Patronizing Psychiatrists, posted by torchgrl on February 17, 2000, at 1:47:29
Lets also remember that unlike the TCA's, which all share the same chemical structure, SSRI are in NO WAY chemically related to each other. They just share an ability (SSRI).
james
Posted by Elizabeth on February 17, 2000, at 10:02:08
In reply to Patronizing Psychiatrists, posted by Vesper on February 17, 2000, at 0:48:07
Effexor does seem to have pretty much the same sort of side effects as the SSRIs, even though it is not an SSRI itself. However, there are other serotonergic meds that have different effects on people, such as the MAOIs, Serzone, and Remeron.
I don't think your psychiatrist was being patronizing so much as thoughtless, but perhaps he thought that if the Effexor worked for you (and it often does work for people who don't respond to SSRIs) you'd be able to put up with the side effects.
> Now they say if I don't do certain things they won't treat me anymore at UCLA, but I'm not sure I can do these things, and if they won't see me anymore, there's nothing else I can do.
On the face of it, this sounds damaging. Can I ask what it is they want you to do, and what other options you have tried? Is there a reason you can't see someone in private practice instead of at UCLA?
> Hey, does anyone know how many stories one must fall to be certain of death?
That varies depending on a number of factors -- you can't really be *certain*, and you don't want to end up paralyzed for life. Same deal with drug overdoses and bullets: you don't want to end up alive but hopelessly brain-damaged. Right now you do have hope (even if you can't see it because of your depression). Don't give it away.
Posted by Abby on February 17, 2000, at 13:41:37
In reply to Re: Patronizing Psychiatrists, posted by saint james on February 17, 2000, at 9:46:50
> Lets also remember that unlike the TCA's, which all share the same chemical structure, SSRI are in NO WAY chemically related to each other. They just share an ability (SSRI).
>
> jamesCutting is bad. What *did* they want you to do. It's so hard, because sometimes a reasonable doctor seems awful, and it is because we feel bad at that moment. Rarely, is one party completely "in the right".
Perhaps they just wanted you to give the drugs adequate trials. Go to the ER now!Abby
Posted by bob on February 17, 2000, at 17:31:46
In reply to Vesper--Go to the hospital, posted by Abby on February 17, 2000, at 13:41:37
Another big vote on that. There's a big difference between being with professionals versus academics, and UCLA's psych department is certainly big enough to be pretty out of touch with what patients, as opposed to subjects, need.
I know about the cutting and how good it feels. I do my cutting from the inside, but it has the same effect -- drawing your attention to feeling control over your pain. There are other ways of exercising control over your pain, tho, and I agree again with the folks who say get yourself to the hospital now.
I also know about patronizing psychologists at "Enormous U". Mine was Michigan -- I think UCLA is the only psych department in the country (or the world) bigger than UM's. When I was a junior there, I tried to get help by going through the proper channels. Forget that I was suicidal--not one campus agency thought I was sick enough to stay in their program for more than 6 visits or so. I was so sick and angry at those bastards for what they did to me that it took me twelve years and daily panic attacks to get myself back into treatment. From where I sit today, I am even sicker and angrier at them for losing twelve years of my life when I could have been in treatment instead of in my own miserable (s)hell.
Who knows? If I had addressed issues back then, I might not have needed twelve years of treatment either.
Having been back at UM for my grad work and having had friends admit themselves to the hospital there really colors my view on this, but the fact remains that what happened to me could be construed as malpractice by several different *agencies* while my friends received immediate treatment that took their problems seriously.
If your current psych contacts with UCLA see you as a subject and not a patient, fuck them. You're more than a statistic, you deserve to be treated as a human being.
Just remember that admitting yourself to the hospital is another way of exercising control over your pain -- only people in control can voluntarily surrender it. Go to the hospital now.
... and for how many stories you need to fall, it really doesn't matter -- if you succeed, the fall never ends, does it?
hang in there
bob
Posted by vesper on February 17, 2000, at 18:26:32
In reply to Re: Vesper--Go to the hospital, posted by bob on February 17, 2000, at 17:31:46
My current therapist at UCLA is on staff, and doesn't do research, so she's good, I like her. My current Pdoc is not bad either, compared to the one to whom I was referring in the original post. Today is the third day since I stopped taking wellbutrin, I also dropped from 1200mg of neurontin daily to 600. I have been feeling better physically since I did that, for the most part, although I am sleeping a lot and I have sudden fits of crying for no apparent reason. I went in for day tx this morning but left because I felt angry and defensive and afraid because they have been putting a certain amount of pressure on me to talk about things I would rather not. I walked by the ip ward and that scared me too. I never want to go back there.
Posted by torchgrl on February 18, 2000, at 0:49:24
In reply to Re: Vesper--Go to the hospital, posted by vesper on February 17, 2000, at 18:26:32
The study I participated in was at UCLA, through the Neuropsychiatric Institute--I really liked the woman psychiatrist that I had to talk to several times, but when I agreed to participate in a discussion involving some of the other doctors there, I got paired up with a man who was definitely more researchy, which made me VERY uncomfortable. I'm usually pretty receptive to talking with psychiatrists, but I don't think I would have wanted to listen to anything he said if I were stuck with him as my prescriber--I'd probably have ignored him and done what I felt like doing, anyway. Finding someone you can connect with is definitely important!
I can understand not wanting to check yourself into a hospital; it sounds a bit daunting, although I've contemplated it before. It sounds like those things that you don't want to talk about are probably the things you need to talk about in order to get through this in one piece. No one can force you to talk if you don't want to, but it might relieve some of the pain and anger to at least start to talk about it and stop carrying it around with you like this. Whenever I've had urges to self-mutilate or bang my head against the wall or whatever, it's usually because there's something painful I'm dealing with that I can't find another way to release other than lashing out at myself, kind of trying to counteract the inner pain with outer pain. If that sounds like what you're dealing with, I've also found strenuous exercise to help release somewhat (walking, running, stairmaster, Tae Bo)... Obviously, the hospital would be the safest environment if you're actually to the point of cutting and wanting to continue, though. I'm just trying to think of something you can do to help even a little if you're that dead set against it...
Posted by vesper on February 18, 2000, at 1:08:44
In reply to Re: Vesper--Go to the hospital, posted by torchgrl on February 18, 2000, at 0:49:24
Thank you everyone...I talked to my pdoc and she agreed to let me change meds if I can't take how I feel, I see her in a week and she said to not stop abruptly, to take one wellbutrin sr 150 and 600mg of neurontin until I see her. I was taking 300mg w. and 1200mg neur., I have had no wellbutrin in a couple of days, and 600mg neurontin. I can't bring myself to tell anyone how bad I really feel because I am really really scared...about hospitalization, etc. I would really rather be free to exercise my options, suicide or cutting, etc.
I'm going on a motorcycle ride with my club tomorrow morning from venice beach to the rock store, maybe that will help. Of course, lately I've been riding like a madman, lane-splitting at 90mph, etc. It seems unreal, like nothing can happen and if it does, I don't seem to care.
Posted by medlib on February 18, 2000, at 2:54:03
In reply to Re: Vesper--Go to the hospital, posted by vesper on February 18, 2000, at 1:08:44
> Thank you everyone...I talked to my pdoc and she agreed to let me change meds if I can't take how I feel, I see her in a week and she said to not stop abruptly, to take one wellbutrin sr 150 and 600mg of neurontin until I see her. I was taking 300mg w. and 1200mg neur., I have had no wellbutrin in a couple of days, and 600mg neurontin. I can't bring myself to tell anyone how bad I really feel because I am really really scared...about hospitalization, etc. I would really rather be free to exercise my options, suicide or cutting, etc.
Vesper-
I believe that you need all the support that you can muster--pharmacological and emotional--to traverse this "Valley of the Shadow." Please don't let anyone pressure you into discussing painful topics until your meds are a source of support, not stress. If you can't trust your pdoc with your suicidal thoughts because she might be professionally obliged to involuntarily commit you, find someone else you CAN trust with this pain. This group is a good start, but try to find someone available when you need it most--maybe Suicide Hotline or Emotions Anonymous. Pain that can't be relieved can be survived if it is shared.
BTW, I don't believe that the Afterlife (if there is one) has any options--if you don't like it, you don't get to leave.
Morbid Thought #2: If you had ever spent time in a rehab hospital (as I have), you would realize that dying is NOT the worst thing that can happen to you (or an Innocent Other) on a "DonorCycle". Be careful--if not for yourself, for others.The part of you that is reaching out WANTS to live; please don't foreclose that person's options. Hang tough-
medlib
Posted by Noa on February 18, 2000, at 7:58:37
In reply to Re: Vesper--Go to the hospital, posted by medlib on February 18, 2000, at 2:54:03
While in the long run it might be necessary to find a way to process the stuff that is so painful and hard to talk about, while you are in crisis, is NOT a time to talk about that stuff, because is is very painful for you. You need to get stable and out of danger first. And, you should feel some control over whether and when you discuss this material.
When you go riding, maybe confide in one friend in the riding group, and ask him/her to keep an eye out on you. Make an agreement with him or her that you will ride safely, and if he or she sees anything too daring, he or she will tell you and you will agree to tone it down. Use the riding experience, and being with a group you like, as a positive, healing experience, not one for toying with a decision that is irreversible once enacted.
Ask your doctor if you can count on a hospitalization to be a safe experience for you, not one to force you to talk about traumatic material. Then, keep the hospital as a safety option, which is what it should be.
Enjoy your ride. BTW what is the Rock Store?
Posted by vesper on February 18, 2000, at 10:27:29
In reply to Re: Vesper--Go to the hospital, posted by Noa on February 18, 2000, at 7:58:37
>
> Enjoy your ride. BTW what is the Rock Store?
The rock store is a landmark biker hangout a few miles up the coast from Malibu, where hundreds of motorcyclists and bikers have breakfast on sundays and other days, then ride the canyons and talk bikes. James Dean used to hang out there, nowadays its people like jay leno, dennis hopper, a couple of jerks like axl rose and billy idol, but mostly regular motorcyle nuts. The main building is made of stone, hence the name. There are some no-longer-working 1930s gas pumps out front and a large patio for dining.
I'm glad I found this place, its very interesting(psycho-babble I mean)
thanks everyone
Posted by Eric on February 18, 2000, at 17:31:24
In reply to Patronizing Psychiatrists, posted by Vesper on February 17, 2000, at 0:48:07
> I have had bad experiences with SSRIs, and I told my Pdoc(this happened last year) that I wouldn't take SSRIs. He recommended Effexor. I asked if it was an SSRI and he said no. Of course I got the same side effects as the SSRIs and when I looked it up I discovered it is not an SSRI, but it IS an SRI. In other words, almost the same thing, with roughly the same side-effect profile, it just isn't selective in its inhibition of the reuptake of seratonin(or something like that.) This seems to be a common thing with psychiatrists, they think they can just say anything they want as long as it is *technically* true. Now they say if I don't do certain things they won't treat me anymore at UCLA, but I'm not sure I can do these things, and if they won't see me anymore, there's nothing else I can do. Anyway my therapist is leaving for several months at least anyway, I don't know what I'm trying to say, sorry for the ramble.
> Hey, does anyone know how many stories one must fall to be certain of death?What are your "bad" experiences with SSRIs? SSRIs make nearly everybody feel like shit for the first two weeks or so. It is just something you have to go thru to get better dude. If you stick with the SSRIs or Effexor for a month or more usually things improve. Id recommend going back on SSRIs or Effexor XR and giving them a second chance. They are good drugs if you can get thru the adjustment phase in the first couple weeks and if you can tolerate some mild side effects like delayed ejaculation, etc.
I hate to say it but if you have clinical depression you should "grow up" and admit to yourself you are going to have to go thru a "get worse" phase where you will suffer from the meds during the adjustment period...lasts a few weeks and then usually goes away.
Posted by vesper on February 18, 2000, at 19:31:46
In reply to Re: Patronizing Psychiatrists, posted by Eric on February 18, 2000, at 17:31:24
> I hate to say it but if you have clinical depression you should "grow up" and admit to yourself you are going to have to go thru a "get worse" phase where you will suffer from the meds during the adjustment period...lasts a few weeks and then usually goes away.Please don't tell me to grow up when you don't even know the facts yet. Thank you. I have had very bad experiences with SSRIs and Effexor, and I took them for quite a long time, far longer than is considered the minimum time required to get used to them. Paxil in particular was also very bad in terms of withdrawal symptoms.(Which one psychiatrist in a hospital insisted didn't exist. After such horrifying withdrawal symptoms were later well documented, my psychiatrist acknowledged it.)
Posted by Cam W. on February 18, 2000, at 21:23:19
In reply to Re: Patronizing Psychiatrists, posted by vesper on February 18, 2000, at 19:31:46
>
> > I hate to say it but if you have clinical depression you should "grow up" and admit to yourself you are going to have to go thru a "get worse" phase where you will suffer from the meds during the adjustment period...lasts a few weeks and then usually goes away.
>
> Please don't tell me to grow up when you don't even know the facts yet. Thank you. I have had very bad experiences with SSRIs and Effexor, and I took them for quite a long time, far longer than is considered the minimum time required to get used to them. Paxil in particular was also very bad in terms of withdrawal symptoms.(Which one psychiatrist in a hospital insisted didn't exist. After such horrifying withdrawal symptoms were later well documented, my psychiatrist acknowledged it.)Vesper - The serotonin withdrawl syndrome you are talking about is especially seen with the shorter acting SRI agents like Paxil, Effexor, and Zoloft.
These meds have short half-lifes which means they clear the body fairly quickly upon stopping them and the faster you quit them, the worse the symptoms are going to be. Tapering the dose slowly over a long period of time is the best strategy. I have seen it take up to 4 months to wean someone from Effexor; who was extremely sensitive to the withdrawl symptoms. This person presented as almost manic, barely indistinguishable from bipolar disorder. Another person was weaned down to a quarter tablet of an antidepressant (can't remember which one) and we had to add 10mg of Prozac for 2 weeks. The offending AD was stopped after 1 week and the Prozac was continued one more week and stopped with no withdrawl symptoms this time. Because Prozac has a long half-life it leaves the body at a much slower rate, protecting against the severity of serotonin withdrawl symptoms. Just a little info - Cam W.
Posted by AprilA on February 19, 2000, at 11:24:19
In reply to Re: Patronizing Psychiatrists, posted by vesper on February 18, 2000, at 19:31:46
>
> > I hate to say it but if you have clinical depression you should "grow up" and admit to yourself you are going to have to go thru a "get worse" phase where you will suffer from the meds during the adjustment period...lasts a few weeks and then usually goes away.
>
> Please don't tell me to grow up when you don't even know the facts yet. Thank you. I have had very bad experiences with SSRIs and Effexor, and I took them for quite a long time, far longer than is considered the minimum time required to get used to them. Paxil in particular was also very bad in terms of withdrawal symptoms.(Which one psychiatrist in a hospital insisted didn't exist. After such horrifying withdrawal symptoms were later well documented, my psychiatrist acknowledged it.)Of course if just "grow up" doesn't work perhaps you could augment with "snap out of" or "get a grip" ;-) [attempt at humor]
I've found lots of good ideas here in reading through the posts but it is SO individual. I'm sorry so many sad things have happened to you lately. Keep hanging on. Stay safe. A
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