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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by MM on October 13, 2001, at 7:51:11
I'm still not sure if the combo he has me on is helping (10mg paxil + 500mg depakote ER) after at least a month and a half.
My diagnoses at this point is Bipolar II, but basically I'm agoraphobic. I've had this same type of uncertainty with all the meds I've tried (which are SSRI's, serzone, effexor, wellbutrin, paxil, prozac) and so far I haven't been getting out of the house much on this combo. Two or three times I've been able to overcome my agoraphobia or whatever (not that I felt too stable or anything, but I got out) for a few months. SUPPOSEDLY the AD's made me hypomanic, which in turn made me do stupid things, that made me embarassed, that made me start staying home again.
I'm losing hope here. I'm mentally prepared to live the rest of my life at home, alone most of the time, in a miserable haze, beating myself up constantly for being such an inept freak.
I have moments where I feel "normal", but then a sadness sets and I don't really know why. It's kind of like I don't want to go back to my normal, because my normal was miserable too, just in a different way, if that makes any sense.
Anyway, the things I DO know about this combo is that I've gained about 10lbs, I have a mild tremor sometimes, some of my hair falls out in the shower (a LOT more than used to, but I'm taking zinc and selenium,, so it's not too bad), I'm not exactly hallucinating, but I see trails, and spots, and what looks like a bug out of the corner of my eye, but then I look and it isn't, just all around weird eye things. I don't know exactly how I FEEL though. Sort of like I did on serzone, which wasn't the best. This IS helping with my anxiety somewhat (I think), but I'm not wanting to leave the house and I sort of feel flattened (apathetic), lazy, and I'm kinda bitchy too, but I honestly have no idea if that's a difference. I also hate it that I don't feel like me. I'm noticing memory/concentration/thinking/cognitive difficulties, and definitely have some vertigo/dizziniess/lightheadedness, but that's gone away some.
I was thinking about trying neurontin, but when I asked my pdoc he basically said it was weak and wouldn't work, so I guess that's out. I think we asked him about benzos, but he's convinced I have BPII, so that's not the way to treat me. I guess I just don't know what to tell him. I mean, I haven't felt a whole lot less like a psycho, and with the terrorist stuff, I'm not exactly living in a world of bliss here. I don't know if I'm better. I'm different I guess. I liked what another poster here said; something like, everyone got a copy of "How To Be a Human Being" except me. THAT'S how I feel.I don't really know what I want to ask. I haven't posted in a while so I'm not used to it anymore. I'm sorry, I went on and on without saying anything. I just keep thinking that maybe something's NOT right here, and it COULD, POSSIBLY, MAYBE get better, and I could go to college, or GET A JOB and not be such an unhappy freakish loser or not be afraid of the world and everyone in it or be able feel like I belong or something.
Maybe I should try something besides paxil along with the depakote? Could that be causing the weight gain? How toxic to the liver is my dose of depakote (rather be crazy than having to get dialysis in 10 years)?Anyway, sorry again for rambling and I appreciate any comments. Thanks in advance.
MM
Posted by houstongirl on October 13, 2001, at 10:25:30
In reply to Seeing my Pdoc on Monday and..., posted by MM on October 13, 2001, at 7:51:11
MM -
Both Paxil and Depakote can cause weight gain. To me, it seems like your doses are fairly low - you could go up on both. It might be worth some weight gain to stabilize, however. For me, it was. If you're not sure it's helping after a month and a half, it's not. Is talking to a different pdoc a possibility? It sounds as though he might not be responding to what you're saying. My advice (for what it's worth) is to get as informed as possible and be agressive with your own treatment. It really helps me to write down everything I want to talk about before I go in there and make him talk through various options with me. (BTW, I've been on up to 40mg Paxil and now I'm on 100mg Celexa + 1500mg Depakote.) You CAN feel better. It may take some time, but I have no doubt that you can. I really hope this helps a little.
Cristy
> I'm still not sure if the combo he has me on is helping (10mg paxil + 500mg depakote ER) after at least a month and a half.
> My diagnoses at this point is Bipolar II, but basically I'm agoraphobic. I've had this same type of uncertainty with all the meds I've tried (which are SSRI's, serzone, effexor, wellbutrin, paxil, prozac) and so far I haven't been getting out of the house much on this combo. Two or three times I've been able to overcome my agoraphobia or whatever (not that I felt too stable or anything, but I got out) for a few months. SUPPOSEDLY the AD's made me hypomanic, which in turn made me do stupid things, that made me embarassed, that made me start staying home again.
> I'm losing hope here. I'm mentally prepared to live the rest of my life at home, alone most of the time, in a miserable haze, beating myself up constantly for being such an inept freak.
> I have moments where I feel "normal", but then a sadness sets and I don't really know why. It's kind of like I don't want to go back to my normal, because my normal was miserable too, just in a different way, if that makes any sense.
> Anyway, the things I DO know about this combo is that I've gained about 10lbs, I have a mild tremor sometimes, some of my hair falls out in the shower (a LOT more than used to, but I'm taking zinc and selenium,, so it's not too bad), I'm not exactly hallucinating, but I see trails, and spots, and what looks like a bug out of the corner of my eye, but then I look and it isn't, just all around weird eye things. I don't know exactly how I FEEL though. Sort of like I did on serzone, which wasn't the best. This IS helping with my anxiety somewhat (I think), but I'm not wanting to leave the house and I sort of feel flattened (apathetic), lazy, and I'm kinda bitchy too, but I honestly have no idea if that's a difference. I also hate it that I don't feel like me. I'm noticing memory/concentration/thinking/cognitive difficulties, and definitely have some vertigo/dizziniess/lightheadedness, but that's gone away some.
> I was thinking about trying neurontin, but when I asked my pdoc he basically said it was weak and wouldn't work, so I guess that's out. I think we asked him about benzos, but he's convinced I have BPII, so that's not the way to treat me. I guess I just don't know what to tell him. I mean, I haven't felt a whole lot less like a psycho, and with the terrorist stuff, I'm not exactly living in a world of bliss here. I don't know if I'm better. I'm different I guess. I liked what another poster here said; something like, everyone got a copy of "How To Be a Human Being" except me. THAT'S how I feel.
>
> I don't really know what I want to ask. I haven't posted in a while so I'm not used to it anymore. I'm sorry, I went on and on without saying anything. I just keep thinking that maybe something's NOT right here, and it COULD, POSSIBLY, MAYBE get better, and I could go to college, or GET A JOB and not be such an unhappy freakish loser or not be afraid of the world and everyone in it or be able feel like I belong or something.
> Maybe I should try something besides paxil along with the depakote? Could that be causing the weight gain? How toxic to the liver is my dose of depakote (rather be crazy than having to get dialysis in 10 years)?
>
> Anyway, sorry again for rambling and I appreciate any comments. Thanks in advance.
> MM
Posted by MM on October 13, 2001, at 11:00:07
In reply to Re: Seeing my Pdoc on Monday and..., posted by houstongirl on October 13, 2001, at 10:25:30
Thanks Cristy.
I'm intimidated by my Pdoc, so it's hard to put my foot down when it comes to what I have researched and want to try. I'll be 19 in Feb. and what trained proffessional would listen to a nutty teenager?
I don't want to gain weight if I don't have to. If I found something that really worked, and I gained weight, I might not mind, but I am worried about that (especially since I'm thinking these meds aren't working). I have a feeling he'll up the dose of the meds, and maybe that will work I dunno, but I'm weary of the paxil because of past experience with SSRI's, and I don't want to be running in place for another 2 months if you know what I mean. I'm somewhat hopeful, though I know I don't sound like it, and I know there are options. I'm just frusterated and impatient with this process, and so is my family. Thanks for the encouragement Cristy, I appreciate it.
Posted by houstongirl on October 13, 2001, at 11:32:47
In reply to Re: Seeing my Pdoc on Monday and... » houstongirl, posted by MM on October 13, 2001, at 11:00:07
It's his JOB to LISTEN to you. Believe me, I've had more than one pdoc that didn't listen (with disastrous consequences, btw). I think one of the things that I've struggled with is that I sometimes I think I don't deserve to feel better, but I do. So do you! I have a great therapist that taught me that. Do you have any one you can talk to? (maybe with your family, too, so that you could get more support from them, too?)
I know the weight gain is frustrating. I'm dealing with that myself too. 9 months of Weight Watchers, and I've only lost 12 lbs - still about 30 over where I want to be, and it's like pulling teeth. I'm contemplating a med change for that very reason (but I don't want to mess with a good thing, ya know?) Don't give up on the SSRI's yet. There's also things they can add to potentiate the SSRI's - can help with the weight too.
good luck!
Cristyps. You're not nutty! I really admire you for being so aware and in tune at nearly 19
> Thanks Cristy.
> I'm intimidated by my Pdoc, so it's hard to put my foot down when it comes to what I have researched and want to try. I'll be 19 in Feb. and what trained proffessional would listen to a nutty teenager?
> I don't want to gain weight if I don't have to. If I found something that really worked, and I gained weight, I might not mind, but I am worried about that (especially since I'm thinking these meds aren't working). I have a feeling he'll up the dose of the meds, and maybe that will work I dunno, but I'm weary of the paxil because of past experience with SSRI's, and I don't want to be running in place for another 2 months if you know what I mean. I'm somewhat hopeful, though I know I don't sound like it, and I know there are options. I'm just frusterated and impatient with this process, and so is my family. Thanks for the encouragement Cristy, I appreciate it.
Posted by MM on October 13, 2001, at 12:19:58
In reply to Re: Seeing my Pdoc on Monday and..., posted by houstongirl on October 13, 2001, at 11:32:47
Thanks again Cristy. I think I've realised I deserve to feel better, at least somewhere in me I know that. I also think I've had to just survive this, and that made me grow up a little. I had a therapist a few months ago (6?) but she soured me on them (at least for now). I have tried quite a few throughout my life, and I don't remember connecting with any of them. I think I just don't know how to DO therapy (or maybe they didn't :P ) I feel stupid though, going into my Pdoc's office and him asking me "How are you doing?"
"Uh, pretty good."
"So do you think these meds are working?"
"I don't really know." :}
"Well how do you feel?"
"Uh, I don't really know. My hair's falling out though, and I gained 10 lbs, heh." :)I guess he'll just have to figure it out?
Posted by houstongirl on October 13, 2001, at 12:56:50
In reply to Re: Seeing my Pdoc on Monday and... » houstongirl, posted by MM on October 13, 2001, at 12:19:58
MM -
Please don't give up on therapy just yet. Maybe you would feel more comfortable in a group setting than one-on-one therapy.
When he asks, "How are you doing?", be prepared to answer. Have a written list. You would not have posted here if you thought things were going well. What did you say? "I'm not wanting to leave the house and I sort of feel flattened (apathetic), lazy, and I'm kinda bitchy too...something's NOT right here, and it COULD, POSSIBLY, MAYBE get better." Be SPECIFIC. PLEASE don't be intimidated by him. He is there to help you.
Also, on the liver toxicity thing, I'm not a professional, but I found an article in the Can Journal of Psych (McElroy and Keck, 1993)that said 2-44% of people on Depakote have an elevation of liver enzymes, but that it is not associated with more serious liver complications. Ask your doctor about your apprehensions.
As I write this, I feel like I'm writing to the 19 year old that I once was (I'm 33) - what I wish someone would have told me. Be strong.
Cristy
> Thanks again Cristy. I think I've realised I deserve to feel better, at least somewhere in me I know that. I also think I've had to just survive this, and that made me grow up a little. I had a therapist a few months ago (6?) but she soured me on them (at least for now). I have tried quite a few throughout my life, and I don't remember connecting with any of them. I think I just don't know how to DO therapy (or maybe they didn't :P ) I feel stupid though, going into my Pdoc's office and him asking me "How are you doing?"
> "Uh, pretty good."
> "So do you think these meds are working?"
> "I don't really know." :}
> "Well how do you feel?"
> "Uh, I don't really know. My hair's falling out though, and I gained 10 lbs, heh." :)
>
> I guess he'll just have to figure it out?
Posted by Rakken on October 13, 2001, at 14:26:11
In reply to Re: Seeing my Pdoc on Monday and..., posted by houstongirl on October 13, 2001, at 12:56:50
Let him know how it's going. If you want to switch let him know. Paxil is one of the more unpleasant SSRI's. Especially when getting off of it. Also, I found out recently that SSRI's are rarely effective in teens. They tend to work more in adults (not implying your not an adult, but people around say 27 or something). In people around yours and my age (18) they have about a 30% effectiveness rate. Effective means that they work (your anxiety is noticeably less, your mood is up reasonably, etc...). I always feel that Pdocs don't really take you seriously and are more cautious with young adults. Say you have done research and heard good things about Klonopin for anxiety. Chances are they'll expect you want to abuse or sell it and suggest something like Buspar or an anti-depressant. It's just an example. Anyhow, if your Pdoc doesn't listen to you or let you contribute in choosing what you think would help your situation then drop him. Get someone more open. You'll never have to tell your old one face to face he's gone. And you don't have to ever see him again.
I read about the effectiveness thing from a new book. Not sure what it's called, but I could find out if anyones interested. I hope what I said helped in some way. I also hope I didn't sound like I know everything, which I definitely don't. Everyone is different. Your Paxil dose definitely seems low. I don't think he's taking you too seriously. Just my opinion. I'm rambling now...
Posted by MM on October 13, 2001, at 15:10:33
In reply to Re: Seeing my Pdoc on Monday and..., posted by Rakken on October 13, 2001, at 14:26:11
Rakken & Houston-- I don't remember if we asked him about benzos last time, but I have a drug history (not what I would call severe; nothing severe like heroin or coke, but I did start young, like 10 (did acid at 12-13) so I don't know if I'll ever get them. I do kind of feel like I'm being jerked around. He may have all the time and patience in the world to try every possible combination of SSRI's etc. but I'm living with the results, or lack there of. He doesn't seem like a bad pdoc, but he doesn't seem too enthusiastic about me, or open minded. My last/first pdoc dxd depression/anxiety and was like we have so many meds to try! you'll be better in no time flat. This one said, BPII is the hardest psychiatric illness to treat and gave me a look that seemed like he was as hopeless as I was. That's about how this last therapist was too (who reccomended the pdoc). AH rambling! Sorry. Anyway, I'm going to see him a few (1-3) more times and see how it goes. I'll try to write down everything I'm feeling on the meds, but I always forget the notebook. Thanks for the info on the effectiveness of SSRI's and the liver thing (whew).
Thanks U2. U both helped just by listening to (reading) my ramblings and replying :)
Posted by Mitch on October 13, 2001, at 16:05:30
In reply to Seeing my Pdoc on Monday and..., posted by MM on October 13, 2001, at 7:51:11
> I'm still not sure if the combo he has me on is helping (10mg paxil + 500mg depakote ER) after at least a month and a half.
> My diagnoses at this point is Bipolar II, but basically I'm agoraphobic. I've had this same type of uncertainty with all the meds I've tried (which are SSRI's, serzone, effexor, wellbutrin, paxil, prozac) and so far I haven't been getting out of the house much on this combo. Two or three times I've been able to overcome my agoraphobia or whatever (not that I felt too stable or anything, but I got out) for a few months. SUPPOSEDLY the AD's made me hypomanic, which in turn made me do stupid things, that made me embarassed, that made me start staying home again.
> I'm losing hope here. I'm mentally prepared to live the rest of my life at home, alone most of the time, in a miserable haze, beating myself up constantly for being such an inept freak.
> I have moments where I feel "normal", but then a sadness sets and I don't really know why. It's kind of like I don't want to go back to my normal, because my normal was miserable too, just in a different way, if that makes any sense.
> Anyway, the things I DO know about this combo is that I've gained about 10lbs, I have a mild tremor sometimes, some of my hair falls out in the shower (a LOT more than used to, but I'm taking zinc and selenium,, so it's not too bad), I'm not exactly hallucinating, but I see trails, and spots, and what looks like a bug out of the corner of my eye, but then I look and it isn't, just all around weird eye things. I don't know exactly how I FEEL though. Sort of like I did on serzone, which wasn't the best. This IS helping with my anxiety somewhat (I think), but I'm not wanting to leave the house and I sort of feel flattened (apathetic), lazy, and I'm kinda bitchy too, but I honestly have no idea if that's a difference. I also hate it that I don't feel like me. I'm noticing memory/concentration/thinking/cognitive difficulties, and definitely have some vertigo/dizziniess/lightheadedness, but that's gone away some.
> I was thinking about trying neurontin, but when I asked my pdoc he basically said it was weak and wouldn't work, so I guess that's out. I think we asked him about benzos, but he's convinced I have BPII, so that's not the way to treat me. I guess I just don't know what to tell him. I mean, I haven't felt a whole lot less like a psycho, and with the terrorist stuff, I'm not exactly living in a world of bliss here. I don't know if I'm better. I'm different I guess. I liked what another poster here said; something like, everyone got a copy of "How To Be a Human Being" except me. THAT'S how I feel.
>
> I don't really know what I want to ask. I haven't posted in a while so I'm not used to it anymore. I'm sorry, I went on and on without saying anything. I just keep thinking that maybe something's NOT right here, and it COULD, POSSIBLY, MAYBE get better, and I could go to college, or GET A JOB and not be such an unhappy freakish loser or not be afraid of the world and everyone in it or be able feel like I belong or something.
> Maybe I should try something besides paxil along with the depakote? Could that be causing the weight gain? How toxic to the liver is my dose of depakote (rather be crazy than having to get dialysis in 10 years)?
>
> Anyway, sorry again for rambling and I appreciate any comments. Thanks in advance.
> MM
Hi MM,There was a couple of important things that you *didn't* mention: Panic, and a trial of a TCA. I would suggest a TCA (if you haven't tried one). It also sounds like you are having more trouble with *wanting* to get out rather than being intensely uncomfortable by *being* out. I mention TCA's because they have a good track record for agoraphobia. Paxil and Depakote can indeed make you rather apathetic and listless, although they probably control panic quite well. It sounds like you need a little noradrenaline going to get you up and out. Have you talked to your doc about adding some Wellbutrin or a TCA(desipramine or notriptyline, i.e.) to your existing combo of Paxil and Depakote? The three-way combo might work quite well.
-Mitch
Posted by stjames on October 13, 2001, at 20:37:33
In reply to Seeing my Pdoc on Monday and..., posted by MM on October 13, 2001, at 7:51:11
> I'm still not sure if the combo he has me on is helping (10mg paxil + 500mg depakote ER) after at least a month and a half.
You have made some good points here. Make sure you write them down and cover them with your doc.
james
Posted by Jackster on October 14, 2001, at 1:46:16
In reply to Re: Seeing my Pdoc on Monday and... » MM, posted by Mitch on October 13, 2001, at 16:05:30
>
> Hi MM,
>
> There was a couple of important things that you *didn't* mention: Panic, and a trial of a TCA. I would suggest a TCA (if you haven't tried one). It also sounds like you are having more trouble with *wanting* to get out rather than being intensely uncomfortable by *being* out. I mention TCA's because they have a good track record for agoraphobia. Paxil and Depakote can indeed make you rather apathetic and listless, although they probably control panic quite well. It sounds like you need a little noradrenaline going to get you up and out. Have you talked to your doc about adding some Wellbutrin or a TCA(desipramine or notriptyline, i.e.) to your existing combo of Paxil and Depakote? The three-way combo might work quite well.
>
> -MitchJust to chime in agreement with Mitch. I have agoraphobia as well, and my PDoc firmly believes in a combo of an SSRI and a TCA. I'm currently on Paxil (30mg) and Clomipramine (10mg). I've been on Paxil before (40mg) which is what they recommend for panic disorder, so you are on a very low dose. May be worth increasing slowly?
Also - I understand about feeling intimidated by PDoc. I felt the Clomipramine of 20mg that he initially prescribed was too activating (made me agressive) - and I went to the appointment to ask to switch to amitripyline instead (have been on before and been fine on it). I came out with another clomipramine prescription, not quite knowing how that happened! I feel better on the lower dose though.
I've had agoraphobia for 15 years, and at 19 I thought I would never be better. When I first went on Paxil it was like a miracle - I ended up travelling the world and living in London. Unfortunately after 3 years, I felt so good I decided to come of it. When I went back on, the Paxil didn't work so well. It is definitely worth trying a higher dose if you can.
There is a right med combo out there.
Good luck,
Jackie
Posted by MM on October 14, 2001, at 12:10:41
In reply to Re: Seeing my Pdoc on Monday and..., posted by Jackster on October 14, 2001, at 1:46:16
Thanks all of you for the suggestions. I don't know much about TCA's. I'm guessing they're tricyclics? Don't they have a pretty bad side-effect profile or something? I'll try and read about them. I think I mentioned that I've tried paxil before, and it was at a normal dose, but I guess it just didn't work like it should (neither did the other SSRI's/SNRI's, so that's why I'm BP now). The AD's were never like a life changer for me. I am still having anxiety, but I think it's gotten a little better. I'm wondering if my Pdoc thinks I'm borderline (I think I might be) and is giving me BPII as the dx so he can treat me (insurance) because my doses are so low.
I'll write down all that I can think of and bring it with me.
Thanks again.
Posted by houstongirl on October 15, 2001, at 17:21:55
In reply to Re: Seeing my Pdoc on Monday and..., posted by MM on October 14, 2001, at 12:10:41
MM -
How did it go?
Cristy
> Thanks all of you for the suggestions. I don't know much about TCA's. I'm guessing they're tricyclics? Don't they have a pretty bad side-effect profile or something? I'll try and read about them. I think I mentioned that I've tried paxil before, and it was at a normal dose, but I guess it just didn't work like it should (neither did the other SSRI's/SNRI's, so that's why I'm BP now). The AD's were never like a life changer for me. I am still having anxiety, but I think it's gotten a little better. I'm wondering if my Pdoc thinks I'm borderline (I think I might be) and is giving me BPII as the dx so he can treat me (insurance) because my doses are so low.
> I'll write down all that I can think of and bring it with me.
> Thanks again.
Posted by MM on October 16, 2001, at 1:43:17
In reply to Re: Seeing my Pdoc on Monday and...????, posted by houstongirl on October 15, 2001, at 17:21:55
It went pretty well actually. He upped both my dose of depakote (to 1000mg) and my dose of paxil (to 20mg) and added 30mg Tomazepam (sp?) at bedtime. I did pretty well asking him my questions, and I felt like he gave me good answers. I see him again in 2 weeks (which is good because we had to wait so long this time) and that's about it. Any feedback on my new combo?
Thanks for checkin on me Cristy ;)
Posted by houstongirl on October 17, 2001, at 10:22:15
In reply to Re: Seeing my Pdoc on Monday and...???? » houstongirl, posted by MM on October 16, 2001, at 1:43:17
MM -
I'm glad he upped both. You still have room to go up more, though, if you don't feel like this is cutting it. I don't know anything about Tomazepam. Is that to help you sleep? One thing about both Depakote and Paxil - they can both cause weight gain... :(
Glad to hear it went well, though.
Cristy
> It went pretty well actually. He upped both my dose of depakote (to 1000mg) and my dose of paxil (to 20mg) and added 30mg Tomazepam (sp?) at bedtime. I did pretty well asking him my questions, and I felt like he gave me good answers. I see him again in 2 weeks (which is good because we had to wait so long this time) and that's about it. Any feedback on my new combo?
> Thanks for checkin on me Cristy ;)
Posted by MM on October 17, 2001, at 15:41:46
In reply to Re: Seeing my Pdoc on Monday and...????, posted by houstongirl on October 17, 2001, at 10:22:15
Ya, the temazepam is for sleep (it's a benzo). It worked pretty well last night so I'm hopeful (it's WAY better than seroquel, which he had me try once). I know I could gain weight, but I've read a few times that "the rich get richer and the poor stay poor (?)" and I'm kind of skinny to begin with so maybe I won't gain much weight. I definitely did on serzone (20lbs??) though. I felt more comfortable with him (ended up staying almost an extra half hour) so I'm finally feeling better about the way things are going.
Thanks Cristy :)
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