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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Alan on November 4, 2001, at 20:21:00
http://bearpaw8.tripod.com/pd.html
A truly astounding, comprehensive overview of panic disorder. Longish, one page plethora of info. on the anxiety disorders. If many psychiatrists could be so thorough and accurate about their understanding of these disorders! (Sounds like a book review/promo, huh?)
Actually it helped me AND my pdoc immensely. They thought it very responsibly and clearly written.
Hope that it helps many of you....
Any comments are welcome.
Best,
Alan
Posted by dannyboy on November 4, 2001, at 23:16:39
In reply to Superb webpage about ANXIETY !!!, posted by Alan on November 4, 2001, at 20:21:00
Amen Alan -
In my previous thread I sing its praises....
Thanks again,
Daniel
Posted by Rick on November 5, 2001, at 1:36:13
In reply to Re: Superb webpage about ANXIETY !!!, posted by dannyboy on November 4, 2001, at 23:16:39
Double Amen! -
I was blown away the first time I saw this essay (after it was posted awhile back by Alan, if memory serves). While I strongly disagree with the author on a handful of points, this is awesome in its thorough, logical and holistic approach that refuses to bow to the marketing and peer-pressure driven biases that can engender a misguided or narrow-minded "conventional wisdom."
This article is indeed a perfect tool for discussion with a doctor, particularly one whose thinking seems to have fallen prey to such biases (e.g., that SSRI use is usually preferable to long-term benzos for panic).
I do wonder why the author chooses to remain anonymous, though. This reads as though it was written by someone who is very educated but knows how to express thoughts in a manner that is thorough enough for the professional, yet easily understood by a patient or potenial patient who is not familiar with "medspeak".
Rick
> Amen Alan -
>
> In my previous thread I sing its praises....
>
> Thanks again,
>
> Daniel
Posted by Alan on November 5, 2001, at 17:58:58
In reply to Re: Superb webpage about ANXIETY !!!, posted by Rick on November 5, 2001, at 1:36:13
> I do wonder why the author chooses to remain anonymous, though. This reads as though it was written by someone who is very educated but knows how to express thoughts in a manner that is thorough enough for the professional, yet easily understood by a patient or potenial patient who is not familiar with "medspeak".
>
> Rick
===========================================He posts quite frequently at the website called tAPir under the name baloo (he's changed his name recently to alden) and every post he writes is revalatory for me and other anxiety sufferers at this site. Everyone's posts are archived under their personal profile so if you look up baloo for instance or me, Ben, you can go back through months of really interesting stuff. The address for this site is:
http://www.algy.com/anxiety/index.html
and click on the bulletin board. Register and join in the different forums such as the PDI (moderated by a fantastic pdoc named Shipko who practices out in Pasadena), Unmoderated: Medications, Medications Debate (there's a lively robust forum for you), Panic, SAD, etc. Baloo, Halee, JillyJ and I (Ben)try to contribute as much as possible and are of like minds when it comes to BZD's and general philosophy.
Watch out for a resident anti benzo crank named bob though. We all love bob but as a voice of one, he's more than a little misguided.
Have fun!
Alan
Posted by dannyboy on November 5, 2001, at 19:42:19
In reply to Re: Superb webpage about ANXIETY !!! » Rick, posted by Alan on November 5, 2001, at 17:58:58
Alan -
I really need your advice. I went to the pdoc today, totally stoked on my success over the last few days on Xanax, and wanted to request a switch to Klonopin...
Her reply - NO! "Xanax is addictive, and not recommended for long term use" end of story. When I told her that I felt very disappointed and devastated by this reply, she told me "that's just your anxiety talking, we need to heal the anxiety with something else" I am so ANGRY! I felt completely ignored and condescended to! She says that she will recommend that I go back on Paxil. I will NOT go back on Paxil, as I will not endure the weight gain (and the chemical lobotomy effect) again .
I am feeling GREAT with the Xanax! Totally normal, totally healed, but am going to have SSRI's (or maybe Effexor - I REFUSE that one) shoved up my butt again. What should I do? I live in L.A., (and am insured by Kaiser). Is there any other place I can go to get a sympathetic, professional ear? Luckily, a friend of a friend is a psychiatrist (and can write me a prescription HA HA HA)... I know now that I will be seen by the docs at Kaiser as incorrible, recalcitrant, and just looking for a fix...
AAAAAHHHHH! Benzos WORK for me! I feel NORMAL, not drugged out, and not gaining weight! I'm functioning! How dare they ignore that!
Sorry for my anger, but I am just boiling.
Please advise,
Daniel
Posted by Rick on November 5, 2001, at 21:07:18
In reply to Alan - Nurse Wratchet (sp?) Experience - Advice?, posted by dannyboy on November 5, 2001, at 19:42:19
http://www.cmeondemand.net/PP/2001BlackBook/PP301_Sussman.html
I’m not Alan, but I hope you don’t mind if I chime in. I’d be mad, too, but hardly surprised.
Your best bet is obviously getting a more enlightened doctor. I’m not familiar with Kaiser, or how it works. But if you have any choice in doctors, simply call around and ask what kinds of treatments they use for long-term panic disorder (or PD with agorophobia, or whatever you have). If the conversation’s going in the right direction, you might even ask what they think about the relative merits of benzodiazepines vs. SSRI’s for PD. If your plan allows, and you have the financial means to pay a greater portion of the cost, you may also want to consider talking to non-network providers if necessary. In a city like LA, there should be no shortage of doctors who realize that most, or at least some, patients will do better in the long-term with Klonopin or Xanax than with an SSRI, especially if there’s no baseline depression.
A patient is a doctor’s client, and should have full rights to “fire” the doctor at any time and find a new one. (Of course, I know that in the world of medical insurance, especially HMO’s, that’s sometimes easier said than done – especially if $$$ are tight.) Doesn’t your friend-of-a-friend psych have any suggestions?
Regardless, you should definitely print out the article at the link above, and both send it to your curent doctor (with appropriate highlighting), and save it for discussion with a (hopefully) new pdoc, if necessary. It is written by a professor at a respected research institution (quoting experts from other highly-respected institutions like Harvard), and it puts the lie to every objection of hers that you recounted in your post.
In addition to the article I provided the link for above, if you run some searches you’ll find plenty of additional material that supports long-term benzo use as a viable option in PD. The abstract below is a good example.
Psychopharmacol Bull 1998;34(2):199-205
Long-term experience with clonazepam in patients with a primary diagnosis of panic disorder.
Worthington JJ 3rd, Pollack MH, Otto MW, McLean RY, Moroz G, Rosenbaum JF.
Department of Psychiatry, Massachusetts General Hospital, Boston 02114-3117, USA.
This study examined the use patterns and efficacy of the high potency benzodiazepine (HPB) clonazepam in panic patients who were treated and followed naturalistically in the Massachusetts General Hospital Longitudinal Study of Panic Disorder. Of 204 patients followed over a 2-year period, 46 percent were receiving clonazepam alone or in combination with an antidepressant. Treatment was not controlled at initial evaluation or during the followup period. The main variables assessed in this analysis included global severity of the panic disorder and stability of clonazepam dose. All treatment groups tended to improve over time without significant differences in outcome between groups. Clonazepam doses remained stable over time. Results of this study suggest that treatment of panic disorder with the HPB clonazepam achieved and maintained a therapeutic benefit similar to that obtained with alternative pharmacologic treatments, without the development of tolerance as manifested by dose escalation or worsening of clinical status.
Publication Types:
Clinical TrialPMID: 9641001 [PubMed - indexed for MEDLINE]
> Alan -
>
> I really need your advice. I went to the pdoc today, totally stoked on my success over the last few days on Xanax, and wanted to request a switch to Klonopin...
>
> Her reply - NO! "Xanax is addictive, and not recommended for long term use" end of story. When I told her that I felt very disappointed and devastated by this reply, she told me "that's just your anxiety talking, we need to heal the anxiety with something else" I am so ANGRY! I felt completely ignored and condescended to! She says that she will recommend that I go back on Paxil. I will NOT go back on Paxil, as I will not endure the weight gain (and the chemical lobotomy effect) again .
>
> I am feeling GREAT with the Xanax! Totally normal, totally healed, but am going to have SSRI's (or maybe Effexor - I REFUSE that one) shoved up my butt again. What should I do? I live in L.A., (and am insured by Kaiser). Is there any other place I can go to get a sympathetic, professional ear? Luckily, a friend of a friend is a psychiatrist (and can write me a prescription HA HA HA)... I know now that I will be seen by the docs at Kaiser as incorrible, recalcitrant, and just looking for a fix...
>
> AAAAAHHHHH! Benzos WORK for me! I feel NORMAL, not drugged out, and not gaining weight! I'm functioning! How dare they ignore that!
>
> Sorry for my anger, but I am just boiling.
>
> Please advise,
> Daniel
Posted by Alan on November 5, 2001, at 23:33:43
In reply to Re: Alan - Nurse Ratched Experience - Advice? » dannyboy, posted by Rick on November 5, 2001, at 21:07:18
Rick is correct. I too had to sack 4 docs to finally find one that wasn't brainwashed by these pharm companies. It was a long and frustrating experience. If you ask around to some doctors, they usually know the inside scoop about those that treat anxiety disorders almost exclusively.
If you want to go to Pasadena, there's Dr. Shipko on the PDI forum at tAPir (the site I've already mentioned). He has a personal email that you can contact him through.
Believe me, the stupidity with doctors about this subject alone make you wonder about what type of information they're getting and applying to the rest of your body, doesn't it?
Kaiser is something I'm familiar with as I used them 20 years ago and a close relative works for them. Not surprised at their response. You haven't seen a specialist that knows how to use these drugs and that specialises in treating anxiety disorders. Would you go to your internist to have them give you specialised drugs to treat lymphoma or diabetes type I? NO! You go to a damn specialist.
Interviewing by phone some docs that you've been referred to after asking around - good idea.
Alan
Posted by Jackster on November 6, 2001, at 3:58:45
In reply to Alan - Nurse Wratchet (sp?) Experience - Advice?, posted by dannyboy on November 5, 2001, at 19:42:19
So many times I have gone into a Doctor's office wanting to change to a certain med, only to come out with a prescription for a completely different med, or an increased dosage of the one I wanted to change! And without quite knowing how it happened! When I saw your earlier post about how you were definitely going to go with the Benzo route - I wondered if it would go pear shaped. I'm on Xanax (down to 1.5mg a day now) and have been for nearly a year now. In that time I've noticed the effectiveness of the dosage decrease - basically I think my body was getting used to them. I'm coming off them (as well as restarting the Paxil) because I couldn't stand the feeling of tiredness they gave me. In saying that, they really helped when I went through my 'meltdown' last Christmas.
Jackie
Posted by dannyboy on November 7, 2001, at 19:32:05
In reply to Re: Alan - Nurse Ratched Experience - Advice?, posted by Alan on November 5, 2001, at 23:33:43
Alan, Rick -
Just an update, and good news! I met with another pdoc at Kaiser today, and he was completely amenable to giving me a prescription of Klonopin (I couldn't believe it!). He shared his concerns with me about addiction, and I compromised by saying that I would try Zoloft (really only because a friend of mine with PD has has success with it.) However, I'm starting on a mini-dose of Zoloft (12.5 mg.). Hopefully it won't exacerbate my PD like Celexa did.
We shall see. Thanks for your support and advise. BTW, Dr. Shipko is about 10 miles from me. I'd like to make an appointment with him; however, it will be pretty pricey. I'll see if I can afford his fee.
Thanks again,
Daniel
Posted by Rick on November 7, 2001, at 21:03:11
In reply to Re: Alan - Nurse Ratched Experience - Advice?, posted by dannyboy on November 7, 2001, at 19:32:05
Thanks for reporting back with the good news! This could be your "answer".
> Alan, Rick -
>
> Just an update, and good news! I met with another pdoc at Kaiser today, and he was completely amenable to giving me a prescription of Klonopin (I couldn't believe it!). He shared his concerns with me about addiction, and I compromised by saying that I would try Zoloft (really only because a friend of mine with PD has has success with it.) However, I'm starting on a mini-dose of Zoloft (12.5 mg.). Hopefully it won't exacerbate my PD like Celexa did.
>
> We shall see. Thanks for your support and advise. BTW, Dr. Shipko is about 10 miles from me. I'd like to make an appointment with him; however, it will be pretty pricey. I'll see if I can afford his fee.
>
> Thanks again,
>
> Daniel
Posted by Alan on November 8, 2001, at 0:40:52
In reply to Re: Alan - Nurse Ratched Experience - Advice?, posted by dannyboy on November 7, 2001, at 19:32:05
> Alan, Rick -
>
> Just an update, and good news! I met with another pdoc at Kaiser today, and he was completely amenable to giving me a prescription of Klonopin (I couldn't believe it!). He shared his concerns with me about addiction, and I compromised by saying that I would try Zoloft (really only because a friend of mine with PD has has success with it.) However, I'm starting on a mini-dose of Zoloft (12.5 mg.). Hopefully it won't exacerbate my PD like Celexa did.
>
> We shall see. Thanks for your support and advise. BTW, Dr. Shipko is about 10 miles from me. I'd like to make an appointment with him; however, it will be pretty pricey. I'll see if I can afford his fee.
>
> Thanks again,
>
> Daniel
*************************************************
Nice work! 10 miles away? What a coincidence...if you believe in them. If you get a bad reaction to the Zoloft are you going to tell him that you don't want to try ssri's anymore? Klonopin (or another BZD) exclusively?Alan
This is the end of the thread.
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