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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by akc on December 10, 2001, at 15:30:54
Okay, no more of this crap. I want to empty my body of all these chemicals and start over. Two+ years ago I sank into a horrible depression and was hospitalized three times, treated by 5 different doctors while hospitalized and by my pdoc outside of the hospital. And now of all things, my pdoc accuses me of taking too much klonopin (what she subscribed) because I am an addict.
I know it is a huge risk, but I want to clear my body of the meds to get to my true state -- I may land in the hospital, but at least we will know if I am just a depressive, or bipolar, or have an anxiety disorder, or what. I am confused as to what is for real or what is med induced.
So for the thousandth time, I am seeking help from you guys. Please help. I really need it. My current cocktail:
600mg/600mg lithium
50mg/50mg topamax
75 Effexor xr
200 mg/200mg Seroquel
50-150 prn of Trazadone.I'm not worried about coming off the trazadone cold turkey. I know I am going to have problems with the effexor, so I think I will save that for last. Any suggestions on how I handle the lithium, topamax and seroquel -- how to titrate down?
Please, this is really important. I hate to beg, but I really need some advice.
akc
Posted by JohnDoenut on December 10, 2001, at 15:57:04
In reply to Just saw my pdoc I'm mad!, posted by akc on December 10, 2001, at 15:30:54
I have no idea myself but if you dont get any replies here is there other info somewhere on the internet? Could you call other pdocs and ask them without going into a whole 9 yards?!
Posted by Dinah on December 10, 2001, at 17:54:08
In reply to Just saw my pdoc I'm mad!, posted by akc on December 10, 2001, at 15:30:54
Sorry you are having trouble with the pdoc. I can't understand her point - you were just in a terrible agitated depression and you contacted her during that. From what I remember, you didn't even particularly want to take Klonopin. Why on earth does she already think you are abusing it?
I can understand your anger, but please try not to make any decisions based on that anger. I once got furious with my old pdoc, fired him, flushed all the medications, and decided that I wasn't going to EVER take anything that @^%%$^ doctor had prescribed. Big mistake. I rapidly went into an agitated depression and was in a horrible place. Fortunately I still had some refills left. I had to pay out of my own pocket of course since I wasn't due for a refill, so it was a very expensive temper tantrum.
Maybe it's time to find a less judgmental pdoc? Just a thought.
Dinah
Posted by Cam W. on December 10, 2001, at 19:34:46
In reply to Just saw my pdoc I'm mad!, posted by akc on December 10, 2001, at 15:30:54
Akc - Sorry, I just finished 7 days of work in a row; 6 of those were 12 hour days; and I just quit my new job of 2.5 months. Also, I haven't been able to log on to PB for the past couple of days.
I don't think a whole dumping of all your meds is a good idea. I have been thinking about your mix, which is fairly standard, as far as treating the symptoms that you describe go.
I don't think that Geodon™ (ziprasidone) replacing the Seroquel™ (quetiapine) is that good of a trade-off. I may suggest to a pdoc who was doing this to try a low dose of Risperdal™ (risperidone) first; or maybe Zyprexa™ (olanzapine). These latter two antipsychotics are better for depression and ruminations than the former two.
As for switching lithium for Depakote™ (divalproex), I am not sure that the Depakote is as good an overall antidepressant as lithium (although many may disagree with me, on this point). Depakote might be worth a try, though. One doesn't know if something works until one tries it.
I would like to see more doctors try a Lamictal™ (lamotrigine) + Topamax™ (topiramate) combination. I have seen this used with Zyprexa in a case of severe, refractory bipolar depression. It did work for at least the first few months, but I had left my job with Mental Health, and I don't know if the good response has been maintained over the long term.
Most studies say that you should always use a classical mood stabilizer (eg. lithium, Depakote, or Tegretol/carbamazepine) with the newer agents (Lamictal, Topamax, and Neurontin/gabapentin). There are only a few studies using the newer agents in monotherapy, or in combination with themselves. I am not sure if these combinations work long term or not.
These are my thoughts on your drug mix. - Cam
Posted by Elizabeth on December 10, 2001, at 19:57:02
In reply to Just saw my pdoc I'm mad!, posted by akc on December 10, 2001, at 15:30:54
> Okay, no more of this crap. I want to empty my body of all these chemicals and start over.
Well, you have my blessings, but be careful (especially going off the anticonvulsants). I hope that it doesn't go too badly -- it will be rough, as you know. I did make a post in another thread giving some ideas about your mix, in case you decide not to go off everything altogether. If you're having problems distinguishing drug side effects from symptoms, I can understand the need for an overhaul, although I'd hope you could get away with doing something less drastic.
> And now of all things, my pdoc accuses me of taking too much klonopin (what she subscribed) because I am an addict.
That's ridiculous. No real addict would be interested in Klonopin. Seriously -- lots of people, even (perhaps especially) doctors, are so bigoted, if I were an addict I'm not sure whether I'd tell my pdoc.
I'm not sure about how to go off the meds, except for the general recommendation to taper off them. As I mentioned, anticonvulsants (Topamax, Klonopin) are the things to be the most careful with. Lithium supposedly doesn't have withdrawal symptoms. You should taper off the lithium and the Seroquel too, but you should be extra careful about the anticonvulsants.
-elizabeth
Posted by Chloe on December 10, 2001, at 20:02:51
In reply to Just saw my pdoc I'm mad!, posted by akc on December 10, 2001, at 15:30:54
Akc,
I am so sorry you are having a hard time. I posted above. I hope it helps.Just one thouoght. Perhaps changing (or stopping! yikes!) meds when you are so angry is not the best time to take on such a momumental task. I know you need pain relief and freedom from you dispair, right now! But in my experience, switching meds during crisis can really make things more unstable and dangerous.
Keep posting, and if I may suggest that you use some of your fury to do google.com searches or medline searches to ocupy your attention for a while. It might give you some informational ammo for you next pdoc visit.
Your fellow suffer,
Chloe> Okay, no more of this crap. I want to empty my body of all these chemicals and start over. Two+ years ago I sank into a horrible depression and was hospitalized three times, treated by 5 different doctors while hospitalized and by my pdoc outside of the hospital. And now of all things, my pdoc accuses me of taking too much klonopin (what she subscribed) because I am an addict.
>
> I know it is a huge risk, but I want to clear my body of the meds to get to my true state -- I may land in the hospital, but at least we will know if I am just a depressive, or bipolar, or have an anxiety disorder, or what. I am confused as to what is for real or what is med induced.
>
> So for the thousandth time, I am seeking help from you guys. Please help. I really need it. My current cocktail:
>
> 600mg/600mg lithium
> 50mg/50mg topamax
> 75 Effexor xr
> 200 mg/200mg Seroquel
> 50-150 prn of Trazadone.
>
> I'm not worried about coming off the trazadone cold turkey. I know I am going to have problems with the effexor, so I think I will save that for last. Any suggestions on how I handle the lithium, topamax and seroquel -- how to titrate down?
>
> Please, this is really important. I hate to beg, but I really need some advice.
>
> akc
This is the end of the thread.
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