![[dr. bob]](/dr-bob-sm.gif)
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 Anna Laura on February 12, 2002, at 5:49:14
Sorry guys if this is going to be so long, but i needed to be accurate in order to get an accurate answer.
Forgive me for my eventual language flaws and imperfections: my cognitive performance got worse lately : thinking and writing in another language it's getting harder then ever as a consequence.
O.K., that said, about pdoc switching:The first doc i met last year was a neurologist who didn't even realize i suffered from double depression (though my description of symptoms had been pretty much accurate) and prescribed
me with benzos. When i finally told him that i believed i had depression, he asked me what i had been prescribed the last time i was depressed: i told him i was prescribed withTofranil, so he put me on Tofranil.
Thanks god the worst part of depression lifted, though i came back to my previous state of flat mood and anhedonia.
When my pdoc realized i wasn't totally cured, he began to worry.
He told me: "I don't know what else to describe since imipramine it's the most potent and stimulating AD in my arsenal. May be you should go to Day Hospital and see what happens".
I didn't want to deal with hospitals, inpatients and all of that misery and sufferings. Moreover, it's quite easy in my country to become an inpatient against your own will just because you don't react properly to medications.
Well, may be i was a little bit too paranoid, but it's far better to be too cautious rather then being over confident and naivel: you never know what might happen.
I was feeling insecure and my biggest fear was being an invalid, chronic depressed person, my urgent need being to feel normal and come back to everyday's activities, feeling in control of my own life, as i had been laying on the couch barely moving for three months in a row.
My former pdoc was pushing me in the opposite direction sort of, not considering my urgencies and fears. I thought it over, considered the situation throughly and i resolved i didn't need that, so i walked away.
During the following months i came back to "normal life" as i began to work and function just like everybody else.
My mood was still flat though and anhedonia bothered me a lot. I thought i needed a psychopharmacologist as my former pdoc didn't know much about medications.
I looked for a psychopharmacologist reference and i eventually found a guy who lived in another town 250 miles away. I told him about my medications history (including my over sensitivity ro APs and benzos that made my depression worse).
He prescribed me with Levosulpiride, Laroxyl (Amytryptiline) and Limbitril (which is Amytryptiline again binded to a benzo compound).
I asked him if the cure he gave me wasn't going to be too sedative and warned him once again about my oversensitivity to APs. He replied in a quite rude manner that he knew best since he was the expert and that i didn't need to worry since levosulpiride was an atypical antypsychotic.
I finally asked him wether i had good chances to recover. "Well, you didn't react properly to Tofranil which is fairly activating med and you didn't seem to benefit from Prozac also which is a pretty good drug: if your chances to recover were good, you should have improved a great deal with those meds, but you didn't, so i guess you're chances are quite low but you're know what's going to happen: let's see what happens with these meds first".
When i left his office i felt very pessimistic and didn't see any way out. But i hang on and took the meds he prescribed me.
I dramatically got worse with his cure within a month. I was supposed to call him once a week :
i never found him and he never returned my calls.
I felt very sedated, apathetic and PMS were horrible. I had my period after 35 days ( i always get it within 25 days!) i was bloating and my face was horribly swollen. Needless to say, i was more depressed.
I went to another pdoc: this guy was a very old experienced neurologist . He was a little bit paternalistic but he was kind and had gentle manners.
He told me that the cure that i had been given was way too much sedating, that i nedeed the opposite
since i was apathetic. He prescribed me Effexor along with SAME.
I got better though the improvment was very slow. He added Reboxetine at last.
Once i told him that i didn't see any way out he told me not to worry since apathy could be cured.
I felt very much relieved and i began to trust him, thinking he was the right pdoc for me.
When i went back to him in mid September, he asked me how i felt with Effexor.
I told him that i felt better even though my anhedonia wasn't improved.
He got very disappointed because of that and he began to question wether "i really wanted to heal or not".
"Of course i want to heal!" I replied.
"Are you sure of that?".
He went on telling me that i was subconsciously resisting the treatment, that my apathy didn't seem to lift since i had inner conflicts and i was disattisfied with myself.
I asked me if i could try Ritalin or some other stimulant which he refused to prescribe.
"May be you could benefit from MAOIS but only at high doses: you should get carefully monitored though and you need to go to the hospital for that" was his sentence.
Needless to say i walked away again, felt vey discouraged and hopeless, but i eventually came over that as Effexor was working pretty well for my motivation and drive.
I was planning to go back to College, i felt more initiative and focus; my negative thinking was almost completelly erased and i began to make plans for the future.
Anhedonia was still a problem but i grew confident i was going to defeat it at last.
I grew more and more confident and i began to consider to start writing again. I called The Writers' School in Torino and asked them about the courses.
I thought about dedicating myself to translations also (i have done that in the past) and i made a few job interviews.
I was still depressed but i felt determined and motivated once again, thinking i was heading towards the right direction.
Then i was hit by severe stress as my mother-in-law (who is like a mother to me) got suddenly sick.
I took her to the hospital since she had urinary retention that didn't seem to go away with normal medications; anyway, i thought it was no big deal since it's a pretty common problem among the elderly population.
My confidence was abruptely disrupted as a Doctor came along with a serious expression on his face , telling me she had cancer stage IV, and that the prognosis was very poor.
I began to worry about my health also, as i had to take hiv test, but i never resolved to take it as i was worrying for my mental stability in case it turned out to be positive.
I always took extremely careful precautions with my mate and with the people around me; i was very cautious, disinfecting toilet and sink after using it and washing my dishes, knives and spoons with bleaching powder: i must say it wasn't a very pleasant way to live.
I decided that i felt strong enough to take the test and after a week of fear and bottled up tension i had the response which it turned out to be negative.
Even if i was very happy with the results i had been loading a great amount of stress by that time, as i found out a week later that my father was going to have an illegitimate son on the top of that.
None of my family had told me that: i found it out by myself as i spotted my 63 years old father walking hand in hand with his 32 years old pregnant girlfriend.
My fianceé was (is still is) mourning over his mother, very often he would burst out in tears and cry over my shoulder.
Sometimes i felt i wasn't going to handle all that stress, had mood shifts and feared i was getting depressed again.
Thanks god it didn't happen as my motivation and drive persisted and i was preparing to attend College lessons by January.
Even though i was pleased to realize i had regained my confidence, i still thought i needed some dopaminergic/stimulant augmentation on the top of Effexor because of anhedonia and lack of sex drive.
A friend of mine gave me a neurologist reference, saying he was the reluctant type at first but that he'd have put down any resistence at last, willing to prescribe the medications i wanted to. "He courses a lot, looks rough, but he is a sensitive person at the core" - He added.
When i finally saw him, i talked to him about the eventuality of Mirapex augmentation; i mentioned Selegiline too. He told me he never heard of Selegiline. I told him it was a MAOI type B. He shrugged his shoulders and told me:
"All i can do is to prescribe Parnate: it's rather stimulating and has shown to be effective for several treatment resistant depressive patients".
I explained to him that i didn't want to drop my medication since it was fairly effective: moreover, i was concerned about depression showing up again, as i had been facing severe stress during the last month.
He told me that i didn't need to worry about it, since i'd have been affected by stress already despite of medication: if i was well, that was a good sign since it was predictory that i was going to do fairly well without medication also.
I thought it over and i decide to switch to Parnate.
I tapered Effexor and i was doing fairly good.
When i was about to drop the last Effexor dose i found out that the Parnate version in my country is tranycylpromine binded to an antypsychotic. (You know, just in case one would get too much euphoric).
Moreover, i found out that the dietary restrictions my pdoc gave me were fairly inaccurate, as chocolate, some fruits and many other foods he didn't even mention of were likely to produce an hypertensive crisis.
I called him on the phone and told him that i got worried as i found out that the tranycylpromine compound was binded to an AP: since i was oversensitive to AP, there was good chance i was going to get depressed on Parmodalin (brand name of Parnate in my country). Moreover, i knew that AP (modaline) pretty well, as i have been taking it before and got even more depressed on that.
He replied that i was full of shit, since he never noticed any problem with Parmodalin.
"You are not supposed to investigate about drugs or read prescription papers, you're a patient and you're supposed to behave like a patient." He shouted.
then he added: "I asked about Selegiline: you're a f*****ng ignorant , it's not a MAOI, but a drug for Parkinson Desease. From now on, follow my instructions and never question anything, understand?"
"Sure Babe! " i replied. And i hang up the phone.
I went back to Effexor(300 mg.) and Reboxetine (8 mg.) : to my dismay they never worked as they did before. I grew more insecure, unmotivated and apathetic. Negative thinking came back again as i found myself endlessly and aimlessly ruminating over possible remedies/medications without being able to accomplish anything.
I got stuck on College, and i began to worry.
So i began to look for a good psychopharmacologist.
I've been very careful and accurate this time, making sure to find a good reference, since i nedeed an expert in his field, who new about medications and its interactions.
I finally found a psychiatrist / psychopharmacologist teaching at Med School in my town and practising in the University Clinic.
I thought it was a good reference, still i was reluctant to call because of the several negative experiences i mentioned before.
I decided to prevent any further disappointment calling him and on the phone and asking him directly about new drugs such as Selegiline to see his reactions to it.
He told me he knew about the drug, that it was sometimes used to treat depression. "We're going to see if you're elegible for it." He told me.
I was pretty sure he was my man at that point.
I saw him that same day and told him about my situation.
To my surprise, he diagnosed me as bipolar.
"You surely need a dopaminergic drug for anhedonia, but i'm going to add a mood stabilizer in order to prevent you from switching to a manic phase".
"How can you tell i am bipolar ? I've been depressed for something like 11 years and never had manic or hypomanic phase, i never experienced euphoria or hyperactivity or significant mood shifts. I've been pretty much apathetic throughout all these years".
"You can never tell: you could become manic even after eleven years of low mood" -
"Since you've been hyperthymic in your teen years, i think you run significant risk of becoming bipolar".
he sentenced.
I was rather puzzled. I'm no expert but i don't think that Wellbutrin is such a potent dopaminergic drug, isn't?So this is my new prescription:
Effexor, 150 mg
Wellbutrin, 300 mg
Depakote, 600 mgI'm afraid this is not going to lift my mood that much.
What do you guys think?
I'm afraid this pdoc it's an "euphoria-phobic",
thinking that a little- bit -depressed person it's preferable to a little- bit -euphoric person. I've seen pdocs like that before.
It seemes that they fear happiness, viewing it as an illness. Am i exaggerating? Don't know what to do anymore. Please help!
Posted by Mr. Scott on February 12, 2002, at 8:13:51
In reply to pdoc-switching: rather puzzled, need some advice, posted by Anna Laura on February 12, 2002, at 5:49:14
>
>
> Sorry guys if this is going to be so long, but i needed to be accurate in order to get an accurate answer.
> Forgive me for my eventual language flaws and imperfections: my cognitive performance got worse lately : thinking and writing in another language it's getting harder then ever as a consequence.
> O.K., that said, about pdoc switching:
>
> The first doc i met last year was a neurologist who didn't even realize i suffered from double depression (though my description of symptoms had been pretty much accurate) and prescribed
> me with benzos. When i finally told him that i believed i had depression, he asked me what i had been prescribed the last time i was depressed: i told him i was prescribed withTofranil, so he put me on Tofranil.
> Thanks god the worst part of depression lifted, though i came back to my previous state of flat mood and anhedonia.
> When my pdoc realized i wasn't totally cured, he began to worry.
> He told me: "I don't know what else to describe since imipramine it's the most potent and stimulating AD in my arsenal. May be you should go to Day Hospital and see what happens".
> I didn't want to deal with hospitals, inpatients and all of that misery and sufferings. Moreover, it's quite easy in my country to become an inpatient against your own will just because you don't react properly to medications.
> Well, may be i was a little bit too paranoid, but it's far better to be too cautious rather then being over confident and naivel: you never know what might happen.
> I was feeling insecure and my biggest fear was being an invalid, chronic depressed person, my urgent need being to feel normal and come back to everyday's activities, feeling in control of my own life, as i had been laying on the couch barely moving for three months in a row.
> My former pdoc was pushing me in the opposite direction sort of, not considering my urgencies and fears. I thought it over, considered the situation throughly and i resolved i didn't need that, so i walked away.
> During the following months i came back to "normal life" as i began to work and function just like everybody else.
> My mood was still flat though and anhedonia bothered me a lot. I thought i needed a psychopharmacologist as my former pdoc didn't know much about medications.
> I looked for a psychopharmacologist reference and i eventually found a guy who lived in another town 250 miles away. I told him about my medications history (including my over sensitivity ro APs and benzos that made my depression worse).
> He prescribed me with Levosulpiride, Laroxyl (Amytryptiline) and Limbitril (which is Amytryptiline again binded to a benzo compound).
> I asked him if the cure he gave me wasn't going to be too sedative and warned him once again about my oversensitivity to APs. He replied in a quite rude manner that he knew best since he was the expert and that i didn't need to worry since levosulpiride was an atypical antypsychotic.
> I finally asked him wether i had good chances to recover. "Well, you didn't react properly to Tofranil which is fairly activating med and you didn't seem to benefit from Prozac also which is a pretty good drug: if your chances to recover were good, you should have improved a great deal with those meds, but you didn't, so i guess you're chances are quite low but you're know what's going to happen: let's see what happens with these meds first".
> When i left his office i felt very pessimistic and didn't see any way out. But i hang on and took the meds he prescribed me.
> I dramatically got worse with his cure within a month. I was supposed to call him once a week :
> i never found him and he never returned my calls.
> I felt very sedated, apathetic and PMS were horrible. I had my period after 35 days ( i always get it within 25 days!) i was bloating and my face was horribly swollen. Needless to say, i was more depressed.
> I went to another pdoc: this guy was a very old experienced neurologist . He was a little bit paternalistic but he was kind and had gentle manners.
> He told me that the cure that i had been given was way too much sedating, that i nedeed the opposite
> since i was apathetic. He prescribed me Effexor along with SAME.
> I got better though the improvment was very slow. He added Reboxetine at last.
> Once i told him that i didn't see any way out he told me not to worry since apathy could be cured.
> I felt very much relieved and i began to trust him, thinking he was the right pdoc for me.
> When i went back to him in mid September, he asked me how i felt with Effexor.
> I told him that i felt better even though my anhedonia wasn't improved.
> He got very disappointed because of that and he began to question wether "i really wanted to heal or not".
> "Of course i want to heal!" I replied.
> "Are you sure of that?".
> He went on telling me that i was subconsciously resisting the treatment, that my apathy didn't seem to lift since i had inner conflicts and i was disattisfied with myself.
> I asked me if i could try Ritalin or some other stimulant which he refused to prescribe.
> "May be you could benefit from MAOIS but only at high doses: you should get carefully monitored though and you need to go to the hospital for that" was his sentence.
> Needless to say i walked away again, felt vey discouraged and hopeless, but i eventually came over that as Effexor was working pretty well for my motivation and drive.
> I was planning to go back to College, i felt more initiative and focus; my negative thinking was almost completelly erased and i began to make plans for the future.
> Anhedonia was still a problem but i grew confident i was going to defeat it at last.
> I grew more and more confident and i began to consider to start writing again. I called The Writers' School in Torino and asked them about the courses.
> I thought about dedicating myself to translations also (i have done that in the past) and i made a few job interviews.
> I was still depressed but i felt determined and motivated once again, thinking i was heading towards the right direction.
> Then i was hit by severe stress as my mother-in-law (who is like a mother to me) got suddenly sick.
> I took her to the hospital since she had urinary retention that didn't seem to go away with normal medications; anyway, i thought it was no big deal since it's a pretty common problem among the elderly population.
> My confidence was abruptely disrupted as a Doctor came along with a serious expression on his face , telling me she had cancer stage IV, and that the prognosis was very poor.
> I began to worry about my health also, as i had to take hiv test, but i never resolved to take it as i was worrying for my mental stability in case it turned out to be positive.
> I always took extremely careful precautions with my mate and with the people around me; i was very cautious, disinfecting toilet and sink after using it and washing my dishes, knives and spoons with bleaching powder: i must say it wasn't a very pleasant way to live.
> I decided that i felt strong enough to take the test and after a week of fear and bottled up tension i had the response which it turned out to be negative.
> Even if i was very happy with the results i had been loading a great amount of stress by that time, as i found out a week later that my father was going to have an illegitimate son on the top of that.
> None of my family had told me that: i found it out by myself as i spotted my 63 years old father walking hand in hand with his 32 years old pregnant girlfriend.
> My fianceé was (is still is) mourning over his mother, very often he would burst out in tears and cry over my shoulder.
> Sometimes i felt i wasn't going to handle all that stress, had mood shifts and feared i was getting depressed again.
> Thanks god it didn't happen as my motivation and drive persisted and i was preparing to attend College lessons by January.
> Even though i was pleased to realize i had regained my confidence, i still thought i needed some dopaminergic/stimulant augmentation on the top of Effexor because of anhedonia and lack of sex drive.
> A friend of mine gave me a neurologist reference, saying he was the reluctant type at first but that he'd have put down any resistence at last, willing to prescribe the medications i wanted to. "He courses a lot, looks rough, but he is a sensitive person at the core" - He added.
> When i finally saw him, i talked to him about the eventuality of Mirapex augmentation; i mentioned Selegiline too. He told me he never heard of Selegiline. I told him it was a MAOI type B. He shrugged his shoulders and told me:
> "All i can do is to prescribe Parnate: it's rather stimulating and has shown to be effective for several treatment resistant depressive patients".
> I explained to him that i didn't want to drop my medication since it was fairly effective: moreover, i was concerned about depression showing up again, as i had been facing severe stress during the last month.
> He told me that i didn't need to worry about it, since i'd have been affected by stress already despite of medication: if i was well, that was a good sign since it was predictory that i was going to do fairly well without medication also.
> I thought it over and i decide to switch to Parnate.
> I tapered Effexor and i was doing fairly good.
> When i was about to drop the last Effexor dose i found out that the Parnate version in my country is tranycylpromine binded to an antypsychotic. (You know, just in case one would get too much euphoric).
> Moreover, i found out that the dietary restrictions my pdoc gave me were fairly inaccurate, as chocolate, some fruits and many other foods he didn't even mention of were likely to produce an hypertensive crisis.
> I called him on the phone and told him that i got worried as i found out that the tranycylpromine compound was binded to an AP: since i was oversensitive to AP, there was good chance i was going to get depressed on Parmodalin (brand name of Parnate in my country). Moreover, i knew that AP (modaline) pretty well, as i have been taking it before and got even more depressed on that.
> He replied that i was full of shit, since he never noticed any problem with Parmodalin.
> "You are not supposed to investigate about drugs or read prescription papers, you're a patient and you're supposed to behave like a patient." He shouted.
> then he added: "I asked about Selegiline: you're a f*****ng ignorant , it's not a MAOI, but a drug for Parkinson Desease. From now on, follow my instructions and never question anything, understand?"
> "Sure Babe! " i replied. And i hang up the phone.
> I went back to Effexor(300 mg.) and Reboxetine (8 mg.) : to my dismay they never worked as they did before. I grew more insecure, unmotivated and apathetic. Negative thinking came back again as i found myself endlessly and aimlessly ruminating over possible remedies/medications without being able to accomplish anything.
> I got stuck on College, and i began to worry.
> So i began to look for a good psychopharmacologist.
> I've been very careful and accurate this time, making sure to find a good reference, since i nedeed an expert in his field, who new about medications and its interactions.
> I finally found a psychiatrist / psychopharmacologist teaching at Med School in my town and practising in the University Clinic.
> I thought it was a good reference, still i was reluctant to call because of the several negative experiences i mentioned before.
> I decided to prevent any further disappointment calling him and on the phone and asking him directly about new drugs such as Selegiline to see his reactions to it.
> He told me he knew about the drug, that it was sometimes used to treat depression. "We're going to see if you're elegible for it." He told me.
> I was pretty sure he was my man at that point.
> I saw him that same day and told him about my situation.
> To my surprise, he diagnosed me as bipolar.
> "You surely need a dopaminergic drug for anhedonia, but i'm going to add a mood stabilizer in order to prevent you from switching to a manic phase".
> "How can you tell i am bipolar ? I've been depressed for something like 11 years and never had manic or hypomanic phase, i never experienced euphoria or hyperactivity or significant mood shifts. I've been pretty much apathetic throughout all these years".
> "You can never tell: you could become manic even after eleven years of low mood" -
> "Since you've been hyperthymic in your teen years, i think you run significant risk of becoming bipolar".
> he sentenced.
> I was rather puzzled. I'm no expert but i don't think that Wellbutrin is such a potent dopaminergic drug, isn't?
>
> So this is my new prescription:
>
>
> Effexor, 150 mg
> Wellbutrin, 300 mg
> Depakote, 600 mg
>
> I'm afraid this is not going to lift my mood that much.
> What do you guys think?
> I'm afraid this pdoc it's an "euphoria-phobic",
> thinking that a little- bit -depressed person it's preferable to a little- bit -euphoric person. I've seen pdocs like that before.
> It seemes that they fear happiness, viewing it as an illness. Am i exaggerating? Don't know what to do anymore. Please help!
I would say you have nothing to lose by giving it a shot. If it doesn't work you will just try something else. Effexor + Wellbutrin has helped a lot of people. I do sympathize with you though. I know what it's like to search with desperation for answers.Scott
Posted by sid on February 12, 2002, at 10:10:39
In reply to pdoc-switching: rather puzzled, need some advice, posted by Anna Laura on February 12, 2002, at 5:49:14
> So this is my new prescription:
>
>
> Effexor, 150 mg
> Wellbutrin, 300 mg
> Depakote, 600 mg
>
> I'm afraid this is not going to lift my mood that much.
> What do you guys think?
> I'm afraid this pdoc it's an "euphoria-phobic",
> thinking that a little- bit -depressed person it's preferable to a little- bit -euphoric person. I've seen pdocs like that before.
> It seemes that they fear happiness, viewing it as an illness. Am i exaggerating? Don't know what to do anymore. Please help!
>I don't know about your med combo, but how about you give it a chance? Stop being afraid and stop changing meds so often. It take months before you can tell anything. This new pdoc seems to talk to you more than the others; that's a plus.
> I'm afraid this is not going to lift my mood that much.
If you don't try it, you'll never know. You need to find someone who will stick with you until you've found what will help you.
Others on this board may know better about your med combo, but it seems to me you're too suspicious at this point. Understandably, given your past experiences with doctors, but don't ruin your chances, stay open-minded, while making sure you're well taken care of.
About your stress, well, things get better with time. You seem to be faring fairly well under the circumstances.
Keep hoping and trusting that you'll find something that will help you.
Posted by IsoM on February 12, 2002, at 12:16:02
In reply to Re: pdoc-switching: rather puzzled, need some advice » Anna Laura, posted by sid on February 12, 2002, at 10:10:39
Whooaa Anna Laura!! No wonder you're leery of pdocs. Their behaviour is abhorrent. I am honestly shocked at the state of psychiatry in Italy if this is a typical response of pdocs there.
As for this new combo, as others have said, give it a trial. See if you can extract a promise from this new doctor that if you don't improve will he consider some ideas that you may have if it comes from reputable sources? Print out as much info as you can to bring next time.
With my doctor, he appreciates me tracking down the info & giving it to him. He does read it too. He's so busy in his practice & with his young family that he doesn't have the time to look up all the new treatments his patients suggest. (He's not a pdoc but a regular one who has some experience in depression.)
I'd also look up as much as you can on bipolar I & II plus your previous diagnoses of depression to find what you think sounds most like you. Print out that info for him too. Ask him for other examples he's treated of bipolar patients who've never had a manic phase & how their treatment went. Ask him in a non-confrontational manner but explain you need to learn more.
When are you supposed to start your new combo? When does he think you'll see benefits? Is he easy to get ahold of in case it doesn't go as planned?
Posted by Mark H. on February 12, 2002, at 16:40:15
In reply to pdoc-switching: rather puzzled, need some advice, posted by Anna Laura on February 12, 2002, at 5:49:14
Dear Anna Laura,
We are not allowed (by law) to give you any medical advice on this forum. In addition to that, I have NO qualifications to advise you on your medications. I am simply a fellow-sufferer. It is very important that you work closely with your doctor to find the right combination and timing of meds that works for you.
That said, if it were I, I would choose to "sequence" the meds, starting with Effexor. I would take just the Effexor for perhaps two or three weeks. In fact, it took me more than a month to build up to 150mg/day. Rushing Effexor gave me leg cramps and insomnia at night and terrible sweats during the day.
Then, I *might* add in the Wellbutrin. For me, it caused such severe short-term memory loss that I could not tolerate it, but it works well for some people. If I started it sooner and it worked, however, I would never know whether it was the Effexor kicking in or the combination that had worked.
If during the Effexor and Wellbutrin time I experienced hypomania, then I might consider adding in the Depakote. For me personally, Depakote made my depression worse, not better.
Paradoxically, I needed a stimulant such as methylphenidate or dexadrine in order to potentiate the Effexor and overcome my sleepiness and lethargy. I also needed a beta-blocker to fight the symptoms that come from producing too much adrenaline (probably a body-level response to my hypersomnia).
I can only say what I would do. Hasten slowly.
With warm regards,
Mark H.
Posted by Anna Laura on February 12, 2002, at 22:51:28
In reply to pdoc-switching: rather puzzled, need some advice, posted by Anna Laura on February 12, 2002, at 5:49:14
Hi guys,
First of all, thanks for answering and being patient enough to read my long post.
I think i've come to a decision: i'm not going to try Depakote (at least for now).
I'll leave it as a last resort just in case other meds wouldn't work.
I've been searching in the psycho-babble archive and read your posts and i don't think i need to flatten my spirits with Depakote.
I don't feel emotional or moody whatsoever and i'm not cycling, my affects being flat all the time. Depakote it's likely to even out your ups and down and make you drowsy or even letargic and i don't need that.
I'd like to try Wellbutrin, but i'm not going to take without medical advice, so i guess i'm going to stick to the effexor/reboxetine combo till i find a pdoc i'm comfortable with.
I'm trying to get a prescription for Adafrinil, i've been looking for a pdoc reference in France but didn't find any yet.
Hope i'll be able to get it as soon as possible as i need it for studying and working: i'm expecting no miracle, just an aid in order to function at a "normal" level
When i get Adafrinil i'll drop Reboxetine and see what happens.
As long as the last pdoc is concerned, he didn't want to question antidepressants options whatsoever, nor he seemed to accept my point of view on the bipolar issue.
May be i should be more trustful but i can't push myself too hard as neglecting my sensations and dislikes makes things worse, 'cause i get even more paranoid and confused.
Too many times i forget to follow my gut instinct which turned out to be right quite often.
My gut instinct is telling me that i don't really like this guy : he might be a real expert and know his job but he doesn't want to question and collaborate and i'm quite sure i'll never be humble enough for him to change his mind.
He's sure i'm bipolar whereas i don't, so i don't see any purpose in insisting about dopaminergic/stimulants augmentation (which is what i need) as he is not going to prescribe them for me.
I called a Neuroscience Research Centre today, i've talked to a psychopharmacologist woman : she has been real kind to me.
She told me about Wellbutrin and i told her that my pdoc wouldn't put me on that without a mood-stabilizer since he thinks i'm bipolar.
She told me i should have questioned his diagnosis and i answered that he wouldn't accept any questioning. She told me that was just nonsense.
I asked her about Mirapex and dopaminergic augmentation and she seemed to be receptive on that issue.
I'll call her back to set an appointment: i'll have to travel since the Centre is down South, but i don't care.Thanks again for your patience and support
Anna Laura
Posted by sid on February 13, 2002, at 8:18:38
In reply to Re: pdoc-switching: Mr. Scott, Sid, Iso M, Mark H., posted by Anna Laura on February 12, 2002, at 22:51:28
Well, I'm glad you came to a conclusion. Good luck with this woman who seem to be open to discussion.
- sid
Posted by Mr. Scott on February 13, 2002, at 20:37:42
In reply to Re: pdoc-switching: Mr. Scott, Sid, Iso M, Mark H., posted by Anna Laura on February 12, 2002, at 22:51:28
Hello A-L,
It is going to take some time and frustration to get where you want to be. You don't want to be pulling and tugging with a doctor who is sure of him/herself when often psychiatry is an uncertain field. At the same time, keep an open mind. I am certain I am am BP II at this point (among other things), but I was sure I was just plain depressed for 10 years!! Who knows...As long as you find something that works, and sounds like you're heading in that direction even though it is frustrating at times..
Scott
Posted by Anna Laura on February 14, 2002, at 0:52:17
In reply to Re: pdoc-switching: Mr. Scott, Sid, Iso M, Mark H. » Anna Laura, posted by Mr. Scott on February 13, 2002, at 20:37:42
>
>
> Hello A-L,
>
> It is going to take some time and frustration to get where you want to be. You don't want to be pulling and tugging with a doctor who is sure of him/herself when often psychiatry is an uncertain field. At the same time, keep an open mind. I am certain I am am BP II at this point (among other things), but I was sure I was just plain depressed for 10 years!! Who knows...As long as you find something that works, and sounds like you're heading in that direction even though it is frustrating at times..
>
> Scott
Hi Scott,
Thanks for your encourangement: i really nedeed that. As a matter of fact i've been ruminating a lot about pdocs/drugs switching
the last days.
I got a little bit paranoid about that lately, and i sometimes feel quite desperate and i wonder if i'm really heading somewhere or not, as it feels like i'm just fooling myself.
I wonder wether i'm pursuing an illusory end in order to keep myself alive!
Posted by Mr. Scott on February 14, 2002, at 20:02:29
In reply to Re: pdoc-switching: Mr. Scott, Sid, Iso M, Mark H., posted by Anna Laura on February 14, 2002, at 0:52:17
wow!
You and me both!
I wonder sometimes if I only want to hear what I want to hear, and cannot accept the truth. Not even so much that I cannot accept it, but that I've actually lost touch with what truth is anymore!
Scott
Posted by anniebananie on February 15, 2002, at 23:54:05
In reply to pdoc-switching: rather puzzled, need some advice, posted by Anna Laura on February 12, 2002, at 5:49:14
Does your insurance pay for you to have an evaluation or two every year? If so pick a doctor or two and go. Even if you end up not switching, getting a new perspective every now and then is most helpful. And you might just find someone great for you.
Good luck,
Annie
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