![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 21 to 45 of 45. Go back in thread:
Posted by cybercafe on August 7, 2002, at 1:34:33
In reply to Re: How Parnate saved my butt » cybercafe, posted by Ritch on August 7, 2002, at 0:19:53
> That is when I tend to have *panic* attacks. Closed in rooms where I have to sit still and listen-be a captive audience in a group of strangers. UGH. College was hell, especially big lecture halls, yuck! I liked "hands-on" stuff like design classes where you have to physically move around some and work on projects. The worst possible thing was listening to a droning lecture class after class. I notice that if I dont' *feel* restless it isn't as bad. Advice-heck I don't know. I was on Prozac and Lithium and I still had panic atacks every semester-sometimes several in one class three times a week! My pdoc at that time was anti
i would often get attacks of terror... but i am told that panic attacks are when you think you are dieing/having a heart attack? so because i was aware that what was going on was anxiety this would mean they are not panic attacks, yes? no?
thanks for the reply :)
Posted by cybercafe on August 7, 2002, at 1:38:05
In reply to Re: How Parnate saved my butt » hildi, posted by Ritch on August 7, 2002, at 0:38:01
>foremost. The next biggest elements that are prominent is "ability to concentrate" and "slowed thoughts" and "fatigue". I have mentioned this
Hey Mitch ... question... my doc says that after your depression remits, it takes 3 to 5 months for you to get your cognitive function back... have you found this to be the case?
Posted by Ritch on August 7, 2002, at 9:53:02
In reply to Re: How Parnate saved my butt, posted by cybercafe on August 7, 2002, at 1:38:05
>i would often get attacks of terror... but i am told that panic attacks are when you think you are dieing/having a heart attack? so because i was aware that what was going on was anxiety this would mean they are not panic attacks, yes? no?
They tend to come on very rapidly. My experience is a sudden feeling of depersonalization and unreality followed immediately by flushed skin with racing heartbeat (often sweating hands, too). I just bite my lip, pinch my arm and ride it out. They usually last about 20-30 seconds or so. The trouble is when the damn things fade and then come back and repeat over and over. I think I would be oddly *relieved* if it *were* a heart attack instead.
> >foremost. The next biggest elements that are prominent is "ability to concentrate" and "slowed thoughts" and "fatigue". I have mentioned this
>
> Hey Mitch ... question... my doc says that after your depression remits, it takes 3 to 5 months for you to get your cognitive function back... have you found this to be the case?There's no way I can really find out, because my moods cycle so rapidly. :)
Mitch
Posted by LLL on August 7, 2002, at 10:59:46
In reply to Re: How Parnate saved my butt, posted by cybercafe on August 7, 2002, at 1:34:33
Panic attacks are just as you described. Some people think they are going to die, others are having heart attacks, others feel like they're going crazy etc. It's all panic attack. You're thinking before any of this takes place, like "oh my God, what if I had one now and couldn't leave" and then of course you become more anxious and think more anxious thoughts until you've spun yourself up to panic. This takes only seconds to do. Try to become aware of your anxious thoughts.
Once you do you can begin to see how you trigger them and can begin to "let these thoughts go". When you're not aware of how your thinking precipitates the panic it seems as if the panic or "terror" just comes out of the blue. The truth is there are automatic, almost habitual, irrational thoughts that come before these symptoms. Again, I highly recommend you buy some self help books on panic disorder so you can begin some CBT.
Posted by hildi on August 7, 2002, at 16:47:08
In reply to Re: How Parnate saved my butt » hildi, posted by Ritch on August 7, 2002, at 0:38:01
> > Yeah Mitch, I get what your saying-there are many times (while I am taking my SSRI's) that I just BS my way through entire social engagements, and then, on my way home I'll be exhausted from all my 'play acting' and my mouth is sore from grinning too much.
> > I feel like such a fake- this is with people that I like, sometimes. Then I feel guilty from not being 'real' with them. . . but how could I be real. If I was real I would be a big downer, not laughing or joking with everyone.
> > It some seem that alot of this could be depression. It takes so much effort to put on this big act that "hey , I'm OK, I am this fun gal". I get totally exausted by social events for this reason- I feel I have to perform.
> >
> > However, there are other times, though, when I really do seem to click with everyone I meet. It is almost effortless and I think I feel almost normal- and am actually having fun. These occasions are usually those kind where I don't spend a lot of time with any one person. I think that takes a lot of pressure off of me, too.
> >
> > I get scared if I think someone is actually going to be able to see how scared and depressed I really am. I don't want people to know- that is too humiliating and would make me way to vulnerable.
> > You know, sometimes my SSRI's make me not "give a shit". . .I don't care about being alone sometimes. . .I think they take away my cares too much where i don't feel many things, including the need to inateract with other people. I don't like this part. I want to feel, but now get blown away. What can I take that will allow that?
> > Hildi
>
>
> Hildi,
>
> Thanks for replying. I know exactly what you mean! I am more convinced than ever that it is all bio-chemically based. When I get my bipolar major depressions (when they are poorly treated), the main symptoms are lack of interest in socializing and this tremendous BOREDOM and TIREDNESS with everything (not just social stuff). It is the "interest in everyday activities" element of the depression that is foremost. The next biggest elements that are prominent is "ability to concentrate" and "slowed thoughts" and "fatigue". I have mentioned this here before, but I think that Social Anxiety is deeply connected with that "limbic" or "depressive" ADD that you hear about. That is where SSRI's fail to some degree IMO. They are good at giving you a "thicker skin", but wouldn't it be superior to feel drawn out of your own shell-by being truly *interested* in what is going on out there (wanting to check it out), instead of just having a THICKER SHELL? That is where SSRI's fall short-motivation and interest. Motivation and interest are often attributed to dopaminergic meds. I have tried stimulants and they have helped so-so, but they tend to worsen panic (in my situation anyhow), despite their ability to improve attention and alleviate depression, etc. That is probably why the MAOI's have the overall superior edge for social phobia. They can reduce panic AND increase dopaminergic transmission which tends to promote motivationi and interest. Just a few ideas here. I don't know if my current pdoc will every write for the things. I am half-ass solving this problem with a low-dose combo of Effexor and Wellbutrin right now. However, I think that the MAOI's might be the best meds. You might want to talk to your doc about them anyhow,
>
> good luck,
>
> Mitch
>
>
Hi Mitch. I did try to talk to my dr. about MAOI's and he wouldn't listen. he is really 'pissed' at me and not open to any of my suggestions. After going off of zoloft because of physical sick symptoms ( shakiness, nausea, fainting spells, more) and maybe hypomanic symptoms (racing thoughts, major irritability, hyper and obsessing over things and thoughts) dr. tried me on celexa and effexor. I hated both of them.
Well, now he says I'm expecting too much, too bad about feeling like shit and just deal with it. he pretty much just threw his hands up in the air and said "I give Up".
So, he gave me paxil-which I didn't want, and told me he won't even discuss anything else.
I am having extreme anxiety attacks on the paxil. I don't want to up the dose because I can't afford it, also I am experiencing a very wierd side effect from paxil CR at 12.5 mg- intense interest in sex!! All I can think about!~ Is this mania?
I am going to TRY to get the dr. to talk to me tomorrow- I am going to PLEAD with him to give me a benzo-I was really against this (because I'm an alcoholic, 9 years sober) but I have changed my thoughts on this big time. If I am going to be dependent on a med, I want it to be something that at least will help me. I am thinking, if I can do benzos for a little while while I clean my body of AD's I may then be able to try an MAOI.
The dr. even suggested benzos to me twice. He knows my situation and doesn't think it would be a problem. BUT, he is really acting wierd with me. I think I insulted his manhood or something by questioning him too much, sometimes in fromt of his collegues. This is when his attitute changed tremendously.
I might be out of luck completely now with this guy. If I cannot get some relief from this anxiety I am afraid I WILL go back to drinking. I used drinking for many years for anxiety. I cannot go it alone.
Hildi
Posted by Geezer on August 7, 2002, at 19:02:57
In reply to Re: How Parnate saved my butt, posted by hildi on August 7, 2002, at 16:47:08
Hi Hildi,
What the h*** is wrong with this pdoc??!!! How did it happen you were discussing things in front of his collegues - he should never let that happen. I haven't read the entire thread - so kind of shooting from the hip here. You are showing some real signs of bipolar disorder and I don't think this ding-a-ling is doing you any favors. Seems to me some of your symptoms could be due to the destabilizing effects of SSRIs you have been given (unless you have used stabilizers at the same time - can't believe he wouldn't try that - although I had one who didn't for 20 years). I have been sober since 1975, clean since 1985, just had to take a benzo (.5mg klonopin) starting a month ago. I find Klonopin gives me no euphoria and have not increased the dose. You might need to use something to hold you togeather.
You are in good hands with Mitch.....he has helped me more than once.
Wishing you the best,
Geezer
Posted by cybercafe on August 7, 2002, at 23:30:28
In reply to Re: How Parnate saved my butt » cybercafe, posted by Ritch on August 7, 2002, at 9:53:02
> They tend to come on very rapidly. My experience is a sudden feeling of depersonalization and unreality followed immediately by flushed skin with racing heartbeat
(often sweating hands, too). I just bite my lip, pinch my arm and ride it out. They usually last about 20-30 seconds or so. The trouble is when the damn things fade and then come back and repeat over and over. I think I would be oddly *relieved* if it *were* a heart attack instead.i tend to get really embarrassed and feel like i'm going to lose control... voice cracks, feel like i'm going to start crying or otherwise lose control... but just as i realize i'm about to cry or something i get an even more major adrenalin rush... as i can't believe it's going to happen or let it happen... and i then put fourth great effort to try and cover up my physical symptoms by... distracting my audience... by..talking faster? ... or trying to act like my totally unbased emotions of FEAR and shame and embarrassment are based on something real (i.e. bring up a topic or talk about something in a way that is based on real emotion) ... or just wait for the fear to go away meanwhile completely not believing that anyone can experience so much fear... and in response to nothing...
so at first did you think it was a heart attack or some other deathly illness? ... i ask because diagnostic criteria indicates that a panic attack is a belief you are going to die/are having a heart attack
> There's no way I can really find out, because my moods cycle so rapidly. :)
hmmm... i find cycling goes away when i totally eliminate all stress (don't leave my house except for martial arts or to visit friends or to work out?)
i guess it's weird that parnate doesn't cause me to cycle at all though
Posted by cybercafe on August 7, 2002, at 23:37:17
In reply to Re: How Parnate saved my butt » cybercafe, posted by LLL on August 7, 2002, at 10:59:46
> Panic attacks are just as you described. Some people think they are going to die, others are having heart attacks, others feel like they're going crazy etc. It's all panic attack. You're
so no one really recognizes that it's all just anxiety?
>thinking before any of this takes place, like "oh my God, what if I had one now and couldn't leave" and then of course you become
hmmm... i thought people who had panic attacks thought they were having something else (heart attacks for example)...
... so how is it that you can go from "i hope i don't have one of those panic attacks" to "i'm having a panic attack" to "no wait a sec -- i'm actually dieing here" ... why don't people realize that they're just having panic attacks.. or do they?>symptoms. Again, I highly recommend you buy some self help books on panic disorder so you can begin some CBT.
hmmm... i'll take a look, thanks :)
Posted by Ritch on August 8, 2002, at 1:19:18
In reply to Re: How Parnate saved my butt, posted by hildi on August 7, 2002, at 16:47:08
> > > Yeah Mitch, I get what your saying-there are many times (while I am taking my SSRI's) that I just BS my way through entire social engagements, and then, on my way home I'll be exhausted from all my 'play acting' and my mouth is sore from grinning too much.
> > > I feel like such a fake- this is with people that I like, sometimes. Then I feel guilty from not being 'real' with them. . . but how could I be real. If I was real I would be a big downer, not laughing or joking with everyone.
> > > It some seem that alot of this could be depression. It takes so much effort to put on this big act that "hey , I'm OK, I am this fun gal". I get totally exausted by social events for this reason- I feel I have to perform.
> > >
> > > However, there are other times, though, when I really do seem to click with everyone I meet. It is almost effortless and I think I feel almost normal- and am actually having fun. These occasions are usually those kind where I don't spend a lot of time with any one person. I think that takes a lot of pressure off of me, too.
> > >
> > > I get scared if I think someone is actually going to be able to see how scared and depressed I really am. I don't want people to know- that is too humiliating and would make me way to vulnerable.
> > > You know, sometimes my SSRI's make me not "give a shit". . .I don't care about being alone sometimes. . .I think they take away my cares too much where i don't feel many things, including the need to inateract with other people. I don't like this part. I want to feel, but now get blown away. What can I take that will allow that?
> > > Hildi
> >
> >
> > Hildi,
> >
> > Thanks for replying. I know exactly what you mean! I am more convinced than ever that it is all bio-chemically based. When I get my bipolar major depressions (when they are poorly treated), the main symptoms are lack of interest in socializing and this tremendous BOREDOM and TIREDNESS with everything (not just social stuff). It is the "interest in everyday activities" element of the depression that is foremost. The next biggest elements that are prominent is "ability to concentrate" and "slowed thoughts" and "fatigue". I have mentioned this here before, but I think that Social Anxiety is deeply connected with that "limbic" or "depressive" ADD that you hear about. That is where SSRI's fail to some degree IMO. They are good at giving you a "thicker skin", but wouldn't it be superior to feel drawn out of your own shell-by being truly *interested* in what is going on out there (wanting to check it out), instead of just having a THICKER SHELL? That is where SSRI's fall short-motivation and interest. Motivation and interest are often attributed to dopaminergic meds. I have tried stimulants and they have helped so-so, but they tend to worsen panic (in my situation anyhow), despite their ability to improve attention and alleviate depression, etc. That is probably why the MAOI's have the overall superior edge for social phobia. They can reduce panic AND increase dopaminergic transmission which tends to promote motivationi and interest. Just a few ideas here. I don't know if my current pdoc will every write for the things. I am half-ass solving this problem with a low-dose combo of Effexor and Wellbutrin right now. However, I think that the MAOI's might be the best meds. You might want to talk to your doc about them anyhow,
> >
> > good luck,
> >
> > Mitch
> >
> >
> Hi Mitch. I did try to talk to my dr. about MAOI's and he wouldn't listen. he is really 'pissed' at me and not open to any of my suggestions. After going off of zoloft because of physical sick symptoms ( shakiness, nausea, fainting spells, more) and maybe hypomanic symptoms (racing thoughts, major irritability, hyper and obsessing over things and thoughts) dr. tried me on celexa and effexor. I hated both of them.
> Well, now he says I'm expecting too much, too bad about feeling like shit and just deal with it. he pretty much just threw his hands up in the air and said "I give Up".
> So, he gave me paxil-which I didn't want, and told me he won't even discuss anything else.
> I am having extreme anxiety attacks on the paxil. I don't want to up the dose because I can't afford it, also I am experiencing a very wierd side effect from paxil CR at 12.5 mg- intense interest in sex!! All I can think about!~ Is this mania?
> I am going to TRY to get the dr. to talk to me tomorrow- I am going to PLEAD with him to give me a benzo-I was really against this (because I'm an alcoholic, 9 years sober) but I have changed my thoughts on this big time. If I am going to be dependent on a med, I want it to be something that at least will help me. I am thinking, if I can do benzos for a little while while I clean my body of AD's I may then be able to try an MAOI.
> The dr. even suggested benzos to me twice. He knows my situation and doesn't think it would be a problem. BUT, he is really acting wierd with me. I think I insulted his manhood or something by questioning him too much, sometimes in fromt of his collegues. This is when his attitute changed tremendously.
> I might be out of luck completely now with this guy. If I cannot get some relief from this anxiety I am afraid I WILL go back to drinking. I used drinking for many years for anxiety. I cannot go it alone.
> HildiHildi,
The reason your pdoc won't write for MAOI's is because of your past drinking history-I feel pretty sure on that one. He is afraid if he puts you on Nardil or Parnate, you might start drinking again and have a fatal interaction with the meds, then his ass is out hanging in the wind. What you might want to do is mention the "safer" (but somewhat less effective) MAOI's such as moclobemide or seligiline, and see what he says about them. You don't have dietary restrictions with those (at the recommended dosages), and alcohol is "ok" as long as it is moderate and low. If that doesn't pan out, you can discuss benzodiazepines (which might work fine). You do have a lot of options.
Mitch
Posted by Ritch on August 8, 2002, at 1:29:49
In reply to Re: How Parnate saved my butt, posted by cybercafe on August 7, 2002, at 23:30:28
> > They tend to come on very rapidly. My experience is a sudden feeling of depersonalization and unreality followed immediately by flushed skin with racing heartbeat
> (often sweating hands, too). I just bite my lip, pinch my arm and ride it out. They usually last about 20-30 seconds or so. The trouble is when the damn things fade and then come back and repeat over and over. I think I would be oddly *relieved* if it *were* a heart attack instead.
>
> i tend to get really embarrassed and feel like i'm going to lose control... voice cracks, feel like i'm going to start crying or otherwise lose control... but just as i realize i'm about to cry or something i get an even more major adrenalin rush... as i can't believe it's going to happen or let it happen... and i then put fourth great effort to try and cover up my physical symptoms by... distracting my audience... by..talking faster? ... or trying to act like my totally unbased emotions of FEAR and shame and embarrassment are based on something real (i.e. bring up a topic or talk about something in a way that is based on real emotion) ... or just wait for the fear to go away meanwhile completely not believing that anyone can experience so much fear... and in response to nothing...
>
> so at first did you think it was a heart attack or some other deathly illness? ... i ask because diagnostic criteria indicates that a panic attack is a belief you are going to die/are having a heart attack
>
> > There's no way I can really find out, because my moods cycle so rapidly. :)
>
> hmmm... i find cycling goes away when i totally eliminate all stress (don't leave my house except for martial arts or to visit friends or to work out?)
>
> i guess it's weird that parnate doesn't cause me to cycle at all though
>
Cyber,When I first had panic attacks (in the early '80's), I *did* think there was something physically wrong (similar to heart attack, etc.). But after I discussed things with my therapist (did biofeedback,etc.), I realized it was all mental with physical symptoms. So, during all of the subsequent panic attacks I KNEW that I wasn't having a heart attack, but I STILL experienced this horrible thing, despite that knowledge. That was probably what "enabled" me to go to college and finish while enduring the attacks. I never did any formal CBT, however. That is something I am going to take on soon (thanks for the reminder LLL). I must say that benzos thus far are the *only* meds that have been successful at PREVENTING a panic attack.
Mitch
Posted by LLL on August 8, 2002, at 8:55:41
In reply to Re: How Parnate saved my butt, posted by cybercafe on August 7, 2002, at 23:30:28
One More Time - yes you are having panic attacks. Each person interprets the symptoms differently. I never thought I was having a heart attack, and only sometimes did I think I might die if I didn't leave. For the most part it was just as you describe with the strong desire to LEAVE from wherever I was.
And again, you play a role in this regardless of your biochemistry. Your thinking about these past experiences influence your future ones and what you think about it at the time it occurs can either inflate or deflate the intensity of the experience. Drugs can only do so much. So, once again I highly recommend you read up on panic and agoraphobia and how YOU can begin to assist yourself in responding differently to this and thus diminish their hold on you over time.
Posted by hildi on August 8, 2002, at 15:00:29
In reply to Re: How Parnate saved my butt » hildi, posted by Geezer on August 7, 2002, at 19:02:57
> Hi Hildi,
>
> What the h*** is wrong with this pdoc??!!! How did it happen you were discussing things in front of his collegues - he should never let that happen. I haven't read the entire thread - so kind of shooting from the hip here. You are showing some real signs of bipolar disorder and I don't think this ding-a-ling is doing you any favors. Seems to me some of your symptoms could be due to the destabilizing effects of SSRIs you have been given (unless you have used stabilizers at the same time - can't believe he wouldn't try that - although I had one who didn't for 20 years). I have been sober since 1975, clean since 1985, just had to take a benzo (.5mg klonopin) starting a month ago. I find Klonopin gives me no euphoria and have not increased the dose. You might need to use something to hold you togeather.
>
> You are in good hands with Mitch.....he has helped me more than once.
>
> Wishing you the best,
>
> GeezerHi Geezer. Thanks for the reply and the kind words of encouragement. Also thanks for confirming that its OK to take a benzo. I thought about this long and hard, and even was suggested benzos by my dr, but I fought against it. The stigma of being an alcoholic on benzos, the reactions I'd get from some around me, my pride, all these were things I was worried about. I fought hard against going on ad's, too, long ago. I guess it's about being dependent on something else that scared me (and still does). But you know, I feel different now. I am dependent on these SSRI's anyhow. And these meds have a multitude of withdrawal symptoms. I don't feel good on these, but they do help a little- while increasing other problems.
I went to dr. today about anxiety meds. Hey was not happy to see me and was impatient. He says to up the paxil dose and won't talk about it any more.
his solutions has always been to up the dose. On Prozac I was hyper, aggressive, irritable, racing thoughts and sexual obsession and he says "up the dose". On zoloft I was physically sick, angry, apathatic, and he says again to 'up the dose'.
When I tried Effexor and Celexa and said the same thing.
Now here he goes again.
I have had it. i ordered some meds online for myself... they won't be here for a month, though.
Till then I don't know what I'll be able to do. What can I take to deal with this anxiety in between then? I cannot sleep either, so I need to buy something for that.
But I don't know if I should try upping the paxil like dr. said.?? paxil scares me.
Oh, by the way, about being bipolar- dr.laughs at this. Says I am not. So what 'am I ?', I ask- he shrugs it off. He does not like me to ask questions of any sort. I really hate this man right now. My life is in his hands and he is playing with my head.
Hildi
Posted by hildi on August 8, 2002, at 15:14:26
In reply to Re: How Parnate saved my butt » hildi, posted by Ritch on August 8, 2002, at 1:19:18
Hi Mitch. Moclobemide or Seligiline are safer? Do they work, though? I hear such great things about nardil and Parnate, but not much about these two.
I don't know if it is the drinking that makes him avoid prescribing an MAOI. For he has suggested benzos for me before, and when I said I didn't think it was a good idea, me being an alcoholic and all, dr said he saw nothing wrong with me being on benzos. This is the same dr. who works at the mental health clinic where I went through detox. He knows my full history of alcoholism. So it seems wierd that he would be OK with benzos but not with MAOIs.
I think ther is more to it. The way he is acting with me now confirms it. He seems to want to be in control and maybe thinks I am too opinionated. he is asian, and I don't mean to sound rasist, but maybe he prefers women to be more silent and demure. He has complained about my questions and attitute on more than one occasion. Now I don't even know how to act with this guy. I feel helpless. I try every angle with him and he treats my with disdain.
i went there today to talk about my over-the -top anxiety. His solution? Same as always: UP the SSRI. He couldn't get me back out the door fast enough.
I left there, again, feeling like shit.
I hate this game. I feel like I am a joke to this man. I feel like he has this power over me and is oppressing me.
I am totally broke, just lost my job, place to live, . . . and want to start waitressing for fast cash. Plus, waitress hours would work well with my school hours. Well, I cannot start this job yet because my anxiety is too over the top- cannot even put on my make-up or write a check, much less serve hot coffee!
i feel trapped!
hildi
Posted by Ritch on August 9, 2002, at 0:03:14
In reply to Re: How Parnate saved my butt, posted by hildi on August 8, 2002, at 15:14:26
> Hi Mitch. Moclobemide or Seligiline are safer? Do they work, though? I hear such great things about nardil and Parnate, but not much about these two.
> I don't know if it is the drinking that makes him avoid prescribing an MAOI. For he has suggested benzos for me before, and when I said I didn't think it was a good idea, me being an alcoholic and all, dr said he saw nothing wrong with me being on benzos. This is the same dr. who works at the mental health clinic where I went through detox. He knows my full history of alcoholism. So it seems wierd that he would be OK with benzos but not with MAOIs.
> I think ther is more to it. The way he is acting with me now confirms it. He seems to want to be in control and maybe thinks I am too opinionated. he is asian, and I don't mean to sound rasist, but maybe he prefers women to be more silent and demure. He has complained about my questions and attitute on more than one occasion. Now I don't even know how to act with this guy. I feel helpless. I try every angle with him and he treats my with disdain.
> i went there today to talk about my over-the -top anxiety. His solution? Same as always: UP the SSRI. He couldn't get me back out the door fast enough.
> I left there, again, feeling like shit.
> I hate this game. I feel like I am a joke to this man. I feel like he has this power over me and is oppressing me.
> I am totally broke, just lost my job, place to live, . . . and want to start waitressing for fast cash. Plus, waitress hours would work well with my school hours. Well, I cannot start this job yet because my anxiety is too over the top- cannot even put on my make-up or write a check, much less serve hot coffee!
> i feel trapped!
> hildiI really still think he will not write for the MAOI's due to your past alcoholism. It *could* be that he is worried about their safety generally, but I think it is the past substance abuse issue. There was a poster here who was being prescribed MAOI's for quite some time and happened to casually mention during a therapy session about casually using cocaine a few times in high school----the pdoc immediately discontinued her MAOI's! The danger is very real for alcohol/stimulant induced death from interaction with an MAOI. That also explains why he is willing to write for benzos. If you fall off the wagon and drink too much on benzos, you aren't going to risk a hypertensive reaction like you might with an MAOI. My suggestion? Let him write for the benzo and see about reducing the SSRI after a time. If that doesn't pan out, then press the MAOI issue (and perhaps bring up a *safer* MAOI like selegiline or moclobemide as a potential first trial). I read your post above about ordering meds online. If you have ordered MAOI's such as phenelzine or tranylcypromine and are not under a doctor's supervison when taking them you can be playing Russian roulette for real.
please be careful,
Mitch
Posted by hildi on August 9, 2002, at 9:33:15
In reply to Re: How Parnate saved my butt » hildi, posted by Ritch on August 9, 2002, at 0:03:14
Hi Mitch. You might be right about my alcoholism probably being the reason my dr. won't prescribe an MAOI. Also I think its because of the diet restrictions and the general safety of these drugs- my guess is that he probably doesn't prescribe them much in general. He is a very conservative guy.
No, I didn't order an MAOI. I am not ready for that yet. I really want to deal with my anxiety and flush the SSRI's out of my body. I'd like to see what I feel like on an anxiety med alone. True, it may not be enough, but at least it will give my body a chance to prepare for an MAOI, if I have to.
I hate these ssri's Mitch. I feel so strange and unemotional on them. Plus, they really don't control all the anxiety. They do help some, but I am still very limited while on these meds.
My mind feels like a machine while on these, a robot. I can't stand anything touching my skin- I'm edgy.
I ordered something for my anxiety online. I saw my dr. again yesterday- he wants to increase dose of paxil and does not want to add anything else. He thinks the paxil may be enough, and I need to give it more time.
My dr.'s advice is always to up the ssri's, even if I feel like hell, so I am leary of this. Plus paxil scares me. I hear so much about poop-out and withdrawal side effects.
I wish that I just would have let him put me on an anxiety med long ago when he suggested it. Now he is very unwilling to even discuss anything with me and is adament about sticking with paxil.
I messed up. I fought against him on the benzos-
What I fool I was. Now I cannot get nowhere with this guy.
Hildi
Posted by Ritch on August 9, 2002, at 10:37:49
In reply to Re: How Parnate saved my butt » Ritch, posted by hildi on August 9, 2002, at 9:33:15
> Hi Mitch. You might be right about my alcoholism probably being the reason my dr. won't prescribe an MAOI. Also I think its because of the diet restrictions and the general safety of these drugs- my guess is that he probably doesn't prescribe them much in general. He is a very conservative guy.
> No, I didn't order an MAOI. I am not ready for that yet. I really want to deal with my anxiety and flush the SSRI's out of my body. I'd like to see what I feel like on an anxiety med alone. True, it may not be enough, but at least it will give my body a chance to prepare for an MAOI, if I have to.
> I hate these ssri's Mitch. I feel so strange and unemotional on them. Plus, they really don't control all the anxiety. They do help some, but I am still very limited while on these meds.
> My mind feels like a machine while on these, a robot. I can't stand anything touching my skin- I'm edgy.
> I ordered something for my anxiety online. I saw my dr. again yesterday- he wants to increase dose of paxil and does not want to add anything else. He thinks the paxil may be enough, and I need to give it more time.
> My dr.'s advice is always to up the ssri's, even if I feel like hell, so I am leary of this. Plus paxil scares me. I hear so much about poop-out and withdrawal side effects.
> I wish that I just would have let him put me on an anxiety med long ago when he suggested it. Now he is very unwilling to even discuss anything with me and is adament about sticking with paxil.
> I messed up. I fought against him on the benzos-
> What I fool I was. Now I cannot get nowhere with this guy.
> HildiHildi,
I would give him another office visit. This time just spell out that in many ways you are *worse* on SSRI's and that dose increases don't seem to help. There *are* a lot of people that are intolerant (or overly sensitive) of them (myself included-I can only take about 1/8 of a standard dose). Ask about BZD's and if he would write for one next time (Ok, let's try it). Then see if the BZD works well. If it does-ask him about a dose *reduction* of the SSRI (if you are still experiencing negative effects from it). At some point you may just need to just switch away from SSRI's altogether. If he just won't consider that possibility (not necessarily going to an MAOI, just no SSRI's please), then shop for a different pdoc. Have you ever tried any of the other AD's from different classes like Serzone, Remeron, amitripytline?
Mitch
Posted by hildi on August 9, 2002, at 22:13:44
In reply to Re: How Parnate saved my butt » hildi, posted by Ritch on August 9, 2002, at 10:37:49
Hi Mitch. These are the meds I've been on: I tried Buspar, prozac, zoloft, celexa, effexor, and trileptal (sp?). Buspar was 1st- didn't do a thing but alieviate a little anxiety, not much. The prozac made me feel calmer and more focused. The buspar and prozac together was a terrible combo for me, but this dr insisted it was OK. It was after I did research on it that confirmed it can make some people worse (for people with ADD or OCD, I cannot remeber but it said for some this combo worsens symptoms). Dr. didn't believe me so I just quit buspar w/o asking him and I did feel better.
Prozac worked for a while then made me feel worse- more anxious and agitated (I later found out-recently actually- that stuff like prozac is being prescribed at way too high a dose. I think most of us do better on something like 1/8 of what they prescribe- just like your experience).
Anyway, I did somw research again and found that zoloft might work better. Talked to dr. about this and he said hogwash- zoloft is the same as prozac- just up your prozac dose. I begged and begged and he finally ordered me zoloft. It did work better, just as I thought.
Of course I had problems on zoloft, too. The racing thoughts, the hyperness and agitation,sometimes apathy, fainting spells, dizzyness, my moods were getting worse than ever and then I just finally started to feel really sick all the time. Occasionally over the years the dr. would suggest benzos or mood stabilizers but I did not want to add anything else. It wasn't until things really got bad and I got super sick that I went in and said enough- no more zoloft! What does he say? "up the meds"- again! I refused so he gave me celexa- I hated it. Effexor then- it was worse!
Now, I go back in again. Dr. is frustrated and says I am not trying hard enough -expecting too much. "Nothing was wrong with the zoloft- after all you were on it for so long" (7 years).
I have suggestions of things to try- things I have heard about what the meds can do to you physically. I try to tell him the SSRI's are affecting my blood sugar, and that the high doses I have been on are maybe too much for me- Dr. is shaking his head and tells me all this stuff I've learned is nonsense. I try to explain my physical symptoms to him and he says "so what. No med is going to be perfect".
I ask him what to do and he says he gives up on me. I bring up suggestions of things to try and he just shakes his head and doesn't answer me. When pushed for an answer, he says he "doesn't know what to do with me . . . I probably won't like anything anyway".
He did bring up the benzo thing again, and I asked if he really thought it was a good idea for me- and he said he saw no reason why not.
So, we just sat there- him looking digusted at me.
After some crying and yelling on my part (yeah, I fell apart. It didn't help things) dr. gives me paxil.
So, for three weeks or so I'm doing this paxil. I have seen him maybe twice since then, each time he doesn't look real happy to see me. I tried to bring up the benzo thing and he won't talk about it.
I bring up this anxiety issue (the fact that I'm still freaking out) and mention that the paxil at 12.5 mg is making me too sexual.
Dr says "Up the dose". He says the paxil is an ultimate anti-anxiety med- "haven't I seen the commercials?"- he says "give it time, double or triple the dose". Then he practically pushed me out the door.
So, instead of being sensitive to the fact that high doses of SSRI's are maybe NOT what I need, this guy only looks at these meds in regards of higher, not lower, doses. Issues of med sensitivity are not even of importance to him. To him, answers to problems of side effects are just to 'up the dose'- geez- is he getting a 'kickback from these companies??I really do believe I need another dr.
I don't trust this man and I do not like the rapport we have. I read other posts of how people question and discuss things with thier dr.s and I think "wow! Some doctors will discuss things openly with you?"No insurance has been the reason I go to this guy. Plus, I have been seeing him ever since I quit drinking. I used to really like this guy. I used to trust him.
I think I can buy what I need online for a while until I figure out a new plan, find a new doctor. My next job will hopefully have insurance- my last one didn't.
What I am thinking is going off SSRI's completely once I'm on a good anxiety med.
I thought Serzone was discontinued or something? My dr. mentioned something like that. Remeron sounds interesting, but it sounds like everyone gains tons of wieght on it! amitriptyline is a TCA, right?
I tried one TCA (no, dr. didn't prescribe it) lately- cl-something- geez- cannot remember the name. It made me sleepy and bloaty, but no nausea and my mind didn't feel spacey or wired like on some meds I've tried.
Maybe down the road I can try an MAOI. What I have heard from cybercafe about parnate sounds very good. There have been some great nardil posts, too.Mitch, how long have you been on Klonopin and how much do you take? Some of these recent posts about klonopin have scared me.
This is a scary decision that I cannot believe I'm even contemplating.
Hildi
Posted by Ritch on August 9, 2002, at 23:33:01
In reply to Re: How Parnate saved my butt » Ritch, posted by hildi on August 9, 2002, at 22:13:44
>....... What I am thinking is going off SSRI's completely once I'm on a good anxiety med.
> I thought Serzone was discontinued or something? My dr. mentioned something like that. Remeron sounds interesting, but it sounds like everyone gains tons of wieght on it! amitriptyline is a TCA, right?
> I tried one TCA (no, dr. didn't prescribe it) lately- cl-something- geez- cannot remember the name. It made me sleepy and bloaty, but no nausea and my mind didn't feel spacey or wired like on some meds I've tried.
> Maybe down the road I can try an MAOI. What I have heard from cybercafe about parnate sounds very good. There have been some great nardil posts, too.
>
> Mitch, how long have you been on Klonopin and how much do you take? Some of these recent posts about klonopin have scared me.
> This is a scary decision that I cannot believe I'm even contemplating.
> HildiHildi,
You could be having a dysphoric hypomanic reaction to SSRI's. You may just be sensitive to them. It really sounds like they are just not a good fit. The Serzone thing... there have been some isolated reports of liver failure associated with Serzone. But, they are very rare. The thing about Serzone that is nice, is it tends to be a somewhat weak antidepressant (easier to tolerate for bipolars) and doesn't mess with your sleep that badly. Remeron, yes, often causes major weight gain probs. Amitriptyline is a sedative TCA, yes. Good for sleep and anxiety, not as likely to cause weight gain as Remeron, but more dry mouth (anticholinergic) side effects. So what benzo have you been prescribed? Klonopin is probably the best for social anxiety of the benzos. It has a long half-life, and a lower potential for abuse than most benzos. I just take .25mg at bedtime now (1/2 a tab of the lowest dose). I would't be worried about it that much. Compared to possible hypomania from SSRI's and their associated withdrawal problems, Klonopin doesn't seem that bad to me.
Mitch
Posted by hildi on August 10, 2002, at 15:08:13
In reply to Re: How Parnate saved my butt » hildi, posted by Ritch on August 9, 2002, at 23:33:01
Hey Mitch. . That was a long message to you I previously posted, thanks for taking the time reading it. I guess I just needed to let it all out in order to feel validated or something by someone who agrees with me that my dr. is hard to deal with. His last words to me from my last visit pretty much sums it all up: "I'm the doctor here and I will make the decisions".
Well, I just made my own decision: I just ordered two anxiety meds online: Klonopin and Ativan. I won't get them for quite a while though. The only klonopin I could get that I could afford is 2mg! Is it possible for me to cut these down to .25 mg?? Or could I dissolve them and calculate a .25mg dose?
I can't wait for these to come, but I'm scared shitless, too. I was always told an alcoholic was basically off the wagon if they did anything like this. Geezer's reply made me feel better. He said (he? she?) that after 20 yrs sobriety he just started klonopin and has no buzzed feeling whatsoever.
There have been other posts in the archives I read who report OK responses of other alcoholics on benzos with no experience of relapse or benzo abuse. These all make me feel less apprehensive, but still a little worried.
What is trazedone? I'm going to do some research on this, too. Gabbi has just gone off benzos and I THINK she said she is taking this now for anxiety. I could be wrong though.Lamictal and gabapentin I can't afford.
Have you tried the amitrypt? Is it good for anxiety?
Serzone sounds interesting, too. I think a mild antidepressant would be fine for me, as long as I have something for anxiety.Dysphoric hypomania? I do believe you may be right? I believe it, even if my dr. doesn't. I find it amazing that this man who spends maybe 5 minutes every few months and sees the face I present those few minutes dares to think he knows more about what I feel than I do myself.
Thanks again for the support Mitch. You have been a real help.
Hildi
Posted by Ritch on August 10, 2002, at 20:14:36
In reply to Re: How Parnate saved my butt » Ritch, posted by hildi on August 10, 2002, at 15:08:13
> Hey Mitch. . That was a long message to you I previously posted, thanks for taking the time reading it. I guess I just needed to let it all out in order to feel validated or something by someone who agrees with me that my dr. is hard to deal with. His last words to me from my last visit pretty much sums it all up: "I'm the doctor here and I will make the decisions".
>
> Well, I just made my own decision: I just ordered two anxiety meds online: Klonopin and Ativan. I won't get them for quite a while though. The only klonopin I could get that I could afford is 2mg! Is it possible for me to cut these down to .25 mg?? Or could I dissolve them and calculate a .25mg dose?
>
> I can't wait for these to come, but I'm scared shitless, too. I was always told an alcoholic was basically off the wagon if they did anything like this. Geezer's reply made me feel better. He said (he? she?) that after 20 yrs sobriety he just started klonopin and has no buzzed feeling whatsoever.
> There have been other posts in the archives I read who report OK responses of other alcoholics on benzos with no experience of relapse or benzo abuse. These all make me feel less apprehensive, but still a little worried.
> What is trazedone? I'm going to do some research on this, too. Gabbi has just gone off benzos and I THINK she said she is taking this now for anxiety. I could be wrong though.
>
> Lamictal and gabapentin I can't afford.
> Have you tried the amitrypt? Is it good for anxiety?
> Serzone sounds interesting, too. I think a mild antidepressant would be fine for me, as long as I have something for anxiety.
>
> Dysphoric hypomania? I do believe you may be right? I believe it, even if my dr. doesn't. I find it amazing that this man who spends maybe 5 minutes every few months and sees the face I present those few minutes dares to think he knows more about what I feel than I do myself.
>
> Thanks again for the support Mitch. You have been a real help.
> Hildi
>
The Klonopin.. you could quarter a 2mg tablet fairly easily and just take it when you feel you need to I guess. However, I thought you said that your pdoc was going to write for benzos himself, so what happened? If that is the case, you ought to see what he wants to write for and try that first.Trazadone is a fairly sedative med often used for sleep. I was taking it with Prozac for a while. It is similar to Serzone, but more sedative. If you need to sleep and get reduced anxiety without the buzzy agitation of most SSRI's, then that might be a good pick-I hadn't thought of that. Come to think of it-why don't you ask your pdoc for Serzone or Trazodone before you take *any* benzos (and ditch the Paxil), and see what he says?
Mitch
Posted by hildi on August 11, 2002, at 12:49:13
In reply to Re: How Parnate saved my butt » hildi, posted by Ritch on August 10, 2002, at 20:14:36
Hey Mitch. Yes, the dr. had suggested two or three times about the benzos, but each time he did I dismissed the idea and said I didn't think it was a good idea. The last time he brought it up, rather recently,was during an awful session in which a psychologist was also present (during a previous visit I had an emotional breakdown, the anxiety had skyrocketed and all I could do was cry- I mentioned I think I needed to talk to a shrink and he said he would set it up. This is through county and they all work together in same mental health office. So when I came in, he pulled Susan, the psychologist, in with us too) and I questioned the dr's benzo suggestion to the psychologist. I asked her I she agreed it was a good idea- what did she think of the dr.'s suggest, etc. . . So, in front of him I asked her to confirm his idea. Maybe that made him mad. I don't know.
I could have had benzos that day had I gone with his plan. When I left I realized I should have, and have tried to talk to him three times about adding benzos and he will not discuss anything other than taking the paxil.
He said that I need someone to make the decision for me and this is what he chooses. He said paxil is an excellent med and just stick with it.
So, here I am. I screwed it up myself, really.
Now he won't budge.
Hildi
Posted by Ritch on August 11, 2002, at 13:17:46
In reply to Re: How Parnate saved my butt » Ritch, posted by hildi on August 11, 2002, at 12:49:13
> Hey Mitch. Yes, the dr. had suggested two or three times about the benzos, but each time he did I dismissed the idea and said I didn't think it was a good idea. The last time he brought it up, rather recently,was during an awful session in which a psychologist was also present (during a previous visit I had an emotional breakdown, the anxiety had skyrocketed and all I could do was cry- I mentioned I think I needed to talk to a shrink and he said he would set it up. This is through county and they all work together in same mental health office. So when I came in, he pulled Susan, the psychologist, in with us too) and I questioned the dr's benzo suggestion to the psychologist. I asked her I she agreed it was a good idea- what did she think of the dr.'s suggest, etc. . . So, in front of him I asked her to confirm his idea. Maybe that made him mad. I don't know.
> I could have had benzos that day had I gone with his plan. When I left I realized I should have, and have tried to talk to him three times about adding benzos and he will not discuss anything other than taking the paxil.
> He said that I need someone to make the decision for me and this is what he chooses. He said paxil is an excellent med and just stick with it.
> So, here I am. I screwed it up myself, really.
> Now he won't budge.
> HildiHildi,
Uh oh, that doesn't sound so good. You may just have to find another pdoc. It sounds like you two are locking horns and the combativeness may not get any better. I wonder if there is a way you can find a psychologist primarily, and discuss all of these issues in the larger time-frame you have available in a visit, and let them give you an opinion and a possible referral to a different pdoc that *they* think may be more likely to be helpful (based on *their* experience and knowledge of different psychiatrists)?
Just an idea,
Mitch
Posted by hildi on August 12, 2002, at 13:02:06
In reply to Re: How Parnate saved my butt » hildi, posted by Ritch on August 11, 2002, at 13:17:46
Hey Mitch. thanks, thats a good idea. Right now I go to county and I'm pretty limited on funds until I start working again. I need to start working again before I can see another dr. outside of this system. I don't know if I should try the referral and see the psychologist there- I might just get sent back to this same dr. I know there is one other pdoc that works at this clinic, but she is new, young and said already she wouldn't see me unless this pdoc 'signed off on me' or something.
Right now I'm a mess. I don't know what to take med-wise. I have a bottle of prozac, a couple pills of zoloft, and a prescription for an order of paxil I really can't afford to fill and a job waitressing I'm to start in two weeks that I won't be able to unless I get my body's anxiety attacks under control and get my head on a little straighter. I am trying to job hunt, too, because I really don't want to waitress for fear of this anxiety, and I have two weeks to come up with something different.
On the up-side, this thread has really helped me with something- I finally got off my butte and started with a volunteer program with a great agency that deals with sexual abuse, children/adults. I've been thinking of this for a long time and it fits in well with my major, but kept putting it off until I 'felt better' and had more time. Well, some of the early posts pointed out about 'getting out there' and doing the things you don't feel you can do- and you'll feel change .. . .So, tonight I go back in- right now I'm in an intense training program for this, so I'm not dealing with the clients yet. I need to get it together SOON so I can be able to be a help, not a basket case. I am thankful this thread was posted- it really gave me a shove.
Hildi
Posted by Ritch on August 12, 2002, at 22:11:27
In reply to Re: How Parnate saved my butt » Ritch, posted by hildi on August 12, 2002, at 13:02:06
Posted by hildi on August 13, 2002, at 15:24:02
In reply to good luck-let us know how things go (nm) ?hildi, posted by Ritch on August 12, 2002, at 22:11:27
This is the end of the thread.
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