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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 Peter on October 29, 2002, at 3:12:09
Hi all:
Well, I'm really overwhelmed; I don't know what's going on anymore. I'm so confused at the validity of my diagnosis, and I'm shocked at the amount of meds I'm on now. And this is coming from someone who's been on multiple combos for almost a decade. My basic diagnosis is cyclothymia/possible ADD/and some SP and Panic (though I haven't had a panick attack in years since I started klonopin-and before that I had only had 2 or 3 within a few months). I've been on just about everything. Lately, after trying lithium w/bad effects, I returned to depakote, since it's at least tolerable-though not very effective (I think it sedates me too much and makes me prone to depression). I've also been taking zoloft for the last 1/2 year for depressive dips and SP, but, though I didn't notice anything but a few days of less sleep, my pdoc immediately designated this occurence as SSRI-induced hypomania. So I'm tapering off the zoloft, and he's slowly adding lamictal to the depakote; Ideally, the Lamictal will replace both depakoter and zoloft. That would be promising, but I'm not even half done here: I used to take 10mg adderall XR, but because of sedation/depression, we've increased the adderall to 50mgIR daily over the last few months. I also take .5mg klonopin during the day to calm any adderall agitation, and then for bed-get this-I take a wopping 3mg klonopin , 30mg temazepam, and ambien all together (with my 750mg depakote and 25mg current lamictal). Once again, I feel like a living pharmacy. But not only does that bother me: it's at times like these when I really wonder if all this negative obsessiveness with meds outweighs the possible positive effects of the meds. In addition, I often wonder how accurate my diagnosis is-I mean, it's very possible that other, more psychological, as opposed to biological, factors might be leading to mood shifts/anxiety, etc. Even drug side-effects could lead to false diagnoses and result in the adding of more drugs instead of elimination of the culprit drug; for instance, I've been on Anti-convulsants for many years. It's very possible that they (especially the benzos) have overall affected my memory/mood/and alertness. So, adding Adderall works to counteract all that, but so would tapering off the AV's themselves! Especially since my case is 'mild,' as my pdoc has put it many times. Now I just find that every day I'm popping pills, and I end up getting utterly consumed with single projects, only to end up after 10 hours or so having forgotten to eat and hardly getting anything constructive done. I can't seem to spread out or balance my responsibilities and I'm neglecting my family and friends; I just want to be alone all the time. So I don't know what's going on. It's 4a.m-I gotta get away from this computer. Been on it all day and night. Thanks in advance for any advice.
Peter
Posted by JonW on October 29, 2002, at 8:58:26
In reply to OVERWHELMED!!, posted by Peter on October 29, 2002, at 3:12:09
Hi Peter,
It sounds to me like you should seek out a new doctor, but not just any doctor. If you can afford it, find a specialist who has the reputation of being one of the best in the business. You may have to travel some, but it's worth it. If you live anywhere near NYC, I highly recommend Dr. Michael R. Liebowitz from Columbia. He's amazing. I have a similar situation to yours. I was seeing a bipolar disorder specialist, and everything I said was treated as a symptom of bipolar disorder. It was assumed that this is a mixed state, or that is hypomania. Anti-convulsants were piled on top of one another and anti-depressants were removed. Anti-psychotics were thrown in. Stimulants were tried, etc. Then I finally sought out Dr. Liebowitz, and that has been the best decision yet. He's really cut through my symptoms and is so skilled at finding the right meds for my chemistry. He also picked up from day one that I should be in cognitive behavioral therapy. He has a therapist that works with him, and the two of them communicate. My therapists observations help Dr. Liebowitz to find the right meds as well. It's a team effort that has been very effective for me. I highly recommend him, or seeking out someone of similar caliber. If for no other reason, simply because you are not getting better.
Hang in there,
Jon
Posted by Peter on October 29, 2002, at 12:20:33
In reply to Re: OVERWHELMED!!, posted by JonW on October 29, 2002, at 8:58:26
Hey Jon:
If this is what I think, it's an amazing coincidence. The pdoc I go to is on 90th between Madison and Park-the plaque on the door says "Klein, Leibowitz & associates." My pdoc is Dr. Gerald Hurowitz, and he and Dr. Leibowitz share the same offices. Idon't know if it's the same Dr. Leibowitz that you go to, but I know both doctors have ties to Columbia U. The funny thing is that about 1 year ago, during another time of frustration, I decided to go to the 'big cheese,' Dr. Donald Klein, who's about 70 years old and is considered one of the top psychopharmacologists in the world; he's the one who originally hired Liebowitz and Hurowitz. I felt a bit uncomfortable with Klein, 'cause he was sort of cold and impersonable, but after two 3-hour sessions, he diagnosed me as 'bipolar-otherwise unspecified' (that stupid DSM definition), and he told me to go off of everything I was on (adderall XR, klonopin, Neurontin) and replace it all with Lithium. He then said I could either go to one of his 'lesser' doctors who he 'checks up' on now and then, or I can continue to see Dr. Hurowitz, who he said he hired with Dr. Leibowitz 'cause they're both such terrific doctors. So, I decided to just go back to Dr. Hurowitz and I'm still seeing him today. BTW, he also mentioned CBT, and he also said there's a therapist who he and Liebowitz work together with, and that she's really good, but I never got around to trying her 'cause I've had some really bad therapy nightmares in the past. Firstly, in terms of what you said about the pdoc referring to everything as signs of bipolar, and the stacking up of anti-convulsants and constant on/off of anti-depressants, experimentation with pstims,etc-all of this explains exactly what I've been going through since '95. Secondly, is this per chance the same doctor or are you referring to another Leibowitz. That would be hilarious if he's the same guy! That means we go to the same office! Anyway, please get back to me-even if it's not the same guy, I'm very interested in pursuing your solution, as it seems we've both gone through very similar stuff. Great to hear from you,
Peter
Posted by JonW on October 29, 2002, at 15:16:17
In reply to Re: OVERWHELMED!! » JonW, posted by Peter on October 29, 2002, at 12:20:33
LOL! Same guy, what a coincidence! :)
If you have never seen Dr. Liebowitz, I would recommend you schedule a consultation with him just to get his opinion. Dr. Hurowitz is a professional and shouldn't be offended by this in the least.
I've had some bad experiences with therapists, too. One guy I went to see once told me he could levitate a chair with his mind! I told him I'd come back if he could demonstrate that... needless to say, I never went back :) I really think you should consider seeing the therapist there, though (Carla Daichman). I have severe social phobia and atypical depression, and may fall in the bipolar spectrum. Working with the therapist along with Dr. Liebowitz has been very helpful. CBT + the right medication is more effective than either alone. It can bring you much closer to remission than either alone. My initial impression of the therapist was not very good, but that was mostly the result of my bias. I was so focused on medication and I took therapy as an insult to my intelligence. The truth is I was closed minded. If you're anything like me, I recommend giving it a few appointments. If you don't like her, have Dr. Liebowitz or Dr. Hurowitz find you someone else.
The other benefit to seeing a therapist is that they are typically more personable than pdocs and can provide you with the emotional support you may not get from your pdoc. My experience with researchers is that they're not the most personable people, but Dr. Liebowitz is somewhat of an exception. In addition to being good, he really does care and that's what makes him different. I do wish he were a little more like my therapist sometimes, but between the two of them it's the perfect combination. It's taken some time to get to know Dr. Liebowitz, and in the beginning I misinterpreted how quick and exact he was as being cold and uncaring. Now I get along with him very well and respect how good he really is. We even joke together and talk about unrelated things sometimes. He's very open to my input. He's willing to discuss anything. You might want to search the archives here and find others opinions of Dr. Liebowitz. When I asked for others opinions of him I got nothing but positive responses, in fact, one person compared him to a god. I think that's overstating it, but I certainly do recommend him. Anyway, think about it... and who knows, we may be in the waiting room together sometime and not even know it :)
Good Luck,
Jon
Posted by Peter on October 29, 2002, at 18:26:51
In reply to Re: OVERWHELMED!!, posted by JonW on October 29, 2002, at 15:16:17
> LOL! Same guy, what a coincidence! :)
> Wow! That's hilarious!
> If you have never seen Dr. Liebowitz, I would recommend you schedule a consultation with him just to get his opinion. Dr. Hurowitz is a professional and shouldn't be offended by this in the least.
> The only hesitation I have with doing that is that if I decide to get a 3rd opinion, I'd prefer this time to go to someone completely outside of the 'Klein, Liebowitz, Hurowitz' circle-to get a totally unbiased opinion.
> I've had some bad experiences with therapists, too. One guy I went to see once told me he could levitate a chair with his mind! I told him I'd come back if he could demonstrate that... needless to say, I never went back :) I really think you should consider seeing the therapist there, though (Carla Daichman). I have severe social phobia and atypical depression, and may fall in the bipolar spectrum. Working with the therapist along with Dr. Liebowitz has been very helpful. CBT + the right medication is more effective than either alone. It can bring you much closer to remission than either alone. My initial impression of the therapist was not very good, but that was mostly the result of my bias. I was so focused on medication and I took therapy as an insult to my intelligence. The truth is I was closed minded. If you're anything like me, I recommend giving it a few appointments. If you don't like her, have Dr. Liebowitz or Dr. Hurowitz find you someone else.
> I was going to a therapist for a few years until 2000, when I began to feel that the work we were doing was too intrusive-I mean, we all need SOME of our ego-defense mechanisms still intact! Everything was so deep and vague, trying to prod into all the layers of my sunconscience and blame all my problems on my upbringing. If I opt for another go at therapy, it would definitely be of the non-psychodynamic sort; something more constructive and practical-is this what CBT is like? I know the basic principles behind CBT, but I never really understood it; what does a typical session entail?
> The other benefit to seeing a therapist is that they are typically more personable than pdocs and can provide you with the emotional support you may not get from your pdoc. My experience with researchers is that they're not the most personable people, but Dr. Liebowitz is somewhat of an exception. In addition to being good, he really does care and that's what makes him different. I do wish he were a little more like my therapist sometimes, but between the two of them it's the perfect combination. It's taken some time to get to know Dr. Liebowitz, and in the beginning I misinterpreted how quick and exact he was as being cold and uncaring. Now I get along with him very well and respect how good he really is. We even joke together and talk about unrelated things sometimes. He's very open to my input. He's willing to discuss anything.
> That's great. It's actually what Dr. Hurowitz is like also. We joke around a lot, but he's highly professional and everyone, including Dr. Klein, etc, regards him as a great doctor. I don't know-maybe it would be ok to stick with him, but also go to the therapist he works with. Maybe the issue here is not so much that I don't have the right pdoc as it is that I don't have that other, emotionally supportive element that you said comes with this type of therapy.
You might want to search the archives here and find others opinions of Dr. Liebowitz. When I asked for others opinions of him I got nothing but positive responses, in fact, one person compared him to a god. I think that's overstating it, but I certainly do recommend him. Anyway, think about it... and who knows, we may be in the waiting room together sometime and not even know it :)
> Yeah, and I might end up going to the same therapist too!LOL
> Good Luck,
> Jon
>Thanks for everything,.
Peter
Posted by JonW on October 29, 2002, at 21:56:51
In reply to Re: OVERWHELMED!! » JonW, posted by Peter on October 29, 2002, at 18:26:51
> > I was going to a therapist for a few years until 2000, when I began to feel that the work we were doing was too intrusive-I mean, we all need SOME of our ego-defense mechanisms still intact! Everything was so deep and vague, trying to prod into all the layers of my sunconscience and blame all my problems on my upbringing. If I opt for another go at therapy, it would definitely be of the non-psychodynamic sort; something more constructive and practical-is this what CBT is like? I know the basic principles behind CBT, but I never really understood it; what does a typical session entail?
I would presume Dr. Hurowitz is a great doctor, and I think you have a good idea to start going to the therapist. Therapy with a CBT therapist is nothing like the previous experiences with therapy you've described. A session is basically spent going through the situations during the previous week that provoked anxiety or depression or whatever. You may do CBT with the therapist which is identifying the negative thoughts and distortions, doing the disputation for those thoughts, and formulating positive rational responses. I read "Feeling Good" and thought I was more than qualified to do CBT on my own. But doing it with a therapist and doing it alone is like night and day. It turned out I wasn't doing the disputation and all of my rational responses were negative statements. Adding the disputation and learning how to formulate better rational responses has made a huge difference. You set goals each week, and set out to achieve them. You need someone to push you but not push too hard. You can bitch about things and challenge the therapist. I've yet to stump mine... It focuses less (if at all) on explaining what may have caused your irrational thoughts, and more on correcting those things and working toward achieving what you have been unable to in the past. You should be sure your pdoc thinks you're ready for CBT. The other advantage of working with a therapist who works with your pdoc is that she always asks how my medication is going and what reactions I'm having to this and that. She observes me over time and gives feedback to my pdoc to help him with the meds, etc. Hope things work out for you!
Jon
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