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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by babs on February 14, 2003, at 17:50:38
Sorry, this is long...I'm thinking about getting a second opinion. I've seen my current pdoc for about 14 years and I love him but lately I've been having medication issues. I was on imipramine for eleven years- worked well on depression but still had some residula anxiety (I refused to take a benzo- I was terrified of addiction). Imipramine did nothing for my obsessions which progressively got worse. Switched to prozac- horrible, so tense and activated I could barely eat. Switched to celexa. Better. Worked for depression but my reaction was incomplete- still had irritability, obsessions and really bad PMS. Added Neurontin- worked ok but pooped out pretty fast. Switched to risperdal which works great- but I gained 60 pounds! Meanwhile, realized celexa (60 mg) was making me completely ADD so added adderall once a day 15 mg. Tried to switch from celexa to lexapro- horrible, physically ill. Back to celexa. Tried to switch from risperdal to geodon, horrible reaction- suicidal ideations and horrible anxiety. Back to risperdal (2mg per day). Pdoc added topamax yesterday for weight (will get up to 50 mg).
I feel like a walking pharmacy. I'm on 4 drugs for unipolar depression, GAD, OCD and ADD (wouldn't need to be on an ADD drug if I wasn't on an SSRI but I guess that works out nicely, numerically anyway). I've been thinking about getting a second opinion about my meds. Don't want to insult my pdoc. Also wondering how one goes about finding a good psychopharmacologist. I'm in the Boston area so I have access to Mass General and McLean's but what do you do? Just call them and say I want an appointment? Thanks in advance, babs
Posted by stjames on February 14, 2003, at 18:09:07
In reply to when and how to get a second opinion?, posted by babs on February 14, 2003, at 17:50:38
Seems like you have chosen to avoid the very meds that is best for anxiety, so I do not see how
another consult would make things better.
Posted by babs on February 14, 2003, at 19:02:29
In reply to Re: when and how to get a second opinion?, posted by stjames on February 14, 2003, at 18:09:07
I did want to avoid benzos in the past (which is actually typical of someone with anxiety- because they are afraid of addiction) but I would have no problem with them now. However, I don't think they would do much for my obsessions which is the real issue. My obsessions (off the risperdal anyway) are pretty bad.
Posted by jumpy on February 14, 2003, at 19:28:29
In reply to when and how to get a second opinion?, posted by babs on February 14, 2003, at 17:50:38
>Imipramine did nothing for my obsessions which progressively got worse.
How about clomipramine?
>Mass General and McLean's but what do you do? Just call them and say I want an appointment?
Hey, my father just drove up into McLean's and Dr Johnathan Cole was sitting at the front desk! Dr Cole just sitting there ... unbelievable. He told my father to come back in the morning and he would fix him up. And he did.
Jumpy
Posted by stjames on February 14, 2003, at 21:17:27
In reply to Re: when and how to get a second opinion?, posted by babs on February 14, 2003, at 19:02:29
However, I don't think they would do much for my obsessions which is the real issue. My obsessions (off the risperdal anyway) are pretty bad.
I am sorry to hear that (the bad obsessions).
I still think benzos would work, and think it is always a bad idea to rule out something without trying it. A few days on a benzo is not going to get you addicted, but a few day would allow you to see it they would work. Benzos are the prototype drugs for anxiety, OCD is an anxiety disorder. Risperdal carries far more risk that a benzo.
Posted by Thomas123 on February 14, 2003, at 21:25:31
In reply to when and how to get a second opinion?, posted by babs on February 14, 2003, at 17:50:38
I think you are on kind of a strange combination. The Risperdal and the Adderall are antagonistic. One is a dopamine antagonist and the other is dopamine agonist. You take Topomax because you gain weight on the Risperdal. Seems like Risperdal is the problem. I think there is little weight gain with Abilify. If you could switch to Abilify perhaps you could get off the Topomax. So then you are then down to three drugs. Abilify is a weak dopamine agonist so there might be less interreaction with the Adderall. Of course this all depends on Abilfy working. I once saw a psychopharmacologist of national renown and he was the worst doctor I have ever seen. So basically I have been unhelpful here. I have no idea what you should do.
Posted by Phil on February 14, 2003, at 22:00:44
In reply to Re: when and how to get a second opinion?, posted by babs on February 14, 2003, at 19:02:29
Benzos are like laser guided missles. They go right to the problem, fix it, and don't disturb anything but the target.
My anxiety ridden self-talk used to be so noisy, I would actually yell shut-up to myself. Nobody around, just me trying to quiet the talk. Benzos took that away immediately. Out of 37 psych drugs I've taken, Klonopin rules.
Like James said, try one for a few days.Phil
Posted by stjames on February 14, 2003, at 22:48:52
In reply to when and how to get a second opinion?, posted by babs on February 14, 2003, at 17:50:38
risperdal or any AP carries a real risk of perm.
movement disorders. Almost no one, who has been on AP's long term, is free of TD, EPS, or another movement disorder. Long term here is 10 or more years; the new APs have not been around this long.If you are taking risperdal for anxiety, you should consider something less risky to treat
this condition.
AP's are fine if you are psychotic or have something nothing else will treat. Almost
all main stream psycomeds carry less risk than APs.I would say add a benzo and then withdraw the risperdal. Get yourself stable. For me, the anxiety has to be controled or it will build.
It also tends to feed itself. Once things are better review your other meds with your doc and decide what you need.Mental Illness is a big deal, do not be afraid
and ashamed of taking what you need to get well
or be stable. Discuss this wih you doc, of course.You seem to like your doc and he is willing to perscribe all the standard psyco meds. Many on this list seem to want for that ! I would say put
the ball in his corner. Tell him your meds are not working and you need help now.If it were me I would go back to what worked, imipramine, and add a benzo. All of this need to be done correctly
and being one a benzo is the only way to change
meds without a big to do. 23 years on meds have
taught me it is better for me and everyone else if
I take a benzo while adjusting my meds.If you liked imipramine, Remeron is much the same
with, for me, less side effects. Gone are the
anticolinergic effects, but it still feels like a TCA.
Posted by viridis on February 15, 2003, at 14:06:08
In reply to Re: when and how to get a second opinion?, posted by stjames on February 14, 2003, at 22:48:52
I'll just second (third?) the suggestion that you try a benzo and see if it helps. You might be surprised. Klonopin is best for me and many others here. You should feel it right away, and although initially side effects like sleepiness and lack of coordination may occur, for me these disappeared very quickly.
I don't have OCD, but I do have obsessive tendencies, and Klonopin helps a great deal. My sister has been diagnosed with OCD -- not really severe, and it comes and goes. She finds Xanax (another benzo) very helpful when she's in an obsessive phase. I respond well to Xanax too, and use it occasionally for very stressful situations, along with Klonopin.
Benzos are excellent drugs for many, and very safe.
Posted by babs on February 15, 2003, at 18:48:08
In reply to Re: when and how to get a second opinion?, posted by viridis on February 15, 2003, at 14:06:08
thanks- you have all given me something to consider! May I ask how benzos work on obsessions? Do they just relieve the anxiety that accompanies them? I would definitely prefer to be on something like klonopin rather than an atypical. I've been on risperdal for two years and that concerns me. Thanks again for all your input. babs
Posted by viridis on February 15, 2003, at 22:26:14
In reply to Re: when and how to get a second opinion?, posted by babs on February 15, 2003, at 18:48:08
Hi Babs,
I don't have a diagnosis of OCD, so I can't relate to the extreme form of this disorder, but I definitely have a tendency to become hyperfocused on particular problems. Whether this causes my episodes of extreme anxiety and depression, or is just a manifestation of these conditions, isn't clear. However, without benzos, I go through periods of severe worry and depression that often revolve around issues that are real, yet aren't worth allowing to dominate my thoughts. I torment myself with all the "what ifs" -- if this happened, then this might happen, which would cause this... etc. etc.
None of this is psychotic, since the problems that I obsess about are real and concrete -- it just isn't worth the mental energy I expend on them. I recognize this, yet I just can't seem to let go.
With benzos, I can let go: I can look at the situation more rationally and say, OK, there's a problem; now how do I solve it? Or, if it's relatively trivial, I can choose to ignore it because the chances of it escalating to anything worse are small.
For me, benzos aren't "dulling" or "tranquilizing" (as many people imagine these drugs to be); they just let me step back and focus my energy on the positives more than the negatives. And, I do feel more relaxed, but certainly not drugged -- just more upbeat and effective.
Posted by zippy on February 16, 2003, at 7:15:32
In reply to when and how to get a second opinion?, posted by babs on February 14, 2003, at 17:50:38
It's seems your entire focus is on finding the right combination of medications to relieve your symptoms. Who is the human underlying this alphabet soup of psychiatric nomenclature?! It sounds like your pdoc is using a reasonable psychopharm approach, though I would tend to agree that you may be overmedicated. If you haven't received some psychotherapy such as a cognitive/behavioral approach, give it some consideration. Outcome studies on OCD for example, suggest that medication alone is woefully inadequate and that best results are seen with combination therapy. Putting it in more concrete terms, you may be focusing too much on the medication issue, which may be only 50% of the solution. Even if your medications are optimized to the best possible outcome, your treatment may fail, without addressing other factors (e.g. psychotherapy, lifestyle changes, etc). I certainly don't intend to insult your intelligence with this suggestion and recognize that this is psychopharm bulletin board, but the only treatment that you mentioned for query was related to your medication regimen. I wish you well.
Posted by babs on February 16, 2003, at 9:03:59
In reply to Re: when and how to get a second opinion?, posted by zippy on February 16, 2003, at 7:15:32
Hi Zippy- I have done quite a bit of psychotherapy and it has helped immensely. I'm just concerned that I'm overmedicated and I'm mostly concerned about the 60 pounds I gained on the risperdal. But the more I think about it, I realize that this combination of meds (celexa, risperdal and adderall) is the best I've ever felt. I decided against the topamax (made me irritable and unable to concentrate)so I guess I'm going to try to do it the old fashioned way- through diet and exercise. Thanks for your input- maybe I am looking for that magic combination and I actually have it.
Posted by judy1 on February 16, 2003, at 12:04:27
In reply to Re: when and how to get a second opinion? » zippy, posted by babs on February 16, 2003, at 9:03:59
I'm going to add another vote to James and Phil, you are over-medicated and could probably be on klonopin or xanax and resolve your symptoms. At one point I was on a 6 med cocktail (and a walking zombie) until my present pdoc tapered me off my meds to just a benzo and (I have bipolar and panic disorders) meds prn when I have symptoms of mania. Do you have insurance? I called a list the insurance co. provided and spoke (by phone) to perhaps 6 doctors who all believed in a polypharmaceutical approach until I found my present pdoc (who isn't on my insurance)- I just did a search for specialists in anxiety disorders. I also spoke to him on the phone first and got such a positive feeling that I drove 100 miles to see him (and still do 3 years later). I really like the phone interview, most reputable pdocs will talk to you for 10 minutes on the phone and you can ask some pertinent questions and get a feel for them. The ones that won't talk are the ones who spend 10 minutes with a patient and prescribe 6 drugs and don't have time to talk to you because they are seeing 4 patients/hour. How can someone like that possibly help anyone? (I have lots of issues with pdocs:-). anyway, you are going to need help to taper off of your meds and a good relationship with a pdoc to do that. I wish you all the best- judy
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