![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by MaryZee on February 19, 2003, at 21:42:38
This might be long. I am feeling very disallusioned right now. I have been reading these posts for about 5 or 6 weeks. It's so sad that I didn't find this site sooner. For about 30 years I suffered with horrible panic attacks, eventually they progressed to terrible anxiety and depression. The only thing any doctor did was put me on valium. When I developed migraines a neurologist put me on Prozac - specifically for the headaches. To my total suprise within months I was free of the panic attacks!! I could go on an elevator, drive over a bridge, be comfortable without being within ten minutes of a hospital emergency room!! I was only told that the med was for headaches. That was my into to SSRI's (is that what Prozac is - I am assuming from what I have been reading here - that is how uninformed I was and still am - I am working this out by myself). I will always be grateful for the relief that Prozac gave me. However, until reading posts here I never connected any of the physical problems I began to develop to the Prozac. Over time I developed even worse heart palpitations than I had with the panic attacks. Then vertigo started. For one three month period I could not even drive because of the dizziness.
Then the terrible heartburn. Along came terrible confusion in stores - everything "blurred" and I couldn't concentrate. And the sweating. I would go to a mall and, along with the confusion, started sweating horribly - would be sopping wet when I left the stores. Also, my muscles became so tight that I developed "shakes" to the point that I thought I had parkinsons. And my neck and jaw were always tight. I ground my teeth so bad they are worn down. Whenever I would mention any of these things to a doctor I was just given more medication. More valium for the heart palpitations. Antivert for the vertigo. Skelaxin for the muscle pain. Prevacid for the acid reflux. And then the Premarin from the OBGYN after my hysterectomy. And then Pravacol for the high cholerestoral - I craved sweets and carbs so bad it was unbelievable - and gained 40 lbs. All this over a period of years I want to make clear.
No one ever mentioned any side effects - in retrospect I was stupid for not questionning more. Then a few months ago the good effects of the Prozac stopped - it happened after I was switched from the daily dose to the once a week time released pill. I do believe that made a difference but why a time released capsule would not work as well I do not know. To make this very long story shorter if I can - when I told the doctor that the Prozac was not working he put me on Lexapro (l0 mg) and took me off the Prozac. The Lexapro for me was horrible! I took it for 18 days and could not tolerate the side effects. I have since weaned myself off every pill I possibly can - and hope to get off every pill I can! No more Prozac, Lexapro, Antivert,
Premarin, Skelaxin, Valium. Am still taking the
Prevacid for my acid reflux and the Pravacal for the cholersteral. But will get off of them too!
I cannot believe how naive I was and how the doctors didn't tell me that one pill would cause a problem requiring another pill, and on and on and on. How do I feel today? It's not been three weeks yet since I've been off all that stuff (18 days). I don't feel good. I am "shakey" inside, anxious and having trouble sleeping at night - but am very tired during the day. But the palpitations are better and so is the vertigo - better but not gone. Also the sweating and constant thirst is better. I just hope that everyone out there is paying better attention to side effects than I did!! Sometimes the cure is worse than the disease. Any help or suggestions would be so appreciated. I am feeling scared and disallusioned :( Thank you to anyone who takes the time to read this - I greatly appreciate it.
Posted by shar on February 19, 2003, at 23:49:12
In reply to Why didn't anyone tell me???????, posted by MaryZee on February 19, 2003, at 21:42:38
I think many (most?) people here have felt very much what the title of your post reflects. Certainly, feeling betrayed by the medical system is appropriate given your experience. I think one reason this place is so active is that so many of us have learned we have to work in concert with docs to get good care....even if they don't want us to.
There is no celebration (usually) when patients begin to educate themselves. One good thing that can happen, is that we end up leaving docs who won't or can't answer questions, and finding docs who will work with us as, if not equals, then equivalents (at least considering our input).
It does require a lot of self-education and study, as you've found out. And, this forum (past and present posts) is a terrific resource. I wish you good luck.
One word of caution, if you're dropping your meds you may want to also be consulting with some doc who knows a bit about it. I know with AD's, stopping suddenly (and, with Effexor, even titrating down for weeks) can have very unpleasant results. With some meds, even life-threatening results.
Take care. If you search archives on this site you can probably find just about anything you're looking for.
Shar
Posted by Gracie2 on February 20, 2003, at 0:11:54
In reply to Why didn't anyone tell me???????, posted by MaryZee on February 19, 2003, at 21:42:38
Bless your heart. My dear you need help, and this is the kind of help you need:
1.) A good general practitioner
2.) A good psychiatrist
3.) A good therapist
First, you need a complete exam, bloodwork and everything, by a caring and competent doctor to rule out any physical reasons for your symptoms.
Once you have a clean bill of health, or have started treatment for any physical problems you may have, it is time to consider psychiatric medication.You're probably thinking, "But I've already done all this, and I just ended up over-medicated and worse off than when I started!" The trick is, you have to start over, and this time you have to do it right.
Doctors are just like other people in every other profession. There are really good ones, and not-so-good ones. Some doctors are stressed out, overworked, bored, uncaring, relatively inexperienced, or just not very good at what they do. There's an old joke in the medical profession: "What do you call the guy who graduated last in his class at medical school?"
The answer, of course, is "Doctor".So your first job is to find two doctors, a GP and a psychiatrist, whom you trust absolutely. You must feel safe in their hands. If you believe that a doctor is not listening to you, if the examination he gives you is not thorough or the treatment he orders is questionable, you must move on to the next doctor. This doesn't make you a hypochrondriac and it doesn't mean you're neurotic. It means that you're serious about wanting to feel better. If you don't know where to start, ask around...ask your friends, your relatives, if they have a doctor that they just love. This will usually bring you better results than just picking someone out of the phone book.
Next, these two doctors have to be in sync. Each of them must know exactly what medications the other doctor is prescribing.
Next, you have to be totally compliant with the doctor's orders. Don't skip appointments. Don't fool with your medications. If you have trouble with side effects, discuss this with your doctor, but don't stop or start taking a drug or attempt to adjust the dosage without medical advice. Believe me, you'll only sabotage your own recovery. I know this for a fact, because I did it myself for years. It is painful to think about how long I delayed my diagnosis and treatment by disregarding my doctor's orders.
At this point, you will be well on your way to feeling better. However, you still need a good therapist. Don't confuse therapy with analysis...
analysis can be painful. A good therapist is wonderful! Here is a person who will listen to your problems, help you cope and give you the support you need to get through the rough patches.
Your psychiatrist can recommend a therapist for you.I guarantee that this will work for you.
Good luck-
Gracie
Posted by missliz on February 20, 2003, at 3:01:04
In reply to Re: Why didn't anyone tell me???????, posted by Gracie2 on February 20, 2003, at 0:11:54
A lot of what you describe as Prozac side effects sounds to me like worsening anxiety disorder. My personal opinion is that SSRIs are wretched for anxiety- they don't do much for depression either. Prozac is notorious for just sitting down and quitting. Gracie2 is right about doctors, and you need new ones who are up on contemporary treatment. There is a new idea that severe anxiety disorders are a "slow seizure" thing, they think the same about bipolar. I have the same stuff as you do and take an anti seizure drug called Trileptal. It stops a lot of the worst symptoms, I still use a low dose of Valium but the GERD, the shakes, palpitations are all anxiety/panic stuff.
Check out < www.algy.com/pdi > This is a site belonging to a doctor specialized in panic and I think you'll find it enlightening. I did. Read all the FAQs.
For gods sakes, get a decent doctor. You've really been jerked around. You can get much better.missliz
Posted by MaryZee on February 21, 2003, at 0:42:12
In reply to Why didn't anyone tell me???????, posted by MaryZee on February 19, 2003, at 21:42:38
I want to thank Shar, Missliz and especially Gracie 2. Your replies to my post really have helped me. I have decided to get a new doctor (my inernist has been prescribing all the med's except the Previcid - after the neurologist first prescribed the Prozac the Internist took over).
I am going to start over from square one. I'm going to take all the pills I have been on to the new doctor - and see what he says. Mentally I feel so so. But better than when on all those meds. Physically I feel miserable. Was so "shaky" today I broke down and took one 5mg Valium. Also had a "mild" panic attack today.
I'm going to really lay it all on the line with the new doctor! Tell him to inform me of any and all side effects if he wants me to take any meds!
Also will have him refer me to a therapist. Is a counselor the same as a therapist? I was in counseling for a year and a half after my sister, my best friend, died from breast cancer three years ago (my younger sister, also my best friend,
is in remission from it now) There was only the three of us. We were exceptionally close, having lost our mother when we were very young (I was six). Lost our father over 25 years ago. Older sister was 56 when she died. I'm getting off the subject here! You get the picture - lots of stress and pain. Anyhow! Thank you all for taking the time to read my post. I so want to feel better. I'm just very, very tired.
Posted by Dysfunk on February 23, 2003, at 12:32:12
In reply to Re: Why didn't anyone tell me???????, posted by MaryZee on February 21, 2003, at 0:42:12
I think the other posts have stated a lot of advice I would give.I want to add a few comments.(First let me say that I am very tired today and I am not feeling too articulate, bear with me. I just increased my Lexapro and had a second night of vidid dreams and a restless sleep). That said.....
I feel US medical treatment is horrendous. I am lucky if I can get all my questions in during a regular doctor's visit cause he is only allowed 7 minutes with me due to my health plan. I don't think general doctors or internists are as knowledgeable about psychotropic drugs and their interactions and side effects as they should be. I don't think doctors can even agree on a treatment.When my doctor went on maternity leave the covering doctor had a conflicting treatment to the one I had been following for years, and when my doctor returned,she changed it back.
We are dealing with arrogant personalities, some of which don't want to admit they are wrong -at least that has been my experience in NYC. I feel our best defense is to take matters into our own hands and if we feel something isn't right,question it! We can do our own research...we have the internet now and I find it enormously helpful.
Good Luck Mary Zee, and don't give up til you feel satisf(PS, I don't think you should rid yourself of all drugs. Concentrate on the symptoms that are worse for you).-dysf
Posted by MaryZee on February 23, 2003, at 13:05:41
In reply to Re: Why didn't anyone tell me??????? » MaryZee, posted by Dysfunk on February 23, 2003, at 12:32:12
Thank you dysfunk. Agree with you about doctors.
Have really lost my faith in them. And I really like my doctor! But that doesn't necessarily mean he is right! I am going to go to another one and start over. Getting off the med's I did has been hard. I still don't feel good. The thing I am experiencing most is that I no longer have that "I don't care", "Nothing bothers me" feeling. My emotions are back - but not sure that is a bad thing! I'm just trying to keep them in check - some things are upsetting - I have to focus on what I'm feeling and why. And try to not overreact. Not sure this makes any sense. Had a very stressful past week (family problems) and did break down and take one valium three days in a row. Was disappointed in myself. And you know what happened? The vertigo that was starting to get better got worse the second day I took a valium!! What does that tell me?? I think the valium had been causing the vertigo for years! Or, does the stress cause the vertigo?
Either way, I'm not taking the antivert - sure there must be a side effect to that too!! Am still off all of the other med's I mentioned in my original post! I am happy about that. Again, thank you for your time. I hope that you are feeling better soon. Glad you can take the Lex.
I could not function on it. Let us know if it keeps working for you! Oh! One more thing. Don't you just love it when one doctor has you on a med's program and then when that doctor is not available another one comes in and switches it??
Then your primary doctor comes back and switches it back! I have had that experience also. Did you get any answers when you questioned this? I sure didn't!! Again, don't think any of them really know what they are doing!!!!
Posted by Gracie2 on February 23, 2003, at 14:28:08
In reply to Re: Why didn't anyone tell me???????, posted by Gracie2 on February 20, 2003, at 0:11:54
The effects of psychiatric medications need to be monitered by a psychiatrist at intervals determined by your psychiatrist. These are powerful drugs and fooling around with them can have devastating consequences; confusion, memory loss, insomnia, psychosis, severe depression, anxiety, agitation, paranoia. To keep switching psychiatric medications throws the chemicals and neurotransmitters in your brain into utter turmoil. Accept psych meds from a psychiatrist only, follow his instructions and don't skip appointments. Very important!
-Gracie
Posted by MaryZee on February 23, 2003, at 22:41:14
In reply to Take psych meds from a pyschiatrist ONLY, posted by Gracie2 on February 23, 2003, at 14:28:08
Thank you Gracie. Would you mind answering a few questions for me? Is valium a psych drug? How do you find a good psychiatrist? When my siser died of breast cancer 3 l/2 years ago (she, along with my other sister - my only siblings - was my best friend)I went into counseling. My living sister is in remission from stage III breast cancer - she had it when the other sister died - to say it was horrible is an understatement. The one who died was living with my husband and me -
sort of like hospice, after she had to give up her place and her job. Anyhow, when I started counseling I was on the Prozac. The counselor knew and put it in her report. A pyschiatrist, whose job was to go from clinic to clinic and check on the patients and their meds once every six months, saw me once for about ten minutes in the entire year and a half. He barely said anything, checked my file, and that was that!! He was totally useless!! I told my counselor that. She just "looked" at me - knew she thought so too. Wish I had such an easy job. I told him about the Prozac, all my symptoms, etc. Nothing. Just said "fine" and that was that!! I don't know how to get a good pyschiatrist. Would going back for counseling, and not taking any meds, be o.k.? I know I must sound like a basketcase - maybe I am. But inspite of how I sound, I am intelligent, try hard and do want to feel better! I know there is more stress and heartache ahead of me. It's a given. I want to be able to handle it better than I did when my first sister died. My mother died when I was six and my father turned into an alcoholic after that.Think that's when all the stress started and it didn't catch up to me until I was in my twenties and started getting those panic attacks.
Thank God I have a great husband - though he doesn't really understand all the time. He is worried that I stopped all the med's. I didn't have children - probably a good thing. Wouldn't want to pass this stuff on to another person.
Insurance will not pay for the counseling - we made sacrifices so I could go when I did. Correction - it paid part of it. Don't know if is would pay for a pyschciatrist. I plan on starting with a new Internist and a good physical, does that sound right? Seeing my current Internist tomorrow morning and am going to let him know that I stopped all the med's he had me on. That should be interesting. I don't think I should get a name of a psychiatrist from him, do you? Well, I'm in my fifties and still don't have anything figured out. Have felt sick for thirty years - can stand it a little longer!
Thank you so much for reading my posts. It really helps and I am trying to take your advise. I hope you are feeling well! You sound like such a kind, "together" person! One who really cares about others. God Bless. to
Posted by Gracie2 on February 24, 2003, at 14:22:08
In reply to Re: Take psych meds from a pyschiatrist ONLY, posted by MaryZee on February 23, 2003, at 22:41:14
MaryZee-
I know exactly what you're going through because I went through it myself, only I was much worse!
I was hospitalized 3 times in 3 years - the first time, the police showed up at my door and escorted me to the hospital after I called 911 to ask for the number to a suicide hotline. Spent a couple of weeks in the psych ward and was started on psychiatric medication.Well, it didn't work. I was under a lot of stress-
working at a job that I hated and where everyone knew I had been hospitalized for mental problems, so I felt like a freak. Even worse, my marriage was going to hell. Worst of all, I was helping my cousins take care of my aunt, who was dying at home with colon cancer. I loved this aunt dearly, she had been more of a mother to me than my own mother, and watching her deteriorate was just torture. I would shut myself in her bathroom and cry into a washcloth so she couldn't hear me. Then I would manage to pull myself together enough to go back and take care of her. After dementia set in, she couldn't be left alone for any length of time.So I understand what you went through with your sister. I know it's terribly painful. I don't know why we're required to go through these events, what purpose there is to suffering, but we have to get through it the best we can.
For a long time I didn't handle it too well. After my aunt died, I cleaned up her bedroom, and I took home some valium and painkillers that were in her bathroom. I told myself that it would help me get through her funeral, and knock out some of my own pain for awhile. I was also taking pretty heavy doses of psychiatric medications, and eventually the inevitable happened. I collapsed at home with drug-induced seizures, woke up looking at a paramedic. Back to the hospital, where I stayed for a few days while they ran tests. Surprisingly, they just let me go home with a prescription for Dilantin to prevent seizures. That was it. I had scared myself pretty good, though, so I threw away all the drugs I was taking.I figured the drugs were my biggest problem, so I would be alright once I was drug-free.
As it turned out, the drugs were not my biggest problem, the drugging and the drinking were symptoms. Oh yeah, I was drinking too, forgot to mention that. My biggest problem was the brain disorder that was causing these symptoms, so even without drugs I continued to crack up. I couldn't sleep, the insomnia was unremitting. Without sleep, my mental condition steadily deteriorated.
I began having panic attacks, would cry uncontrollably, started to isolate myself from the world. I had to quit working because I couldn't function. I wouldn't answer the door or pick up the phone. I became psychotic, and would do bizarre and dangerous things. Finally, a year ago, I hit bottom. After staying up and drinking all night, I decided to kill myself. I had some Seroquel and some Xanax, and I took all those along with every other pill I could find in the house. Apparently I took over 50 pills.My husband found me in time and rushed me to the hospital. They pumped my stomach, and I woke up a couple of days later in ICU. I was bitterly disappointed to find myself still alive. Spent another week in the psychiatric ward, then home again.
The reason I'm telling you all this is to show you how far I've come since that dark and dreadful time, to let you know what the right medication can do for you. Once I was correctly diagnosed with manic depression, my bipolar symptoms slooooowly began to improve with Seroquel, an anti-psychotic. I began to sleep at night. My anxiety level went down and the panic attacks stopped. I was still somewhat depressed, but Paxil helped to clean that up. I no longer spend my days holed up in my bedroom, I'm back to doing stuff that I used to enjoy but had lost interest in - specifically, writing and painting. I no longer think about killing or hurting myself. Sometimes I even laugh.
Not that there's a lot to laugh about these days.
I'm facing an impending separation from my husband
of 20 years. Even though he can see that I'm improving, I guess that all the trauma and bullshit I put him through was just too much for him, and he's pretty much lost interest in me. I believe there's another woman, although he denies it. I may be crazy, but I'm not stupid.Anyway, I'm seeing a really good therapist, and she will help me get through this. I feel so good after I talk to her, she bolsters my self-confidence and gives me advice - and knowledge is power. That's why I so strongly recommend a therapist, because a psychiatrist will not do this for you. A psychiatrist is pretty much concerned with monitering the effects of the medication that he prescribes for you, he doesn't really want to hear about your husband or your kids or your cat. A therapist does.
Okay, back to you! I'm happy to hear that you've scheduled an appointment with your internist. A lot of your symptoms could be either physical or mental in origin, so you have to rule out the physical stuff first. For instance, starting in my 30s, I began to have constant headaches. At first I thought that it must just be stress, that they were tension headaches. Finally, the headaches got so bad, I was afraid that I had a brain tumor or something. I finally went to the doctor, and the first thing he discovered was that I had high blood pressure. Of course, this is still a serious condition, but it's better than a brain tumor if you ask me. After my blood pressure was stabalized with medication, the headaches went away.
After you get a complete physical, then you need to find a good psychiatrist. It would be best if you could find one that accepts your medical insurance plan. You can pay for it yourself but it's expensive, around $50 to $80 for a 15-minute visit. So find the book from your insurance company that lists the medical providers in your city who will accept that insurance.
Ask your internist if he can recommend a good psychiatrist. If not, and if you don't know anyone else who's seeing a psychiatrist that they would heartily recommend (I bet it's more common than we think), you might have to just start with any psychiatrist who accepts your insurance plan, who is fairly close to where you live, and who can get you in for an appointment fairly soon. I had to do this myself recently after my old psychiatrist bugged out on me, and it did take some calling around before I found a doctor who was accepting new patients right away. So don't get discouraged, just keep going down the list in your insurance provider manual until you find somebody.
After that, you just have to visit him (substitute "her" if appropriate) for awhile to see what you think of him, there's no other way. If he seems competent and compassionate, I would stick with him. If he doesn't, move on to the next doctor. Going through this process is a pain, but once you find the right doctor for you,
it's all worth it.My God, I'm writing a book here. About the valium-
I believe all benzodiazepenes are considered psychiatric medications, but valium is only a "quick-fix" that can be dangerous for long-term use because of its addictive qualities. In the hands of a person like myself who has difficulty with moderation control, it's probably not a good idea at all. But if you can use it responsibly yourself - taking only what you need, only when you really need it - then you might want to keep an emergency supply until you start feeling better.Have courage!
-Gracie
Posted by ace on February 24, 2003, at 23:37:21
In reply to Take psych meds from a pyschiatrist ONLY, posted by Gracie2 on February 23, 2003, at 14:28:08
>
> The effects of psychiatric medications need to be monitered by a psychiatrist at intervals determined by your psychiatrist. These are powerful drugs and fooling around with them can have devastating consequences; confusion, memory loss, insomnia, psychosis, severe depression, anxiety, agitation, paranoia. To keep switching psychiatric medications throws the chemicals and neurotransmitters in your brain into utter turmoil. Accept psych meds from a psychiatrist only, follow his instructions and don't skip appointments. Very important!
> -GracieJust remember, family doctors also deal with these drugs -- they also know vast amounts of knowledge about them and also have psychiatric patients. I think using a family doctor for psychiatric treatment is a very viable option.
I have seen family doctors who are actually better at dispensing psych meds and in some areas know more on psych diagnosis and symptoms than psychiatrists. A lot of people with psychiatric probs DO NOT need to see a pdoc, they can explain their symptoms and be medicated from a normal doc. In fact, a lot of people have been mistreated and misdiagnosed hundreds of times by pdocs and have finally gotten some treatments from a caring family doc.Ace.
Posted by Gracie2 on February 25, 2003, at 2:06:56
In reply to Re: Take psych meds from a DOCTOR only » Gracie2, posted by ace on February 24, 2003, at 23:37:21
Posted by viridis on February 25, 2003, at 11:56:39
In reply to Re: Take psych meds from a DOCTOR only » Gracie2, posted by ace on February 24, 2003, at 23:37:21
There's so much variation among doctors -- both GPs and psychiatrists -- that it's hard to predict who will provide the best treatment. I do think, though, that the chances are greater that a psychiatrist will try schedule II drugs, combinations, unorthodox treatments, etc. (at least based on my limited experience).
If you're lucky enough to respond to "standard" treatments like SSRI monotherapy etc., it probably doesn't matter much which kind of doctor you see, and then it's just a matter of finding someone sensible and compassionate, and probably some trial and error. But if you require something a little more risky (or perceived as such) -- say, long-term benzo or stimulant therapy, a somewhat complex combo, and so on -- then the chances are that a psychiatrist will be more willing to try it. After all, they are specialists, whereas GPs by definition have more general training and have to deal with a huge range of conditions, so few have time to learn the ins and outs of psychiatric meds in particular.
That doesn't mean that all psychiatrists are good (I've seen some who were terrible), but I'd put my money/time on them, even if you have to see several before you find one you connect with.
Posted by shar on February 26, 2003, at 1:55:47
In reply to Re: Take psych meds from a DOCTOR only, posted by viridis on February 25, 2003, at 11:56:39
Good points, V. I agree that in the more simple cases, family docs might be ok. But, if one is treatment resistant or needs something more complex, a pdoc is a better bet. There are so many psychotropic meds, and so many meds used for things they weren't originally designed for, I don't see how a GP would be able to keep up with all of that PLUS everything else he or she sees in their practice.
Shar
> There's so much variation among doctors -- both GPs and psychiatrists -- that it's hard to predict who will provide the best treatment. I do think, though, that the chances are greater that a psychiatrist will try schedule II drugs, combinations, unorthodox treatments, etc. (at least based on my limited experience).
>
> If you're lucky enough to respond to "standard" treatments like SSRI monotherapy etc., it probably doesn't matter much which kind of doctor you see, and then it's just a matter of finding someone sensible and compassionate, and probably some trial and error. But if you require something a little more risky (or perceived as such) -- say, long-term benzo or stimulant therapy, a somewhat complex combo, and so on -- then the chances are that a psychiatrist will be more willing to try it. After all, they are specialists, whereas GPs by definition have more general training and have to deal with a huge range of conditions, so few have time to learn the ins and outs of psychiatric meds in particular.
>
> That doesn't mean that all psychiatrists are good (I've seen some who were terrible), but I'd put my money/time on them, even if you have to see several before you find one you connect with.
Posted by stjames on February 26, 2003, at 10:52:24
In reply to Re: Take psych meds from a DOCTOR only, posted by shar on February 26, 2003, at 1:55:47
> Good points, V. I agree that in the more simple cases, family docs might be ok. But, if one is treatment resistant or needs something more complex, a pdoc is a better bet. There are so many psychotropic meds, and so many meds used for things they weren't originally designed for, I don't see how a GP would be able to keep up with all of that PLUS everything else he or she sees in their practice.
I have to disagree. Unless the problem is short term, GP receive no training in mental illness
so they are not the ones to give long term treatment.
Posted by ace on February 26, 2003, at 19:28:51
In reply to Re: Take psych meds from a DOCTOR only, posted by viridis on February 25, 2003, at 11:56:39
> There's so much variation among doctors -- both GPs and psychiatrists -- that it's hard to predict who will provide the best treatment. I do think, though, that the chances are greater that a psychiatrist will try schedule II drugs, combinations, unorthodox treatments, etc. (at least based on my limited experience).
>
> If you're lucky enough to respond to "standard" treatments like SSRI monotherapy etc., it probably doesn't matter much which kind of doctor you see, and then it's just a matter of finding someone sensible and compassionate, and probably some trial and error. But if you require something a little more risky (or perceived as such) -- say, long-term benzo or stimulant therapy, a somewhat complex combo, and so on -- then the chances are that a psychiatrist will be more willing to try it.I'm not sure about this...My GP was ht ONLY doc willing to try Nardil...the last shrink i ever saw, and ever will, said "I'm certainly not going to prescribe one of those (MAOIs) for you).
Furthermore, my GP lets me have an ACTIVE process in the drugs I take (after I do lots of research and it is going into MY body) -- most psychiatrists like to be in total control and aren't always amenable to patient suggestion. It's funny, the only drug that really has helped me - Nardil - was the one I researched and asked for. Most of the pdoc's drugs have done not much or actually made me worse. WE HAVE EVERY RIGHT TO HAVE THE FINAL DECISION OF WHAT WILL GO INTO OUR BODIES, unless we are incarcerated. It's that simple. And GPs DO have extensive knowledge of psychiatry - especially the older ones.Ace.
Posted by shar on February 26, 2003, at 21:03:52
In reply to Re: Take psych meds from a DOCTOR only, posted by stjames on February 26, 2003, at 10:52:24
hmmm, that's sort of what I was saying, here, james. That for anything other than simple cases (equivalent to "short term" or especially a reaction to an external event, like depressed feelings following the death of a loved one) a pdoc is a better bet.
Shar
> I have to disagree. Unless the problem is short term, GP receive no training in mental illness
> so they are not the ones to give long term treatment.
> > Good points, V. I agree that in the more simple cases, family docs might be ok. But, if one is treatment resistant or needs something more complex, a pdoc is a better bet. There are so many psychotropic meds, and so many meds used for things they weren't originally designed for, I don't see how a GP would be able to keep up with all of that PLUS everything else he or she sees in their practice. Shar
>
Posted by viridis on February 26, 2003, at 21:12:52
In reply to Re: Take psych meds from a DOCTOR only » viridis, posted by ace on February 26, 2003, at 19:28:51
You're very fortunate to have an open-minded GP. I'm sure there are others out there, and I realize that there are plenty of bad psychiatrists (I've seen some!). I'm just speaking in terms of probabilities, and my guess is that for a complex psychiatric problem, the chances of finding a psychiatrist competent to treat it are greater than the chances of finding a GP who's equipped to do so.
A GP is, by definition, a general practitioner, who has to see patients with all sorts of complaints. Unless a GP has a special interest in psychiatry, I can't see how they could possibly keep up with all the developments in this field, and cardiology, and urology, and oncology, and dermatology, and podiatry...and so on.
If I had a simple rash, I'd probably trust a GP to treat it; if I had melanoma I'd want to see a cancer specialist. If my blood pressure was just a bit high, a GP would probably be OK; if I had a serious heart condition, I'd want to see a cardiologist. There's no guarantee that any given specialist would be ideal, but that's where I'd focus my efforts, and move to others if necessary. I view psychiatry the same way -- it took me a while, but now I've found a very good, understanding psychiatrist who listens to what I say, has excellent intuition, and considers my ideas regarding treatment.
I might get lucky and find a GP who's willing to prescribe two benzos, a mood stabilizer, and an amphetamine (my current regimen, and very effective) long-term, but somehow I suspect the chances of a given GP doing so are low. Not impossible, but unless I got very lucky, I expect I'd still be in bad shape and going from GP to GP.
Like almost everything else, there are no absolutes here; every doctor is a gamble, and I think you just have to do your best to maximize the chances of finding appropriate treatment as quickly as possible. In my opinion, the chances are best with a psychiatrist.
Posted by Gracie2 on February 26, 2003, at 21:22:12
In reply to Re: Take psych meds from a DOCTOR only » ace, posted by viridis on February 26, 2003, at 21:12:52
Posted by ace on February 26, 2003, at 22:41:35
In reply to Re: Take psych meds from a DOCTOR only » ace, posted by viridis on February 26, 2003, at 21:12:52
> You're very fortunate to have an open-minded GP. I'm sure there are others out there, and I realize that there are plenty of bad psychiatrists (I've seen some!). I'm just speaking in terms of probabilities, and my guess is that for a complex psychiatric problem, the chances of finding a psychiatrist competent to treat it are greater than the chances of finding a GP who's equipped to do so.
>
> A GP is, by definition, a general practitioner, who has to see patients with all sorts of complaints. Unless a GP has a special interest in psychiatry, I can't see how they could possibly keep up with all the developments in this field, and cardiology, and urology, and oncology, and dermatology, and podiatry...and so on.
>
> If I had a simple rash, I'd probably trust a GP to treat it; if I had melanoma I'd want to see a cancer specialist. If my blood pressure was just a bit high, a GP would probably be OK; if I had a serious heart condition, I'd want to see a cardiologist. There's no guarantee that any given specialist would be ideal, but that's where I'd focus my efforts, and move to others if necessary. I view psychiatry the same way -- it took me a while, but now I've found a very good, understanding psychiatrist who listens to what I say, has excellent intuition, and considers my ideas regarding treatment.
>
> I might get lucky and find a GP who's willing to prescribe two benzos, a mood stabilizer, and an amphetamine (my current regimen, and very effective) long-term, but somehow I suspect the chances of a given GP doing so are low. Not impossible, but unless I got very lucky, I expect I'd still be in bad shape and going from GP to GP.
>
> Like almost everything else, there are no absolutes here; every doctor is a gamble, and I think you just have to do your best to maximize the chances of finding appropriate treatment as quickly as possible. In my opinion, the chances are best with a psychiatrist.This is so interesting, because the complete opposite is true for me! Soon I will (probably) be on Nardil + Zyprexa + Klonopin under my GP. Now, keep in mind that I have studied psychopharmacology at uni. That is probably why he trusts me.
Unless you thoroughly research the drugs and know a little on organic chemistry you probably are better off at a shrink. But otherwise, go to the GP i say!
BTW, it's great you found a good psychiatrist. This eluded me. I have been hurt, misdiagnosed, misdrugged, disrespected by all but 1 psychiatrist. I have seen 10. The last one called me 'wierd' and refused to even contemplate a MAOI. Another one, after a 15 minute consultation, said I was an "unusual young man" I gave him a plethora of note to read about my illness. He read 2 pages and then, on the basis of his 15 min consultation and reading 2 pages, said I probably have a personality d/o. He didn't like me simply because I stood up for myself -- I told I didn't like SSRIs and let him know I was thoroughly educated. This must have annoyed him - goodness knows why. But both me & my GP were very angry and unhappy with the 'unusual young man' comment he made in his referral letter.
Psychiatrists--- NEVER again for me.
Ace.
Posted by IsoM on February 27, 2003, at 0:12:33
In reply to Re: Take psych meds from a DOCTOR only » viridis, posted by ace on February 26, 2003, at 22:41:35
Posted by viridis on February 27, 2003, at 3:39:26
In reply to Re: Take psych meds from a DOCTOR only » viridis, posted by ace on February 26, 2003, at 22:41:35
Just a followup -- my psychiatrist is an interesting guy; he's done some very different things in his life, and actually practiced as a GP for years before going into psychiatry. He told me that he found being a GP somewhat unsatisfying (too general), and was fascinated by psychiatry, so he went back and trained as a psychiatrist when he was in his 50s. He's only been a practicing psychiatrist for a few years, but seems to genuinely love it, and enjoys discussing the details of brain function, how meds work etc. I'm a research biologist, so I get into this too and always investigate the meds in depth, so we have some pretty interesting discussions.
Anyway, I thought I'd mention this, in part because I guess my pdoc is kind of a "hybrid", with lots of experience as a GP but excellent skills as a psychiatrist. I just dread the day he retires (which he is starting to think about), but at least I believe that I can trust him to refer me to someone sensible if and when that happens.
Posted by Gracie2 on February 27, 2003, at 14:10:33
In reply to Re: Take psych meds from a DOCTOR only » ace, posted by viridis on February 27, 2003, at 3:39:26
Complicated medical history, untreated manic depression for many years, major depressive episodes including a serious suicide attempt,
both drug and alcohol abuse contributing to sometimes dangerous and psychotic behavior and,
just to ice the cake, a paradoxical reaction to many medications. No way could I be treated by just a general practitioner.
-Gracie
Posted by michael on February 27, 2003, at 14:56:36
In reply to Re: Take psych meds from a DOCTOR only » ace, posted by viridis on February 27, 2003, at 3:39:26
> Just a followup -- my psychiatrist is an interesting guy; he's done some very different things in his life, and actually practiced as a GP for years before going into psychiatry. He told me that he found being a GP somewhat unsatisfying (too general), and was fascinated by psychiatry, so he went back and trained as a psychiatrist when he was in his 50s. He's only been a practicing psychiatrist for a few years, but seems to genuinely love it, and enjoys discussing the details of brain function, how meds work etc. I'm a research biologist, so I get into this too and always investigate the meds in depth, so we have some pretty interesting discussions.
>
> Anyway, I thought I'd mention this, in part because I guess my pdoc is kind of a "hybrid", with lots of experience as a GP but excellent skills as a psychiatrist. I just dread the day he retires (which he is starting to think about), but at least I believe that I can trust him to refer me to someone sensible if and when that happens.Viridis,
Just wondering if you'd mind saying what city you're in? I know it's unlikely that you're near me, and even moreso that your pdoc would be in my hmo... but just in case, thought I'd ask.
Just wondering - no need to reply if you're uncomfortable w/the Q.
Thanks either way...
michael
Posted by ace on February 27, 2003, at 19:28:45
In reply to Re: Take psych meds from a DOCTOR only ?ace, posted by viridis on February 27, 2003, at 3:39:26
> Just a followup -- my psychiatrist is an interesting guy; he's done some very different things in his life, and actually practiced as a GP for years before going into psychiatry. He told me that he found being a GP somewhat unsatisfying (too general), and was fascinated by psychiatry, so he went back and trained as a psychiatrist when he was in his 50s. He's only been a practicing psychiatrist for a few years, but seems to genuinely love it, and enjoys discussing the details of brain function, how meds work etc. I'm a research biologist, so I get into this too and always investigate the meds in depth, so we have some pretty interesting discussions.
>
> Anyway, I thought I'd mention this, in part because I guess my pdoc is kind of a "hybrid", with lots of experience as a GP but excellent skills as a psychiatrist. I just dread the day he retires (which he is starting to think about), but at least I believe that I can trust him to refer me to someone sensible if and when that happens.The only pdocs that are think are potentially good are those who spent years as GPs. Otherwise, one has to question why they went into psych straight away. BTW, your pdoc does sound like one of the few 'normal' ones.
Ace.
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