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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Eggy on March 14, 2003, at 21:03:36
Do any of you have side effects to meds that are not listed in the clinical studies? Do you have to convince your Pdoc that these side-effects are valid?? For instance...Sonata makes me manic...he says NO...that's it just "NO". Then he will not write the side-effects on my chart, because to him they were not side-effects. I just love my doc but he can be so hard headed!
Posted by justyourlaugh on March 14, 2003, at 21:36:19
In reply to Does your Pdoc believe your side-effects??, posted by Eggy on March 14, 2003, at 21:03:36
egg,
my pdoc wrote a scripe for me..
(i was suicidal)
300mg wellbutrin twice a day...300 repeat twice...
i told pharmasist to call...she talk to him directly.....was correct...
itwas suppose to be
..150mg twice a day duh....30 tabs--repeat twice.......(i see every month).....
i called my md...i am so glad i was on a upswing.....when i am not..i dont even remember...
j
Posted by Eggy on March 14, 2003, at 21:59:58
In reply to Re: Does your Pdoc believe your side-effects?? » Eggy, posted by justyourlaugh on March 14, 2003, at 21:36:19
Geez that would have not been very good. I hope it wasn't Wellbutrin SR. I never pay any attention to what my pharmacy gives me. Once I paid for Lexapro along with 3 other meds. Came home and dished out 14 days worth of meds in my dispenser. My Lexapro wasn't there and I didn't even notice it until I went back after the two weeks to refill the dispenser. The pharmacist hadn't put it in the bag.
Posted by Krissy P on March 14, 2003, at 22:20:41
In reply to Does your Pdoc believe your side-effects??, posted by Eggy on March 14, 2003, at 21:03:36
Hi, I had a pdoc that really ignored any symptom I brought up-blamed it on anxiety or something else. I truly believe he felt that I would worry, and he knew what to look out for. But still, I had tingling in my lips -nope anxiety. Maybe you want to find a doc who will believe you or at least discuss it with you instead of 1-word answers?
All the best:-)Kristen
==================================================================================================> Do any of you have side effects to meds that are not listed in the clinical studies? Do you have to convince your Pdoc that these side-effects are valid?? For instance...Sonata makes me manic...he says NO...that's it just "NO". Then he will not write the side-effects on my chart, because to him they were not side-effects. I just love my doc but he can be so hard headed!
Posted by stjames on March 15, 2003, at 2:19:43
In reply to Does your Pdoc believe your side-effects??, posted by Eggy on March 14, 2003, at 21:03:36
You are the customer, it is your money here.
Be professional but upfront about this. Never
pay for a service and then allow someone to ignore your valid conserns.
Posted by Tabitha on March 15, 2003, at 2:43:25
In reply to Does your Pdoc believe your side-effects??, posted by Eggy on March 14, 2003, at 21:03:36
No, not always. Mine has been very skeptical of side effects I report. My hair fell out in huge amounts while on effexor, and he told me it's only a 1 in 1000 side effect so was not likely the med. Maybe so, but do you think the side effect profiles on hair loss could possibly be accurate-- when the clinical trials are short term and hair loss doesn't occur for months after starting the med? I doubt it. I totally freaked when my hair fell out-- thought I was getting some freak female pattern baldness. It sure would have saved me much mental anguish to know it was likely just a med side effect.
I also told him antidepressants kill my artistic creativity, and he told me that's not the meds, it's breakthrough depression. Which I know is wrong because I was depressed more before the meds (obviously) but my artistic creativity was still functioning. On the ADs I just lose interest in making stuff, don't get spontaneous ideas anymore, and don't respond as strongly to visual art and music. Why would he disbelieve this? I don't know, but it sure pissed me off. So I did not bother to report that the ADs apparently also made me lose interest in religion. My mind just doesn't seem to need to go there anymore.
I also reported other health problems including chronic GI bloat and inflammation in my joints, and he did not relate these to meds. He suggested I have some other health problem causing general inflammation. Maybe, but I'm inclined to think it could be the meds too.
We got into a pattern where he disbelieves my reported side effects, then when I resist upping the dose, or adding more, or want to reduce meds, he suggests that I'm really addicted to my high moods. Which I'm not-- my hypomanic behavior embarasses me. All these sort of low-grade side effects really reduce the quality of life over time, and I'm sick of having weird health problems crop up, worrying myself over them, and then have them be med side effects nobody warned me to look for. Wow, I'm finally remembering why I started looking for another doctor.
You'd think pdocs' response to patient reports of side effects would include a little more curiousity instead of total skepticism. Sometimes I think it's the bias in their training against anecdotal evidence. They're naturally skeptical of individual experience, until it's been documented in an approved, double-blind study. Problem is, the med studies are short term. Plus, some of these weird effects are stuff you wouldn't even think to associate with the med, so it's not going to get reported. And arent' they probably questionnaires anyway? Have you ever tried to fill out a questionnaire, and none of the options are really right? I just doubt they're really picking up all the side effects with such studies.
OK I'm rambling. It's my major gripe with the whole pill-popping thing. The cure isn't always better than the symptoms once you add in all the side effects, and I don't think docs appreciate that.
Posted by jay on March 15, 2003, at 3:15:28
In reply to Re: Does your Pdoc believe your side-effects?? » Eggy, posted by Tabitha on March 15, 2003, at 2:43:25
Have a read through this following abstract.(below) Read the end about "crying in movies", and the author treats this like it is 'wrong' or means you are 'depressed'. (Oh, and how SSRI's can "cure" this!!) Fer gawd sakes...really, think about it. A drug that kills: artistic creativity; human emotion; natural healthy sex drive. For highly emotionaly, artistic oriented people like myself and many others, this is killing *what is human*!!Int J Neuropsychopharmacol 2002 Dec;5(4):415-6
Emotional blunting, sexual dysfunction and SSRIs.
Balon R.Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA.
The recent interesting report on SSRI-associated emotional blunting and its possible association with SSRI-induced sexual dysfunction (Opbroek et al., 2002) presents a somewhat confusing concept and raises far more questions than it provides answers. First is the question of the concept of emotional blunting. The authors (Opbroek et al., 2002) state that up to 80% of their patients described 'a treatment emergent blunting of certain emotions'. Which of the symptoms or blunted emotions are part of the emotional blunting and which are part of the patient's personality or residual symptoms of depression? As the authors pointed out, their outcome measure for emotional blunting lacks evidence of validity (what about reliability?) and thus it is not clear what this scale really measures. Other reports on emotional blunting in the literature are not very clear about this concept, either. Hoehn-Saric et al. (1990) reported apathy, indifference, loss of initiative and disinhibition in panic disorder and depressed patients on SSRIs. In another report, Hoehn-Saric et al. (1991) described apathy, indifference, inattention, and perseveration in an obsessive-compulsive patient taking fluoxetine. These changes were associated with a decrease in cerebral blood flow in the frontal lobes on SPECT and changes in neuropsychological tests generally associated with frontal lobe impairment. Oleshansky and Labbate (1996) described rapid improvement of excessive or inappropriate crying, without apathy or indifference, in depressed patients treated with SSRIs. Similarly, Vinar (2000) reported that eight depressed women spontaneously mentioned that for years they cried during moving scenes in the theatre, cinema, or on TV.
Posted by Tabitha on March 15, 2003, at 3:31:14
In reply to AMEN! SSRI/SNRI = Blunting Human Emotions » Tabitha, posted by jay on March 15, 2003, at 3:15:28
Yes, they change everything, and some of that change is not so good. They are not little smart bombs that target depression. They just make everything different, and you might as well call the antidepressant effect a side effect. My brain feels like it is happy, but it is disconnected from my body. All kinds of sensuality are gone or diminished-- enjoyment of sleep, eating, and sex. The 'emotional blunting' I'm not sure has even registered to me. My natural emotions wear me out and slide into obsession too easily, so a little blunting would feel like a relief.
As much as I hate the crappy drugs though I'm terrified to go off them, since the pit of depression was the worst feeling ever. I've gone off SSRIs probably 4 times and each time I bottomed out again. It's a devil's bargain to stay on them.
Posted by noa on March 15, 2003, at 7:13:00
In reply to Does your Pdoc believe your side-effects??, posted by Eggy on March 14, 2003, at 21:03:36
This, to me, is an essential quality of a pdoc: listening to and believing me about my experiences from the medications I take. I, personally, wouldn't go to a doctor who didn't. But I guess I'm lucky on two counts: 1) I live in an area with lots of pdocs, and 2)I have the means (just barely,perhaps, but I do have it) to pay the difference between the pdoc's price and what the insurance covers.
Posted by Krissy P on March 15, 2003, at 11:23:35
In reply to Re: Does your Pdoc believe your side-effects??, posted by stjames on March 15, 2003, at 2:19:43
Posted by Krissy P on March 15, 2003, at 11:34:55
In reply to Re: Does your Pdoc believe your side-effects?? » Eggy, posted by Tabitha on March 15, 2003, at 2:43:25
God, amen to this, you sound like me and my experiences. I had gobbs of hair fall out when I was on Depakote, gained 30 Lbs in a month. Geeeeeez. My pdoc totally ignored it, as he did a lot of times, and said oh no no no no-I'm like yes yes yes. Frustrating! We know our body's better than anyone else, I wish docs would listen a little better.
Thanks for a great post!
Kristen
==================================================================================================> No, not always. Mine has been very skeptical of side effects I report. My hair fell out in huge amounts while on effexor, and he told me it's only a 1 in 1000 side effect so was not likely the med. Maybe so, but do you think the side effect profiles on hair loss could possibly be accurate-- when the clinical trials are short term and hair loss doesn't occur for months after starting the med? I doubt it. I totally freaked when my hair fell out-- thought I was getting some freak female pattern baldness. It sure would have saved me much mental anguish to know it was likely just a med side effect.
>
> I also told him antidepressants kill my artistic creativity, and he told me that's not the meds, it's breakthrough depression. Which I know is wrong because I was depressed more before the meds (obviously) but my artistic creativity was still functioning. On the ADs I just lose interest in making stuff, don't get spontaneous ideas anymore, and don't respond as strongly to visual art and music. Why would he disbelieve this? I don't know, but it sure pissed me off. So I did not bother to report that the ADs apparently also made me lose interest in religion. My mind just doesn't seem to need to go there anymore.
>
> I also reported other health problems including chronic GI bloat and inflammation in my joints, and he did not relate these to meds. He suggested I have some other health problem causing general inflammation. Maybe, but I'm inclined to think it could be the meds too.
>
> We got into a pattern where he disbelieves my reported side effects, then when I resist upping the dose, or adding more, or want to reduce meds, he suggests that I'm really addicted to my high moods. Which I'm not-- my hypomanic behavior embarasses me. All these sort of low-grade side effects really reduce the quality of life over time, and I'm sick of having weird health problems crop up, worrying myself over them, and then have them be med side effects nobody warned me to look for. Wow, I'm finally remembering why I started looking for another doctor.
>
> You'd think pdocs' response to patient reports of side effects would include a little more curiousity instead of total skepticism. Sometimes I think it's the bias in their training against anecdotal evidence. They're naturally skeptical of individual experience, until it's been documented in an approved, double-blind study. Problem is, the med studies are short term. Plus, some of these weird effects are stuff you wouldn't even think to associate with the med, so it's not going to get reported. And arent' they probably questionnaires anyway? Have you ever tried to fill out a questionnaire, and none of the options are really right? I just doubt they're really picking up all the side effects with such studies.
>
> OK I'm rambling. It's my major gripe with the whole pill-popping thing. The cure isn't always better than the symptoms once you add in all the side effects, and I don't think docs appreciate that.
Posted by Krissy P on March 15, 2003, at 11:36:57
In reply to AMEN! SSRI/SNRI = Blunting Human Emotions » Tabitha, posted by jay on March 15, 2003, at 3:15:28
Ummmmmm, so the docas are saying basically "don't feel" I get some of my feelings out at movies, better than taking them out on another. You think?
>
> Have a read through this following abstract.(below) Read the end about "crying in movies", and the author treats this like it is 'wrong' or means you are 'depressed'. (Oh, and how SSRI's can "cure" this!!) Fer gawd sakes...really, think about it. A drug that kills: artistic creativity; human emotion; natural healthy sex drive. For highly emotionaly, artistic oriented people like myself and many others, this is killing *what is human*!!
>
> Int J Neuropsychopharmacol 2002 Dec;5(4):415-6
> Emotional blunting, sexual dysfunction and SSRIs.
> Balon R.
>
> Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA.
>
> The recent interesting report on SSRI-associated emotional blunting and its possible association with SSRI-induced sexual dysfunction (Opbroek et al., 2002) presents a somewhat confusing concept and raises far more questions than it provides answers. First is the question of the concept of emotional blunting. The authors (Opbroek et al., 2002) state that up to 80% of their patients described 'a treatment emergent blunting of certain emotions'. Which of the symptoms or blunted emotions are part of the emotional blunting and which are part of the patient's personality or residual symptoms of depression? As the authors pointed out, their outcome measure for emotional blunting lacks evidence of validity (what about reliability?) and thus it is not clear what this scale really measures. Other reports on emotional blunting in the literature are not very clear about this concept, either. Hoehn-Saric et al. (1990) reported apathy, indifference, loss of initiative and disinhibition in panic disorder and depressed patients on SSRIs. In another report, Hoehn-Saric et al. (1991) described apathy, indifference, inattention, and perseveration in an obsessive-compulsive patient taking fluoxetine. These changes were associated with a decrease in cerebral blood flow in the frontal lobes on SPECT and changes in neuropsychological tests generally associated with frontal lobe impairment. Oleshansky and Labbate (1996) described rapid improvement of excessive or inappropriate crying, without apathy or indifference, in depressed patients treated with SSRIs. Similarly, Vinar (2000) reported that eight depressed women spontaneously mentioned that for years they cried during moving scenes in the theatre, cinema, or on TV.
>
Posted by Dysfunk on March 15, 2003, at 13:28:32
In reply to Does your Pdoc believe your side-effects??, posted by Eggy on March 14, 2003, at 21:03:36
Yes my body aches and rage from Effexor were my side effects and my doctor didn't believe me. He said "well that has never been reported before"!
Posted by viridis on March 15, 2003, at 14:26:34
In reply to Does your Pdoc believe your side-effects??, posted by Eggy on March 14, 2003, at 21:03:36
I had this problem with my GP. I've told this story before so won't go into all the details, but the key points are that he prescribed Wellbutrin; I told him that I wanted to be cautious since I have major anxiety problems, and he said that since Wellbutrin and other modern ADs can't cause side effects, this wasn't a concern. He added that there's no such thing as an anxiety disorder; all anxiety is the result of depression, so antidepressants almost invariably prevent anxiety.
I didn't buy any of this, but tried the WB (at 1/3 the dose he wanted me on) for two months. I had a bunch of very strange side effects, including extreme dizziness, sensitivity to light, intense pressure in my head, shaking hands, bursts of anger etc. -- things I just don't experience normally. On top of this, it sent my anxiety through the roof.
When I told my GP this, he said it was "impossible" and that I must have "psychological" problems because clearly my side effects were imaginary. They did stop, though, within a day of discontinuing WB.
So I went to a psychiatrist, who said that WB was just about the last med he'd consider for me. He wasn't at all surprised by the side effects, and said some were actually fairly common. I'm doing much better with benzos and Adderall, but the ignorance of that GP (who must deal with quite a few people who suffer from mental problems) really shocked me.
Posted by jay on March 15, 2003, at 15:15:47
In reply to Re: AMEN! SSRI/SNRI = Blunting Human Emotions » jay, posted by Tabitha on March 15, 2003, at 3:31:14
Yes, I do agree Tabitha that as difficult as these meds can be, they also can be very helpful. It seems so much like a balancing game. I honestly have found smaller doses of a few meds so much better than a large dose of one. That's what bugs me about some doctors, especially with the popular antidepressants, is that they have this black and white thinking that if you don't get the "textbook" responses from a med, then you must be a liar! Gawd Bless the docs out there who are willing to go the extra, unconventional mile and believe what we have to say..heh.Best as always..:)
Jay
Posted by Phil on March 15, 2003, at 20:56:50
In reply to Does your Pdoc believe your side-effects??, posted by Eggy on March 14, 2003, at 21:03:36
Maybe he could read about the infrequent side effects of euphoria and agitation or the rare side effect of CNS stimulation.
Here's part of the Sonata monograph on http://www.RXList.com.
Nervous system - Frequent: depression, hypertonia, nervousness, thinking abnormal (mainly difficulty concentrating); Infrequent: agitation, apathy, ataxia, circumoral paresthesia, confusion, emotional lability, euphoria, hyperesthesia, hyperkinesia, hypotonia, incoordination, insomnia, libido decreased, neuralgia, nystagmus; Rare: CNS stimulation, delusions, dysarthria, dystonia, facial paralysis, hostility, hypokinesia, myoclonus, neuropathy, psychomotor retardation, ptosis, reflexes decreased, reflexes increased, sleep talking, sleep walking, slurred speech, stupor, trismus.
Posted by Eggy on March 16, 2003, at 21:05:28
In reply to Re: Does your Pdoc believe your side-effects?? » Eggy, posted by Phil on March 15, 2003, at 20:56:50
Phil, are all of those side-effects to Sonata?? Geez no wonder I flipped out! Krissy...I also lost major amounts of hair on Depakote but no one believed it was the depakote...funny though my hair quit falling out when I quit taking it. My Pdoc thinks I complain about my meds just because I don't like taking them. This is my own opinion though. But, I don't like taking something that makes my sex drive zero,my hair fall out,my face break out and my ass get tens times bigger. Are these drugs not suppose to make me feel better?? I can't see how weighing 600 lbs.,being bald with zits is going to make me feel better!! Just ain't gonna happen.
Posted by Krissy P on March 16, 2003, at 21:27:03
In reply to Re: Everyone » Phil, posted by Eggy on March 16, 2003, at 21:05:28
EGGY says: "Krissy...I also lost major amounts of hair on Depakote but no one believed it was the depakote...funny though my hair quit falling out when I quit taking it".
AMEN !!!!!!!! Ditto, ditto, and more ditto lol
--------------------------------------------------------------------------------------------------
> Phil, are all of those side-effects to Sonata?? Geez no wonder I flipped out! Krissy...I also lost major amounts of hair on Depakote but no one believed it was the depakote...funny though my hair quit falling out when I quit taking it. My Pdoc thinks I complain about my meds just because I don't like taking them. This is my own opinion though. But, I don't like taking something that makes my sex drive zero,my hair fall out,my face break out and my ass get tens times bigger. Are these drugs not suppose to make me feel better?? I can't see how weighing 600 lbs.,being bald with zits is going to make me feel better!! Just ain't gonna happen.
Posted by Tabitha on March 17, 2003, at 13:21:49
In reply to Re: Everyone » Phil, posted by Eggy on March 16, 2003, at 21:05:28
Eggy, Depakote is notorious for causing hair loss. As far as I know they halfway understand the reason for that one-- your zinc gets depleted by depakote, so taking zinc supplements can help.
I understand your frustration. Why can't docs take us at our word about intolerable side effects? Some of them just don't have very good people-skills. Maybe they're dumping their frustration on us, that they can't be the all-knowing all-competent healers.
Posted by noa on March 17, 2003, at 16:04:17
In reply to Re: Does your Pdoc believe your side-effects?? » Eggy, posted by Dysfunk on March 15, 2003, at 13:28:32
How about this comeback?
"Well, every reported adverse effect has a first report, and even if I'm it, I'd like it reported."
Posted by stjames on March 18, 2003, at 1:54:23
In reply to Does your Pdoc believe your side-effects??, posted by Eggy on March 14, 2003, at 21:03:36
I had a funny side effect to tofranil,
it made just one hand slightly numb. Dose related.
I asked my doc to explain and she said she
could not give me a neurological answer
but that it was not uncommon to a have a few
patients with uncommon side effects. Some
SE's are just unique to one person. It is neurology being effected here, and this extends
to many systems.
Posted by worrier on March 21, 2003, at 19:54:03
In reply to Re: Does your Pdoc believe your side-effects??, posted by viridis on March 15, 2003, at 14:26:34
> I had this problem with my GP. I've told this story before so won't go into all the details, but the key points are that he prescribed Wellbutrin; I told him that I wanted to be cautious since I have major anxiety problems, and he said that since Wellbutrin and other modern ADs can't cause side effects, this wasn't a concern. He added that there's no such thing as an anxiety disorder; all anxiety is the result of depression, so antidepressants almost invariably prevent anxiety.
>
> I didn't buy any of this, but tried the WB (at 1/3 the dose he wanted me on) for two months. I had a bunch of very strange side effects, including extreme dizziness, sensitivity to light, intense pressure in my head, shaking hands, bursts of anger etc. -- things I just don't experience normally. On top of this, it sent my anxiety through the roof.
>
> When I told my GP this, he said it was "impossible" and that I must have "psychological" problems because clearly my side effects were imaginary. They did stop, though, within a day of discontinuing WB.
>
> So I went to a psychiatrist, who said that WB was just about the last med he'd consider for me. He wasn't at all surprised by the side effects, and said some were actually fairly common. I'm doing much better with benzos and Adderall, but the ignorance of that GP (who must deal with quite a few people who suffer from mental problems) really shocked me.>Hey viridis...once again we've had such similar experiences...my GP put me on wellbutrin, prozac, then paxil (which sent me to the ER with a horrible serotonin reaction. When I described the side effects (all those you mentioned plus panic like I'd never experienced ...and I've had panic attacks for almost 20 years) she told me to increase the paxil dose. Like an idiot I did, things got worse which she said indicated I was probably Bipolar and then ran a drug screen without asking/telling me. She then told me to stop the paxil and try effexor. At that point I came to what was left of my senses and got myself to a pdoc. He said I should go ask for my money back from my GP. He actually expressed suprise that I managed to get through her "treatment" without killing myself. No more ADs for me. Benzos are the ticket, but I'm still not myself after almost a year. Trust yourself above all else...only you know what these meds are making you feel. Best to all, worrier.
This is the end of the thread.
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