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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by ladylight57 on April 11, 2003, at 17:10:13
I'm in the midst of trying to make some decisions regarding medication. I've recently weaned myself off of Effexor XR, which seemed to work very well for me for a long time. But I got very tired of the side effects and weaned off about 3 weeks ago. That is a story in and of itself.
I am feeling overwhelmed, depressed, anxioius and generally hopeless about this whole medication issue. When I last went to see my p-doc she pretty much gave me the choice of either Remeron or Serzone, since I've tried many SSRI's and not been able to tolerate the side effects. She suggested I not try Paxil or Lexapro.
I feel so incapable of making a decision. The Serazone scares me, the Remeron isn't even an option for me because of the weight gain and I can't imagine going back on the Effexor by default. When I called her this afternoon, she pretty much told me that these were my only choices and it was my decision...
That just sort of ticked me off, but you know, I hardly know the lady, I've only met with her twice and with the way insurance is now, they don't want to pay for any "get to know you" type appointments. I guess I'm not supposed to build that kind of relationship with a P-doc, but how can I trust her reccomendations if I don't even know her.
I've run through 2 P-docs in the last couple of months because I feel like I'm not being heard. The feeling I have is that somehow I am a squre peg trying to fit into a round hole. I have issues with being on meds, I know.......but I am feeling rejected and frustrated.
I'm sorry this is so rambling....I could sure use some perspective and some support.
ladylight
Posted by Janelle on April 11, 2003, at 18:09:30
In reply to Looking for perspective, posted by ladylight57 on April 11, 2003, at 17:10:13
I and I'm sure others, understand how you feel.
I was also on EffexorXR and it did some horrible things to me (in terms of side effects) before I finally got off it. So I can relate to your problems with that particular a-d.
As for your pdoc's *final* recommendation of either Remeron or Serzone, since you have tried many SSRI's and not been able to tolerate the side effects, well those are NOT your final choices (I'll get into that a bit more below).
I'm wondering - why did she suggest that you NOT try Paxil or Lexapro? (I had quite a few very good years on Paxil until it made me hypomanic and then pooped out).
I'm currently doing fairly well (KNOCK ON WOOD) on Celexa - have you tried that one?
Given the two a-d's that you mentioned above as being your pdoc's final recommendations, I can understand your feeling incapable of making a decision. In fact, for awhile, I had it in my mind that those were the only two I thought I had as options. My pdoc had not even mentioned either of them to me!
Why does Serzone "scare" you - cuz it is sedating? You could take it at night for sleeping.
Have you considered some of the *older* meds, like the tricyclics? I know people on them with succes. These meds can have a lot of side effects, but I was on one and the side effects DO GO COMPLETELY AWAY fairly shortly and the meds tend to kick in a bit faster than the SSRI's.
Also, what about an MAOI? You just have to watch certain things you eat with these. The two main MAOI's are Nardil and Parnate that I have heard of.
If you do not like this third pdoc, so what if she's the third - KEEP ON GOING UNTIL YOU FIND A FIT FOR YOU, for YOU! You are #1 here, not the pdoc, in my opinion.
I know firsthand what it feels like NOT to be heard; it is so frustrating. You have to advocate for yourself which can be so hard when you feel so bad.
I hope I have been able to give you some perspective and some support.
Good luck and let me know if you want me to expand on anything I might have said here.
Posted by ladylight57 on April 11, 2003, at 18:26:55
In reply to Re: Looking for perspective » ladylight57, posted by Janelle on April 11, 2003, at 18:09:30
Thanks! yes, I appreciate your post tremendously as my meeting and subsequent phone calls with my doctor left me feeling railroaded, angry and totall out of control of the situation.
I have tried Prozac and Celexa and found they seemed to make me more anxious than I would have liked and had sexual side effects that I couldn't tolerate. That makes me leery of the Lexapro, but I've heard good things about Paxil.
I know that there are several other families of A-D's but just didn't have the fortitude to argue the fact with the doc on the phone. What would be the point anyway. I'll be out shopping for a new doctor....again.
Thanks again.
Posted by Janelle on April 11, 2003, at 18:44:53
In reply to Re: Looking for perspective, posted by ladylight57 on April 11, 2003, at 18:26:55
Sorry to hear that your meeting and subsequent phone calls with your doctor left you feeling railroaded, angry and totally out of control of the situation -- been there, felt that.
Bummer that both tried Prozac and Celexa and seemed to make you more anxious than you would have liked and had sexual side effects that you couldn't tolerate. I've heard that Prozac can increase anxiety, and unfortunately all the SSRI's tend to have those darn sexual side effects.
I can understand the Celexa situation you had make you leery of the Lexapro, but I've posted on here about these two and despite the fact that Lexapro is supposed to be only the *active* part of Celexa, people say these two can make a person feel quite differently. Meaning they may be similar chemically but in the body they may not be all that similar. Something to ponder ... perhaps a trial of Lexapro (I hear one needs just a low dose - like 10 mg - to see if it will work).
As I said, I did well on Paxil for many years ... then it did the other thing (besides sexual side effects) that SSRI's are known for and that is inducing mania/hypomania. Argh. Then I got depressed and realized that it pooped out. I crashed after the period of hypomania - a mood swing had occurred, which then continued to happen after I was switched to EffexorXR.
I can understand and relate to your frustration with the pdoc. Sounds like you've got a few options now (sorry to confuse the matter!) - Lexapro, Paxil, Serzone (you didn't say why it scares you) the older tricyclics or MAOI's.
But it sounds like the first order of business for you is finding another pdoc?
Good luck 2 U.
Posted by ladylight57 on April 11, 2003, at 18:53:23
In reply to Re: Looking for perspective » ladylight57, posted by Janelle on April 11, 2003, at 18:44:53
I am concerned about the Serzone because of the liver damage issue. Those Black Box warnings can be a little unnerving. However, I have read some of the posts here reagarding Serzone and it sounds like some people have used them without any ill effects, as far as the liver is concerned.
As you said, finding a new doc is the first order of the day. This will give me time to think over which side effects I am willing to live with and which drug I might wish to try first......
Thanks again.
Posted by noa on April 11, 2003, at 19:42:28
In reply to Re: Looking for perspective, posted by ladylight57 on April 11, 2003, at 18:53:23
I take Serzone and have asked my internist, my pdoc and my friend, who is a gastroenterologist who specializes in treating liver disease, and all three told me that if I would have a problem it would have shown up already--ie, you monitor it and if there is going to be a problem, then liver enzymes are going to go abnormal pretty early in the process. I do have one nonspecific liver enzyme that was elevated once or twice over the years, but the gastro said it was only because I was taking a lot of meds and reflected my liver working hard to process them all, but that particular enzyme was not one that alarmed her. In any event, subsequent retesting showed the enzyme had gone back to normal.
I think you could probably monitor your liver function closely when you start Serzone and see if you will have a problem with it.
The other thing about Serzone, to keep in mind, though, is that it does have an adjustment period that is challenging. I recommend starting "low and slow". In the first month, even with low and slow, I had grogginess and balance problems and emoional jags, but after that, these went away.
It is sedating, so I take it at night. That also helps with the sleep issues caused by Effexor being rather activating for me.
I don't know anything about Lexapro.
Yes, I think you need to keep searching for that more compatible pdoc. Or, if really expensive, consider just a consultation with someone you have gotten good rec's about from people you trust. Then maybe that doc can refer you to an insurance covered doc that could do the continuing care.
Posted by Janelle on April 11, 2003, at 19:57:08
In reply to Re: Looking for perspective, posted by ladylight57 on April 11, 2003, at 18:53:23
Oh gosh, I forgot all about the concern/black box regarding liver damage with Serzone. My guess is that if you did go on it, you'd have to have periodic blood tests to see if it was adversely affecting your liver.
I'd say to put that one - Serzone - last on your list of possbilities for an antidepressant for now.
Find your new pdoc, present your med *dilemma* and see what that person suggests!
You are so right - with all these meds it comes down to a tradeoff of which side effects we're willing to stand versus which ones we are not.
Good luck and keep me/us posted here, please.
Posted by carlyb on April 11, 2003, at 20:34:28
In reply to Looking for perspective, posted by ladylight57 on April 11, 2003, at 17:10:13
I've been on serzon for at least 4-5 years and my liver function is good. I sleep good at night and i feel pretty good. i am still concerned about the liver thing, i am considering trying a natural anti depressent like 5htp. good luck carly
Posted by Janelle on April 11, 2003, at 20:37:57
In reply to Re: Looking for perspective, posted by carlyb on April 11, 2003, at 20:34:28
I think that's a great idea to try a natural antidepressant like 5HTP. In fact, I did just that - went on 5HTP and it did NOTHING. I found out that the reason is that it does not cross the blood brain barrier the way that meds and some other natural substances do.
Just my experience I thought I'd relate. Other natural substances that are supposed to work well are St. John's Wort (although this is for *mild* depression; also it actually breaks down into one of the older tricyclic a-d's I forget which one) and Sam-E.
Good luck 2 U.
Posted by leeran on April 12, 2003, at 14:28:56
In reply to Re: Looking for perspective, posted by ladylight57 on April 11, 2003, at 18:26:55
"left me feeling railroaded, angry and totally out of control of the situation"
I had similar feelings with the first psychiatrist I ever visited (which was just a few months ago).
Not to be nitpicky (well, I can be very nitpicky) but my feeling was that the insurance and my co-pay were covering a 50 minute session. At one point (about 10 minutes into the session) he had the unmitigated gall to interrupt me (very tersely) and basically tell me I was giving him too much information!
I immediately clammed up and I'm sure he could see the change in my demeanor, which was fine with me - it matched his. He refused to consider the possibility that I might have A.D.D. and wrote out a doubled prescription for Wellbutrin (which I was on) handed me a card and ordered me back in two weeks. He didn't even ask me if the time he wrote on the card would be feasible!
I got up, said "thank you" and cancelled the next appointment via his answering machine before the day had ended.
Oh yeah, and he was far more concerned about my insurance, getting my co-payment and calling my insurance company (again, all in that 50 minute period). All told, I spent 30 minutes in his office and at least 5 - 10 of those were spent with him stewing about insurance concerns. He didn't have a receptionist and the each wall of the waiting room was "decorated" with signs instructing patients to follow this or that procedure (I think they call that cardboard office administration).
He seemed so morose that I couldn't imagine why he had chosen this as a profession. Not one SMILE during the entire appointment.
Sorry to write so much about this, but your post really struck a chord in me since it was so recent that I had a somewhat similar experience. I realized (in about two minutes) that I would feel better going without medication than seeing him again.
Luckily, I had kept an initial consult with a psychiatrist who had been recommended and who couldn't see me as soon. The aforementioned doctor was available much sooner . . . which seems telling in retrospect.
I'm relatively new to the area and I don't have a network of people for recommendations. Fortunately, I found my psychiatrist (the original guy I had the consult with but couldn't get in as soon) via a recommendation on a message board and he is the polar opposite of this other fellow.
They're both in the same atrium type office building and I have to walk by the one guy's office to get to my doctor's office and I just thank God under my breath each time that it only took two tries to find the right person.
I have heard that it can take many, many attempts to find someone with whom you "geehaw." I think this is so important, I mean, it's nice to have someone you "like" for a pap smear (or to look down your throat with a popsicle stick) because symptoms that might be associated with those procedures are easier to detect. But, when someone is diagnosing something that isn't as obvious and can't be "tested for" in the traditional sense, it seems imperative to have someone you can trust - and who doesn't make you feel "put down" or like you are left without options.
In closing - you said:
(I) just didn't have the fortitude to argue the fact with the doc on the phone
I can understand completely! This is your well-being, not a case of strep throat.
Good luck with whatever decision you make and I hope you can find something soon that works for your set of circumstances!
Posted by lauran on April 12, 2003, at 15:12:45
In reply to Looking for perspective, posted by ladylight57 on April 11, 2003, at 17:10:13
Hi ladylight. Sending support your way big time! Don't give up on finding the right pdoc. I had a similar experience with the pdoc my HMO had me see. I then looked elsewhere and found an excellent pdoc. I had to pay out of pocket but the money has been well spent.
In terms of medication, you know what is right for your body. I am very med sensitive and had a severe reaction to a recent med switch. I decided to go off all meds altogether and am now deciding if I will even resume them. Trust yourself to make the right decisions.
Posted by ladylight57 on April 12, 2003, at 18:54:01
In reply to Looking for perspective, posted by ladylight57 on April 11, 2003, at 17:10:13
Thank You both lareen and Lauren,
I'm thinking hard about going outside the preferred provider plan and paying out of pocket, feeling certain that the extra cash would indeed be well spent.
I am beginning to recognize that Doctors who work within an HMO (at least the ones I've had contact with) Are looking to get you onto something as quickly as possible so as to fit you into the 5-10 minute perscription appointment.
Now that I am med free, I too am considering finding myself a good therapist and trying to for go the meds for as long as I can. I dread the thought of going back on, especially living wtih the side effects.....I figure if and when the depression gets bad enough, I will be motivated to do so.
I've read a bit about fish oil both on and off this board and have decided it that I will add that to my daily regimine of vitamins in the hopes of keeping my brain as healthy as possible. Maybe it will be what makes the difference between being on or off meds....or at least being able to put off the meds for a bit.
It is so re-assuring to hear that others have had similar experiences to mine and as I was beginning to feel a bit like a "problem" patient.
Where does one go for a refferal to a good Therapist.
Beth
Posted by noa on April 12, 2003, at 20:02:44
In reply to Re: Looking for perspective, posted by ladylight57 on April 12, 2003, at 18:54:01
>>Where does one go for a refferal to a good Therapist?
I asked around. I found mine through a friend who was in therapy. We talked about what I was looking for and then she asked her therapist for some names. I got two names and I think mine called me back soonest. I also think I like the way he sounded better than the other one, but I know that is not always a good way to tell. I figured I'd go to one appointment and see how it was and if it didn't feel right, I'd make an appointment with the other one. And if neither one seemed right, I'd go asking for more names again.
Good luck!
Posted by fanni on April 13, 2003, at 14:33:47
In reply to About 5 HTP » carlyb, posted by Janelle on April 11, 2003, at 20:37:57
is it okay to take 5htp with lexapro?
Posted by Janelle on April 15, 2003, at 0:35:14
In reply to Re: About 5 HTP, posted by fanni on April 13, 2003, at 14:33:47
This is the end of the thread.
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