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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 52. Go back in thread:
Posted by Phillipa on April 8, 2006, at 23:25:01
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by Phillipa on April 8, 2006, at 20:30:27
Well you know your own body right?And you're saying you felt better on a lower dose of dizempam(some say it's depressing) and the trileptal was helping and you still have it. And I was on l0mg of paxil for anxiety and panic attacks with a benzo. I was sick for three months even on that low of a dose of paxil. Nausea, diarreah, couldn't do anything but lay in a hammock (it was summer) So I would suggest starting the trileptal again. I also took it for a time at low doses. didn't feel a thing l50mg a day supposed to go up to 300mg twice a day. So start low and go up and see how you feel. love Phillipa
Posted by Phillipa on April 8, 2006, at 23:31:58
In reply to Re: Would you listen to this doctor? Help please!!!!!! » Phillipa, posted by Phillipa on April 8, 2006, at 23:25:01
Besided trileptal is a mood stabalizer and when I tried 20mg of paxil my anxiety skyrocketed to horrible anxiety which my pdoc at the time said was too energizing for me and boy was he right. Not everyone can tolerate the SSRI's at conventional doses. We are all individuals with different body chemistry. Don't feel guilty I wouldn't and I'm a people pleaser. Love phillipa
Posted by qbsbrown on April 9, 2006, at 1:12:24
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by Phillipa on April 8, 2006, at 23:31:58
I hear and understand you racer. But with trileptal, i could be doing the irish jig in one week, and take a vacation to the phillipines.
There is nothing wrong w/ taking a mood stabilizer with a SSRI, actually becoming more and more common. There are no interactions.
My depression was fine, it was the anxiety that was killing me, and 10mgs of diazepam is nothing, and trileptal does nothing for it either.She doesn't think it benefits me (or i wasn't at a high enough dose), she doesn't want me tinkering and prescribing my own meds (although i was already on it for a month). I'm bed ridden today (mostly from seroquel last night), and im getting so much crap from my family for not going out and doing things. I've been so active the last couple of weeks. This is killing me. So not only do i feel like dung, i feel guilty for feeling like dung, and not going out, and having fun w/ my hubby.
Regards,
Brian
Posted by Racer on April 9, 2006, at 1:46:14
In reply to Re: Would you listen to this doctor? Help please!!!!!! » Phillipa, posted by Phillipa on April 8, 2006, at 23:25:01
> Well you know your own body right?And you're saying you felt better on a lower dose of dizempam(some say it's depressing) and the trileptal was helping and you still have it. ... So I would suggest starting the trileptal again.
Phillipa, I'm writing this as another poster on the board, not in any sort of quasi-official capacity. I think it might be wise to be careful writing things like this. It sounds as though you're prescribing medications for this poster, without a medical license. He's already told us that his doctor told him to stop the Trileptal, and you're telling him you think he should start it again. I'm not sure that's either wise or safe.Please be careful, and consider whether you feel that writing such things is appropriate here.
Thank you.
Posted by ed_uk on April 9, 2006, at 12:58:25
In reply to Please be careful here » Phillipa, posted by Racer on April 9, 2006, at 1:46:14
Brian,
I'm dismayed by your pdoc.
Ed
Posted by Phillipa on April 9, 2006, at 19:16:09
In reply to Please be careful here » Phillipa, posted by Racer on April 9, 2006, at 1:46:14
Well who prescirbed what Brian has been taking me? Sounds like a doctor did so how can I be presciribing for him. I have no license just like none of us does here. It's what I and I repeat I would do. I statements are civil. And people only want others opinions don't you think? Love Phillipa
Posted by Phillipa on April 9, 2006, at 19:33:52
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 9, 2006, at 1:12:24
Brian a real doctor did prescribe the trileptal for you?Love Phillipa
Posted by qbsbrown on April 9, 2006, at 20:08:03
In reply to Re: Please be careful here » Racer, posted by ed_uk on April 9, 2006, at 12:58:25
> Brian,
>
> I'm dismayed by your pdoc.
>
> EdWhy? How? Half of me understands what she is doing, the other half knows what is better for my body and how it is responding. But keep in mind that i haven't given an SSRI more than a 2 month trial in years.
Posted by Caedmon on April 10, 2006, at 0:14:52
In reply to Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 6, 2006, at 20:05:20
Could there be a cultural difference here? You're in China - are doctors there more inclined to be paternal and the patients should be more passive? I'm just wondering about that, and if you're any likelier to get better treatment from another doc. I mean, maybe, I'm just asking.
I am guessing your doc wants to try stuff that is in more classic Tx algorithms for OCD. So, Paxil, and maybe Seroquel. That's fine, but my opinion is often that if something works, then it works. Any drug can have any effect in someone. I don't know, I empathize, I wish you could have just stayed with the Trileptal and either monkeyed with that or added something to it, not take it away when it was obviously beneficial.
Would I listen to this doctor? Yes, I would listen, but then I would do what I thought was right for my body and mind. I've had a few times in my life where I had to comply to my pdoc's wishes despite my own, but those were times when I was verging on psychosis. The rest of the time I'm a very independent thinker.
BTW I'm not so sure I'd give up on this doctor, either; I'm impressed that you can have so much communication. I think your trick is going to be to communicate effectively your desire for Trileptal. Try not only the regular modes of communication, but also, do research and send her that research. Docs respond best when they feel valued and respected. So, journal articles, polite emails and letters, etc. Just a thought anyway.
- C
Posted by ed_uk on April 10, 2006, at 13:50:20
In reply to Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 6, 2006, at 20:05:20
Hi B :)
>I was on 600mg trileptal, which had lifted my depression and stabilized my mood greatly
I am not happy that she made you stop the Trileptal.
>So doubled my diazepam to 20mg
I thought diazepam was aggravating your depression?
>20mg of paxil
Paroxetine is pretty potent stuff. 20mg is too high a starting dose for some people. Starting at a lower dose is often a good idea.
>But now she wants to add seroquel for sleep.
Antipsychotics are not a first-line treatment for insomnia.
>The PDOC refuses to treat me unless i follow her strict orders for 6 months
I think that's awful. I really do. She is abusing her power.
Kind regards
Ed
Posted by qbsbrown on April 10, 2006, at 19:39:53
In reply to Re: Would you listen to this doctor? Help please!!!!!! » qbsbrown, posted by ed_uk on April 10, 2006, at 13:50:20
> Hi B :)
>
> >I was on 600mg trileptal, which had lifted my depression and stabilized my mood greatly
>
> I am not happy that she made you stop the Trileptal.
Here is her response, she seems not to believe me that it was working.
"Trileptal, even though it has been told it could have an antidepressant-like
effect, that would be with higher dosage and with longer time. It could be
beneficial as an adjunctive treatment for resistant depressions or OCD,
together with an antidepressant when this last one alone has proven
insufficient"
> >So doubled my diazepam to 20mg
>
> I thought diazepam was aggravating your depression?
it was/had, but my state of acute anxiety had grown so bad, it was necisarry. But remember on 17mgs of diazepam and trileptal, there was no depression anymore.
> >20mg of paxil
>
> Paroxetine is pretty potent stuff. 20mg is too high a starting dose for some people. Starting at a lower dose is often a good idea.I agree. I felt great the first 2 days on 10mgs paxil, and i still took my last doses of trileptal. Best i had felt in years. 20mgs threw me for an acid trip. I am on day 10 of 20mgs,so should just push through right? My anxiety/derealization is still way worse.
> >But now she wants to add seroquel for sleep.
>
> Antipsychotics are not a first-line treatment for insomnia.I brought this one up, wanting to stay away from the benzo like sleep pills.
I think now that my withdrawal wasn't necisarily withdrawal. Possibly more underlying anxiety, obsessing about WD, and some psycosomatic. So i probably should be on an SSRI while coming off the benzos.> >The PDOC refuses to treat me unless i follow her strict orders for 6 months
>
> I think that's awful. I really do. She is abusing her power.Mostly was saying that i had to remain on the antidepressant for 6 months minimum. That im not self prescribing, changing meds, switching doses constantly.
Oh yeah, im not supposed to look anything up on the internet regarding mental health.
WHOOPS.
I did write her a huge email expressing all of mine and your concerns. I'll let ya know how it goes.
Regards,
Brian
Posted by qbsbrown on April 10, 2006, at 21:00:16
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 10, 2006, at 19:39:53
How long is a fair trial to give paxil while it is greatly increasing my anxiety/derealization?
Plus depression is back since im not on the trileptal, now i don't look forward to teaching/tutoring, whereas before i was loving it.
Morning anxiety is killing me.
Gentlemen (women close your eyes), has it ever occured that the anxiety from a med is/was so bad, that your genital shrink up (adreneline rush), almost to receed in to your stomach? This happens non stop.Thanks,
Brian
Posted by Phillipa on April 10, 2006, at 21:57:43
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 10, 2006, at 21:00:16
For goodness sakes. Your doc in the US prescribed the trileptal right? If so follow what she or he prescribed til you get a new pdoc and cut down on the paxil if she/he in the US didn't prescribe it for you. Love Phillipa ps but remember do not prescribe for yourself . Can you phone your old pdoc even if it costs you money and tell him/her what is going on?
Posted by SLS on April 11, 2006, at 6:31:54
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 10, 2006, at 21:00:16
> How long is a fair trial to give paxil while it is greatly increasing my anxiety/derealization?
> Plus depression is back since im not on the trileptal, now i don't look forward to teaching/tutoring, whereas before i was loving it.I found that Trileptal 900mg produced a significant antidpressant effect. However, I was taking it with antidepressants. My main reasons for stopping it were that the degree of improvement was inadequate and it produced excema like lesions on my hands.
> Morning anxiety is killing me.
Have mornings always been your worst time?
> Gentlemen (women close your eyes), has it ever occured that the anxiety from a med is/was so bad, that your genital shrink up (adreneline rush), almost to receed in to your stomach? This happens non stop.
This can be the result of a phenomenon called "dysautonomia". I too have found that there is a tendency towards testicular ascension, especially upon orgasm. It is a sort of exaggerated cremaster reflex. It should abate once the depression remits.
Have you ever tried a tricyclic antidepressant?
- Scott
Posted by Racer on April 11, 2006, at 10:30:03
In reply to Re: Would you listen to this doctor? Help please!!!!!! » qbsbrown, posted by Phillipa on April 10, 2006, at 21:57:43
Posted by Phillipa on April 11, 2006, at 10:52:20
In reply to Re: Would you listen to this doctor? Help please!!!!!! » qbsbrown, posted by Phillipa on April 10, 2006, at 21:57:43
I said if his doc in the US prescribed the other to him to call him and ask his advise. Since what he had prescribed worked for him. Not prescribe for himself two pdocs heads are better than one. And maybe the trileptal isn't available in China and his old Doc may know this. Too many circumstances for mere peers to know of. Just my take. Love Phillipa
Posted by Phillipa on April 11, 2006, at 10:58:06
In reply to Re: Would you listen to this doctor? Help please!!!!!! » qbsbrown, posted by ed_uk on April 10, 2006, at 13:50:20
And I am not the only one suggestioning that this may or may not be the correct or right med for this person. I feel another opinion should be sought. Why suffer for six weeks if he can resolve the med issue sooner with info from his old doc or another and I do understand it is few and far between to find a pdoc in China according to the poster who started the thread. Just like you or I we have to weigh all the options available to us. Love Phillipa
Posted by Phillipa on April 11, 2006, at 11:13:33
In reply to Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 6, 2006, at 20:05:20
I reread your opening thread I would see your GP then and maybe they could talk together. Love Phillipa
Posted by ed_uk on April 11, 2006, at 15:32:49
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 10, 2006, at 19:39:53
Hi B :)
>she seems not to believe me that it was working
Doctors believe what they want to believe........the influence of expectation.
>that would be with higher dosage
600mg is not especially low. Even in epilepsy, 600mg can sometimes be adequate.
>I agree. I felt great the first 2 days on 10mgs paxil, and i still took my last doses of trileptal. Best i had felt in years. 20mgs threw me for an acid trip. I am on day 10 of 20mgs,so should just push through right? My anxiety/derealization is still way worse.
I would go back to 10mg if I were you. You can increase to 20mg in a few weeks time *if necessary*. I would never let anyone force me to take a higher dose than I was comfortable with. It's my body!
>Oh yeah, im not supposed to look anything up on the internet regarding mental health.
Some doctors prefer that their patients lack knowledge RE medications. This way, the doctor can assume the role of the expert. It's got a lot to do with ego.
Regards
Ed
Posted by ed_uk on April 11, 2006, at 15:43:57
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 10, 2006, at 21:00:16
Hi Brian
>How long is a fair trial to give paxil while it is greatly increasing my anxiety/derealization?
Decrease the dose to 5-10mg. 20mg was clearly much too high a starting dose.
>Gentlemen (women close your eyes), has it ever occured that the anxiety from a med is/was so bad, that your genital shrink up (adreneline rush), almost to receed in to your stomach? This happens non stop.
Anxiety causes the testes to be brought closer to the body. The scrotum may appear 'tight'. The size of the penis at any one time is related to the amount of blood that it contains. Your penis can be many different sizes throughout the day! An erection occurs when the erectile tissue of the penis fills with blood. During the flaccid state, the penis is smaller because it contains less blood. Anything which decreases the blood flow to the penis (eg. very cold weather) will cause a temporary decrease in size. Anxiety can affect the blood flow to the penis, causing a *temporary* shrinkadge - which *immediately* reverses when the anxiety is relieved. Anxiety related to sex is particularly likely to cause these symptoms.
Regards
Ed
Posted by Racer on April 11, 2006, at 18:05:50
In reply to Re: Would you listen to this doctor? Help please!!!!!! » qbsbrown, posted by ed_uk on April 11, 2006, at 15:32:49
>
> >Oh yeah, im not supposed to look anything up on the internet regarding mental health.
>
> Some doctors prefer that their patients lack knowledge RE medications. This way, the doctor can assume the role of the expert. It's got a lot to do with ego.
>
>I didn't read it this way. Brian said that he tends to obsess about things, and I kinda figured his doctor was trying to minimize his obsessing about meds and mental health. Not that she was trying to stop him from being an informed consumer, just that she didn't want him to be an obsessing consumer, you know?
Then again, could be I'm wrong...
Posted by Phillipa on April 11, 2006, at 18:40:45
In reply to I guess I got a different reading on this » ed_uk, posted by Racer on April 11, 2006, at 18:05:50
Ahhh Racer don't feel bad we all make mistakes. I do it all the time myself. Such is life. Love Phillipa
Posted by gardenergirl on April 11, 2006, at 19:32:00
In reply to Re: I guess I got a different reading on this » Racer, posted by Phillipa on April 11, 2006, at 18:40:45
I think she was saying she interpreted the comment differently than Ed did.
Of course I may be wrong.
gg
Posted by Phillipa on April 11, 2006, at 19:38:55
In reply to Re: I guess I got a different reading on this » Phillipa, posted by gardenergirl on April 11, 2006, at 19:32:00
Well that's what makes us individuals with different opinions and different diagnoses and different career choices, different locations to live and on and on. Love Phillipa
Posted by qbsbrown on April 11, 2006, at 19:51:03
In reply to Re: I guess I got a different reading on this ?Racer, posted by Phillipa on April 11, 2006, at 18:40:45
Great news! She came through with flying colors. I could not be more satisfied with her email. Thanks for your support. Enjoy reading.
"First of all, this is not a fight of egos. Not at all. I acknowledge the amount of information you have regarding mental health and medication effects/side effects. And yes, it is true that every person is an individual, meaning we are not supposed to generalize.
?/div>
But, in your case, I believed it was best to follow the "guidelines" to treat your anxiety and OCD. You have tried almost everything, with different timing and combinations; and your feelings, sometimes not only affected by the chemicals, are too subjective to be reliable. Please, understand me, I do not mean you are making up anything. I truly believe what you tell me is exactly how you felt. But I am somewhat skeptical due to the way your psyche works. That is why I preferred to follow the guidelines.
?/div>
SSRI is the first line treatment for anxiety, depression and OCD. After that, almost everything else is considered adjunctive treatment, working together with SSRI. (another treatment could be another antidepressant, such as the old tricyclic ones with many many side effects). My plan is using the paroxetine for as long as needed, 20 to 40 mg, initially together with benzodiacepines, for 3 to 4 weeks and then decrease and eventually stop benzodiacepine.
An hypnotic such as Ambion could do the trick to help you sleep better. And I do believe sleeping well is important for a good recovery.But continuing with the guideline:
1. SSRI for 4-5 weeks with benzo and then decrease/stop benzo,
2. increase SSRI,
3. change SSRI or add adjuvant treatment such as (I prefer the last, if not it is a waste of time)?
?. another antidepressant
?. antipsychotic
? mood stabilizer
?/div>
I decided to wear you off Trileptal because you were already complaining about its side effects (mostly those terrible headaches) and in order not to interfere with a "proper" treatment. Trileptal was not really bothering me, it was bothering you. You were taking Trileptal as a treatment for benzodiazepine withdrawal, and we know that's not the case. Also, I sincerely believe antidepressants will help you more in improving your symptoms than Trileptal, but with time. Antidepressants need 2 to 6 weeks to work, it depends on the individual. A 3 week trial of paroxetine as you did before is not enough to know if it is beneficial for you or not.?
?/div>
Having said all that I really do not want to discuss further this issue about taking or not taking Trileptal (there is not such an important reason against it) and as it will not do harm (apart from side effects) I let you restart it as you wish. If it helps, we shouldn't care if it is due to the placebo effect or due to its antidepressant-like effect, we should just be grateful it helps. ?/div>
?/div>
On the other hand, I understand your derealization as an anxiety symptom. Anxiety symptoms are many and respond differently to SSRI. Some respond quicker than others. The slowest ones could take one and a half or two months to disappear or to become better. Some might be resistant to an SSRI and need further treatment (another antidepressant, an antipsychotic...). We will need to give paroxetine a chance to improve this particular symptom. At the beginning of the treatment with SSRI there is a chance of worsening of symptoms, that is one of the reasons why, I am sure you already know about that, FDA imposed the drug companies a black box warning to SSRI saying at the beginning of the treatment it could increase suicidality.
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Dr. Bob is Robert Hsiung, MD,
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