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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 41. This is the beginning of the thread.
Posted by jealibeanz on May 23, 2006, at 19:05:53
Hey all...
My doc just gave me a script for Xanax. His directions were to take .25 mg 3 x daily. I've been taking 1-1.5 mg total daily, so it's a little more than he had written it for, but I don't think he'd object. I need to go see him and discuss a longterm plan. This was an "emergency" script as I was going to college and having extreme anxiety (also extreeeme depression, but he doesn't know that right now).
The Xanax helps the anxiety quite a bit, although I'm a tiny bit groggy, forgetful, and slurring my speech. But I am much more relaxed and able to easily interact with all my new classmates and deal with the pressure of a new move and intense school, so things have improved greatly over the past few days. I'm a little suprised since Klonopin used to make me incredibly tired, dumb, and depressed. Xanax almost has a slight antidepressant effect I feel.
We've tried Paxil, Buspar, Adderall, Wellbutrin, Klonopin, and Effexor in the past for social/general anxiety and for major depression. I'm unwilling to try an SSRI. I've had dysthimia for my whole life! Is it possible this and the chronic anxiety has a chance of being properly medicated?
I know he's one of the few GP's who'd be willing to give me daily Xanax b/c I don't appear that "bad" in person. If I were to stop taking it right now, I was at a point in my life we're I was nearly suicidal and too unhappy and anxious to get out of bed and be productive. I think the depression does need to be addressed. He's very nice and understanding.
I hate talking about depression, especially in a very serious way, but I think he needs to know that I was very much not wanting to continue my life til I just started taking my Xanax. I'm not even completely sure he's willing to do it longterm, but I'm not living near him and can't constantly travel back to appointments, so options need to be looked at.
I've thought about adding EMSAM to the Xanax. It's something I've never tried. I just wonder if he'd look at me like I'm crazy. Do GP's know much about it and are willing to try? He's very supportive of me and my future, so I know he may at least give me an honest answer, but I feel silly asking, like I'm jumping on the bandwagon. I know they like to have drugs on the market for a while before handing them out like candy, but I need to address this matter quickly before it gets out of control and interferes with my future. Any thoughts?
Posted by Phillipa on May 23, 2006, at 21:22:07
In reply to What should I consider for long term treatment?, posted by jealibeanz on May 23, 2006, at 19:05:53
Well unless the drug reps have visted him he probably hasn't even heard of it. Love Phillipa
Posted by jealibeanz on May 23, 2006, at 21:50:56
In reply to Re: What should I consider for long term treatment? » jealibeanz, posted by Phillipa on May 23, 2006, at 21:22:07
Could he really not know about it? I mean, I do! I understand not knowing much or being comfortablw enough to prescribe, but to have no idea a novel new antipressant option has been released is completely ignorant. Is there a way I could contact the drug company to see if they are marking to family practices? Does EMSAM along with the Xanax seem smart?
Posted by Phillipa on May 23, 2006, at 21:55:41
In reply to Re: What should I consider for long term treatment?, posted by jealibeanz on May 23, 2006, at 21:50:56
Where did you learn about it here? Bet you doc doesn't come here. We seem to know more than they do. No joke. Love Phillipa
Posted by jealibeanz on May 23, 2006, at 23:44:55
In reply to Re: What should I consider for long term treatment? » jealibeanz, posted by Phillipa on May 23, 2006, at 21:55:41
yeah I did. Are you sure they don't ever look at publications like Pubmed or look at new FDA approvals and bans?
Posted by B2chica on May 24, 2006, at 11:15:02
In reply to What should I consider for long term treatment?, posted by jealibeanz on May 23, 2006, at 19:05:53
xanax does have a slight AD effect so i'm glad he chose that one for you. i think 1-1.5/day is just fine if it's what works for you.
i know you said you didn't want to try an ssri but what if you used it to augment something like wellbutrinXL. that seems to be a good mix.
Posted by jealibeanz on May 24, 2006, at 12:00:33
In reply to Re: What should I consider for long term treatment, posted by B2chica on May 24, 2006, at 11:15:02
I've actually used Wellbutrin. It, like the other meds I've tried has caused major weight gain.
(i know, hard to believe since it's not supposed to)
Posted by bassman on May 24, 2006, at 13:32:49
In reply to What should I consider for long term treatment?, posted by jealibeanz on May 23, 2006, at 19:05:53
My two cents is that if other meds haven't worked well and the Xanax is helping enough with the depression and anxiety, consider just being on the Xanax long term and see if that works well enough. It saves the pain of trying another med-OTOH, if it turns the Xanax isn't enough in the antidepressant area, you might try an SSRI in a very low dose and see if you respond-and without the side effects.
Posted by Racer on May 24, 2006, at 13:38:07
In reply to What should I consider for long term treatment?, posted by jealibeanz on May 23, 2006, at 19:05:53
>(also extreeeme depression, but he doesn't know that right now).
But that's gonna change, right? After you tell him, he will know, and y'all can start addressing it, right? ;-)
>
> We've tried Paxil, Buspar, Adderall, Wellbutrin, Klonopin, and Effexor in the past for social/general anxiety and for major depression. I'm unwilling to try an SSRI.Well, Paxil is an SSRI. Why are you unwilling to try any others? They're all the same class, but they're all very different in "feel." If it would improve your depression, what makes you unwilling to give one a try?
And I'm not trying to say you're wrong, just asking what's on your mind about it.
>
> I hate talking about depression, especially in a very serious way, but I think he needs to know that I was very much not wanting to continue my life til I just started taking my Xanax.That information is relevant to your treatment, and I think it's in your best interest to tell him.
>
> I've thought about adding EMSAM to the Xanax. It's something I've never tried. I just wonder if he'd look at me like I'm crazy. Do GP's know much about it and are willing to try? He's very supportive of me and my future, so I know he may at least give me an honest answer, but I feel silly asking, like I'm jumping on the bandwagon. I know they like to have drugs on the market for a while before handing them out like candy, but I need to address this matter quickly before it gets out of control and interferes with my future. Any thoughts?It's good that you've got such a good relationship with your doctor. That part is so much more important than most doctors quite realize. (But don't let me get started on that topic...)
As for thoughts on EMSAM, I'm not sure I'd recommend that as a next step, for a variety of reasons. Just because there aren't dietary restrictions on the lowest dose, and it's said not to have the same risks of hypertensive crisis, that doesn't mean that it doesn't have side effects, including blood pressure related side effects. What's more, if you read the posts here, it seems as though it's a bit underwhelming so far. And, at the higher doses, they are recommending the dietary restrictions.
You're probably right about a GP not feeling comfortable prescribing it yet, but if you talk to him about it, maybe he'll offer a referral to a pdoc? Once you get something going that works, you can go back to your GP for maintenance.
Good luck.
Posted by jealibeanz on May 24, 2006, at 19:27:37
In reply to Re: What should I consider for long term treatment » jealibeanz, posted by Racer on May 24, 2006, at 13:38:07
I feel like a broken record, since I mention this as my main concern when talking about AD's to everyone! They all caused my to gain large amounts of weight (20 lbs on a small person!) in a short period of time. I was always very very active as an athlete and eat very well, so I know this is how my body reacts to the types of medications. That's going to make depression and anxiety worse for a female college student! I don't recall feeling huge symptom relief from the meds either, but they may have helped, I wasn't good at perceiving my progress when younger. While I realize I could try Prozac, Zoloft, ect., it's not worth the heartache and frustration that the others have caused.
Posted by Phillipa on May 24, 2006, at 19:31:46
In reply to Re: What should I consider for long term treatment » jealibeanz, posted by Racer on May 24, 2006, at 13:38:07
I agree with Racer after following the threads that ENSAM is not a good choice unless you've tried so many you are out out options. And hopefully he does read the literature for docs.But last month my pdoc hadn't heard of it. This month he forgot about it. Oh he did say the drug reps hadn't yet made their rounds with latest info. If my pdoc took the time to talk to me I had wanted to suggest low dose prozac yesterday with the valium I already take. Have you considered low dose prozac? Love Phillipa ps stupid me should have opened my mouth!!!!!I'm angry at me
Posted by Phillipa on May 24, 2006, at 19:34:08
In reply to Re: What should I consider for long term treatment, posted by jealibeanz on May 24, 2006, at 19:27:37
Well if it's any consolation it's been l0 years for me trying to find a mix but I never gained wt on them. And the first one I tried did work l0mg of paxil with xanax. Love Phillipa
Posted by jealibeanz on May 24, 2006, at 19:56:58
In reply to Re: What should I consider for long term treatment, posted by Phillipa on May 24, 2006, at 19:34:08
Well, my problem is that they've all put weight on, otherwise I'd be willing to explore another SSRI, but it would be ignorant to believe that my next trial would be greatly different from the others.
Posted by jealibeanz on May 24, 2006, at 20:04:48
In reply to Re: What should I consider for long term treatment, posted by Phillipa on May 24, 2006, at 19:31:46
I'm suprised you'd think that I'm not a good candidate. After recurrently battling nearly dehabilitating anxiety/depression I feel that I need a medication to give me a good quality of life. I have tried several medications and tolerable. What would be the next try past the SSRI, Wellbutrin, and SNRI trials? I know MAOI's were shied away from in the past, but isn't this a new and safer circumstance?
Posted by Phillipa on May 24, 2006, at 21:08:56
In reply to Re: What should I consider for long term treatment, posted by jealibeanz on May 24, 2006, at 20:04:48
I think it is as you can just take it off. But I'm waiting for more positive responsives to come in. Love phillipa
Posted by Racer on May 24, 2006, at 22:19:13
In reply to Re: What should I consider for long term treatment, posted by jealibeanz on May 24, 2006, at 19:27:37
> They all caused my to gain large amounts of weight (20 lbs on a small person!) in a short period of time. I was always very very active as an athlete and eat very well, so I know this is how my body reacts to the types of medications. That's going to make depression and anxiety worse for a female college student!
Yeah, you don't have to sell me on it -- you're preaching to the choir. Although, to put it in perspective for you, I gained OVER 50 POUNDS on virtually every AD I've taken. (So far, Wellbutrin doesn't seem to be doing it. Much.) And you're right -- there ain't no drug on earth that can make you feel OK if that happens.
There are drugs that can mitigate the weight gain, though. The two I've read about as being effective are Topomax and Metformin. Now, both have side effects, but they both work. I'd actually think about pointing you towards Effexor XR and Metformin to counter the weight gain, but I'm not a doctor, don't play one on TV, and try not to play one on Babble. That's just my take on what might be worth looking at.
How about this -- and this is coming from someone who is nuts when it comes to weight, and understands how frustrating it is to try to explain things to other people, and how easy it is to fly off into miseryville when someone suggests you rethink your priorities* -- how about you list your symptoms, rather than diagnosis, and let us know which are most problematic for you. Maybe that will help clear up that picture?
I suggest this because I was brought up short once, by a pdoc who asked, "What is your depression like?" Uh... I'd never thought about it -- I had depression, it had a name, it was like depression, right? But thinking about it kinda helped, at least in clearing my mind enough to think about which symptoms were most problematic for me, so that those could be addressed first. I hope that it might be a helpful exercise for you, and that it might lead to someone making a good suggestion for you.
*I've posted here that I will not take certain drugs again, and been told that I really need to get over that, it's worth it to gain the weight if I get over my depression, etc. And I've also had people tell me that it's a slap in the face for me to say that I won't take something that might work, because nothing works for them. Believe me -- I'm not suggesting you are wrong for feeling this way. I'm suggesting that if you look symptom by symptom, you might find something ala carte that wasn't included in the entree selections.
And I'll tell you right now that I agree that quality of life, which is what we're really talking about, does matter.
Good luck, and I hope something here helped, at least a bit.
Posted by Phillipa on May 24, 2006, at 22:46:46
In reply to Re: What should I consider for long term treatment » jealibeanz, posted by Phillipa on May 24, 2006, at 21:08:56
Everyone but blueberry and me seems to
report wt gain on meds. Wonder why we don't? Love Phillipa ps now I probably will
Posted by jealibeanz on May 25, 2006, at 0:35:21
In reply to Re: What should I consider for long term treatment » jealibeanz, posted by Racer on May 24, 2006, at 22:19:13
I've mentioned those adjunctive treatments to severaldoctors in my practice. They look at me with blank stares, and then explain there is not enough research on the matter and that they can have some pretty nasty and serious side effects that outweigh the potential benefits. Disappointing, but completely understandable.
My depression symptoms:
-overwhelming sad feeling. The last few weeks have been beautiful and sunny. I hardly notice. I only notice gloom. I almost literally see clouds and darkness. I was shocked when a professor pointed out the wonderful weather and flowers. I can't even begin to see or appreciate such things.-When "depression" hits, it hits hard. It seemingly comes out of nowhere in my typical successful life, which is full of great opportunities and support. It's feels as if the ground has fallen out below me and I'm spiraling down uncontrollably into a negative, despondant, helpless, and hopeless mood.
-I walk around with tears in my eyes. There is nothing majorly upsetting going on in my life. There are no small things that I am crying about. It's just a physical reaction to being awake in a happy and well functioning world!
-I have difficulty laughing and jokes and relaxing at times when others normally do. My mind is either blank from a form of numbing I've created to stop the hurtful feelings to care or notice the humor, or I am so fixated on the pain that I cannot imagine how people are laughing at a time like this!
-I want to sleep. I want to sleep all day everyday. It's not because I'm lacking rest or truely tired. It's a foggy/groggy feeling. Lying in bed is also a way of not having to see the world of happy people.
-I don't care about future goals or responsibilities. I don't care about work, school, a future career. At very bad times I've skipped work or school, quit jobs, did little schooling, and withdrew from classes.
-My moods can be described as doom and gloom. Everyday is a battle to just get through in one piece, doing normal chores and activities. Everything is a huge effort, especially because I lack the desire and drive to do little more than sleep.
-I feel like I'm simply going through the motions of life. I don't seek out friends. I start skipping events. I give up on lifelong activities I've always enjoyed. I feel no pleasure. I have no desire to be alive and can't understand why anyone would.
Posted by nickguy on May 25, 2006, at 1:29:17
In reply to Re: What should I consider for long term treatment, posted by jealibeanz on May 25, 2006, at 0:35:21
it's good to hear that you decided to go to school, I hope it works out for you. If not, no big deal, things will be o.k either way. Not saying you shouldn't pursue meds at all, but I'd still reccomend talking to a pyschologist, I know we all want a quick med fix but it's not that simple, and from my experience 2 months of CBT has been more eye opening and uplifting than 2 years of talking to a pyschiatrist.
As for meds, I'm going for an MAOI right now. You seem to have a similar med history to me but I've tried (and failed) a few more. I would bring up EMSAM with your doctor. Try to convey that you understand about the diet and medical restrictions and that your not completely ignorant on that subject. Also, a letter from a family member saying that they know about the risks of an MAOI and can help you might help persuade your doctor. I definetely wouldn't just take XANAX if you are feeling depressed. Xanax can be like alcohol for people with depression, which is not healthy.
Posted by bassman on May 25, 2006, at 6:47:18
In reply to Re: What should I consider for long term treatment, posted by nickguy on May 25, 2006, at 1:29:17
Saying taking Xanax is like alcohol is like saying CBT is like going to AA meetings...I think this is a support board, not a judgment-of-others board. Maybe you didn't mean it that way, but that's the way it came across to me.
Posted by B2chica on May 25, 2006, at 9:08:43
In reply to Re: What should I consider for long term treatment » jealibeanz, posted by Racer on May 24, 2006, at 22:19:13
> *I've posted here that I will not take certain drugs again, and been told that I really need to get over that, it's worth it to gain the weight if I get over my depression, etc.
i agree with racer. people can think, wow, wouldn't you rather gain weight than be depressed all the time. but it depends on the person. some of us are really sensitive to weight gain and though the AD helps with depression at first, when we gain all that stupid weight guess what comes back...that's right depression. so no, it doesn't always work. and i certainly understand.
but i wanted to ask if you've ever tried effexor. i'm not a big advocate of this drug as i had a cruddy experience but it seems to work wonders on many people and i did actually loose quite a bit of weight on it...have you tried this one?
Posted by gardenergirl on May 25, 2006, at 9:35:08
In reply to What should I consider for long term treatment?, posted by jealibeanz on May 23, 2006, at 19:05:53
You might want to look into Lamictal. It's a drug used to combat the depressive side of bipolar, and now it's being used for unipolar depression. I take 100 mg along with an MAOI (Nardil), and it's really helped me.
And I'd definitely consider getting a referral to a psychiatrist. I sought treatment from my GP for awhile, but he simply is not familiar or skilled enough with pyschotropics to treat me most effectively.
Also, I agree with others who mention therapy. You might be able to do this through school. If not, your doc can probably provide some referrals. A lot of the literature suggests that meds and therapy together are more likely to lead to remission versus one or the other alone.
Good luck. Depression can be horribly debilitating. I hope you find what's the best course of treatment for you.
gg
Posted by nickguy on May 25, 2006, at 11:52:19
In reply to Re: What should I consider for long term treatment » nickguy, posted by bassman on May 25, 2006, at 6:47:18
> Saying taking Xanax is like alcohol is like saying CBT is like going to AA meetings...I think this is a support board, not a judgment-of-others board. Maybe you didn't mean it that way, but that's the way it came across to me.
I was saying that xanax is in a way kind of a depressant, like alcohol. So theres nothing wrong with taking it for anxiety, but it's probably not a good treatment for depression.
Posted by bassman on May 25, 2006, at 11:58:42
In reply to Re: What should I consider for long term treatment, posted by nickguy on May 25, 2006, at 11:52:19
I was going on the "Xanax almost has a slight antidepressant effect I feel" on the original post-I find that Xanax has an antidepressant effect, too. But you sure are right about some benzos-I find Klonopin depressing..
Posted by Racer on May 25, 2006, at 12:32:42
In reply to Re: What should I consider for long term treatment, posted by jealibeanz on May 25, 2006, at 0:35:21
Have you considered trying Parnate? It's said to be the most weight neutral of the MAOIs, and one of the most consistently weight neutral ADs in general, and it is a bit activating, which sounds like something that would help you. There is the Diet to consider, of course, and a few other things regarding blood pressure, etc. Otherwise, that's where my mind went. (If I wasn't trying to get pregnant, I would consider it my next choice. My T and my pdoc disagree, though, because of my eating disorder. They don't want any excuses for me to restrict more.)
Otherwise, Lamictal is probably a good one to try, because it does seem to help a lot of people, and it doesn't seem to cause any weight gain. Other people have also said it seems activating, but I didn't experience that. (Then again, it increased my depression, so I'm not exactly a typical user...)
Mostly, though, you know what I think I'd offer up as an option? Combine one of the ADs, almost any one of them, with Provigil. Heck, combine Lamictal and Provigil. Provigil can be a very good augmenting agent, it will provide some stimulation to counter any sedation from the AD, and it should also help avoid any weight gain. It's also a fairly safe drug. For a while, it was ALL that I was taking, and while I was definitely not well, at least I was functioning. (Functioning better than I think I am right now, even...)
Hope that helps, and good luck.
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