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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by Tom Twilight on September 4, 2006, at 4:56:48
In reply to Forgot to mention., posted by deniseuk190466 on September 4, 2006, at 4:03:53
Hey Denise
I'm sorry I can't think of any practical suggestions right now! I've got to go to work.
I understand how frustrated you feel with your Pdoc though.
There's this daft idea in the UK that you have to be on a med for 3-months or longer to know if it will work.Have you considered trying something like VNS, I understand rTMS is not all its cracked up to be.
Posted by linkadge on September 4, 2006, at 5:39:39
In reply to Following Psychiatrists instructions - advice???, posted by deniseuk190466 on September 4, 2006, at 3:56:40
Have you tried other atypicals? I found seroquel to have less side effects than zyprexa, and seemed to work as well. I think its a bit safer, and it has a shorter half life.
I know what you mean though. For me, this board is essentially useless in that sure it can give great advice, but who am I fooling, my doctor doesn't listen to suggestions. In fact, sometimes he does the opposite just to proove he's incharge.
Have you tried 5-htp? It may help SSRI's work again.
Linkadge
Posted by Phillipa on September 4, 2006, at 10:00:17
In reply to Re: Following Psychiatrists instructions - advice???, posted by linkadge on September 4, 2006, at 5:39:39
Sorry about your Mom. Love Phillipa
Posted by Racer on September 4, 2006, at 10:56:30
In reply to Forgot to mention., posted by deniseuk190466 on September 4, 2006, at 4:03:53
> Hi,
>
>
> Surely three months is a bit too long to have to wait to know whether something is working for you.
>
> When I have responded to drugs in the past it's always been withing days, weeks not months and months.I know this won't make me popular, but I'd bet that the response within days is more placebo than real. Truly -- at least for SSRIs and most of the other newer meds, it takes longer than a few weeks to respond.
As for the three months, that bugs me, too. I don't necessarily think that it's out of line to ask you to stay on them -- and actually take them, you know? -- for three months, but I'd certainly want him to check on you after a month, and maybe adjust the dose at that time. That just makes sense to me.
Honestly? I think I'd be in favor of going in hospital to get the meds started, but largely because you've admitted that you're noncompliant. It might also be to your benefit, since the doctor could actually SEE that you weren't responding, if you didn't. (Of course, there's a chance that you actually would respond, if you took them, you know?)
On the other hand, it would be nice to see if there's a way to improve your relationship with your doctor. Have you tried telling him that you're feeling as though you've got an adversarial relationship right now, which doesn't help with your treatment, and asked him what it would take to improve it? He might say you just need to do exactly what he says, but that would give you an opening to tell him that you can't do that -- especially when you feel so strongly that he isn't listening to you. It would be hard -- and why do these things happen when we're least able to address them? -- but it might help you get through this better.
Good luck.
Posted by willyee on September 4, 2006, at 17:21:33
In reply to Re: Forgot to mention. » deniseuk190466, posted by Racer on September 4, 2006, at 10:56:30
> > Hi,
> >
> >
> > Surely three months is a bit too long to have to wait to know whether something is working for you.
> >
> > When I have responded to drugs in the past it's always been withing days, weeks not months and months.
>
> I know this won't make me popular, but I'd bet that the response within days is more placebo than real. Truly -- at least for SSRIs and most of the other newer meds, it takes longer than a few weeks to respond.
>
> As for the three months, that bugs me, too. I don't necessarily think that it's out of line to ask you to stay on them -- and actually take them, you know? -- for three months, but I'd certainly want him to check on you after a month, and maybe adjust the dose at that time. That just makes sense to me.
>
> Honestly? I think I'd be in favor of going in hospital to get the meds started, but largely because you've admitted that you're noncompliant. It might also be to your benefit, since the doctor could actually SEE that you weren't responding, if you didn't. (Of course, there's a chance that you actually would respond, if you took them, you know?)
>
> On the other hand, it would be nice to see if there's a way to improve your relationship with your doctor. Have you tried telling him that you're feeling as though you've got an adversarial relationship right now, which doesn't help with your treatment, and asked him what it would take to improve it? He might say you just need to do exactly what he says, but that would give you an opening to tell him that you can't do that -- especially when you feel so strongly that he isn't listening to you. It would be hard -- and why do these things happen when we're least able to address them? -- but it might help you get through this better.
>
> Good luck.Just curious,in the same way i cant say for sure that ssris have a direct,or semi direct effect of some sort in the first few days since it is crossing in the brain,and active,and in this case would have to be the only substance i can think of going back as far as i can think of that behaves this way,i would ask you the same,only because you say it with such certaintity.
Yess we are told this,but do we know for sure that in everyones case,these drugs again entering the brain upon ingestion are not having a direct effect,can we at the least say this is the case for everyone.Building up to therputic levels is something entirly different,buti still dont understand the logic of an antidepressant being just about the only substance able to enter the brain,drig wise and not have a immediate effect.
You have fish oil and other lower end supplements,but anything considered a drug,even aspirin have a direct noticable effect.
I think it would be odd actualy to take a weeks supply of one of these drugs and not notice it,it would not make much sense to me,and again as far as long term effects,and its building in the brain,that is something i can apply logic to and understand.Anyway as far as the original posters question,i notice that some docters are in are spectrum where they read,and stay active in there profession,and then i personaly think there are some who simply work there daily practice,attend the seminars they are too,and thats about it,something every profession has,which is a degree an individual goes once they have gotten in.
I know i hear stories here of docters working with posters or even discussing these off label medicications,while in my life time of numerous docters have never had a docter mention or dare i say acnowledge the use of a off label medication the majority if hearing it from me would look at me like im the worst person to sit in front of them.
I had one who took my ideas i brought seriously and of course she then retires so now im back to a docter who the minute i mention something she doesent have a leaflet on her desk about she blows me off in two seconds.
I cant even get her to replace Nuerontin with lyrcia and ive asked 3 times now.
Posted by fca on September 4, 2006, at 17:58:09
In reply to Following Psychiatrists instructions - advice???, posted by deniseuk190466 on September 4, 2006, at 3:56:40
successful in developing mutually acceptable TX plans and negotiating your preferences--including a second and third opinion and trials with numerous drugs. ALso. I do not think that waiting 12 weeks to evaluate the response to TX is unusual given your extensive history--it often takes 8-10 weeks to fully evaluate the response to a new medication plan. I am not sure why he would want to admit you to a hospital unless he thought you were a danger to yourself or others or were not treatment compliant (which is partially the case). Your staement
"I wanted to try something with a completely mode of action like maybe (Effexor and Remeron) combined, ECT or lyrica. I really don't know what I'm doing anymore" may sum it up. The remeron/effexor, ECT or Lyrica are very different strategies (I am confused about the Lyrica which is an anxiolytic). I sincerely hope you find a physician with whom you are willing to trust and let him/her give it a fair shot on their own based on your history and responses. I run a large community health center in the States and employee 12 psychiatrists. I purposely picked a willful one who would listen but still push me to do what she thoughts was best. I know enough to be dangerous and to easily manipulate my symptoms and presentation to get what I want (If I was so inclined, which I am not). My Best wishes fca
Posted by linkadge on September 5, 2006, at 1:27:59
In reply to Re: Forgot to mention. » deniseuk190466, posted by Racer on September 4, 2006, at 10:56:30
I don't think its impossable to experience overnight improvement from an antidepressant. Here's why I say that. Sleep deprivation produces an imediate antidepressant response in 40-60% of people who try it. That is, they go into remission the next day. The more potent REM supressing medications such as the TCA's can reduce REM sleep very quickly, and are perhaps mimicking the effects of sleep deprivation in some way. I don't think its typical, but I don't think its impossable.
Some people who say they responded the next day, will say things like, "the world was so much brighter the next day". This is not an illusion, these are effects of REM supression.
Linkadge
Posted by Meri-Tuuli on September 5, 2006, at 9:12:31
In reply to Re: Forgot to mention. » Racer, posted by linkadge on September 5, 2006, at 1:27:59
I'm sorry to hear about your frustrations.
Personally, I can't get along with my NHS pdoc - honestly, he doesn't tell me anything I don't know already, and doesn't even come up with any useful med suggestions - I'm the one suggesting the meds! Although, I haven't crossed invisible line into the drugs like AT APs, or MAOIs etc. I refused to try remeron/mirtapisine. The weight gain scares me.
So I find pdocs pretty useless to be honest. I get much more help and support from my herbalist, who is really great. She kinda treats you as a whole person, rather than just a problem to be fixed, if that makes sense.
Kind regards
Meri
Posted by deniseuk190466 on September 5, 2006, at 10:29:01
In reply to Re: Forgot to mention., posted by Tom Twilight on September 4, 2006, at 4:56:48
Hi Tom,
Yes I've thought about VNS before but I don't think it's even an option, I mean if my psychiatist won't prescribe anything other than SSRIs and antipsychotics and looks at me gone out when I mention anything out of the ordinary. How on earth am I going to persuade him to let me try VNS.
Do you have any suggestions?
By the way, whereabouts in the UK are you?
Denise
Posted by deniseuk190466 on September 5, 2006, at 11:08:03
In reply to Re: Following Psychiatrists instructions - advice???, posted by linkadge on September 4, 2006, at 5:39:39
Hi Linkadge,
Yes I have tried 5HTP although have to confess didn't take it very long before giving up on it.
I was wondering if L-Tryptophan would be more effective??
Denise
Posted by Tom Twilight on September 6, 2006, at 1:55:15
In reply to Re: To Tom, posted by deniseuk190466 on September 5, 2006, at 10:29:01
Hi Denise
I sorry your in such a bad way,
I remember how helpful your were in the past :)I really don't have a high opinion of NHS Psychs, although I've found out private ones can be just a bad, only more expensive.
> Do you have any suggestions?
This is a vebsite about VNS, although it focuses on Epillepsy suffers they might be able to help
http://www.epilepsy.org.uk/info/vagal.htmIf I remember correctly you live in the live near Birmingham?
This means your near Bristol?
Proffesor David Nutt is based in Bristol.
He is the only Doctor in the UK who seems to be really on the ball, although I've never met him.He was talking about using DBS for depression.
Don't know if you can afford him though
> By the way, whereabouts in the UK are you?I live in Cambridge, which is annoying!
Wish I lived somewere more centralP.S. Turn your Babblemail on!
Got to go now
Good luck
Tom
Posted by deniseuk190466 on September 6, 2006, at 12:15:19
In reply to Re: Following Psychiatrists instructions - advice???, posted by Phillipa on September 4, 2006, at 10:00:17
Hi Phillipa,
Thanks, luckily she caught it early so it's only at level 1 and hopefully they won't find anything else when they remove the lump.
Denise
Posted by deniseuk190466 on September 6, 2006, at 12:45:14
In reply to Re: Forgot to mention. » deniseuk190466, posted by Racer on September 4, 2006, at 10:56:30
Hi Racer,
Thanks for responding and I'm not going to jump down your throat about the placebo bit as you're entitled to your opinion and I expect your opinion is based on your own experiences with Antidepressants.
But I have to say that I know hand on heart that the response I had within a couple of days was not placebo, a) because the experience was far too profound, I literally felt as though I'd stepped through this portal into a 3 dimensial world, it may however be that I was not experiencing the true antidepressant effect but some other chemical effect. All I can say is that the first few times I ever took them my depression was totally erradicated and very quickly. B) I just don't respond to anything in a placebo kind of way, if that was the case the two years I spent trying everything under the sun would have given me a placebo effect antidepressant type response and they didn't. The rTMS that I had in vancouver would have initially helped, the hypnotherapy I had would have initially helped etc, etc.
Thanks for your advice though about my relationship with my psychiatrist and I have tried to explain to him and other people at the hopsital that we have communication problems but that really istn't the issue is it? I guess the issue is that he is not offering enough options or possibilities and the fact that unless it has been completely tried and tested to the hilt he doesn't really want to know.
Denise
Posted by deniseuk190466 on September 6, 2006, at 13:14:09
In reply to Re: Forgot to mention. » Racer, posted by linkadge on September 5, 2006, at 1:27:59
Hi Linkadge,
Thanks for believing to some degree that an early response doesn't necessarily mean a placebo effect, especially when you've not been lucky enough to have a quick response. And the brightening of the room effect is exactly what occurred to me within a few days of taking the drugs (at one time). It was literally like being in another world.
What you say about REM sleep really interests me because I find that the more depressed I am the more I seem to wake up remembering my dreams and I take it REM sleep is the dream state of sleep. This means that I must be waking up during REM sleep or that I'm experiencing more of it.
Denise
Posted by deniseuk190466 on September 6, 2006, at 13:35:04
In reply to Re: Forgot to mention.denise..., posted by Meri-Tuuli on September 5, 2006, at 9:12:31
Hi Meri,
I think the problem is that like another poster said, they tend to just do their job, go to the seminars and know the text book stuff but when it comes to really asking questions and going any further they either don't have the time or are not that interested in finding out because their need is not so great.
I'm pleased that you get some help from your herbalist but I have to say I have very little faith in many alternative therapies based on my own experiences.
With this particular episode, when it first started, my mum encouraged me to go and see a hypnotherapist and admittedly to humour her I went along. Every session the guy would say "if this doesn't work I'll eat my hat" and at the end of the 14 sessions I really felt like saying "well either eat your hat or give me my money back". I think hypnotherapy only works for people who are suggestable.
When I was about 22 and didn't realise I was suffering from depression but just thought I was ill my mum took me to see a homeopathist, she presecribed this liquid which was the bark of some tree, I took it in the prescribed manner and it did nothing, fortunately about a year after I was prescribed prothiaden/doxepin a tricyclic and even though I didn't think it would help as as far as I was concerned I was not depressed it changed my life so much for the better. The tree bark was a joke!
I am very cynical when it comes to alternative therapies because I have to admit I think most of them are money making rackets, and maybe in some cases the intentions are good but they mostly rely on the suggestibility of the people receiving the treatments (which is not a bad thing) but I'm not suggestable. If something is to work then as far as I'm concerned if something is to work then it should work on it's own merits and should not rely on my either wanting it to work or believing it will work.
Denise
Posted by linkadge on September 6, 2006, at 13:46:17
In reply to Re: To Linkadge, posted by deniseuk190466 on September 6, 2006, at 13:14:09
I totally believe you when you say that you responded right away. I have heard quite a few people say the same thing. Officially, they say that you shouldn't respond right away for a few reasons.
1) Immediate responses make antidepressants
look more like pep pills.2) It encourages the patient to stick with
with treatment.3) Some people do take a while to respond.
My mother had a similar response to a related drug (Doxapin) when she had her first depression.
I think the medications that effect norepinephrine can work faster too. Drugs like amphetamine block the uptake of norepinephrine and improve mood almost immediately.
Depressed people tend to have altered REM sleeping patterns. It is possable that your nightmares are related to this type of alteration.
If you ever got the opportunity, you could try one night of total sleep deprivation, and then try starting an antidepressant like dothepin the next night.
There are a number of articles which seem to suggest that a short courses of sleep deprivation can accelerate the antidepressant response to certain drugs.
http://www.psycom.net/depression.central.sleepdep.html
Linkadge
Posted by tizza on September 6, 2006, at 21:25:31
In reply to Re: To Linkadge, posted by linkadge on September 6, 2006, at 13:46:17
> I totally believe you when you say that you responded right away. I have heard quite a few people say the same thing. Officially, they say that you shouldn't respond right away for a few reasons.
>
> 1) Immediate responses make antidepressants
> look more like pep pills.
>
> 2) It encourages the patient to stick with
> with treatment.
>
> 3) Some people do take a while to respond.
>
> My mother had a similar response to a related drug (Doxapin) when she had her first depression.
>
> I think the medications that effect norepinephrine can work faster too. Drugs like amphetamine block the uptake of norepinephrine and improve mood almost immediately.
>
> Depressed people tend to have altered REM sleeping patterns. It is possable that your nightmares are related to this type of alteration.
>
> If you ever got the opportunity, you could try one night of total sleep deprivation, and then try starting an antidepressant like dothepin the next night.
>
> There are a number of articles which seem to suggest that a short courses of sleep deprivation can accelerate the antidepressant response to certain drugs.
>
> http://www.psycom.net/depression.central.sleepdep.html
>
> Linkadge
>
> Very interesting topic, I just went to a sleep disorders clinic for an initial consultation. The doctor asked me how I fell asleep and I told him I just wait for a dream to begin, latch onto it and dive in. He told me that this was not normal at all and you shouldn't go straight into REM sleep so he is setting up a Multiple Sleep Latency Test. He thinks I might have a form of Narcolepsy because I also suffer from sleep paralysis, hypnogogic and hypnopompic hallucinations, insomnia, excessive daytime sleepiness and shocking nightmares. He also told me that this might be the cause of my depression. The only crappy thing is that they can't get me in for this test until next year, Not happy!!!!!
>
>
>
>
Posted by Phillipa on September 6, 2006, at 22:02:20
In reply to Re: To Linkadge » linkadge, posted by tizza on September 6, 2006, at 21:25:31
Next year? That's ridiculous. And how would they treat it CPAP? Love Jan
Posted by tizza on September 7, 2006, at 0:08:52
In reply to Re: To Linkadge » tizza, posted by Phillipa on September 6, 2006, at 22:02:20
> Next year? That's ridiculous. And how would they treat it CPAP? Love Jan
Thanks Jan!! No not CPAP, that's more from sleep apnoea, he was talking about stimulants and sedatives to regulate my REM sleep. I have slipped backwards big time depression wise because I can't believe how long I have to wait. I just got back from seeing my GP and he tried to put me back on Luvox and Zyprexa and I said NO!! So I went and got some SAMe, St Johns Wort and some mega B complex it cost me $100.
Posted by deniseuk190466 on September 7, 2006, at 3:05:45
In reply to Deniseuk--It seems to me you have been relatively, posted by fca on September 4, 2006, at 17:58:09
FCA,
Thanks for responding and I entirely agree with you about knowing enough to be dangerous but I wonder exactly what these psychiatrists know as far as these drugs go (not much). What they know is based on mainly conjecture anyway.
I rarely lie to my psychiatrist (this was a first) and tend to be compliant most of the time but if something still doesn't seem to be helping after a month is up then I'd rather disgard it and move onto something else and I wish he would go along with that. If I was seeing glimmers of light during the first month or noticing some signs of improvement then I'd be moe inclined to give them longer but when there is none I can't see the point.
Denise
Posted by deniseuk190466 on September 7, 2006, at 9:09:03
In reply to Re: To Denise, posted by Tom Twilight on September 6, 2006, at 1:55:15
Tom,
Thanks for the link.
Yes I wrote to Dr Nutt about the DBS trials they were supposed to be starting in Bristol, I just wanted the chance to go and discuss it with him but my Psychiatrist wouldn't refer me and the people in Bristol were saying that he had to refer me in order for me to be able to go and discuss it with them!
Also, I know somebody (by email only) who was down as a candidate for the trial but last time I heard from him they had cancelled the trials in September for some reason and don't know what the outlook is. Dr Nutt tried this man on a particular combination which included Lithium and Tryptophan but unfortunately it didn't work.
Denise
Posted by deniseuk190466 on September 7, 2006, at 9:11:01
In reply to Re: To Linkadge, posted by linkadge on September 6, 2006, at 13:46:17
Thanks Lindadge,
I might try that but sometimes getting through the day awake is difficult enough without having to get through the night as well.
Denise
Posted by linkadge on September 7, 2006, at 11:52:31
In reply to Re: To Linkadge » linkadge, posted by tizza on September 6, 2006, at 21:25:31
Yeah, there have been a number of theories over the years of how sleep may relate to depression.
I hope this lead of yours prooves to be helpful.Linkadge
Posted by linkadge on September 7, 2006, at 11:55:23
In reply to Re: To Linkadge, posted by deniseuk190466 on September 7, 2006, at 9:11:01
I don't know about you, but I'd be hard pressed to take information on a mental illness from a man named Dr. Nutt. :)
But thats just me.
Linkadge
Posted by tizza on September 7, 2006, at 20:29:11
In reply to Re: To Linkadge » tizza, posted by linkadge on September 7, 2006, at 11:52:31
This is the end of the thread.
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