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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 23 to 47 of 47. Go back in thread:
Posted by jealibeanz on March 10, 2007, at 5:46:03
In reply to Re: Wow, your doc said he was taking Parnate » bulldog2, posted by UGottaHaveHope on March 10, 2007, at 0:51:54
> Your doc told you he is taking Parnate, it is working for him, and recommended that you try it? First of all, bravo for the doc, for dropping his ego and shield to admit he is like the rest of us (Ive never had any pdoc admit they take anything). Secondly, if you choose to take Parnate, he will be a wonderful source to walk you through it. Man you are lucky. You going to do it?
Wow... as a med student, I've wondered how I'd approach this situation myself. It's tricky!As a provider, you're taught not to get too close to the patient. If they start to think of you as a friend, their treatment could suffer for many reasons.
But at the same time, if you want to really be a good practitioner, you want to have some sort of relationship. Smalltalk about both the doctor's and patient's lives helps.
I was thinking about this the other day actually. If someone came to me, embarrassed and scared to admit to being depressed, and told me there's no way I could understand, what would I say? I've been there before? I've been depressed and taken several medications? I know what it's like to be frustrated when you have to endure side effects or find a medication to stick with? I know that weird little feeling you get, physically and emotionally, inside your head on days 4-5 on a Effexor XR trial?
Or would I just want to stick with the... "I've seen this many times. It's much more common than you think, don't be ashamed. It's OK to talk about. There's many medications to try and all my patients have different reactions and preferences" line?
I think most doctors tend not to share any medical experiences whatsoever. Haha, I remember last year I was complaining about my allergies and the bad allergy season, my doctor was like... yeah, I noticed my eyes have been really itchy lately. I was sitting there thinking to myself... whoa! oh my god! you're not supposed to tell me that! You're my doctor, not a real person. Doctors don't have medical problems! They can't admit them to patients!
Haha, yes, that is what I thought. About a small allergy comment. Not even about medications. And this is a doctor who I have a pretty close relationship with. But I was just floored by the first time that a practitioner ever gave any information about their own health.
I think this really depends on the situation. A well established doctor can do this much easier than a young one. You need your credibility built up first. You'd also need to judge your relationship with the patient, and the emotional capacities of the patient. If you know and trust your patient, and have earned his/her trust, revealing something after years may be OK, although I'd have to say... telling someone you're on Parnate is risky!
OK, I'll stop now with my random thoughts on life and medical practice.
Posted by UgottaHaveHope on March 10, 2007, at 10:44:28
In reply to Re: Wow, your doc said he was taking Parnate, posted by jealibeanz on March 10, 2007, at 5:46:03
You bring up a lot of excellent issues. I have had pdocs say they experienced anxiety and depression themselves all the time, as to relate to me, but they never revealed any drug history.
I am surprised this pdoc admitted he was on Parnate. But perhaps he is very well-established and confident in himself or herself. You know, Parnate is a MOAI, and just the pure mention of MAOIs (only because the diet and medicine restrictions) scares the heck out some people, including ME. Perhaps the pdoc said it to give his or her patient the confidence to take it. I know if my pdoc said that, my confidence level would shoot through the roof.
There is also another view: If there is a medicine that radically changes your life in a positive way (like Parnate has done with some of this board), you tend to want to share that glorious news with the world. For the pdoc, it would be taking a little hit on his ego or appearance of perfection for the betterment of humankind.
Finally, and this is most important, I think far and away the No. 1 thing that helps anyone out there challenged by emotional issues is TO KNOW OTHER PEOPLE ARE STRUGGLING, TOO. When it first started with me, I thought I was the only one who had those challenges because no one else ever talked about it openly. Only when I found out I was in the boat with many, many others did I come to terms with what I was facing.
Cheers to that pdoc! And I hope you find the same compassion and selflessness in your med field. Michael
Posted by stargazer on March 10, 2007, at 11:36:06
In reply to Higher calling: Your pdoc said he taking Parnate » jealibeanz, posted by UgottaHaveHope on March 10, 2007, at 10:44:28
My pdoc hasn't said he takes meds but he has alluded to having personal experience with depression. I think I may have even asked him if he has depression.
My belief is that many people who are in the psych profession have had experience with it themselves. It is my imagination or are there many people here who work in psychiarty?
Or all we all psychiatrists due to the research and conversations we have so often?I think it makes sense for a doctor to reveal this only in the right situation, either when asked directly or when it seems appropriate like, when someone has no faith in meds, it can provide a personal connection that may be the difference between life and death.
It's different than a doc saying I have allergies or something that tivial. I would find that more annoying than helpful.
It is a judgement call, but in this instance where your doc revealed that, I find it really a statement of strength, not one of weakness.
It probably depends alot on the patient, as well. You wouldn't want to reveal this to just any patient. Some might find this too equalizing, where the doctor is supposed to be the one without any problems (fat chance of this).
Stargazer
Posted by jealibeanz on March 10, 2007, at 12:10:10
In reply to Re: Higher calling: Your pdoc said he taking Parnate, posted by stargazer on March 10, 2007, at 11:36:06
My allergy comment wasn't meant to imply that itchy eyes are comparable, in terms of suffering, to chronic mental illness. I wrote that just to show how surprised I was by the mention of a minor condition, so I can't even imagine how I'd react to my doc admitting to depression and taking an MAOI. I'm not saying it's a poor choice by the doc, just my way of reacting, since most doctors keep a distance from their patients.
I personally would never consider asking my doctor if he has personally experienced a given condition or used a particular medication. I just would be uncomfortable, since he may be uncomfortable.
But I do expect people to ask me questions about my own personal experience when I'm out in practice. It probably won't be the norm, but I'm sure it'll happen.
Posted by bulldog2 on March 10, 2007, at 12:17:45
In reply to Re: Wow, your doc said he was taking Parnate » bulldog2, posted by UGottaHaveHope on March 10, 2007, at 0:51:54
I haven't made up my mind yet because of the dietary restrictions. As I've said before I would be fine at home as I eat very simply. However I eat over at friends and family quite a bit. I would hate to start grilling them about wether they used soy or cheese or any forbidden foods in what they made. Really don't want to start telling people about depression or meds for that. Some people act like your damaged goods or stay away from you once you tell them you have an emotional disorder.
Posted by bulldog2 on March 10, 2007, at 12:56:36
In reply to Re: Wow, your doc said he was taking Parnate, posted by bulldog2 on March 10, 2007, at 12:17:45
I find it very helpful that my p-doc is very open about personal problems in his life that may be similar to what I am experiencing. I don't find that it compromises the therapy but gives it an aspect of group therapy. There's a certain synergy to the therapy.
Posted by Phillipa on March 10, 2007, at 18:37:46
In reply to Re: Wow, your doc said he was taking Parnate, posted by jealibeanz on March 10, 2007, at 5:46:03
Jelly seriously I've had many doctors tell me about their own treatment. I had one pdoc who said he trials all the meds himself before using so he is familiar with how the med feels. And my ortho doc has shared that he has arthritis and takes meds for it. And others have too. That's just a sample. And when I was a nurse we all shared our med experiences with the patients helped to develope trust. And they knew we were also human not some immortal. Love Phillipa
Posted by Phillipa on March 10, 2007, at 18:42:51
In reply to Re: Wow, your doc said he was taking Parnate, posted by bulldog2 on March 10, 2007, at 12:17:45
Bulldog funny I don't find that. When I open up and talk about psych meds I find most of my neighbors are also on some sort of ad or benzo. Seriously I have no problem talking to others about it. Love Phillipa
Posted by Declan on March 10, 2007, at 21:24:05
In reply to Don't many Nardil side effects eventually go away? » Declan, posted by UGottaHaveHope on March 10, 2007, at 0:59:26
Deprenyl citrate..........took it for years. Lovely stuff, but it disturbed my sleep.
Nardil.........interestingly I had ONE dose and felt great all day. Placebo reaction, I guess, but I remember it 30 years later.
Parnate........It doesn't really suit me, in any reasonable dose. It's not the dopaminergic thing...there is something about it I find agitating.
Posted by UgottaHaveHope on March 10, 2007, at 22:40:01
In reply to Re: Wow, your doc said he was taking Parnate, posted by bulldog2 on March 10, 2007, at 12:17:45
Bulldog2, I feel your pain. I know the situation. You have got to make the call: Do you want to risk your friends knowing about it or do you want to take a chance of feeling better? In my own experiences, with the exception of girls I am trying to court, if I start talking about my issues my friends usually either (1) dont believe it and act if they didn't hear anything and (2) listen with great understanding and then start pouring out their own issues, which seem to be more complex than mine.
There are a couple of ways you can get around it when over at friends. 1, tell them you are allergic to cheese, just found out, causes you acid reflux. 2, just tell them you are trying to eat healthier because of diabetes or cholesterol fear, per doctors orders.
> BULLDOG2 SAID: I haven't made up my mind yet because of the dietary restrictions. As I've said before I would be fine at home as I eat very simply. However I eat over at friends and family quite a bit. I would hate to start grilling them about wether they used soy or cheese or any forbidden foods in what they made. Really don't want to start telling people about depression or meds for that. Some people act like your damaged goods or stay away from you once you tell them you have an emotional disorder.
Posted by UgottaHaveHope on March 10, 2007, at 22:41:29
In reply to Re: Don't many Nardil side effects eventually go a » UGottaHaveHope, posted by Declan on March 10, 2007, at 21:24:05
Is that all you took? Or did you try it longer and never felt anything? What dose did you take and for how long?
Are you feeling OK these days? Michael
Posted by bulldog2 on March 10, 2007, at 23:05:11
In reply to Re: Wow, your doc said he was taking Parnate » bulldog2, posted by Phillipa on March 10, 2007, at 18:42:51
> Bulldog funny I don't find that. When I open up and talk about psych meds I find most of my neighbors are also on some sort of ad or benzo. Seriously I have no problem talking to others about it. Love Phillipa
That sometimes happens but people can be unpredictable in their reactions. I remember years ago at work a girl opened up and told everyone she was on Lithium for bipolar. Well within a couple days some people were referring to her as the nut. There's still much prejudice out there towards mental illness. Be careful about feeling you have to open up to everyone. What people say to your face and what they say behind your back can often be different.
Posted by Declan on March 11, 2007, at 3:05:53
In reply to Re: One Nardil dose? » Declan, posted by UgottaHaveHope on March 10, 2007, at 22:41:29
Well Michael, I'm not feeling that great, but I'm kinda used to it.
And that's all I took...a day's dose.
Can the placebo effect be that good?
I don't ever have days like that.
So why don't I try it? It would mean the end of sex, which is entirely hypothetical but still.
And my nutritional doctor wouldn't like it (and I owe him what health I have) so I'd have to think about it carefully.
Posted by Phillipa on March 11, 2007, at 19:25:42
In reply to Re: Wow, your doc said he was taking Parnate, posted by bulldog2 on March 10, 2007, at 23:05:11
Bulldog a lot of them were fellow nurses and immediate supervisors and no problems with any of them. The rest are neigbors on psych meds themselves . No problems for me in all these years. The worst are family members. Love Phillipa
Posted by FredPotter on March 15, 2007, at 23:17:53
In reply to Re: Don't many Nardil side effects eventually go a » UGottaHaveHope, posted by Declan on March 10, 2007, at 21:24:05
Declan I once told a really good psychiatrist that Moclobemide worked in 2 days but (I said) that was probably placebo effect. He said if I didn't expect it to be that quick (I didn't) it was probably not placebo. Unfortunately it stopped working almost as quickly
Fred
Posted by crazycomputerboy on March 20, 2007, at 22:52:25
In reply to Need your ADVICE: What would you do? Emsam/Nardil, posted by UGottaHaveHope on March 9, 2007, at 12:20:07
Michael,
I wanted to drop you a line and let you know that I have been on the 9mg EMSAM patch now for 4 weeks and the 6mg patch for 7 before that. It seems that the longer I use the patches the more relief from anxiety/panic that I get, the more energy that I feel, and the less I oversleep. My original diagnosis was atypical depression. It took almost 4 weeks before I noticed anything at all with the 6mg patch. I hope this is helpful, and if you do decide to go the Nardil route please inform on how it works for ya :)
> I am on week nine of Emsam for generalized anxiety (along with 100mg of Seroquel and 3mg of Klonopin). The Emsam didn't do much for the first 6-7 weeks, perhaps even causing more anxiety. I was all prepared for a Nardil trial, and my pdoc gave me a prescription.
>
> Here's the deal: In the last week, I have had about three days with zero anxiety. The other days, I had episodes where I had a couple of hours of midrange anxiety and then a few hours of high anxiety.
>
> Right now, I have decided to stay on Emsam for at least another week to document everything. If anything, it can be backup if I take the Nardil and it does not work out.
>
> So here is my question: With Ensam, I am like I am on second base. Would you take the Nardil to swing for the homerun? Or course, I could also strike out. But I will never know unless I try.
>
> There are a couple of other factors: There is no washout period between Emsam and Nardil. And most importantly, my job is slowing up for the next few months, which would the best timing if I had a lot of highs and lows on Nardil.
>
> What do you do? Stay on second or swing for the fence? Thanks in advance for your opinion. You guys have been in my shoes, therefore I highly value your opinion. Thanks, Michael
Posted by jealibeanz on March 21, 2007, at 4:43:15
In reply to Re: Need your ADVICE: What would you do? Emsam/Nardil, posted by crazycomputerboy on March 20, 2007, at 22:52:25
> Michael,
>
> I wanted to drop you a line and let you know that I have been on the 9mg EMSAM patch now for 4 weeks and the 6mg patch for 7 before that. It seems that the longer I use the patches the more relief from anxiety/panic that I get, the more energy that I feel, and the less I oversleep. My original diagnosis was atypical depression. It took almost 4 weeks before I noticed anything at all with the 6mg patch. I hope this is helpful, and if you do decide to go the Nardil route please inform on how it works for ya :)
>
> > I am on week nine of Emsam for generalized anxiety (along with 100mg of Seroquel and 3mg of Klonopin). The Emsam didn't do much for the first 6-7 weeks, perhaps even causing more anxiety. I was all prepared for a Nardil trial, and my pdoc gave me a prescription.
> >
> > Here's the deal: In the last week, I have had about three days with zero anxiety. The other days, I had episodes where I had a couple of hours of midrange anxiety and then a few hours of high anxiety.
> >
> > Right now, I have decided to stay on Emsam for at least another week to document everything. If anything, it can be backup if I take the Nardil and it does not work out.
> >
> > So here is my question: With Ensam, I am like I am on second base. Would you take the Nardil to swing for the homerun? Or course, I could also strike out. But I will never know unless I try.
> >
> > There are a couple of other factors: There is no washout period between Emsam and Nardil. And most importantly, my job is slowing up for the next few months, which would the best timing if I had a lot of highs and lows on Nardil.
> >
> > What do you do? Stay on second or swing for the fence? Thanks in advance for your opinion. You guys have been in my shoes, therefore I highly value your opinion. Thanks, Michael
>
>Oh, so nice to see this working for someone. Are you taking anything else with the EMSAM?
I'm gonna need to get the guts to try again with another AD at some point in my life, otherwise, it will be hell. I just don't want another med to make me fat and emotionless.
I have GAD and atypical depression at the moment (doc doesn't know about the later). I'm not getting put on another SSRI.
Posted by crazycomputerboy on March 22, 2007, at 10:12:21
In reply to Re: Need your ADVICE: What would you do? Emsam/Nardil, posted by jealibeanz on March 21, 2007, at 4:43:15
Hi jealibeanz,
Actually, I am not taking any augmenters with the EMSAM at this point. It was briefly talked about, and the target area would be a glutamate line of treatment. There are some new areas of breakthrough I am learning about from my pdoc about glutamate treatment options for atypical or "treatment resistant" depression/anxiety. My understanding is that there are two specific meds currently out there known as Riluzole and Ketamine with Riluzole being the primary choice.
Here is a link to a good article about this emerging option:
http://www.ajp.psychiatryonline.org/cgi/content/full/161/11/2132For the record I have been on 25 different SSRI's/SNRI's/Tricyclics/SDRI's and many combinations thereof. At this point, although not perfect by any means, EMSAM is by milestones the best I have used. Hope this helps!
Crazycomputerboy
> Oh, so nice to see this working for someone. Are you taking anything else with the EMSAM?
>
> I'm gonna need to get the guts to try again with another AD at some point in my life, otherwise, it will be hell. I just don't want another med to make me fat and emotionless.
>
> I have GAD and atypical depression at the moment (doc doesn't know about the later). I'm not getting put on another SSRI.
Posted by FredPotter on March 22, 2007, at 16:44:46
In reply to Re: Need your ADVICE: What would you do? Emsam/Nardil » jealibeanz, posted by crazycomputerboy on March 22, 2007, at 10:12:21
That looks like a very important paper. Many thanks. Fred
Posted by FredPotter on March 22, 2007, at 16:47:18
In reply to Re: One Nardil dose? » UgottaHaveHope, posted by Declan on March 11, 2007, at 3:05:53
Declan I think I've improved in 1 day of Nardil too, but I'm still suffering Effexor withdrawal Fred
Posted by FredPotter on March 26, 2007, at 18:13:05
In reply to Re: One Nardil dose? » Declan, posted by FredPotter on March 22, 2007, at 16:47:18
Posted by UgottaHaveHope on March 26, 2007, at 23:27:46
In reply to Re: Need your ADVICE: What would you do? Emsam/Nardil, posted by crazycomputerboy on March 20, 2007, at 22:52:25
How is it going now? And are you following the diet restrictions at 9mg? Thanks, Michael
Posted by crazycomputerboy on March 27, 2007, at 9:15:47
In reply to Re: Need your ADVICE: What would you do? Emsam/Nar » crazycomputerboy, posted by UgottaHaveHope on March 26, 2007, at 23:27:46
> How is it going now? And are you following the diet restrictions at 9mg? Thanks, Michael
Hi Michael,
Yes, so far so good. Energy levels are good (am in teh gym 5 to 6 days a week now) and its much eaiser to get up in the morning. I am loose endedly following the dietary restrictions... I did slip some on that when my pdoc stated that there is a pending request with the FDA to have the dietary restrictions removed from the 9mg patches. I really dont think the dietary restrictions are all that much anyway, I cant remember the last time I ate "moldy fish" or "fava beans" ??? :)
Posted by Honore on March 27, 2007, at 10:39:59
In reply to Re: Need your ADVICE: What would you do? Emsam/Nar, posted by crazycomputerboy on March 27, 2007, at 9:15:47
Yes, but what about cheese?
Actually, I'm not following the dietary restrictions at all, now that you mention it. I ';ve been having some really great cheese that I"m sure wouldn't fit within them-- with no problems.
I'm not advising anyone to do anything, but there seemed to be evidence, in the original application, that even large amounts of tyramine didn't evoke any hypertensive reaction. It's always best to be cautious and experiment, though-- or refrain. But depending on what develops, I'm not sure the dietary restrictions are anything like what they would be on Parnate or Nardil.
Honore
Posted by crazycomputerboy on March 27, 2007, at 14:59:02
In reply to Re: Need your ADVICE: What would you do? Emsam/Nar, posted by Honore on March 27, 2007, at 10:39:59
Right you are my friend! That is the reason that the application has been filed with the FDA to remove the dietary restrictions on the 9mg patch because they have evidence that it really dosent have the same effect as the oral variety of MAOI's. I also am not advising anyone to do anything, I am a calculated risk taker myself so I wasnt to shy about experimenting gradually with certain foods/beverages once I went to the 9mg patch. I have to wonder how long it will be before Nardil/Parnate are supplied in a patch form considering the obviously better saftey that is provided (I am also aware that Selegiline/EMSAM is a selective MAO-B inhibitor in its lower doses).
> Yes, but what about cheese?
>
> Actually, I'm not following the dietary restrictions at all, now that you mention it. I ';ve been having some really great cheese that I"m sure wouldn't fit within them-- with no problems.
>
> I'm not advising anyone to do anything, but there seemed to be evidence, in the original application, that even large amounts of tyramine didn't evoke any hypertensive reaction. It's always best to be cautious and experiment, though-- or refrain. But depending on what develops, I'm not sure the dietary restrictions are anything like what they would be on Parnate or Nardil.
>
> Honore
This is the end of the thread.
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