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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by wishingstar on March 29, 2007, at 17:15:44
I see my pdoc tomorrow morning. I have a long history of depression that has so far been completely resistant to any medication. My pdoc is great at listening to me and asking my opinion on things.. and often asks me what *I* think we should try next, since it has become such a guessing game now. I've never gone in prepared with any suggestions that were well researched but I think I'd like to try and have a few ideas tomorrow. Given my history (below) does anyone have any thoughts on things I should look into or suggest to my pdoc?
Meds I've tried:
*zoloft - no effect
*prozac - no effect
*effexor - no effect
*lexapro - no effect
*wellbutrin - no effect the first time, incredible brain zaps the second time that I couldnt tolerate
*celexa - couldnt tolerate
*cymbalta - couldnt tolerate
*lithium - small relief of depression at low dose but increased my anxiety to the point that it wasnt worth it (odd, i know)
*lamical - increased my depression
*desipramine - couldnt tolerate due to crazy effects on pulse/blood pressure in the hospital
*adderall - boosted energy at first but after a few days was not useful. didnt effect the depression piece.Some were also tried in combination as well as seperatly. Still no effect.
My diagnosis is unipolar depression. Anxiety is not usually a significant problem for me. I already have low energy/motivation so I dont do well on things that are additionally sedating. I also tend to get nauseaus very easily to the point that I've had to discontinue a few meds because I was just unable to leave my bathroom for days while on it.
Cost is also a concern. My insurance does reimburse for some of the cost, but not for several weeks after the purchase and I'm still often left with a significant cost myself.
The last concern is about weight gain. My dr suggested remeron at one point but decided against it due to the weight gain side effect. I have a history of restricting and tend to slip back into eating disorder behavior pretty easily when I start gaining weight. I am in therapy and trying to get over this, but its still an issue.
I'm willing to try just about anything. I realize there arent any perfect meds that meet every criteria I have.. I just wanted to list my concerns to give everyone a full picture.
Thanks everyone!
Posted by Phillipa on March 29, 2007, at 19:42:21
In reply to pdoc tomorrow... suggestions?, posted by wishingstar on March 29, 2007, at 17:15:44
Wishingstar you've tried it looks like something from every class of meds and if money is a concern then EMSAM is out But it would be my suggestion . Love Phillipa
Posted by wishingstar on March 29, 2007, at 19:50:41
In reply to Re: pdoc tomorrow... suggestions? » wishingstar, posted by Phillipa on March 29, 2007, at 19:42:21
yes phillipa, I wish I could try emsam.. but you're right, with the price, there's just no way right now. maybe in a few months once I've saved more money from this new job, but not right now.
Posted by greywolf on March 29, 2007, at 20:14:52
In reply to pdoc tomorrow... suggestions?, posted by wishingstar on March 29, 2007, at 17:15:44
Wishingstar:
I didn't see Nardil or Parnate on there. I also didn't see Trazodone, Clomiprimine (Anafranil), Luvox, Paxil, Imiprimine (Tofranil), Remeron . . .
I understand what you're saying, and I imagine you are frustrated. I have taken everything you mentioned except Desipramine and Adderall), also without success. But there are many other options remaining to you, so don't give up hope.
Greywolf
Posted by football on March 29, 2007, at 23:04:13
In reply to Re: pdoc tomorrow... suggestions?, posted by greywolf on March 29, 2007, at 20:14:52
Maybe it's Nardil time?
Posted by UgottaHaveHope on March 30, 2007, at 1:45:20
In reply to pdoc tomorrow... suggestions?, posted by wishingstar on March 29, 2007, at 17:15:44
I would say Emsam, but it costs $500 per month. Parnate, which is better but has food restrictions, is about $50-70.
Posted by rvanson on March 30, 2007, at 7:56:19
In reply to pdoc tomorrow... suggestions?, posted by wishingstar on March 29, 2007, at 17:15:44
> I see my pdoc tomorrow morning. I have a long history of depression that has so far been completely resistant to any medication. My pdoc is great at listening to me and asking my opinion on things.. and often asks me what *I* think we should try next, since it has become such a guessing game now. I've never gone in prepared with any suggestions that were well researched but I think I'd like to try and have a few ideas tomorrow. Given my history (below) does anyone have any thoughts on things I should look into or suggest to my pdoc?
>
> Meds I've tried:
> *zoloft - no effect
> *prozac - no effect
> *effexor - no effect
> *lexapro - no effect
> *wellbutrin - no effect the first time, incredible brain zaps the second time that I couldnt tolerate
> *celexa - couldnt tolerate
> *cymbalta - couldnt tolerate
> *lithium - small relief of depression at low dose but increased my anxiety to the point that it wasnt worth it (odd, i know)
> *lamical - increased my depression
> *desipramine - couldnt tolerate due to crazy effects on pulse/blood pressure in the hospital
> *adderall - boosted energy at first but after a few days was not useful. didnt effect the depression piece.
>
> Some were also tried in combination as well as seperatly. Still no effect.>
> I'm willing to try just about anything. I realize there arent any perfect meds that meet every criteria I have.. I just wanted to list my concerns to give everyone a full picture.If you are as sensitive as you indicate here, I can almost bet that you wouldnt tolerate Remeron anyway. That &*$#@$#% knocked me out for over three days at a 15 mg, low dose.
There is no way to know for certain unless you were on a trial of it, so this is only an educated guess at best.
I'm no Pdoc, but I have 27 years of depression and psych medications behind me and I notice that you havent been Rx'ed a med like Nardil, an MAO inhibitor.
That would be my next recommendation, if I were a P-doctor.
Unfortunately, it isnt available as a generic even though its been an Rx since 1959, so its going to cost more then you may be able to pay right now.
Posted by Honore on March 30, 2007, at 8:12:38
In reply to I vote for Parnate!!! » wishingstar, posted by UgottaHaveHope on March 30, 2007, at 1:45:20
Posted by wishingstar on March 30, 2007, at 11:43:29
In reply to Re: pdoc tomorrow... suggestions?, posted by football on March 29, 2007, at 23:04:13
Well, I saw my doctor. He was running 45 min late this morning... lovely. He asked what I thought would be good and I mentioned the MAOIs and parnate in particular, as you all suggested. He seemed somewhat okay with this idea but said he doesnt generally use them or know a lot about them.. but that he could learn as we went. Eh. He does use emsam but the cost makes that impossible for me. I explained that I wasnt sure another SSRI was the answer though as I've been on so many and never had any effect.
So I walked out of my appointment with... drumroll... paxil. Another SSRI. I told him I wasnt sure it was the best choice but he was sold on it I guess. I'm taking 5mg for a week (I tend to have strong side effects so he wants me to start slowly), 10mg for 2 weeks, 15mg for a week, then holding at 20mg. My next appointment isnt until May 15.. thats the earlier I could get in.
I'm thinking about finding a new pdoc. He asked if I'd be okay for 6 weeks and I said probably not, and I think I'll end up back inpatient within the next few months again.. but no response to that really. I know pills take so long to work and he cant speed that up, but I dont know. In the past I've been without meds for weeks when I started a new one, couldnt tolerate it, and couldnt get in any earlier to see the dr again. The office manager told me today to call the office because they always have someone on call or available for those situations.. but I've called 500 times before, explained my problem, and basically been told "sorry, nothing we can do". I was in inpatient a month ago, was released on no meds, and spend the entire last month on nothing because I couldnt get in before today, when a med could have at least been building up in my body is nothing else. It makes me so mad.
Any thoughts?
Posted by Phillipa on March 30, 2007, at 12:07:13
In reply to and the verdict is..., posted by wishingstar on March 30, 2007, at 11:43:29
Maybe a new pdoc who won't leave you hanging like that. I hope the paxil works for you Love Phillipa
Posted by stargazer on March 30, 2007, at 15:08:57
In reply to and the verdict is..., posted by wishingstar on March 30, 2007, at 11:43:29
Hi wishingstar,
I'm stargazer...nice to meet you...I took all of the meds you have, including Paxil, and my old notes reflect little improvement in the 1 year I took it for depression.
I'm currently on Emsam and I believe the only med you have left to try is either Parnate or Nardil, although I only had success on Nardil and Marplan, not on Parnate. There have been some changes in formulas in the MAO's as they became generic and new manufacturing processes changed supposedly inert additives, affecting their response in absorption rates, ths affecting their effects.
Many here still tout Nardil as the end all and be all in terms of meds for resistent depression.
That would be my choice and your pdoc is just prolonging your misery by avoiding his own discomfort with prescribing a med which can eliminate your depression. Not fair to you! Forget his comfort level and find another pdoc that experience in these drugs. Where do you live, perhaps we can help you find a pdoc with MAO experience. Are you near a major medical center or large city?
Paxil is just more of the same, in my opinion. The SSRI's are not the meds for you!
Good luck,
Stargazer
Posted by greywolf on March 30, 2007, at 16:35:41
In reply to Not Paxil...try Nardil or Parnate/wishingstar, posted by stargazer on March 30, 2007, at 15:08:57
A good psychiatrist should not have inexperience with MAIOs. And my guess is that when a doctor says he has a discomfort level with a particular medicine it may be shorthand for a discomfort level with liability should you have an interaction.MAOIs are safe as long as they are used within the rules. The rules are relatively easy to understand and remember (it's not like you have to worry about all those gluten-free things), and my own experience with Nardil and now with Emsam establishes that they are almost side effect free. Of course, that's only my experience, but I have heard much the same from others who have used MAOIs.
Nardil did a pretty good job for me for many months. It was wonderful not suffering from the dismal SEs I experienced with most SSRIs, NDRIs, etc.
That being said, give the Paxil a fair chance to work. There's no point in hopping from med to med without getting any of them to a therapeutic level unless the SEs are too severe to tolerate.
Let us know how it's working out.
Greywolf
Posted by DStupid on March 30, 2007, at 17:33:20
In reply to Re: Not Paxil...try Nardil or Parnate/wishingstar, posted by greywolf on March 30, 2007, at 16:35:41
Terrible news. The doctor cheated you. He sold you garbage (Paxil) because he doesn't want to be troubled with a MAO hypertension crisis if you were to break the MAO diet.
Here's what I'd do in your case: (1) Don't take Paxil. It's not going to work. Don't waste your time. (2) Look for a new pdoctor. (3) In the meantime, go to a primary care doctor (pdoctors don't have a prescription monopoly over psychiatric drugs; any doctor can prescribe them) and ask for a MAO prescription that others have recommended you. If he refuses, ask him for a TCA (tricyclic anti-depressant). I'm personally for Nortriptyline (with Toprol XL to keep pulse from increasing), but people on the board have better ideas about TCAs. (4) Stop calling the pdoctor's office about hospitalization. They won't help you. (5) If you can't find any doctor that will prescribe what you want, try ethnic pharmacies; they are not as rigid as the chain stores when it comes to procedures. Remember what you want is not a controlled substance; it's just an anti-depressant.
Posted by wishingstar on March 30, 2007, at 17:57:10
In reply to Re: Not Paxil...try Nardil or Parnate/wishingstar, posted by DStupid on March 30, 2007, at 17:33:20
Thanks everyone for your thoughts...
Just to clarify, almost all the SSRIs I listed I did take for a significant amount of time. Long enough to know if they were going to work.
I agree with what you all are saying about my pdoc not wanting to take the risks.
I dont think I'm going to take the paxil. It did fill it, but it was only $5 (generic) so it doesnt feel like a big loss. It feels like a waste of time to bother with it. Besides, if I find a new doctor who does perscribe an MAOI, I dont want to have to wait for the paxil to get out of my system before I can start taking it. I did take nortryptline (despiramine) while I was in the hospital recently and wasnt able to tolerate it on its own. My pulse got very high (145) and blood pressure very low (70/40). They gave me ativan to control my pulse while I was there but it didnt seem to be a great choice. I think an MAOI is the obvious next choice. I'm not sure why the doctors dont see that! Okay, I am... risks, etc.. but it sure is frustrating.
I emailed an old therapist who works in the DC area (2 hours from me) and asked her for referrals. I'm also planning to ask my therapist on Tuesday for some in Charlottesville, which is nearby and the home of the Unv of Virginia and their medical school. Unfortunately there arent really other pdoc choices in my town, but I'm sure I can find a good doctor in one of those cities.
Posted by wishingstar on March 30, 2007, at 18:00:37
In reply to Re: Not Paxil...try Nardil or Parnate/wishingstar, posted by wishingstar on March 30, 2007, at 17:57:10
I made a mistake in my last post. Obviously nortryptline and desipramine arent the same drug. I confused it with "norpramin", which is indeed desipramine, and is the one I took in the hospital. Sorry about that.
Posted by UgottaHaveHope on March 30, 2007, at 21:44:27
In reply to Re: Not Paxil...try Nardil or Parnate/wishingstar, posted by wishingstar on March 30, 2007, at 17:57:10
I just emailed my pdoc, who has a reputation as one of the top researchers in the country, if he knew of someone in the UVA area. Will Babblemail if he does. If he does, it would be someone well-versed in MAOIs, unlike your pdoc who I think avoided Parnate simply because he knew nothing about it or loves the free lunches from the Paxil drug rep.
Naw Paxil may work wonders for you, but it seems you have already tried many drugs just like it. And Parnate is so cheap ($50 a month).
Posted by Sebastian on March 30, 2007, at 23:45:35
In reply to pdoc tomorrow... suggestions?, posted by wishingstar on March 29, 2007, at 17:15:44
Even though its expensive, I'm going to suggest Abilify. An AP.
Posted by rvanson on March 31, 2007, at 1:15:14
In reply to and the verdict is..., posted by wishingstar on March 30, 2007, at 11:43:29
> Well, I saw my doctor. He was running 45 min late this morning... lovely. He asked what I thought would be good and I mentioned the MAOIs and parnate in particular, as you all suggested. He seemed somewhat okay with this idea but said he doesnt generally use them or know a lot about them.. but that he could learn as we went. Eh. He does use emsam but the cost makes that impossible for me. I explained that I wasnt sure another SSRI was the answer though as I've been on so many and never had any effect.
>
> So I walked out of my appointment with... drumroll... paxil. Another SSRI. I told him I wasnt sure it was the best choice but he was sold on it I guess. I'm taking 5mg for a week (I tend to have strong side effects so he wants me to start slowly), 10mg for 2 weeks, 15mg for a week, then holding at 20mg. My next appointment isnt until May 15.. thats the earlier I could get in.
>
> I'm thinking about finding a new pdoc. He asked if I'd be okay for 6 weeks and I said probably not, and I think I'll end up back inpatient within the next few months again.. but no response to that really. I know pills take so long to work and he cant speed that up, but I dont know. In the past I've been without meds for weeks when I started a new one, couldnt tolerate it, and couldnt get in any earlier to see the dr again. The office manager told me today to call the office because they always have someone on call or available for those situations.. but I've called 500 times before, explained my problem, and basically been told "sorry, nothing we can do". I was in inpatient a month ago, was released on no meds, and spend the entire last month on nothing because I couldnt get in before today, when a med could have at least been building up in my body is nothing else. It makes me so mad.
>
> Any thoughts?<<Yes I do. Pack up your bags and find a new Pdoc.
I will sum it up here, and it might seem a bit cruel, but I have dealt with these Pdocs for 27 years, and been left hanging in the lurch by them a couple of times over the years.
One of these docs went straight to work for one of the gaint pharmacuetical companies and left all his patients with a brief "good-bye" letter.
Thanks doc! We love ya !!
Anywho, here is my take on your issue with Mr. Pdoc:
Reason# 1 : You are doing all his work for him.
Reason# 2: He is taking the easy path with you.
Reason# 3: He is still using monotherapy?
Reason# 4: He is making you wait 6 weeks is-
way too long, for a start-up med.
Reason# 5: Problems & "No-Can-Do"? Bye-bye, doc!
Reason# 6: No back-up Pdoc? Bye-bye, doc !
Reason# 7: No MAOI experience, or even try? Bye!Reason# 8: The most important of all is that I believe that he lied to you about using MAOI's.
If he had ever used them in the past, he would not be so hesitant to Rx them now; therfore what he told you was a lie. (my own experiences)
Seriously, run, don't walk into the office of someone who cares, because this man obviously doesn't.
Posted by wishingstar on March 31, 2007, at 18:45:44
In reply to Re: I still vote for Parnate » wishingstar, posted by UgottaHaveHope on March 30, 2007, at 21:44:27
Thank you! I really appreciate you doing that for me. Please let me know if he has any ideas.
Posted by wishingstar on March 31, 2007, at 18:55:19
In reply to Re: and the verdict is..., posted by rvanson on March 31, 2007, at 1:15:14
Thanks for your thoughts rvanson. After hearing all the opinions of you all on the boards, I am defintely on the search for a new pdoc. I'd been leaning towards doing it anyway, but now I'm positive it's time to move on. I really appreciate that he is willing to involve me in my treatment and listen to what I want and what I dont, but we're getting to the point that I feel like he's not really doing much work, I agree. We have done some mixing of drugs, but not a lot. So far nothing has worked even a tiny bit so we havent really had the chance to try and augment it.
Going to make some calls early this week and try to get in to somewhere new in the next few weeks. Decided not to take the paxil at all. Not worth it.
Thanks!
Posted by UGottaHaveHope on March 31, 2007, at 23:34:28
In reply to Re: I still vote for Parnate » UgottaHaveHope, posted by wishingstar on March 31, 2007, at 18:45:44
I sent it.
Posted by UGottaHaveHope on March 31, 2007, at 23:38:30
In reply to Re: Check your Babblemail » wishingstar, posted by UGottaHaveHope on March 31, 2007, at 23:34:28
Here's who he recommended ... Anita Clayton
http://www.healthsystem.virginia.edu/internet/news/experts/clayton.cfm
Her email is in there, so perhaps you could explain your need to see her ASAP in 2-3 sentences. Mention my pdoc name's, saying her referred him to her.
Posted by wishingstar on April 1, 2007, at 10:25:03
In reply to Re: Check your Babblemail » wishingstar, posted by UGottaHaveHope on March 31, 2007, at 23:34:28
thank you so much! I wrote down her name. My insurance does cover her, so it's a very real possibility. I didnt receive any babblemail though... do they normally have a delay? Weird. I'll keep watching for it. Thanks again.
Posted by UgottaHaveHope on April 1, 2007, at 11:37:25
In reply to Re: Check your Babblemail » UGottaHaveHope, posted by wishingstar on April 1, 2007, at 10:25:03
send me a Babblemail or regular email at sportscarvell@yahoo.com
Michael
Posted by wishingstar on April 1, 2007, at 11:59:40
In reply to Re: Check your Babblemail » wishingstar, posted by UgottaHaveHope on April 1, 2007, at 11:37:25
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