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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by deniseuk190466 on June 4, 2007, at 9:09:30
Hi,
On the 1st March after an awful christmas and New Year (with very suicidal feelings) the psychiatrist put me on 10mg of Lexapro a month later when I saw her I told her that the depression felt slightly better but I was still experiencing a lot of anxiety so she added on 5mg of Zyprexa.
I only took 2.5 Zyprexa with the lexapro which did help a lot with the anxiety but I still felt like I wasn't really looking forward to anything or enjoying anything then my psychiatrist rescheduled my next appointment for 12th June which was over two months away.
I went back to my GP and asked him (after checking with the psychiatrist first) to double the dose of the lexapro which he did.
I have tried taking 20mg of lexapro and added the zyprexa for about a week and then I figured that if the lexapro was really working properly then I wouldn't need the zyprexa so I tried stopping the Zyprexa and still the anxiety was there. Over the last week or so I've increased the lexapro to 40mg which seems to help with the anxiety I'm just sooooooo tired all the time and am constantly fighting tiredness so I know that the lexapro istn't working as it should. If it was working properly I'd be enjoying life again and be having more energy. The lexapro pretty much feels like the Seroxat did when it stopped working.
I want to tell the psychiatrist what I've been doing but I think she already thinks I'm a law unto myself and in her words "my own worst enemy" and I'm scared she'll refuse to continue to treat me.
Then you read stories where experts say that depression is not a biological or chemical illness and when the tablets work you can think "well think what you like because I'm feeling much better on medication" but when they don't you just end up more confused than ever.
I know that medication used to work for me and I know how I felt when I took it. I also know that having responded to it so well that after coming off it I never felt as bad as I had prior to taking it so in some ways the medication healed me (for a while anyway).
Denise
Posted by Squiggles on June 4, 2007, at 9:52:11
In reply to Should I tell mypsychiatrist about what I've done?, posted by deniseuk190466 on June 4, 2007, at 9:09:30
I think there must be great variation in
tolerance of non-compliance among doctors.
It doesn't sound to me as if you have been
consistently non-compliant, but it's best
to at least ask beforehand if there is some
leeway you can have in adjucting your meds for
personal comfort.Some doctors understand that if you are getting
sick on a med you will stop, but they really should know, so that an adjustment can be tried.Personally, I prefer the assertive dr. approach but i understand that in the current absence of psychiatric knowledge, this is not as easy as in other medical fields.
Good luck.
Squiggles
Posted by sunnydays on June 4, 2007, at 9:54:39
In reply to Should I tell mypsychiatrist about what I've done?, posted by deniseuk190466 on June 4, 2007, at 9:09:30
Usually you have to give drugs like Lexapro four or five weeks to start working at a particular dose. I would let your psychiatrist know, so that he/she can get you onto the proper dose again. Give it time, and it may or may not help. It's harder to tell if a drug is working if you change the dose around. Good luck, I know how hard it can be.
sunnydays
Posted by Phillipa on June 4, 2007, at 10:08:22
In reply to Re: Should I tell mypsychiatrist about what I've done? » deniseuk190466, posted by sunnydays on June 4, 2007, at 9:54:39
I'm constantly changing my luvox dose on my own so I know how you feel but you should tell your pdoc so he can help find the right dose for you. Love Phillipa
Posted by Racer on June 4, 2007, at 16:57:57
In reply to Should I tell mypsychiatrist about what I've done?, posted by deniseuk190466 on June 4, 2007, at 9:09:30
I agree with SunnyDays, it's best to tell your pdoc what you've done -- AND it's best to stick to one dose for a fairly extended period of time before changing it. Changing the dose too soon can interfere with finding the best dose for you. It could easily be that you'd do great on 20mg, and less than great on 40mg. A lot of these drugs have a therapeutic window -- more is not necessarily better.
And there's something else I'd like to challenge you on: you say that if the Lexapro was working, you wouldn't need the Zyprexa. That might be true -- and it might not. It could be that you'll need to be on a combination of drugs to treat both the depression and the anxiety.
SSRIs like Lexapro usually need about six weeks at a given dose to show whether or not they'll work. That's the hardest part of looking for something that works -- it's trial and error, and the trials can drag on seemingly forever...
Good luck, whatever you decide.
Posted by Meri-Tuuli on June 5, 2007, at 12:29:11
In reply to Should I tell mypsychiatrist about what I've done?, posted by deniseuk190466 on June 4, 2007, at 9:09:30
Hey denise,
Well I've also totally changed my doses and things without my NHS GP or pdoc know - in fact, I took reboxetine and cipramil (celexa to Americans) at the same time without my GP knowing. It was just easier that way.
Anyway some points you could think about:
Yeah like sunnydays says, the Lex will take a good while to kick in - I reckon I didn't really get the full effect of cipramil (Lex's sister drug) for like 6 weeks or something and it was pretty good at zapping anxiety. I took 20mg which is equivalent to 10mg of Lex. So perhaps give it abit more time because 40mg is quite alot of Lex so fast in your system.
Just because you're tired all the time on Lex, doesn't mean its not working properly -- it means that you're getting one of the unfortunate people who experience this as a side effect. The Lex will be working, its just how your body responds to it. I got really tired all the time on the Cipramil, so much so that it completely impaired all normal functioning for me. But anyway, it didn't mean it wasn't working properly, it just meant that I wasn't one of the lucky ones who it works for AND doesn't give them nasty side effects.
But yeah sure tell your pdoc how're playing around with the doses yourself, although it would be good if you know what the maximum doseage is.....are you in the UK? Well I've been assuming you are, but you might want to check out the BNF (its that book that docs/pdocs have on their desk to consult about drugs)
Its simple to register and then you can read up about the drug and work out doseages etc yourself. just to be safe - you don't want to end up taking an amount that is like over the limit!
Kind regards
Meri
Posted by linkadge on June 5, 2007, at 14:48:38
In reply to Re: Should I tell mypsychiatrist about what I've d, posted by Meri-Tuuli on June 5, 2007, at 12:29:11
I've often wondered how to tell a doctor if you have come across something that helps (that you probably weren't explicitly prescribed)
Sometimes I've combined old prescriptions and found seemingly helpful combinations, but have abandoned them for fear that the doctor would freak out.
Anyone have similart situations? How did you deal with them?
Linkadge
Posted by Racer on June 5, 2007, at 15:33:55
In reply to Re: Should I tell mypsychiatrist about what I've d, posted by Meri-Tuuli on June 5, 2007, at 12:29:11
>>
> But yeah sure tell your pdoc how're playing around with the doses yourself, although it would be good if you know what the maximum doseage is.The max dose of Lexapro is apparently 30mg, according to SLS's drug chart. RxList.com doesn't offer a maximum dose, but says that 10mg is standard, and that you can go up to 20mg.
You may already be above the effective window. The fatigue you're experiencing may resolve at a more appropriate dose.
Good luck.
Posted by Racer on June 5, 2007, at 16:05:44
In reply to What if you find something that helps?, posted by linkadge on June 5, 2007, at 14:48:38
>
>
> Anyone have similart situations? How did you deal with them?
>
> Linkadge
>
>I've only done that sort of thing a couple of times, and have told the doctor each time. It's been hard, too, especially since I've really only done it when I'm not doing well with a pdoc anyway...
I've made the decision to tell the doctor for a pretty simple reason: it makes it a whole heckuva lot easier to get the prescriptions! It's been hard to bring it up, but I have generally started the conversation with, "I know that a lot of doctors are not pleased when patients self-medicate, but I tried this, and it helped a lot. Can we continue it?" You know, addressing what they're likely to see as an issue, and then moving on to what I consider the primary issue: continuing a treatment which may work...
That's what I've done. I'll be interested to see other answers.
Posted by Jedi on June 6, 2007, at 2:06:19
In reply to Re: What if you find something that helps? » linkadge, posted by Racer on June 5, 2007, at 16:05:44
Hi,
I've combined meds and have re-started previous meds that have worked before. I always tell my doctor, but I usually do it in a letter with lots of backup research before I see him in person. This gives him some time to think about it before making a decision on what to do.I know I'm far from the doctor's dream patient, but at least I'm proactive in my quest to be well. And I'm very, very careful with the combination of medications I put in my body. I think this comes from being on MAOIs for over ten years.
Take care,
Jedi
Posted by Meri-Tuuli on June 6, 2007, at 5:59:01
In reply to What if you find something that helps?, posted by linkadge on June 5, 2007, at 14:48:38
Hey
Well I think in an ideal world, the patient should be able to tell the doc what he/she is doing themselves and that the doc should be receptive and supportive of that choice.
But....I know how it works IRL. I think it all boils down to a) control and b) the doctors ego.
Docs like to think that they're the ones calling the shots-- when in reality, I bet some of us here are far more knowledgable about what works for us and what drugs we'd like to try etc. But I think that we can be great pharmacologists, just as long as we know the risks, interactions, etc. With most of the ADs I've tried, it has been me who has suggested them. The docs suggestions were usually way off to be honest - they'd recommend a sedating AD when I was sleeping to much already, simple things like that.
Plus there's the docs ego, I have a feeling that alot of them tend to not realise how intelligent some of their patients can be. I guess its something that drummed into them. 'We're the doc, we know best' mentality -- but sometimes, they don't know best, and they don't like to accept this.
Anyway, well I would like to think that the relationship is good and that patients and doctors can work together to figure something out -- I don't see why a doc would freak if you re-started something they already prescribed or whatever. I think they would like to know what a patient is up to! Having said that, it depends on the doctor, you know? But I don't see how a good one would be angry over things. Afterall, the goal is to help patients, no? So I really urge everyone just to talk to the docs about all the things you're trying etc. Otherwise, how else can you get the best treatment from them? You're not giving them all the information are you? They might think you're doing fine on X when in fact, you're messing about with Y as well -- they need to know everything thats going on.
Just talk to them, I've found that quite alot are receptive and supportive - you just need to gently discuss matters with them and build up a rapport.
Anyway I'm rambling.
Meri
Posted by Quintal on June 6, 2007, at 17:22:36
In reply to Should I tell mypsychiatrist about what I've done?, posted by deniseuk190466 on June 4, 2007, at 9:09:30
I was in a similar situation to you a few years ago. My psychiatric nurse once called me a 'loose cannon' and that was for taking 25mg Seroquel during benzo withdrawal when I hadn't slept for two days! But I confessed to taking clonazepam and other benzos long after my scripts had been stopped and I think that's ultimately what lead to me being discharged. If tension is already high over 'unauthorized' med tweaking I'd advise you to tread very carefully. If you'd accidentally stumbled across a miracle cure and were 100% well again, I'd say go for it, but that doesn't seem to be the case. Since Lexapro doesn't seem to be all that good for you it seems too risky to me for you to jeopardise your chances of having access to other meds in the future by confessing. Once you've been discharged (and possibly labelled as one of 'those' patients) it can be very hard to get another appointment with an NHS psychiatrist in the future however great your need may be.
Q
Posted by waterfall on June 6, 2007, at 18:33:38
In reply to Should I tell mypsychiatrist about what I've done?, posted by deniseuk190466 on June 4, 2007, at 9:09:30
When I've made changes in between appointments I found it worked best when I told the doctor before I did it. If I really felt strongly about making a change before I saw her again I dropped her an email or a phone call to say what I was going to do. Anyway, that worked for me.
Posted by deniseuk190466 on June 8, 2007, at 14:29:32
In reply to Re: Should I tell mypsychiatrist about what I've done? » deniseuk190466, posted by Quintal on June 6, 2007, at 17:22:36
Quintal,
Thanks, I think you are right there is no point in telling the psychiatrist but what worries me is that if I tell my psychiatrist I am not getting a good antidepressant response from the lexapro next time I see her she might suggest upping the dose from 20mg (and I've already done that to no avail!)
I will however,tell her that that the Zyprexa does help along with the Lexapro (which it does just not enough) but that I keep stopping the Zyprexa in the hope that the lexapro alone is working (which I do) but then find that on the lexapro alone I have a lot of anxiety (which I do).
Thanks.....Denise
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