![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Ali Jones on June 21, 2008, at 10:36:22
I think i've always had obsessive tendencies. Ever since i was a kid i would go from one obsession and compulsion to the next. Some examples when i was younger i would actually do things like gently slap my cheek several times everytime i yawned. I would also say this phrase in my home language at least 3 times before i went to bed. And if i didnt say it just right i would have to repeat myself. I was always adjusting things around me to make sure that everything was alright. Eventually i lost these compulsions diminished only to turn into something else. I would constantly over-analyze everything and feel guilt about the most trivial things. As a result i would confess to my parents to even the smallest and most trivial things. At first i thought i was just being honest but looking back i feel as though the confessing was only a way to relieve the anxiety associated with the guilt.
As a i got older, these were again replaced by other obsessive thoughts. I would be in conversations with friends and i would be analyzing everything said and done. I would read into every joke and think about the perfect response. It got to the point where i couldn't enjoy talking to anyone because i would obsess about how i should function and act socially.
I finally went to the doctor about this and he prescribed lexapro. At first it didnt do much but after a month or so i found the obsessive thoughts lessened. Unfortunately i gained a whole bunch of weight and also found that i couldnt finish during sex so he switched me over to wellbutrin. Big mistake, i was anxious and all over the place. Eventually he switched me over to prozac. A month into prozac, during the middle of sex i found i couldnt maintain an erection. I immediately freaked out and apologized to my partner and told her this kind of thing never happened to me (which was true, even on my worst days i was always able to perform. Ever since that day i've been worrying non-stop about this. Everytime i would engage in sex it would be a test to see if i could perform rather than an enjoyable experience. Some days i wouldn't be able to and this would worsen my anxiety and other days i would be able to function just fine and my anxiety would be kept at bay for just a little while until the "what if" thoughts come back. Hell i remember one time where the sex was amazing and after leaving her house i was just overcome with anxiety because i was thinking "yeah this time it was fine, but next it probably wont".
Its gotten so bad that its all i can think about these days. I would be sitting in a movie theatre see a beautiful woman on screen and try to will an erection. I would hug my girlfriend or kiss her just to see if i can get a reaction out of myself.
I told the doctor about this and he put me on luvox for the obssessional thoughts and told me that it wouldn't have as many sexual side effects as the others. Unfortunately, it was much worse than everything else and made me lose all sensation down there. When i told him about this he put me on parnate. I've been on 30 mg for about a week now and while i know its too early to tell if its working it already feels incredible hard to have an orgasm. Just like with the luvox sensation is lessened.
I feel like this is a double edge sword. My obsessions are of a sexual nature about how i can't perform, and the medications that are supposed to treat me are making me feel less confident about myself sexually.
Oh and the doctor gave me viagra to see if i could perform and give myself the confidence. I remember trying it once and it not working (because popping the blue pill made me even more aware of my situation). It also sucks because even if it did allow me to perform i would just feel anxious about the next time. I feel like these tests to see if i can get an erection are my compulsions...
Posted by Racer on June 21, 2008, at 12:55:51
In reply to Sexual Obession, posted by Ali Jones on June 21, 2008, at 10:36:22
You're probably right about the "tests" of performance being compulsions. And, of course, there's the history of obsessionality. And here's the kicker: SSRIs such as Luvox, Prozac, and Lexapro have sexual side effects.
The statistics vary about how many people experience sexual side effects from SSRIs. I don't know numbers, but let's say there's at least a significant chance that someone taking SSRIs will experience sexual side effects. For many people, it's as you first discovered -- anorgasmia, or the inability to "finish" the act. For some, it may also include diminished libido, inability to achieve or maintain an erection, etc. Your anxiety about erectile difficulties or ability to orgasm are probably exacerbating the situation, too. That's common, and unfortunate -- I know for me, the sexual side effects of SSRIs are a major issue, because sexuality is important to me. It's a natural and vital part of life for many people.
So, what to do about it? There are a lot of strategies proposed for addressing sexual side effects. These range from medication "holidays" to medications to mitigate the problem. Many doctors recommend Viagra, on the theory that increased blood flow might help -- although I am skeptical about the efficacy. I've never tried that, so I couldn't tell you. Someone else here probably has tried it, and can probably offer some insight about it. I am also skeptical about the medication holiday, since it seems to me that the longish half-life of many of these drugs would suggest the sexual side effects would continue through the holiday. Adding Wellbutrin to an SSRI is another option. An old anti-histamine called cyproheptidine will temporarily block the action of SSRIs, and is effective for some people. I have used cyproheptidine, and found it quite effective for me. It lasts about four hours or so, and does make me fall asleep after having my fun -- but that's not necessarily a bad thing.
Honestly, I know that one thing has helped me more than anything else with the obsessive concern about the sexual side effects I've experienced when on SSRIs: information. Once I understood that the inability to achieve orgasm was a side effect of the medication, and that it could be countered by another medication, I was able to relax. While it's not a great feeling to have to take a pill in order to enjoy sex, it was easier for me once I understood the problem. So, educating yourself about this sort of issue might help you a bit, and make it easier for you to counter those obsessions.
Here's a starting point for you: http://www.dr-bob.org/tips/
Good luck!
Posted by IAMtheWalrus on June 21, 2008, at 17:12:26
In reply to Sexual Obession, posted by Ali Jones on June 21, 2008, at 10:36:22
I think the tests are most definitely your compulsions. I believe and i'm sure you'd agree that you have a type of OCD. Parnate can be a very pro-sexual drug, so give it a couple of weeks and you just might be truly amazed. It can also be very affective for OCD. I have had similar symptoms as you do, Prozac works great for me..Parnate worked great for me in the past. Good Luck!
-W
Posted by bulldog2 on June 21, 2008, at 18:47:54
In reply to Sexual Obession, posted by Ali Jones on June 21, 2008, at 10:36:22
> I think i've always had obsessive tendencies. Ever since i was a kid i would go from one obsession and compulsion to the next. Some examples when i was younger i would actually do things like gently slap my cheek several times everytime i yawned. I would also say this phrase in my home language at least 3 times before i went to bed. And if i didnt say it just right i would have to repeat myself. I was always adjusting things around me to make sure that everything was alright. Eventually i lost these compulsions diminished only to turn into something else. I would constantly over-analyze everything and feel guilt about the most trivial things. As a result i would confess to my parents to even the smallest and most trivial things. At first i thought i was just being honest but looking back i feel as though the confessing was only a way to relieve the anxiety associated with the guilt.
>
> As a i got older, these were again replaced by other obsessive thoughts. I would be in conversations with friends and i would be analyzing everything said and done. I would read into every joke and think about the perfect response. It got to the point where i couldn't enjoy talking to anyone because i would obsess about how i should function and act socially.
>
> I finally went to the doctor about this and he prescribed lexapro. At first it didnt do much but after a month or so i found the obsessive thoughts lessened. Unfortunately i gained a whole bunch of weight and also found that i couldnt finish during sex so he switched me over to wellbutrin. Big mistake, i was anxious and all over the place. Eventually he switched me over to prozac. A month into prozac, during the middle of sex i found i couldnt maintain an erection. I immediately freaked out and apologized to my partner and told her this kind of thing never happened to me (which was true, even on my worst days i was always able to perform. Ever since that day i've been worrying non-stop about this. Everytime i would engage in sex it would be a test to see if i could perform rather than an enjoyable experience. Some days i wouldn't be able to and this would worsen my anxiety and other days i would be able to function just fine and my anxiety would be kept at bay for just a little while until the "what if" thoughts come back. Hell i remember one time where the sex was amazing and after leaving her house i was just overcome with anxiety because i was thinking "yeah this time it was fine, but next it probably wont".
>
> Its gotten so bad that its all i can think about these days. I would be sitting in a movie theatre see a beautiful woman on screen and try to will an erection. I would hug my girlfriend or kiss her just to see if i can get a reaction out of myself.
>
> I told the doctor about this and he put me on luvox for the obssessional thoughts and told me that it wouldn't have as many sexual side effects as the others. Unfortunately, it was much worse than everything else and made me lose all sensation down there. When i told him about this he put me on parnate. I've been on 30 mg for about a week now and while i know its too early to tell if its working it already feels incredible hard to have an orgasm. Just like with the luvox sensation is lessened.
>
> I feel like this is a double edge sword. My obsessions are of a sexual nature about how i can't perform, and the medications that are supposed to treat me are making me feel less confident about myself sexually.
>
> Oh and the doctor gave me viagra to see if i could perform and give myself the confidence. I remember trying it once and it not working (because popping the blue pill made me even more aware of my situation). It also sucks because even if it did allow me to perform i would just feel anxious about the next time. I feel like these tests to see if i can get an erection are my compulsions...CBT may also be helpful..Parnate is a dopamine enhancing drug so should help. Stay away from ssri as they have to many sexual effects.
Right now your focusing on not performing being the end of the world. You have a mindset that equates performance with self esteem. So you have to reprogram your thinking and concentrate on pleasure. Also if you don't perform it's not the end of the world. You have to realize that you can perform and your mind is what's blocking you.Maybe if your tense before sex don't even try. You need to be relaxed.Stay away from ssri's for this problem.
Posted by Jay_Bravest_Face on June 22, 2008, at 9:59:11
In reply to Sexual Obession, posted by Ali Jones on June 21, 2008, at 10:36:22
Hey bud....
(This is all YMMV, IMHO, etc...)
I am myself in the same boat. This is a REALLY tough one, as I have had a problem for the past 15 or so years being on SSRI's. (Right now I am on Prozac). What works and what is just a waste of money. The first ones are the ones claimed by doctors and many to be "the best" treatment. I say (mostly;-) nonsense.
1) Wellbutrin (for many cases anyways.) Women seem to have a better response from this med.
2)Viagra...does not work on sexual feeling or the 'drive'. I've tried 'em all..Cialis, etc
3) Periactin (generic Cyproheptadine) Absolutely nothing.
4)Stimulants (Ritalin, Dexedrine.) While Dexedrine was a great drug for me, it still did nothing in the libido dept. Ritalin, no go either.
5)Requip and Mirapex: I've tried every dose and way on these drugs, with no go.
Here are a couple of things that "may" work, out of them all. Now this is from some referenced studies, and case examples as well as my own subjective (bias..heh) experience.
I don't have the references off hand, but you can find the info on line quite easily.1) Apomorphine: will work about 99.9 percent of the time. It's a med not marketed in N. America, but it is in Europe. If you have the cash, you can import it from Europe. It's of course a very expensive (even moreso then Vigara) drug because it pretty much guarantees a male will have an erection after taking the drug. Again, though, cost and ability to get in N. America are difficult factors.
2)Dostinex: (generic Cabergoline) Is a prolactin inhibitor. This med will not only improve libido, it will make you lose weight. (Mostly if you are overweight, especially from many psych meds that increase prolactin levels.) It only has to be taken usually once a week. It is very expensive as well. There are some concerns around long term use and the med causing leaky heart valves. So there may be a bit of a risk, but I have chosen to take the medication in 8 doses. (2 months)
3) Testosterone (Gel or Patch). This one is a little 'iffy', as I have been on the highest dose for two months, and just a 'tiny' change in my libido. My testosterone levels are still coming back low from the lab. I am at about a 12, which is in the lower end of the scale, as between 20-30 are optimal levels (I don't know what that is measured in.) There is yet ANOTHER drug that can help, and it is called Arimidex (generic name is anastrozole). Now, it is officially labeled as a drug for cancer patients, but is used 'off-label' for men with low testosterone combined with the testosterone gel, as it quite quickly increases testosterone levels, and reduces harmful estrogen levels in men. (Yes, us men do have Estrogen too:)
You don't want TOO much testosterone, as that can be dangerous in men too.4)This is a REALLY 'iffy' experience, and not a lot of data to back it up, but Serzone (nefadizone) has helped myself with sexual stimulation. (i.e. esp. around a girlfriend or admiring the ladies..:)
Well, that is all of my latest research. Yes, I've been VERY desperate, and that is why I've gone to the edge and back to find what REALLY works, with some scientific data backup. I'll know, hopefully, in a few weeks if Dostinex goes well. I will post about my experience.
Best wishes,
Jay
Posted by bulldog2 on June 23, 2008, at 9:39:39
In reply to Sexual Obession, posted by Ali Jones on June 21, 2008, at 10:36:22
> I think i've always had obsessive tendencies. Ever since i was a kid i would go from one obsession and compulsion to the next. Some examples when i was younger i would actually do things like gently slap my cheek several times everytime i yawned. I would also say this phrase in my home language at least 3 times before i went to bed. And if i didnt say it just right i would have to repeat myself. I was always adjusting things around me to make sure that everything was alright. Eventually i lost these compulsions diminished only to turn into something else. I would constantly over-analyze everything and feel guilt about the most trivial things. As a result i would confess to my parents to even the smallest and most trivial things. At first i thought i was just being honest but looking back i feel as though the confessing was only a way to relieve the anxiety associated with the guilt.
>
> As a i got older, these were again replaced by other obsessive thoughts. I would be in conversations with friends and i would be analyzing everything said and done. I would read into every joke and think about the perfect response. It got to the point where i couldn't enjoy talking to anyone because i would obsess about how i should function and act socially.
>
> I finally went to the doctor about this and he prescribed lexapro. At first it didnt do much but after a month or so i found the obsessive thoughts lessened. Unfortunately i gained a whole bunch of weight and also found that i couldnt finish during sex so he switched me over to wellbutrin. Big mistake, i was anxious and all over the place. Eventually he switched me over to prozac. A month into prozac, during the middle of sex i found i couldnt maintain an erection. I immediately freaked out and apologized to my partner and told her this kind of thing never happened to me (which was true, even on my worst days i was always able to perform. Ever since that day i've been worrying non-stop about this. Everytime i would engage in sex it would be a test to see if i could perform rather than an enjoyable experience. Some days i wouldn't be able to and this would worsen my anxiety and other days i would be able to function just fine and my anxiety would be kept at bay for just a little while until the "what if" thoughts come back. Hell i remember one time where the sex was amazing and after leaving her house i was just overcome with anxiety because i was thinking "yeah this time it was fine, but next it probably wont".
>
> Its gotten so bad that its all i can think about these days. I would be sitting in a movie theatre see a beautiful woman on screen and try to will an erection. I would hug my girlfriend or kiss her just to see if i can get a reaction out of myself.
>
> I told the doctor about this and he put me on luvox for the obssessional thoughts and told me that it wouldn't have as many sexual side effects as the others. Unfortunately, it was much worse than everything else and made me lose all sensation down there. When i told him about this he put me on parnate. I've been on 30 mg for about a week now and while i know its too early to tell if its working it already feels incredible hard to have an orgasm. Just like with the luvox sensation is lessened.
>
> I feel like this is a double edge sword. My obsessions are of a sexual nature about how i can't perform, and the medications that are supposed to treat me are making me feel less confident about myself sexually.
>
> Oh and the doctor gave me viagra to see if i could perform and give myself the confidence. I remember trying it once and it not working (because popping the blue pill made me even more aware of my situation). It also sucks because even if it did allow me to perform i would just feel anxious about the next time. I feel like these tests to see if i can get an erection are my compulsions...There's an drug memantine that show's promise for ocd and doesn't have any side effects.
Posted by atmlady on June 25, 2008, at 21:19:10
In reply to Re: Sexual Obession..my research so far... » Ali Jones, posted by Jay_Bravest_Face on June 22, 2008, at 9:59:11
Hello, Jay - How are you liking the Dostinex? How much do you take and how often? Just curious, as I saw my pdoc today, who told me I needed some dopamine in addition to my ixel+provigil cocktail. She prescribed Wellbutrin 75 in the a.m. only (immediate release I suppose, not the XL). So. I'll be adding that on Friday morning. But just in case I'm looking at other sources of dopamine and spotted your post. I'm curious as to how you are experiencing Dostinex? Is it going to be a regular part of your "routine", or is it just "as needed"?
Posted by undopaminergic on June 30, 2008, at 6:30:01
In reply to How's the Dostinex Working?, posted by atmlady on June 25, 2008, at 21:19:10
> Hello, Jay - How are you liking the Dostinex? How much do you take and how often? Just curious, as I saw my pdoc today, who told me I needed some dopamine in addition to my ixel+provigil cocktail. She prescribed Wellbutrin 75 in the a.m. only (immediate release I suppose, not the XL). So. I'll be adding that on Friday morning. But just in case I'm looking at other sources of dopamine and spotted your post.
>Provigil is (almost certainly) a more powerful dopaminergic agent than Wellbutrin, but the latter may be more effective as an antidepressant in general. For dopaminergic augmentation, however, methylphenidate (Ritalin, Concerta, etc.) or dextroamphetamine (Dexedrine) would seem more suitable choices.
As for cabergoline (Dostinex, Cabaser), alas, it is one of those dopamine (DA) agonists that are associated with a serious risk of cardiac valvulopathy and other severe adverse effects if used extensively. The same goes for pergolide (Permax), and to a lesser extent bromocriptine (Parlodel). In fact, as a general rule, and in the absence of more specific information, it may be prudent to regard all ergot-based drugs as suspect.
The non-ergot DA agonists are apomorphine, ropinirole, pramipexole, piribedil, quinagolide, rotigotine, and possibly others. I recall that you've already tried one or two of them. Apomorphine may have the best DA receptor binding profile, but it's troublesome in terms of a short half-life and the necessity of parenteral adminitration.
Low doses of aripiprazole (Abilify) may be worthy of consideration due to its partial agonist action at DA D2 receptors.
Sulpiride and amisulpride can be very effective dopaminergic agents at low doses. They are less likely to cause sleepiness than most - or all - of the DA direct agonists mentioned above.
Etc... I've probably overlooked a lot of what should be mentioned.
Posted by atmlady on July 1, 2008, at 19:43:23
In reply to Re: How's the Dostinex Working?, posted by undopaminergic on June 30, 2008, at 6:30:01
Thanks, Undopa, for the info!
I'm amazed that you can remember what I've already taken, when my pdoc apparently cannot. Background to the conversation between dumb and dumber below:
Ixel + provigil working great 6 months, then all of a sudden - depression and crying come back. I know from experience that my pdocs first response is to up the dose of whatever I'm already taking, so on my own I experimented with upping the ixel, which blew my head off, then upping the provigil, which didn't really do much for the mood, then tried adding 150 wellbutrin xl which really brightened my mood, but again blew my head off. So I'm like, hmmm... I could use something like wellbutrin, but without the NE stim.
So I make my appointment. Pdoc says same thing, I need more dopamine, so let's try a really low dose of wellbutrin. I'm like YEAH, I can't wait, I really want this to work. But unfortunately, it was still too much NE I think. My heart hurt, was beating fast, my throat hurt, and I was kinda spacey, not driving well. Disapointed to say the least.
So I call my pdoc yesterday and the "assistant" answers, and here I relate the incredible frustrating experience for my psychobabble friends' enjoyment. You decide which one of us is dumb, and which one is dumber.
Me: Yes, this is Ms. X and I need to make an appointment with Dr. Y.
Assistant: Weren't you just in here?
Me: Yes, but the doc made some changes to my meds and they aren't really working out, so I need to come in.
Assistant: Well, how about if she just calls you?
Me: Sure, I didn't know she did that. (So I relate the story and she says "we'll get back to you")
Later that day ....
Assistant: The doctor says she can prescribe either celexa or lexapro instead of the wellbutrin, which do you want?
Me: Uhhh. Well, those are SSRI's I think - lemme look online real quick - why, yes, those are SSRI's, and I already use an SNRI and it's working well. Is she wanting me to replace the Ixel with one of the others?
Assistant: Uhhh. No, she wants you to add it to what you are already taking.
Me: Well, I'm just kind of confused because those two act on serotonin and her objective with the wellbutrin was to give me more dopamine.
Assistant: Well, I don't know, this is just what she said.
Me: THh other thing is, it's in my records that I can't take the side effects of SSRI's, and I've already taken lexapro and I don't like it!
Assistant: Well, you should have told her you'd already tried lexapro when she took your medical history at your first visit, or she would have known that.
Me: But she's the one who prescribed me the lexapro!
Assistant: Oh? Lemme see. Oh, I see it. Well..... do you have some other medication in mind that you think would work?
Me: Well, maybe something like ritalin would do the job of increasing the dopamine.
Assistant: What? That's not for depression, that's for ADD!!!
Me: Well, I know, but it's also used to augment anti-depressants sometimes, so I have read.
Assistant: Well, it's really expensive, you know. (She remembers I am self-pay)
Me: Well, I don't mind paying for something that works. My god, the provigil and the wellbutrin are expensive too! Maybe she could just give me a 7 day sample or something, and I could just experiment and see if it works.
Assistant: Don't you know that's a controlled substance? We can't give out samples!
Me: OK, so a 7-day prescription, maybe, I don't know. Could you just talk to her? I think she is not remembering what we discussed during the appointment and she's not remembering my issues with SSRI's.
Assistant: OK, I'll call you back.
(24 hours later, no call back, so I initiate the call, today.)
Me: Hi, it's Ms. X, did you get a chance to talk to her about all that?
Assistant: Yeah, she said she was *NOT* going to prescribe adderall.
Me: Well, Ok, so then what are my options? Did she have any other suggestions?
Assistant: Well, either the celexa or the lexapro, that's it.
Me: I don't understand. Did she say why? Has her theory changed about the dopamine or does celexa work in some way on dopamine too? I mean, what's the rationalization behind those two choices for my specific problem?
Assistant; I don't know. She's just not going to prescribe adderall.
Me: OK, but I just threw ritalin out there because you asked me for a suggestion. I'm not a doctor, like she is, I just pulled ritalin off the top of my head, but I'm open to other options, if they make sense to me. Did she mention any other options, other than the celexa and lexapro?
Assistant: Nope.
Me: (Well, speechless for a minute) BYE
So. Now, after two years of building a relationship with a pdoc, a partner who could work with me at managing my depression. And now what? I gotta find another because this one thinks I'm a speed freak or something? I've never taken ritalin before - I have NO idea if it will work, I just figure it's worth a try. Isn't that what these pdocs do anyway? Make an educated guess and throw out a med in the hopes it will work? And when it doesn't work, well, hey, you've added another bit of info to use in your next educated guess, right? I don't get it. The assistant made it sound like I had asked for the most outrageous thing on earth by asking to try ritalin!So anyway, Undopa, I will peruse your list some more later this week and do some more research and heck, I don't know, keep experimenting on my own, I suppose. Shoot, you'd think she's WANT to keep me as a customer, being self-pay I have to pay the "regular" rate of $100 per 15 minutes, as opposed to the lower insurance rate. Geez.
Posted by undopaminergic on July 2, 2008, at 11:14:44
In reply to Dumb and Dumber - Convo w/ Pdoc's 'assistant' » undopaminergic, posted by atmlady on July 1, 2008, at 19:43:23
>
> So anyway, Undopa, I will peruse your list some more later this week and do some more research and heck, I don't know, keep experimenting on my own, I suppose.
>Experimenting on your own is indeed the only way with some of the drugs mentioned - e.g. sulpiride - that aren't available in the US as prescription medications.
> Shoot, you'd think she's WANT to keep me as a customer, being self-pay I have to pay the "regular" rate of $100 per 15 minutes, as opposed to the lower insurance rate. Geez.
>Considering her apparent memory impairment (judging from your story), she probably didn't recall how profitable you are.
Posted by dcruik518 on July 6, 2008, at 14:53:41
In reply to Re: Dumb and Dumber - Convo w/ Pdoc's 'assistant', posted by undopaminergic on July 2, 2008, at 11:14:44
I think if you want to discuss things with your P-doc, you will have to make another appointment. My experience has been that most docs really resent it when you expect them to give you help without paying for an appointment. You don't need her permission to stop the wellbutrin. The suggestion for celexa or lexapro was probably something she pulled out her *ss, because she was busy and preoccupied and when she has a lot of patients it's not really reasonable to expect these dopes to remember what you specifically are taking and they're not going to take the time to study your chart if they're not getting paid. I know, it sucks--she sucks--but it's sometimes better to just play by their rules, order other stuff online and don't tell them about it. BTW, not everyone who is a psychiatrist is a psychopharmacological expert--lots of time you see a resident at a university and these kids often don't know squat.
~DC
Posted by dcruik518 on July 6, 2008, at 15:19:12
In reply to Sexual Obession, posted by Ali Jones on June 21, 2008, at 10:36:22
You need to ask your p-doc for a prescription of cyproheptadine, which is totally safe antihistamine that counteracts the sexual side effects caused, for the most part, by serotonin-boosting drugs like SSRIs, SNRIs and MAOIs. Cyproheptadine helps both with lack of sensation and anorgasmia.
Your doctor may suggest wellbutrin but if I were you I wouldn't bother with it. It doesn't work nearly as well as cyproheptadine, and it has the worst effectiveness rate of all the anti-depressants. P-docs often prescribe simply because it's the only supposedly dopamine boosting AD they feel qualified to prescribe.Also, I really doubt you have OCD. It sounds more like the usual rumination associated with depression combined with the tendency most men have to be obsessive about sex in the first place.
Posted by sunnydays on July 6, 2008, at 17:56:37
In reply to Dumb and Dumber - Convo w/ Pdoc's 'assistant' » undopaminergic, posted by atmlady on July 1, 2008, at 19:43:23
I would encourage you to assist on an appointment. I think the assistant may not be getting the pdoc's meaning across to you correctly or something. Why not talk with your pdoc first directly and not through a third person before deciding to dump her?
sunnydays
Posted by atmlady on July 7, 2008, at 7:54:47
In reply to Re: Dumb and Dumber - Convo w/ Pdoc's 'assistant', posted by sunnydays on July 6, 2008, at 17:56:37
Thanks, SunnyD - I should have insisted on an appointment once I realized the assistant wasn't an effective messenger. I am hesitating now, however, because I fear that she's not going to listen to me and I'll just get frustrated all over again.
I may look into seeing an adult ADD specialist. Ever since my great response to Provigil - better focus, clearer thinking - I have wondered if ADD wasn't a factor/contributor to the MDD I've suffered from since my 20's. Both my kids were diagnosed with it, and my only sister as well. Maybe I just found a way to live with being a space cadet. It was never an issue that I'd go to a doctor about, unlike the depression, which forced me to the doctor when my thoughts turned morbid - scary.
So anyway, that's what I'm thinking. I just have a feeling my current pdoc won't be very open to exploring this possibility. But maybe I'm just being paranoid. I'm thinking an adult ADD specialist (if there is such a thing) could tell me if I'm barking up the wrong tree or not. At this point, I'd trust an objective third party over my pdoc, who I already know has issues with prescribing ritalin.
In the meantime I've decided to take a 6-week break from the Provigil, with the hopes of re-creating the first 6 month's feeling of happiness and productivity right as school starts. That's the most important thing - I cannot let my depression f*up my school!
Posted by undopaminergic on July 7, 2008, at 11:57:48
In reply to Re: Dumb and Dumber - Convo w/ Pdoc's 'assistant' » sunnydays, posted by atmlady on July 7, 2008, at 7:54:47
>
> I may look into seeing an adult ADD specialist. Ever since my great response to Provigil - better focus, clearer thinking - I have wondered if ADD wasn't a factor/contributor to the MDD I've suffered from since my 20's. Both my kids were diagnosed with it, and my only sister as well. Maybe I just found a way to live with being a space cadet. It was never an issue that I'd go to a doctor about, unlike the depression, which forced me to the doctor when my thoughts turned morbid - scary.
>My experience is similar. I've probably always had some type of ADD, as I've always had trouble with following through on tasks, but no problems starting new ones and a strong tendency to becoming distracted or side-tracked by whatever turns up and seems interesting. However, none of those issues seemed severe enough to seek professional help for until they become compounded by depression. Now in retrospect, I cannot help but wonder what my life had been like if I had received proper assistance in time, as opposed to trying harder and harder only to accomplish less and less and eventually burning myself out. I think there's a good chance that my grades would have been better - in particular, the extreme lows in the subjects I found boring might have been avoided with proper medication. Perhaps I might even have finished my college degree. Fortunately, when I think of such matters of the past or of future possibilities, it's more in the form of curious speculation rather than morbid rumination, so there's at least one problem I'm free from.
> So anyway, that's what I'm thinking. I just have a feeling my current pdoc won't be very open to exploring this possibility. But maybe I'm just being paranoid. I'm thinking an adult ADD specialist (if there is such a thing) could tell me if I'm barking up the wrong tree or not. At this point, I'd trust an objective third party over my pdoc, who I already know has issues with prescribing ritalin.
>From the little that I know about your doctor, I'm inclined to think that finding one that is more knowledgeable and open minded would be a good idea. Although no-one, including doctors, is perfect, it should not be impossible to find one who is not phobic about important medications that may be of value for your treatment.
Posted by undopaminergic on July 7, 2008, at 12:36:42
In reply to Re: Dumb and Dumber - Convo w/ Pdoc's 'assistant', posted by dcruik518 on July 6, 2008, at 14:53:41
> I think if you want to discuss things with your P-doc, you will have to make another appointment. My experience has been that most docs really resent it when you expect them to give you help without paying for an appointment.
>While it's reasonable for a doctor - or any other professional - not to want to spend a lot of time and effort for no compensation, it's also unreasonable to always insist on a formal appointment. E-mail and phone conversations are useful - and sometimes essential - complements that should be offered for a sensible fee.
> BTW, not everyone who is a psychiatrist is a psychopharmacological expert--lots of time you see a resident at a university and these kids often don't know squat.
>Doctors early in their career are one class of health professionals who may not possess the knowledge one would desire or expect, but another class that I find more troublesome is the lazy ones who seem to be in it merely to make a living and appear totally lacking in passion for what should be their field of expertise, but rather do little more than flip the pages of a standard reference book (such as as the PDR or BNF), and who neglect continuing education to the point that they are scarcely more knowledgeable at the time they retire than they were when receiving their medical degree.
Posted by BrightEyed+Blueberry on July 12, 2008, at 4:45:55
In reply to Re: Dumb and Dumber - Convo w/ Pdoc's 'assistant', posted by undopaminergic on July 7, 2008, at 12:36:42
Here's a suggestion from a friend's success story in finding a pdoc who's been very helpful with treating my friends adult onset add. The pdoc was found through the Amen Clinics (the book by Dr. Daniel? Amen, though I believe the web site has more current listings/referrals) ....easy enough to find the website (amenclinics.com?) Dr. Amen, he wrote that book, um, Change your Brain Change your Life? He did the PBS special you can catch every month or so on the pledge drives....There are several clinics across the US, or at least in California--but my friend actually looked at a referral list in the back of the book (dated 2006-ish? to find what he hoped would be "helpful" pdocs in his area (as opposed to going to the actual clinic, which he wasn't close enough too, and he wanted a local pdoc really, not necessarily brain scans, etc.)
So, you may want to try that route to find a compatible pdoc who works with Adult ADD. His doc funnily enough was listed in the book but not on the current web page list--so there are 2 places to look, the web site, and the book (worth buying- for the list but definitely for the read anyway, i think)
So unless my friend just lucked out - but he had, in addition to past dx of depression and anxiety , a history of substance abuse--specifically with stimulants/xanax (obvious hand-in-hand rship there). My friend now wonders if his depression/anxiety could perhaps have always been/be secondary/in relation to the main problem of ADD--his doctor suggested as much. OF course-- or does it matter-- his adult ADD onset could be from the stimulant substance abuse; the depression and anxiety having always been there, worsened by the abuse..... But again, does it matter the cause of the Adult Onset ADD - is the brain messed up similarly either way? And therefore the meds prescribed would be similar? But more to the point of responding to your email about finding a pdoc....
I can understand how it matters in terms of finding doctors being comfortable prescribing the proper range of ADD meds (from the ahem Wellbutrin to Strattera to the , it seems, more successful Ritalins and Adderals and other amphetamines )to a patient with a dx of Adult onset ADD (+depression/anxiety) who has a history of substance abuse. So doctors who will work with this potential kind of Adult Onset ADD/(+depression/anxiety) patient, seems like they're pretty comfortable and believe in wha t they are doing and are up on the latest research as they have to be-- working with this population - the meds they're given are practically the same ones they've abused/self-medicated? with in the past. They're paid up on their malpractice insurance and sit comfortably on the "cutting edge" of brain scan technology. They're down with the brain and not just reading medication inserts.
So give it a try! His is definitely a more expensive doc, but, worth it to him--after all, it's his brain, it's his life.... it's your life. I'm sure I could quote a commercial here ("and you're worth it" but I think I'll hit the sack.
*Brightness Falls...asleep.
> > I think if you want to discuss things with your P-doc, you will have to make another appointment. My experience has been that most docs really resent it when you expect them to give you help without paying for an appointment.
> >
>
> While it's reasonable for a doctor - or any other professional - not to want to spend a lot of time and effort for no compensation, it's also unreasonable to always insist on a formal appointment. E-mail and phone conversations are useful - and sometimes essential - complements that should be offered for a sensible fee.
>
> > BTW, not everyone who is a psychiatrist is a psychopharmacological expert--lots of time you see a resident at a university and these kids often don't know squat.
> >
>
> Doctors early in their career are one class of health professionals who may not possess the knowledge one would desire or expect, but another class that I find more troublesome is the lazy ones who seem to be in it merely to make a living and appear totally lacking in passion for what should be their field of expertise, but rather do little more than flip the pages of a standard reference book (such as as the PDR or BNF), and who neglect continuing education to the point that they are scarcely more knowledgeable at the time they retire than they were when receiving their medical degree.
Posted by Crotale on July 16, 2008, at 21:31:24
In reply to Re: Dumb and Dumber - Convo w/ Pdoc's 'assistant', posted by undopaminergic on July 7, 2008, at 12:36:42
> While it's reasonable for a doctor - or any other professional - not to want to spend a lot of time and effort for no compensation, it's also unreasonable to always insist on a formal appointment. E-mail and phone conversations are useful - and sometimes essential - complements that should be offered for a sensible fee.
Absolutely!
> > BTW, not everyone who is a psychiatrist is a psychopharmacological expert--lots of time you see a resident at a university and these kids often don't know squat.
My current doc is a resident and actually he's great -- very up to date, always pays attention to my ideasm, etc.
> Doctors early in their career are one class of health professionals who may not possess the knowledge one would desire or expect, but another class that I find more troublesome is the lazy ones who seem to be in it merely to make a living and appear totally lacking in passion for what should be their field of expertise, but rather do little more than flip the pages of a standard reference book (such as as the PDR or BNF), and who neglect continuing education to the point that they are scarcely more knowledgeable at the time they retire than they were when receiving their medical degree.I have trouble respecting a doc who's less intelligent than me.
-Crotale
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.