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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 NKP on November 16, 2008, at 10:57:50
A person that I know is on the following med regime:
Mornings:
0.5 mg clonazepam
10 mg Buspar
60 mg fluoxetine
450 mg lithium
300 mg valproateEvenings:
0.5 mg clonazepam
10 mg Buspar
450 mg lithium
600 mg valproate
200 mg Seroquel
11.25 mg zopicloneI think she is overmedicated and getting worse on this med regime. Her cognition is badly affected since starting the lithium and valproate.
She's so "out of it" she doesn't seem to realise what's happening to her.
Any thoughts?
Thanks.
Posted by Maxime on November 16, 2008, at 11:26:03
In reply to Is this person overmedicated?, posted by NKP on November 16, 2008, at 10:57:50
Yes, that person is over medicated. Looks like a case of poly pharmacy. Poor thing. No wonder she is having cognition problems.
Posted by Phillipa on November 16, 2008, at 12:06:11
In reply to Is this person overmedicated?, posted by NKP on November 16, 2008, at 10:57:50
Didn't you post above about this problem and it's getting worse for her? Have you consulted the pdoc she's seeing now and maybe time for another. Did you give a diagnosis first time. Sorry don't remember. My heart goes out to you both. Love Phillipa
Posted by Phillipa on November 16, 2008, at 12:16:41
In reply to Is this person overmedicated?, posted by NKP on November 16, 2008, at 10:57:50
Okay found the other thread seems that lamictal was helping fot two weeks and then the rash. Question was her depression getting worse with the old pdoc . May sound stupid from me but that was when she attemped suicide. So what are your thoughts one this and was there a reason for the suicide attempt? Seems a missing link here what was her initial reason for seeing pdoc l and how long had she been on an ad and age? Love Phillipa babblemail is always open.
Posted by NKP on November 16, 2008, at 13:45:38
In reply to Re: Is this person overmedicated? » NKP, posted by Phillipa on November 16, 2008, at 12:16:41
Her first pdoc diagnosed her with unipolar depression and treated her with SSRIs, benzodiazepines, and Seroquel. She was OK most of the time, depressed some of the time, and functional.
Her new pdoc has diagnosed her with bipolar depression, and also claims she has epilepsy, despite the fact that she has NO epilepsy symptoms, and without having yet received her EEG results. Ever since he began treating her, she is depressed most of the time, OK some of the time, and dysfunctional.
He also did a brain scan on her, why I don't know. The report came back clear, yet he claims there are white spots on the scan indicative of epilepsy.
When I share my concerns with people that she is not being correctly treated, and that her old pdoc was better, they respond something to the effect that "he's the doctor, he knows best, stop thinking you know more than the doctor".
I think her pdoc is a pill-happy, diagnosis-happy, greedy, evil quack. Is it a coincidence that he is one of the main shareholders in the clinic where she spent two weeks?
Probably when her medical insurance runs out, he'll decide that she's cured.
I'm sorry for being so cynical, but I am not happy with what is happening.
Posted by Maxime on November 16, 2008, at 14:11:33
In reply to Re: Is this person overmedicated?, posted by NKP on November 16, 2008, at 13:45:38
I don't think you are being cynical. I think you are realistic and that you see what is going on.
I would be in a coma if I was on all those meds!
Posted by bleauberry on November 16, 2008, at 14:44:41
In reply to Is this person overmedicated?, posted by NKP on November 16, 2008, at 10:57:50
I wouldn't say she is overmedicated in terms of dose sizes, but yes likely overmedicated in terms of too many drugs. And likely overmedicated in terms of taking drugs that are bad for her. Those meds can work well to calm down someone who is wild and manic. But for someone who doesn't need them, or someone misdiagnosed, or someone who those meds just are not correct for, yeah, serious out-of-it-ness could be expected.
Drugs take on whole new powers and behaviors when combined. Kind of like 1 + 1 = 3. It's called synergy. It can work for the benefit of the patient, if the synergy is in the direction that helps them feel better. Or it can work against them if it is in the wrong direction. Her current cocktail has lethargy and cognitive disfunction written all over it. No wonder she is so out of it. I feel for her.
I generally shy away from the antipsychotics, but not always. I don't even know her symptoms or history, but I can get a clue from the drugs the doctor has chosen. Based on the little I know, I wonder why they didn't go with something simpler like Zyprexa? Of all the things to add to Prozac for depression, anxiety, schizophrenia, mania, or bipolar, I can't think of anything better than Zyprexa. And the side effect profile of that combination would be practically nill compared to what she is experiencing now. And at least the Prozac/Zyprexa combination has a strong scientific body of robust success behind it, where the cocktail she is on doesn't.
Just the .5mg klonopin alone can knock some people for a loop.
The doctor probably had some particular train of thought when doing this, but it looks like bad polypharmacy to me. As is often true in life, simpler is better, I believe anyway. Personal bias here, but I do not believe anyone needs more than 3 meds in a cocktail, assuming that the ones they are taking prove themselves worthy and life-improving choices. The ones she is on don't sound like that.
Posted by Phillipa on November 16, 2008, at 19:51:42
In reply to Re: Is this person overmedicated?, posted by bleauberry on November 16, 2008, at 14:44:41
Back to the old pdoc. Love Phillipa
Posted by yxibow on November 16, 2008, at 23:07:37
In reply to Is this person overmedicated?, posted by NKP on November 16, 2008, at 10:57:50
> A person that I know is on the following med regime:
>
> Mornings:
>
> 0.5 mg clonazepam
> 10 mg Buspar
> 60 mg fluoxetine
> 450 mg lithium
> 300 mg valproate
>
> Evenings:
>
> 0.5 mg clonazepam
> 10 mg Buspar
> 450 mg lithium
> 600 mg valproate
> 200 mg Seroquel
> 11.25 mg zopiclone
>
> I think she is overmedicated and getting worse on this med regime. Her cognition is badly affected since starting the lithium and valproate.
>
> She's so "out of it" she doesn't seem to realise what's happening to her.
>
> Any thoughts?
>
> Thanks.
This seems awful familiar -- shouldn't she be having this conversation with her doctor.I think all of us playing armchair psychiatrists without her years of history and diagnosis is particularly wrong for just a medication list.
Polypharmacy is necessary sometimes. I'm on polypharmacy and it is a mess sometimes, so are other people online. It takes a good savvy psychopharmacologist to really manage things well, but if this person's doctor has reasons for some of this then there are reasons.
The Seroquel may be causing some blunting, a change of affect which is natural with APs
The Klonopin doesn't seem particular abnormal
Depakote doses can be fairly high but this one may be a bit too high
Lithium is often energizing but may not be for some people, again doses can be high
The BuSpar probably is almost irrelevant because it only works for 30% of the people who take it at all. Can make you dizzy
The Prozac is normally energizing, but maybe not for this person.
The zopiclone, well Lunesta similarly can be taken for long periods
The only thing I can say is that there are several combinations of potentially CNS depressants stacked. That may be the cause of lethargy.That is not a reason for micromanaging someone else's medicine, not that I'm accusing that, I know you're concerned.
There are a lot of medications involved although I'm sure someone looking at my pad of paper would say what's this?
Talk to the person, ask them to have a real face to face talk with their doctor, bring in this pad of paper of medications, ask the reasons and state the side effect.
Psychiatry shouldn't just be a sit there and be given pills. Its a two way street.
-- best wishes
Jay
Posted by Larry Hoover on November 17, 2008, at 16:07:59
In reply to Is this person overmedicated?, posted by NKP on November 16, 2008, at 10:57:50
> She's so "out of it" she doesn't seem to realise what's happening to her.
I think that statement answers the question directly.
Lar
Posted by NKP on November 18, 2008, at 11:50:17
In reply to Re: Is this person overmedicated? » NKP, posted by Larry Hoover on November 17, 2008, at 16:07:59
She's now on the following:-
Mornings:
clonazepam 0.25 mg
buspar 5 mg
valproate 300 mgEvenings:
clonazepam 0.25 mg
buspar 5 mg
valproate 300 mg
zopiclone 7.5 mgShe's normal now.
Let me tell you a story to demonstrate just how badly the meds affected her. She had to fill out a doctor's form. She couldn't remember what her own phone number was. I read it to her. She kept asking me to repeat it. She tried to write it down, but couldn't. She then asked me to "please spell it". I kept slowly reading it to her, but she wasn't able to write it down. Eventually she started crying, saying she didn't understand what it meant.
Posted by Phillipa on November 18, 2008, at 19:13:41
In reply to Yay! Her pdoc reduced her meds., posted by NKP on November 18, 2008, at 11:50:17
That is wonderful news and so happy for you both what a relief for you. Love Phillipa
Posted by Mikez on November 19, 2008, at 2:36:10
In reply to Re: Is this person overmedicated?, posted by NKP on November 16, 2008, at 13:45:38
Her new pdoc is a quack. Get her out of there ASAP.
Posted by yxibow on November 19, 2008, at 8:05:55
In reply to Re: Is this person overmedicated?, posted by Mikez on November 19, 2008, at 2:36:10
> Her new pdoc is a quack. Get her out of there ASAP.
No matter how bad the things seem to be with doctors and medications, there always seems to be the "dump the doctor syndrome".
This is someone's friend, we all understand the concern, but not the person themselves. There is room for third party observation of something that might not be what one thinks of it always. Nevertheless, possibly an over medicated condition.
One liners really aren't particularly useful additives, but that's just me.
-- Jay
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