Shown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by West on February 19, 2009, at 7:51:39
Finally saw a doctor privately after 3 years of the nhs. Going through the process could be compared to banging the proverbial head against a brick wall. He's called Dr Gupta and works privately but does pro bono stuff for the maudsley.
* Anxiety (social rather than general)
* Depression
* Difficulty concentrating
* Insomnia
I was taking escitalopram for a month before i saw him. I deluged my previous gp with literature (star*d algorythms, papers on mirt + ssris/snris) he obviously got a little impatient after i kept comoing in and he kept writing me p'scripts for zolpidem and temazepam, referred me to psych. He wrote back essentially saying 'i wouldn't want to waste the patient's time if he is confident escitalopram + bupropion is the answer." (i.e he's only got time for serious cases) and "We should meet only if he wants lithium or a mood stabilizer" SO, I went back to Gp who said he wouldn't prescribe bupropion and was angry i had been refused an appointment and referred me again. 2 weeks later with sleep still a nightmare I rung him up and outright asked for a small dose of mirtazapine at night, to which he replied he wasn't prescribing 'major tranquilizers'. What a cu*t.
Heavens! Now on:
* 10mg Escitalopram
* 300mg Bupropion
* 2mg Klonopin noct.
I seem to be doing quite well. Is the K dose a little high perhaps. I like the combo of bup + benzo though.
West
Posted by SLS on February 19, 2009, at 8:04:14
In reply to I've got me a cocktail, posted by West on February 19, 2009, at 7:51:39
> Heavens! Now on:
>
> * 10mg Escitalopram
>
> * 300mg Bupropion
>
> * 2mg Klonopin noct.
EXCELLENT treatment regime. If you get "stuck", I am sure you would plan on moving the Lexapro up a bit.
> I seem to be doing quite well.That doesn't surprise me.
> Is the K dose a little high perhaps. I like the combo of bup + benzo though.
You have plenty of time to experiment with dosages. You might even find that you won't need as much, if any at all, if the Lexapro does what it is supposed to.
Stay well.
- Scott
Posted by West on February 19, 2009, at 9:49:30
In reply to I've got me a cocktail, posted by West on February 19, 2009, at 7:51:39
Posted by West on February 19, 2009, at 10:24:56
In reply to Re: I've got me a cocktail » West, posted by SLS on February 19, 2009, at 8:04:14
To anyone living in the UK and struggling with adequate health treatment on the NHS I can recommend the Capio Nightingale clinic. It's in London near Marylebone tube. I went there just to see a psych and have a consultation but they have a full inpatient programme and specialise in all sorts of things including substance abuse (amy winehouse had a stint there), eating disorders, psychosis/schizophrenia. Although quoted prices for care are pretty eye watering - something like 3k a week- you may be referred by a primary care doc if you're deemed a suitable case.
Prescriptions from the psychs are usually more expensive but my one seemed perfectly happy to write to my GP recommending the drugs he prescibed and from there you can just do repeat prescriptions. It's obtaining the kind of drugs flagged for risk +/or cocktails of drugs together which nhs practitoners are uncomfortable with - this is a general case of one-size-fits-all protocol and general back-covering against the watchful gaze of those more senior.
It's silly to think it has taken 3 years to get the drugs that will (crossed fingers) help me stay alive without inhabiting a belle and sebastien song: in an alternate existence (and in the wake of a highly contagious virus from which i had immunity) I could have simply walked past the counter at any chemist and picked out the meds and gone about my day. What's next i wonder?
I heard d-amphetamine is only a reuptake inhibitor at low doses - and therefore presumably safe? It's the high doses that reverse the mechanism from inhibition to efflux (at which point the body-thrusting forward 'rush' is supposed to occur) and we all know about DA releasers and their rep within neurochemmistry.
Posted by Phillipa on February 19, 2009, at 11:10:57
In reply to Re: Doctors in England, posted by West on February 19, 2009, at 10:24:56
West did you say you first doc said remeron was a major tranquilizer? Why would he say that as it's really an ad? Love Phillipa
Posted by West on February 19, 2009, at 13:25:47
In reply to Re: Doctors in England » West, posted by Phillipa on February 19, 2009, at 11:10:57
> West did you say you first doc said remeron was a major tranquilizer? Why would he say that as it's really an ad? Love Phillipa
Because he's an idiot. He also thought lamotrigine and lithium were.
Posted by Phillipa on February 19, 2009, at 20:41:10
In reply to Re: Doctors in England, posted by West on February 19, 2009, at 13:25:47
West I agree. Love Phillipa
Posted by Neal on February 22, 2009, at 21:57:15
In reply to Re: Doctors in England, posted by West on February 19, 2009, at 10:24:56
West,
Interesting comments about Britain/NHS. We has some posts a while back from English who said that they needed to wait 3 months for inititial appointment with a Pdoc, and similar tales.
Can you give your take on the NHS? In particular as regards mental issues?
We might be on the verge of our own NHS in America, so we'd be interested. Any others, also Canadians or others with a national health service, please jump in. Thanks
Posted by desolationrower on February 27, 2009, at 1:28:57
In reply to Re: Doctors in England » West, posted by Neal on February 22, 2009, at 21:57:15
its a 3 month wait in america too, and thats if you can afford to pay for it.
-d/r
Posted by detroitpistons on February 28, 2009, at 12:47:21
In reply to Re: Doctors in England, posted by West on February 19, 2009, at 10:24:56
West,
What do you think about the NHS in general? Obviously, you are frustrated with it right now, but do you think that it's a good system in the grand scheme?
This is a subject of great interest to me because I am an American, and our healthcare system needs repair. As you probably know, we have 48 million citizens with no healthcare. Medical expenses are the #1 cause of bankrupcy.
I am not comfortable with healthcare being entirely profit driven. This basically means that the people who need it the most have the least chance of getting it. I lost my job, and therefore, I lost my health insurance. Now I'm walking a tightrope.
Hospitals here legally can't refuse you treatment, but they can send you a bill for $100,000.
I don't know what we should do. If you bring up nationalized healthcare here, the people on the right start screaming SOCIALISM. I don't know what we should do, but I do know that we can't go on like this.
> To anyone living in the UK and struggling with adequate health treatment on the NHS I can recommend the Capio Nightingale clinic. It's in London near Marylebone tube. I went there just to see a psych and have a consultation but they have a full inpatient programme and specialise in all sorts of things including substance abuse (amy winehouse had a stint there), eating disorders, psychosis/schizophrenia. Although quoted prices for care are pretty eye watering - something like 3k a week- you may be referred by a primary care doc if you're deemed a suitable case.
>
> Prescriptions from the psychs are usually more expensive but my one seemed perfectly happy to write to my GP recommending the drugs he prescibed and from there you can just do repeat prescriptions. It's obtaining the kind of drugs flagged for risk +/or cocktails of drugs together which nhs practitoners are uncomfortable with - this is a general case of one-size-fits-all protocol and general back-covering against the watchful gaze of those more senior.
>
> It's silly to think it has taken 3 years to get the drugs that will (crossed fingers) help me stay alive without inhabiting a belle and sebastien song: in an alternate existence (and in the wake of a highly contagious virus from which i had immunity) I could have simply walked past the counter at any chemist and picked out the meds and gone about my day. What's next i wonder?
>
> I heard d-amphetamine is only a reuptake inhibitor at low doses - and therefore presumably safe? It's the high doses that reverse the mechanism from inhibition to efflux (at which point the body-thrusting forward 'rush' is supposed to occur) and we all know about DA releasers and their rep within neurochemmistry.
Posted by meltingpot on February 28, 2009, at 13:11:27
In reply to I've got me a cocktail, posted by West on February 19, 2009, at 7:51:39
Hi West,
I'm in the UK, did you managed to referred in the UK to this clinic?
Denise
Posted by West on February 28, 2009, at 16:33:30
In reply to Re: I've got me a cocktail, posted by meltingpot on February 28, 2009, at 13:11:27
> Hi West,
>
> I'm in the UK, did you managed to referred in the UK to this clinic?
>
> DeniseNo. I 'referred' myself, meaning i rang them and they made me an appointment to see someone the next day. It would have been 6 weeks through a local mental health unit. I've been trying to get bupropion for ages and i'm so happy finally i got it.
Posted by West on February 28, 2009, at 16:48:49
In reply to Re: Doctors in England » West, posted by detroitpistons on February 28, 2009, at 12:47:21
> West,
>
> What do you think about the NHS in general? Obviously, you are frustrated with it right now, but do you think that it's a good system in the grand scheme?I think it is a great institution all things considered, though obviously where specialist help is required the system suffers under the strain a bit. I don't know enough about psychiatric drug prescribing to make an educated judgement. I'd be inclined to say it was conservative and follows rigourously guidelines set out in the bnf though this might not always be the case, all of the time.
> This is a subject of great interest to me because I am an American, and our healthcare system needs repair. As you probably know, we have 48 million citizens with no healthcare. Medical expenses are the #1 cause of bankrupcy.
I think healthcare should be nationalised. You do have medicaid, a similar entity offering dispensation to low income patients correct? I have always wondered how it must feel not just to have the luxury of a free healthcare system. Remember me are taxed very highly in the UK which funds the NHS, often incredibly inefficiently.
> I am not comfortable with healthcare being entirely profit driven. This basically means that the people who need it the most have the least chance of getting it. I lost my job, and therefore, I lost my health insurance. Now I'm walking a tightrope.
Yes, I see the problem. Can you apply for any special government-aided discounts on your meds? Aren't generic versions of drugs widely available and very cheap in the US
> Hospitals here legally can't refuse you treatment, but they can send you a bill for $100,000.
> I don't know what we should do. If you bring up nationalized healthcare here, the people on the right start screaming SOCIALISM. I don't know what we should do, but I do know that we can't go on like this.That's crazy. The politics are so rudimentary. Maybe things will be better under obama?
West
Posted by detroitpistons on March 1, 2009, at 13:11:49
In reply to Re: Doctors in England-detroitpistons, posted by West on February 28, 2009, at 16:48:49
From what I read and hear, there are some great healthcare systems in the world. While none of them is perfect, at least everyone in those countries has access. It's not even up to debate in Europe (and Canada and pretty much everywhere)....It's just a generally accepted principle that healthcare is a basic necessity that everyone should have and that the state should provide.
Change from the status quo is scary for people, even if the status quo is terrible. Here we have these conservative ideologues (no offense to any conservative ideologues reading this) that think that government is the bane of existence. I see myself as more in the center. I think government is necessary for some things, and bad for others. The idea that "free market capitalism" is a magic panacea that will cure all of societies' ills is just absurd to me. Don't get me wrong, I am "pro business," but there has to be a balance.
One of the arguments against nationalized healthcare here is that we will all be waiting months and months in order to get care. They say that people come here from Canada to get surgeries because they can't get them at home. While that's true in some cases, I think it's exaggerated. The thing is, you can always have private clinics and hospitals in addition to nationalized healthcare. You can still keep this insurance system for anyone that's "dissatisfied."
We do have Medicare and Medicaid here, but only the seriously disabled and the very poor qualify for that. If you are in the middle class or lower-middle class, you are basically on your own. You can purchase "individual" insurance plans for yourself and your family, but the coverage is generally minimal and very expensive. Only the "group" plans generally offer good insurance. The only way to get into a group plan, generally, is to be employed by a company or entity who offers it. Group insurance is what you what. For the most part, you are covered, no questions asked. You are part of a larger "risk pool," whereas with individual insurance, YOU are the risk pool, as the name implies. Therefore, you can't spread the risk. A lot of people would rather not even buy this type of insurance because it feels like you are wasting your money.
This individual garbage subjects you to all sorts of scrutiny, and it can actually be a little humiliating. You have to disclose your entire medical history. Therefore, if you have an ongoing illness, they're not going to cover it for a certain period of time, if at all! If they know they are going to lose money on you, they won't take you. This is the existing incentive system.
I have found a state funded for mental health clinic that's free of charge. Your doctor appointments are free, and they'll cover you with med samples in the short term. They asked me to apply for Medicaid so that I'll receive a rejection letter (it's generally accepted that someone of my young age and "employability" doesn't stand a snowball's chance in hell of being accepted), in order for the drug companies to be willing to accept me into their "patient assistance" programs. That's right, some of the drug companies will give you reduced price meds if your income is below the poverty level and you have exhausted all attempts to get aid from the state....They are real philanthropists. I lost my job and now I'm back in school, and so I should qualify.
The thing is, no matter what your financial situation, a lot of medications are unaffordable to begin with. If you don't have drug coverage, one month's worth of Effexor XR is going to cost you about $900.00 (probably depends on dosage - that's for 90 x 225mg)! Generics aren't necessarily all cheap either. If you are taking 3 or 4 different drugs, you could still end up paying a couple hundred dollars a month.
I had a debate online not too long ago with some people on a newspaper's website, in response to an article about new money coming into our state from the federal government, to help fund our Medicaid system. The state that I live in (Michigan) has the highest unemployment rate in the country, and our budget is a mess. There were some people who made comments about a "welfare state," etc, etc...I think these people are generally brainwashed by various sources, but that's a separate issue. They say, "Why should I have to pay for someone else's healthcare? I pay for my own, socialism, socialism, I am an angry little troll, blah, blah, blah."
They are entitled to their opinions and philosophies, but I question their sense of morality. After all, this article was about Medicaid for people who are needy by no choice of their own, not nationalzed healthcare for all. One person claimed that our constitution doesn't say anything about providing healthcare to the public. It doesn't say anything about healthcare specifically, but it does say something about "general welfare." I would say that health falls into that category.
Sorry to be so longwinded...I do think Obama is going to address all of this. But if you listen to some of the hardcore conservatives here, you'd think that Obama is the reincarnation of Karl Marx.
Again, the status quo is important in all of this. Do the strict conservatives in England argue that the NHS should be abolished, and that England should go to an American style insurance system? I doubt it.
It's true...The government can be very inefficient. The government can screw things up badly. However, the current system ain't working either. The "free market" extreme doesn't solve the problem either.
> > West,
> >
> > What do you think about the NHS in general? Obviously, you are frustrated with it right now, but do you think that it's a good system in the grand scheme?
>
> I think it is a great institution all things considered, though obviously where specialist help is required the system suffers under the strain a bit. I don't know enough about psychiatric drug prescribing to make an educated judgement. I'd be inclined to say it was conservative and follows rigourously guidelines set out in the bnf though this might not always be the case, all of the time.
>
> > This is a subject of great interest to me because I am an American, and our healthcare system needs repair. As you probably know, we have 48 million citizens with no healthcare. Medical expenses are the #1 cause of bankrupcy.
>
> I think healthcare should be nationalised. You do have medicaid, a similar entity offering dispensation to low income patients correct? I have always wondered how it must feel not just to have the luxury of a free healthcare system. Remember me are taxed very highly in the UK which funds the NHS, often incredibly inefficiently.
>
> > I am not comfortable with healthcare being entirely profit driven. This basically means that the people who need it the most have the least chance of getting it. I lost my job, and therefore, I lost my health insurance. Now I'm walking a tightrope.
>
> Yes, I see the problem. Can you apply for any special government-aided discounts on your meds? Aren't generic versions of drugs widely available and very cheap in the US
>
> > Hospitals here legally can't refuse you treatment, but they can send you a bill for $100,000.
>
> > I don't know what we should do. If you bring up nationalized healthcare here, the people on the right start screaming SOCIALISM. I don't know what we should do, but I do know that we can't go on like this.
>
> That's crazy. The politics are so rudimentary. Maybe things will be better under obama?
>
>
> West
Posted by West on March 1, 2009, at 14:33:00
In reply to Re: Doctors in England-detroitpistons » West, posted by detroitpistons on March 1, 2009, at 13:11:49
A nation that has at its bedrock the acquisition of private wealth through trade might be hypothesized to lead inevitably to the status quo you describe. It's true no conservative here would be in favour of abolishing national healthcare, on the contrary, tory and labour governments have consistenly built establishments for the express puropose of caring for the poor and needy. The victorians were a civilised lot and when not building bridges, civic buildings and half of britain they pondered morality extensively
The problem it seems is in size. Organising something like the nhs from a centralised government on the scale of nation like the US is simply too great a prospect for anybody, however good their intent.
Perhaps creating separate interstate healthcare organizations with central funding brought about by a mandatory tax, might be thought a realistic option. Since most gnvt revenue in the US goes to the military and safeguarding its global superiority i doubt if there'd be much left for muggins and his unshakable melancholy.
Another idea might be to include lowering the mandatory requirements for healthcare or recognizing specific 'hotspots' where an individual is especially vulnerable: a depressed or otherise mentally ill individual who cannot earn a living and who cannot gain an already undesirable insurance plan because of his own undesirability in the eyes of the insurer would i think pass for one.
Ok. Sorry for the brevity, but to summarise ( yes with an 's' at the end - where i notice spellcheck will only settle for a z. silly yanks, you must learn to spell properly :0 )... i am variously: shocked at the cost of your effexor, which is entirely proposturous, appalled that someone with an affliction which fulfills so totally the criteria for 'terrible' and 'death' should have to suffer further at the hands of such a corrupt and indifferent healthcare system, impressed at your writing; its balance and coherence (which can only reflect a working mind, which is good), hopeful that change will happen for you, for america, for everyone.
Get you doc to keep those free pill samples coming. I don't care what they are, just as long as you don't let your brain go through the awful all round cell-death and hippocampus shrinking that depression brings about. 3 months ago i wouldn't have been able to string a sentence together whereas you just wrote 8 or 9 paragraphs all of which sounded like good sense to me. Keep it up.
West
Posted by West on March 1, 2009, at 14:37:19
In reply to Re: Doctors in England-detroitpistons » West, posted by detroitpistons on March 1, 2009, at 13:11:49
'If you don't have drug coverage, one month's worth of Effexor XR is going to cost you about $900.00 (probably depends on dosage - that's for 90 x 225mg)!'
So isn't that 30 pills a $300 a month assuming you're taking the 225mg dose?
Posted by detroitpistons on March 1, 2009, at 15:18:31
In reply to Re: Doctors in England-detroitpistons, posted by West on March 1, 2009, at 14:37:19
Oops...I have my occasional moments of clarity (thanks in part to adderall), only to be followed up with things like this...I meant to say 270 x 75 mg for a total of 225 mg/ day x 90 days. Therefore, the $900 that I cited was actually for a 3 month prescription, and you are correct. It comes out to $300/ month. I also take Lamictal, which is less costly. It was $412 for a 3 month prescription, but when it went generic, it went down to $220 for a 3 month prescription. That's with the bulk mail order service. If you were to buy 1 month at a time from a pharmacy, it would be considerably more.
I know some other drugs are even more costly. I know one depressed person who was prescribed Abilify as add-on therapy because he is extremely treatment resistent. I believe Abilify is at least double the cost of Effexor XR.
> 'If you don't have drug coverage, one month's worth of Effexor XR is going to cost you about $900.00 (probably depends on dosage - that's for 90 x 225mg)!'
>
> So isn't that 30 pills a $300 a month assuming you're taking the 225mg dose?
>
>
Posted by detroitpistons on March 1, 2009, at 15:48:03
In reply to Re: Doctors in England-detroitpistons, posted by West on March 1, 2009, at 14:33:00
The good news is that Obama is planning to downsize the size and cost of the military to something like 3% of GDP. Of course, there are some here who see this as a bad thing. The philosophical and ideological rifts have become unbearable here, at least for me.
The size of this country is definitely a challenge to the healthcare situation. Hopefully, we can come up with some sort of solution. I just think that, perhaps, we have our priorities screwed up in this country. Let me rephrase that...I KNOW that we have our priorities screwed up in this country.
Money rules everything here. If you have money, you have power. If you are a large institution (for example, the military-industrial complex) and you have a lot of money, you do everything you can to safeguard your interests, and you don't think about who's affected. "We have to think about the shareholders!" Lobby, lobby, lobby, and then lobby again. We have the drug and healthcare lobby, the energy lobby, the tobacco lobby, the fill-in-the-blank lobby....you get the idea. Money buys influence here much too easily. It's sick and depraved.
While our extremist, warp speed, capitalistic style may create innovation, efficiency, and wealth (for some), it comes at the expense of other important things, like, ummm, sanity. Most Americans get around 2 weeks of vacation per year. That's just insane. The pace of life is sickening. Stores are open 24 hours. We've been entrenched in this rampant consumerism for quite some time now, but I think that's beginning to change with the recent economic downturn. People aren't as concerned with material things anymore. Hopefully, it will stay that way. There's no point in maintaining a "high standard of living" if you throw everything else away in the process.
Ultimately, I think it all boils down to morality and ethics. Fortunately, we still have a few good people here, but the "masses" are too busy going to work to notice that they are being fleeced...
I don't normally write this much, but these are subjects that deserve all the time in the world, as far as I'm concerned...Thanks for the compliment regarding my writing. Sometimes I surprise myself. Adderall has really helped me in that regard.
>
>
> A nation that has at its bedrock the acquisition of private wealth through trade might be hypothesized to lead inevitably to the status quo you describe. It's true no conservative here would be in favour of abolishing national healthcare, on the contrary, tory and labour governments have consistenly built establishments for the express puropose of caring for the poor and needy. The victorians were a civilised lot and when not building bridges, civic buildings and half of britain they pondered morality extensively
>
> The problem it seems is in size. Organising something like the nhs from a centralised government on the scale of nation like the US is simply too great a prospect for anybody, however good their intent.
>
> Perhaps creating separate interstate healthcare organizations with central funding brought about by a mandatory tax, might be thought a realistic option. Since most gnvt revenue in the US goes to the military and safeguarding its global superiority i doubt if there'd be much left for muggins and his unshakable melancholy.
>
> Another idea might be to include lowering the mandatory requirements for healthcare or recognizing specific 'hotspots' where an individual is especially vulnerable: a depressed or otherise mentally ill individual who cannot earn a living and who cannot gain an already undesirable insurance plan because of his own undesirability in the eyes of the insurer would i think pass for one.
>
> Ok. Sorry for the brevity, but to summarise ( yes with an 's' at the end - where i notice spellcheck will only settle for a z. silly yanks, you must learn to spell properly :0 )... i am variously: shocked at the cost of your effexor, which is entirely proposturous, appalled that someone with an affliction which fulfills so totally the criteria for 'terrible' and 'death' should have to suffer further at the hands of such a corrupt and indifferent healthcare system, impressed at your writing; its balance and coherence (which can only reflect a working mind, which is good), hopeful that change will happen for you, for america, for everyone.
>
> Get you doc to keep those free pill samples coming. I don't care what they are, just as long as you don't let your brain go through the awful all round cell-death and hippocampus shrinking that depression brings about. 3 months ago i wouldn't have been able to string a sentence together whereas you just wrote 8 or 9 paragraphs all of which sounded like good sense to me. Keep it up.
>
>
> West
>
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.