![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by g_g_g_unit on July 15, 2009, at 0:53:24
i am (skeptically) meeting with a new pdoc who a GP recommended as being a specialist on anxiety and OCD (i have not been officially 'referred', so she knows nothing of my case history, etc.)
now, i have some questions about how i should conduct myself.
at the moment, my worst symptom is anhedonia, which impinges on every aspect of my life - social, work, etc. there are times when i feel teary and suicidal (basically anytime i am left with the freedom to reflect on how i got to where i am now), but more often than not, i just feel flat, numb, stoo-pid - no attention span, bad working memory, etc.
now it seems that as soon as i tell somehow i have OCD, that they filter every complaint through the prism of my neurosis - ignoring the fact that my situation now is clearly not what it was pre-SSRI's.
what i am looking at trying is possibly something like Mirapex or Requip, but every doc i meet wants to try and assist my "treatment resistant" OCD with an antipsychotic, which i refuse to be on, since i don't really think what i'm dealing with now is an outgrowth of OCD.
so would it be some kind of breach to omit the fact that i have OCD, and just present my symptoms as they currently affect my life? for what it's worth, i've never officially been diagnosed with OCD. it's always just something i've assumed i had .. one guy once contested it thinking i had GAD instead. as my therapist understands it, i'm a perfectionist; is that a classification in its own right? i see a lot of similar traits in my friend with ADHD. i'm not really after an armchair diagnosis here .. just wondering if 'perfectionism' can overlap with ADHD AND OCD, or if it's more often a product of one or the other ..?
Posted by floatingbridge on July 15, 2009, at 2:28:29
In reply to meeting new pdoc - some advice please, posted by g_g_g_unit on July 15, 2009, at 0:53:24
Hi, I don't think it'd be a breech at all, esp. if you haven't been officially diagnosed. See what it's like not to be seen through that filter. Good luck to you. Hope you get what you want.
fb
Posted by bleauberry on July 15, 2009, at 5:16:22
In reply to meeting new pdoc - some advice please, posted by g_g_g_unit on July 15, 2009, at 0:53:24
What you want is nortriptyline. Insist on the brand Pamelor to start with. 10mg to start and work up higher every week or so.
At askapatient.com you can check it out. Nortriptyline is excellent for anxiety, panic, OCD, depression, pain, and sleep. It has side effects like other meds, but different sides than otheer meds. As you roam through the comments of other people who have used it, you will see the ones with negative experiences are greatly outnumbered by the ones with positive experiences. If you then type in the search box names of other meds you or your doctor might consider, you will see the opposite...negative experiences outnumber the good ones.
Even in the 50 years or so that the TCAs and MAOIs were invented, I do not see evidence that any of the newer meds have been able to top their reliability.
Anxiety, OCD, anhedonia, post-ssri syndrome suspected...if all of those are true, look no further than nortriptyline. You don't need anything exotic, just something that really works.
Posted by HyperFocus on July 15, 2009, at 7:08:47
In reply to meeting new pdoc - some advice please, posted by g_g_g_unit on July 15, 2009, at 0:53:24
I think you should do a full disclosure and tell your new doc all your symptoms and maybe mention your concerns about being pigeonholed . I don't think it's a good idea to hold back on anything. Your pdoc might have unique experiences and insight into treatment of somebody in your situation. It's hard to characterize one symptom as the result of one specific thing - our brains and mind are much more complex than that.
Also remember that atypical APs are very often used to augment treatment of depression and anxiety - it's not just for psychosis.
Posted by g_g_g_unit on July 15, 2009, at 7:11:28
In reply to Re: meeting new pdoc - some advice please, posted by bleauberry on July 15, 2009, at 5:16:22
> What you want is nortriptyline. Insist on the brand Pamelor to start with. 10mg to start and work up higher every week or so.
>
> At askapatient.com you can check it out. Nortriptyline is excellent for anxiety, panic, OCD, depression, pain, and sleep. It has side effects like other meds, but different sides than otheer meds. As you roam through the comments of other people who have used it, you will see the ones with negative experiences are greatly outnumbered by the ones with positive experiences. If you then type in the search box names of other meds you or your doctor might consider, you will see the opposite...negative experiences outnumber the good ones.
>
> Even in the 50 years or so that the TCAs and MAOIs were invented, I do not see evidence that any of the newer meds have been able to top their reliability.
>
> Anxiety, OCD, anhedonia, post-ssri syndrome suspected...if all of those are true, look no further than nortriptyline. You don't need anything exotic, just something that really works.Thanks; i went on nortriptyline at a low dose for a couple weeks last year, but don't think i gave it a fair evaluation.
my doctor actually wants me to stay off all meds for a little while so we can evaluate what my real issues are, so i'm not sure what to do actually. i keep thinking this might be the time i gotta 'spend in the wilderness' while i readjust, since i've only been off meds a week (though i donno how much withdrawal Memantine would create; otherwise last thing was Nardil in may). anyway, it sounds nice in theory, but it's a lot harder in practice ...
i know my parents are running out of patience with me (my mom seems to have this huge stigma about their not being anything 'physically' wrong with me). i just don't know who to rely on .. i kind of want to just throw in the towel and declare myself an invalid or something, but then i know that's just a fantasy .. that if i turned myself over to hospital, i'd probably receive worse treatment than the kind i'd receive in private consulation. i haven't disregarded your ideas about candida/yeast etc. - i've actually been e-mailing doctors to see who would be willing to attempt to make a diagnosis. but it's like i need meds to garner the will power to stay off meds ...
sigh .. apologies for being such a downer.
Posted by floatingbridge on July 15, 2009, at 10:23:16
In reply to Re: meeting new pdoc - some advice please, posted by g_g_g_unit on July 15, 2009, at 7:11:28
Hey ggg,
I'm afraid I was a bit glib in my first response to you. I've changed my mind. I like what hyperfocus had to say. Do you trust your pdoc (somewhat)? Hope you get what you need, and keep us posted. (You're not a downer! You're probably more tired of having to deal w/ this stuff yourself.)
fb
Posted by Phillipa on July 15, 2009, at 10:50:16
In reply to Re: meeting new pdoc - some advice please » g_g_g_unit, posted by floatingbridge on July 15, 2009, at 10:23:16
I'd tell the doc just what you told us here and how you're confused as to what you have and all your fears and seriously exactly what you wrote us. Seriously good luck!!!! Love Phillipa
Posted by Zana on July 15, 2009, at 14:07:12
In reply to Re: meeting new pdoc - some advice please, posted by bleauberry on July 15, 2009, at 5:16:22
I really like what Phillipa said. I think you should avoid diagnosing yourself and let the doc come to his own conclusions based on how and what you are feeling and then see if it fits with how you see yourself.
I can really empathize with your anxiety. It's always hard to go to new docs not knowingn what it' going to be like or if they are going to be able to help.
Good luck with it. And keep us posted.
Zana
Posted by bleauberry on July 15, 2009, at 16:39:30
In reply to meeting new pdoc - some advice please, posted by g_g_g_unit on July 15, 2009, at 0:53:24
I totally agree with everyone here, that full disclosure of all details and feelings needs to be shared with the doctor.
At the same time, you need to somehow spell out to him your expectations in guiding you forward.
For example, if you don't want an antipsychotic, tell him so, tell him why, but tell him you would consider it if he could fully explain his reasoning, and then if he says you should have a particular antipsychotic, ask him why, how many patients of his have gotten huge help from it, if he could show you the clinical studies supporting the decision, and what his personal reasoning is for the decision. You have the power and the right to interrogate, especially since you are the paying customer. During the process you will gleam some insight into what makes the doctor tick. You will get a sense whether he is truly using his best experience for your best benefit or whether he is just shooting from the hip with you as just another face in a long workday.
The above antipsychotic example is just an example. It could be any med in question.
I still like the idea of Nortriptyline and feel it would be a good idea to mention it at some point in your conversation to get a sense of his thoughts on it. If it goes that route, be sure it is brand Pamelor at the start and that you are thinking in terms of 12 weeks. You can always try a switch to a generic later.
No matter what route it goes, being fully open about your feelings, your fears, your med experiences, side effects, private thoughts you might not usually share, and such, is important.
Posted by Sigismund on July 15, 2009, at 19:47:53
In reply to meeting new pdoc - some advice please, posted by g_g_g_unit on July 15, 2009, at 0:53:24
>so would it be some kind of breach to omit the fact that i have OCD, and just present my symptoms as they currently affect my life? for what it's worth, i've never officially been diagnosed with OCD. it's always just something i've assumed i had .. one guy once contested it thinking i had GAD instead. as my therapist understands it, i'm a perfectionist; is that a classification in its own right? i see a lot of similar traits in my friend with ADHD. i'm not really after an armchair diagnosis here .. just wondering if 'perfectionism' can overlap with ADHD AND OCD, or if it's more often a product of one or the other ..?
There's no reason to mention the OCD. It hasn't existed forever. It's not real in the sense of stones or trees; it's a concept created in a particular time. Just present your symptoms.
Perfectionism doesn't have to have anything to do with OCD. Autistic and Aspergers people often have perfectionist traits, but that relates to the difficulty they have in interpreting the world, and that feels a little different to me.
Posted by friesandcoke on July 18, 2009, at 22:26:02
In reply to meeting new pdoc - some advice please, posted by g_g_g_unit on July 15, 2009, at 0:53:24
just talk about what you are presently experiencing. that is my two cents.
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.