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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 Meatwood_Flack on July 27, 2012, at 20:51:36
I had an appointment with my pdoc (actually a pnurse) today to discuss progress or problems related to my depression (likely melancholic). We started a trial of Zoloft a few months ago that didn't take, then started a trial of Effexor that lasted 5 weeks and ended at 100 mg per day when I was taken off that and put on Cymbalta 60 mg and Abilify 5 mg in hospital. A week later Cymbalta was bumped to 120 mg and Wellbutrin 150 mg, Lamictal 25 mg and BuSpar were added. I've been on this combination a little over three weeks. Today, my pnurse tells me, "I don't know what else I can do for you." She said she discussed the case with a psychiatrist who recommended psychotherapy. I had previously also tried Doxepin for about a week for sleep and Quietapine for sleep but was put on a different drug as the Doxepin wasn't working and the Quietapine was giving me hypnic jerks and worked too well for sleep. When I asked about maybe giving a tricyclic a try, she told me Trazodone was a TCA (I had previously been on Traz for sleep), which made me a little leery. She also said they prescribe TCAs for night time use because they are often sedating. She left my meds the same and set me an appointment for 8 weeks from today, but I'm wondering if I might not be better off finding a second opinion? She also said in her opinion, since the meds hadn't worked, the depression probably isn't biological.
Posted by Tomatheus on July 27, 2012, at 22:26:12
In reply to Time For New PDoc?, posted by Meatwood_Flack on July 27, 2012, at 20:51:36
Meatwood_Flack,
If I were in your position, I think that I would be seeking a second opinion on your treatment right about now. If my psychiatrist or pnurse were to refer to trazodone as a tricyclic antidepressant, I too would be leery, and it would lead me to question whether or not my treatment provider is knowledgeable enough about psychopharmacology to make sound treatment decisions. I would also feel put off if my psychiatrist or pnurse were to say that my depressive symptoms probably aren't biological just because they haven't been responsive to prescribed medications. I do think that the extent to which depression is likely to be biological probably varies from one depressed individual to the next and that psychological and social factors oftentimes play a key role in the development of depressive disorders, but even if some of the medications used to treat depression do correct "chemical imbalances" in some individuals, I think it's hardly the case that the medications correct every biochemical abnormality that can contribute to depression. Sure, there are some things that are known about the biology of depression -- and what is known seems to indicate that there are other things going on in the brains and bodies of depressed individuals besides "imbalances" of serotonin, dopamine, and norepinephrine -- but with there being so much that isn't known about the biology of depression, it amazes me that someone can suggest that one's depression probably isn't biological simply because it doesn't respond to today's medications. Having said what I've said, I do think that psychotherapy might be worth trying if you haven't already tried it. Generally speaking, a combination of medications and psychotherapy works better than either treatment strategy works by itself, and I think that the more treatment approaches you utilize, the greater your odds will be of beating your depression. But I also think that a person's odds of being successfully treated for depression probably depend on the knowledge and expertise of the treatment practitioners, and it sounds based on what you've written that knowledge and expertise may be things that your pnurse is lacking in.
Tomatheus
Posted by Phillipa on July 27, 2012, at 23:09:46
In reply to Re: Time For New PDoc?, posted by Tomatheus on July 27, 2012, at 22:26:12
I agree. Also why were you taken off effexor at l00mg as that isn't high at all. How many meds have you been on? I must read your original thread to comment further. Phillipa
Posted by Phillipa on July 27, 2012, at 23:14:19
In reply to Time For New PDoc?, posted by Meatwood_Flack on July 27, 2012, at 20:51:36
Why the switch to cymbalta from the effexor? Effexor and wellbutrin as with some very complimentary meds. Why the lamictal and is the plan to raise the dose? I'd definitely get the second opinion also. A Nurse can in the USA be a Nurse Practitioner Or a Certified Psychiatic Nurse. But a pdoc signs off on all treatments and diagnosis. What country are you in? Phillipa
Posted by SLS on July 28, 2012, at 0:56:03
In reply to Time For New PDoc?, posted by Meatwood_Flack on July 27, 2012, at 20:51:36
I agree with Tomatheus.
- Scott
Posted by Emily Elizabeth on July 28, 2012, at 8:10:17
In reply to Re: Time For New PDoc? » Meatwood_Flack, posted by SLS on July 28, 2012, at 0:56:03
> I agree with Tomatheus.
>
>
> - ScottI agree with Tomatheus and Scott. :)
Many people struggle for years to find the right combo and she is ready to throw in the towel already?! Not only does she seem to be iffy on medical info, she seems so dismissive. Find someone better.
Best,
EE
Posted by papillon2 on July 28, 2012, at 11:55:43
In reply to Re: Time For New PDoc?, posted by Emily Elizabeth on July 28, 2012, at 8:10:17
> > I agree with Tomatheus.
> >
> >
> > - Scott
>
> I agree with Tomatheus and Scott. :)
>
> Many people struggle for years to find the right combo and she is ready to throw in the towel already?! Not only does she seem to be iffy on medical info, she seems so dismissive. Find someone better.
>
> Best,
> EEMake that four!
Posted by 10derheart on July 28, 2012, at 16:00:38
In reply to Re: Time For New PDoc?, posted by Emily Elizabeth on July 28, 2012, at 8:10:17
>>I agree with Tomatheus and Scott. :)
Me, too. Wholeheartedly.
Posted by Meatwood_Flack on July 28, 2012, at 18:07:50
In reply to Re: Time For New PDoc?, posted by Phillipa on July 27, 2012, at 23:09:46
I did a trial of Zoloft and was in the midst of a trial of Effexor when switched to Cymbalta. I think all the depressives in that hospital started on eiter Celexa or Cymbalta. I am also on abilify, Wellbutrin, Lamictal and BuSpar. The only two other meds were, at one time, Doxepin and Quietapine for sleep.
Posted by Meatwood_Flack on July 28, 2012, at 20:47:27
In reply to Re: Time For New PDoc? » Phillipa, posted by Meatwood_Flack on July 28, 2012, at 18:07:50
Thanks everyone for your thoughts and opinions. I agree it's probably time for a second opinion.
Posted by phidippus on July 31, 2012, at 20:48:47
In reply to Time For New PDoc?, posted by Meatwood_Flack on July 27, 2012, at 20:51:36
Trazadone is not a TCA, its actually in its own little family.
As far as trying a TCA, Clomipramine would be my recommendation.
BTW, Doxepin is a TCA as well.
Tell me what you're trying to treat.
Eric
Posted by Meatwood_Flack on August 1, 2012, at 15:47:05
In reply to Re: Time For New PDoc? » Meatwood_Flack, posted by phidippus on July 31, 2012, at 20:48:47
Trying to treat a stubborn case of major depression with melancholic features.
Posted by phidippus on August 2, 2012, at 8:15:21
In reply to Re: Time For New PDoc? » phidippus, posted by Meatwood_Flack on August 1, 2012, at 15:47:05
What have you tried?
Eric
Posted by Meatwood_Flack on August 3, 2012, at 16:36:22
In reply to Re: Time For New PDoc? » Meatwood_Flack, posted by phidippus on August 2, 2012, at 8:15:21
I did a trial of Zoloft with no luck. Was five weeks into a trial of Effexor (at 100 mg.) when I was switched to Cymbalta and Abilify, with Lamictal, Wellbutrin and BuSpar added the following week. Now at the end of week four of Cymbalta at 120 mg.
Posted by phidippus on August 3, 2012, at 22:28:52
In reply to Re: Time For New PDoc? » phidippus, posted by Meatwood_Flack on August 3, 2012, at 16:36:22
Cymbalta and Abilify, with Lamictal, Wellbutrin and BuSpar
If you're bipolar, your regimen makes sense to me. If you're treating depression, I'm totally at a loss. Do you know how well you would do on just Abilify and Cymbalta?
Abilify pretty much does the job Buspar does. I don't see any point in taking both medications. Drop the Buspar.
Eric
Posted by Meatwood_Flack on August 6, 2012, at 16:26:48
In reply to Re: Time For New PDoc? » Meatwood_Flack, posted by phidippus on August 3, 2012, at 22:28:52
Not bi-polar, being treated for unipolar depression. Not sure how I would do on just Cymbalta and Abilify. Been at the max dose of Cymbalta for a month with no improvement that I've been able to notice. I also think one of the medications is giving me drowsiness through the day, but not sure which one since I'm on so many at the moment.
Posted by phidippus on August 6, 2012, at 19:14:19
In reply to Re: Time For New PDoc? » phidippus, posted by Meatwood_Flack on August 6, 2012, at 16:26:48
You need to cut back on your meds and find an antidepressant that works for you. Then add the other meds.
eric
Posted by Meatwood_Flack on August 6, 2012, at 20:38:17
In reply to Re: Time For New PDoc? » Meatwood_Flack, posted by phidippus on August 6, 2012, at 19:14:19
I agree.
This is the end of the thread.
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