![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Dinah on October 28, 2012, at 10:17:10
Judging from my experience with it, it should only be prescribed with the greatest of caution, to people who don't have a predisposition to anxiety and agitation.
I still think the pdoc from h*ll was grossly negligent in not only prescribing those things, but in assuming my poor response merely meant I wasn't taking enough of them. I do think my brain was damaged from his increasing doses. I finally put my foot down when he wanted to exceed the maximum.
My next pdoc, the best one I've ever had - as low a bar as that is, saw on our first appointment that a mood stabilizer was essential. And was not at all reluctant to drop anything to do with NE, and SSRI's as well. My current pdoc, as much as he scares me personally, has told me that he would never even consider putting me back on SSRI's, never mind Wellbutrin, Effexor, nortriptyline, etc.
Posted by Phillipa on October 28, 2012, at 12:36:39
In reply to Doctors are too free with norepinephrine, posted by Dinah on October 28, 2012, at 10:17:10
Is that pamelor? As took it once it put me to sleep til mid afternoon. Didn't take it again. But I feel safer with SSRI's and didn't do bad on cymbalta. I don't know we are all different I guess. Phillipa
Posted by Dinah on October 28, 2012, at 12:44:15
In reply to Re: Doctors are too free with norepinephrine » Dinah, posted by Phillipa on October 28, 2012, at 12:36:39
Which is my point, really. I know some people find it helpful. But I think doctors tend to prescribe by rote. First try this, then that. And don't consider the potential harm of what they prescribe.
It's not limited to mental health.
There needs to be more subtypes in channels of treatment, and more thinking by pdocs.
Posted by phidippus on October 28, 2012, at 22:30:25
In reply to Doctors are too free with norepinephrine, posted by Dinah on October 28, 2012, at 10:17:10
What's your DX?
Eric
Posted by Dinah on October 29, 2012, at 8:21:27
In reply to Re: Doctors are too free with norepinephrine » Dinah, posted by phidippus on October 28, 2012, at 22:30:25
At the moment, I believe it's OCD. Although most of the anxiety diagnoses would be a good fit.
At the time of the increasing doses of medications, it was postpartum depression.
Personally, I see it as having the nervous system of an overly inbred cocker spaniel and am waiting for the appropriate DSM diagnosis. I have a whole theory on it, which I can't quite remember at present. Something about HPA axis and a cluster of physical and emotional ailments that used to fit under the umbrella of "neurotic". Far better than it fits the hodgepodge of current day diagnoses that don't cover the entire problem.
Posted by jono_in_adelaide on October 29, 2012, at 8:44:01
In reply to Re: Doctors are too free with norepinephrine » phidippus, posted by Dinah on October 29, 2012, at 8:21:27
Some people need an SSRI, some people need an NARI, some people need both together, some people need a different drug, others need counseling, not drugs - noradrenalin reuptake inhibitors arnt any "worse' than any other type of antidepressant drug, or any better, they are all different and all have their uses
Posted by Dinah on October 29, 2012, at 8:52:14
In reply to Re: Doctors are too free with norepinephrine, posted by jono_in_adelaide on October 29, 2012, at 8:44:01
Perhaps I'm just more familiar with the negative consequences of the one. It's one thing to try a drug that doesn't work. It's another altogether to prescribe something that can cause harm. On Wellbutrin, I was as close to suicide as I've ever been before realizing it was because of the agitation that I didn't feel before starting it.
I'm not saying they shouldn't prescribe it. I'm saying they should prescribe it with extreme caution, and an understanding of the sort of illnesses it may exacerbate. They should be on the lookout for signs of a bad reaction.
They shouldn't hand it out as if it were aspirin, and suggest seeing you in six weeks.
Posted by Dinah on October 29, 2012, at 8:57:00
In reply to Re: Doctors are too free with norepinephrine » phidippus, posted by Dinah on October 29, 2012, at 8:21:27
Oh good. I found it, thank google.
If I ever find a pdoc I'm not afraid of, it would be interesting to get their feedback. I wouldn't dream of mentioning it to my current pdoc. Rightly or wrongly, he intimidates me. Still, he's so very much more sensible than the one who did so much damage.
Posted by Beckett on October 29, 2012, at 13:28:11
In reply to Re: Doctors are too free with norepinephrine, posted by Dinah on October 29, 2012, at 8:57:00
Wow Dinah, I remember that discussion very well. It was very helpful to me, and I remember your cocker spaniel analogy :) Since then I have come to cobble a treatment plan, too. It can take time and observation to find one's proper treatment. I think of the years I spent being treated by medication, in my case SSRI's and SNRI's, that in hindsight worsened my condition or created extra symptoms that distracted from the primary symptoms I originally sought to treat.
I also remember the pdoc prior to my current one. If I didn't
respond to 50 Pristiq, there was the dreaded jump to 100 until I wound up in his office wringing my hands, begging for the trial to be aborted. The same with Cymbalta. Strattera was a nightmare. After that I put my foot down. But you might have thought that doctor might have used his own powers of observation....
Posted by phidippus on October 29, 2012, at 14:30:36
In reply to Re: Doctors are too free with norepinephrine » phidippus, posted by Dinah on October 29, 2012, at 8:21:27
OCD would mean a broader array of symptoms and certainly more anxiety symptoms, including generalized anxiety and panic symptoms.
OCD and postpartum depression often go hand in hand.
Do you experience intrusive and recurrent thoughts?
Eric
Posted by Dinah on October 29, 2012, at 19:35:12
In reply to Re: Doctors are too free with norepinephrine » Dinah, posted by Beckett on October 29, 2012, at 13:28:11
That's exactly the sort of doctors I was objecting to.
It's good to see you again. :)
What are you cobbling together?
Posted by Dinah on October 29, 2012, at 19:41:37
In reply to Re: Doctors are too free with norepinephrine » Dinah, posted by phidippus on October 29, 2012, at 14:30:36
Oh yes. My OCD is pretty standard, without many compulsions. Sometimes I do try to be careful when I do something to sort of anchor it in time so that I don't need to check and double check. I might check to see what I'm wearing when I lock the door so that I remember I locked the door today rather than some locking moment from the past. But as compulsions go, it isn't bad.
When I'm under stress, it acts up. I'll wonder how I can be sure I didn't run over someone, or make some outrageous error at work. There may be a wee bit of scrupulosity. It's harder to get things done at those times because finishing work is very anxiety provoking.
But it's pretty well in hand, and those times it does flare up, I try to keep a sense of humor.
I am definitely diagnosed with it, but I don't really consider it the root of my difficulties. I sometimes even wonder if my brain tries to distract me from my real concerns by focusing on something too foolish to be possible. I think the underlying problem is my very poor reaction to stress.
Posted by phidippus on October 30, 2012, at 10:51:49
In reply to Re: Doctors are too free with norepinephrine » phidippus, posted by Dinah on October 29, 2012, at 19:41:37
>Oh yes. My OCD is pretty standard
There are a wide variety of OCD symptoms. Most involve repetitive behavior or thinking of some sort. I get 'bad thoughts' that pester me, sometimes until I'm driven mad.
>I'll wonder how I can be sure I didn't run over someone, or make some outrageous error at work.
Your compulsion is checking.
>I don't really consider it the root of my difficulties.
What do you consider to be the root of your difficulties.
The American Psychiatric Association recommends ERP as the first line of treatment for OCD. Do you have a therapist you work with regularly who specializes in OCD and practices ERP?
Eric
Posted by phidippus on October 30, 2012, at 10:54:36
In reply to Re: Doctors are too free with norepinephrine » phidippus, posted by Dinah on October 29, 2012, at 19:41:37
>Oh yes. My OCD is pretty standard
There are a wide variety of OCD symptoms. Most involve repetitive behavior or thinking of some sort. I get 'bad thoughts' that pester me, sometimes until I'm driven mad.
>I'll wonder how I can be sure I didn't run over someone, or make some outrageous error at work.
Your compulsion is checking.
>I don't really consider it the root of my difficulties.
What do you consider to be the root of your difficulties.
The American Psychiatric Association recommends ERP as the first line of treatment for OCD. Do you have a therapist you work with regularly who specializes in OCD and practices ERP?
Eric
Posted by Beckett on October 30, 2012, at 13:24:14
In reply to Re: Doctors are too free with norepinephrine » Beckett, posted by Dinah on October 29, 2012, at 19:35:12
So far, I seem to be responding well to just topamax and buspar. There are the medications I take for sleep, trying to move me from temazepam which is an imperfect solution. Last might was my first night of rozarem. I feel down this morning and am wondering if depression will be a side effect for me which will make it a no-go.
Letting go of the idea that I had to have a classic AD on board after ten years of AD's and being dx'd primarily MDD was a revelation.
I respond poorly to stress and that seems to be the critical factor for me. I can see this more clearly now that the right dose of topamax has provided a mood anchor. I find that Topamax also alleviates anxiety.
Good to see you, too :)
Posted by phidippus on October 30, 2012, at 13:44:06
In reply to Re: Doctors are too free with norepinephrine » Dinah, posted by Beckett on October 30, 2012, at 13:24:14
>Last might was my first night of rozarem. I feel down this morning
Depression is not one of the side effects of Rozerem. Rozerem is simply a melatonin synthesist. Its almost just like taking melatonin.
Eric
Posted by Beckett on October 30, 2012, at 13:56:31
In reply to Re: Doctors are too free with norepinephrine, posted by phidippus on October 30, 2012, at 13:44:06
> >Last might was my first night of rozarem. I feel down this morning
>
> Depression is not one of the side effects of Rozerem. Rozerem is simply a melatonin synthesist. Its almost just like taking melatonin.
>
> EricWould you think it's like a hangover? I definitely feel different
in a negative way today. (I did not sleep well either, but I have not slept well on neurontin and not felt so lousy. ) My pdoc advised it may take a week or two to kick in...
Posted by phidippus on October 30, 2012, at 14:40:46
In reply to Re: Doctors are too free with norepinephrine » phidippus, posted by Beckett on October 30, 2012, at 13:56:31
How much did you take?
Eric
Posted by Beckett on October 30, 2012, at 16:36:58
In reply to Re: Doctors are too free with norepinephrine » Beckett, posted by phidippus on October 30, 2012, at 14:40:46
Just the lower dosage one. 8mg? Plus 300mg gabapentin.
I'm not giving up yet. I'm hoping the trend is not to wake up feeling fragile and negative.
Posted by phidippus on October 30, 2012, at 17:04:16
In reply to Re: Doctors are too free with norepinephrine » phidippus, posted by Beckett on October 30, 2012, at 16:36:58
I go to sleep on Seroquel and Lunesta-my mind doesn't know when to give up. I always wake up frazzled and unpleasant. I'm no good until I take my Vyvanse.
8mg is the low dose of Rozerem. Try to sleep with just the Rozerem.
Eric
Posted by brynb on November 4, 2012, at 0:54:57
In reply to Re: Doctors are too free with norepinephrine » Dinah, posted by Beckett on October 30, 2012, at 13:24:14
> So far, I seem to be responding well to just topamax and buspar. There are the medications I take for sleep, trying to move me from temazepam which is an imperfect solution. Last might was my first night of rozarem. I feel down this morning and am wondering if depression will be a side effect for me which will make it a no-go.
>
> Letting go of the idea that I had to have a classic AD on board after ten years of AD's and being dx'd primarily MDD was a revelation.
>
> I respond poorly to stress and that seems to be the critical factor for me. I can see this more clearly now that the right dose of topamax has provided a mood anchor. I find that Topamax also alleviates anxiety.
>
Hi Beckett,I totally relate. I didn't respond well to Rozarem either. It made me feel weird and also kind of depressed.
I'm all over the place in terms of how to treat my depression and anxiety right now. It's not clear whether I have MDD or Bipolar, but my pdoc now wants to lower my Lexapro. It's so interesting that you found a good combo with Topamax and Buspar. I tried both (while on Lexapro) and they worsened my anxiety.
I also respond TERRIBLY to stress. Good to hear that a different approach to MDD is working for you.
-b
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.