![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by joe f on March 3, 2014, at 6:11:00
when is is time to get a second opinion not so much on a diagnosis but on a medicine regimine
Posted by Christ_empowered on March 3, 2014, at 12:59:18
In reply to 2nd opinion, posted by joe f on March 3, 2014, at 6:11:00
I dunno...maybe if you're not making progress and you have the time and resources. I think its really a personal decision.
Posted by Tomatheus on March 3, 2014, at 14:19:24
In reply to 2nd opinion, posted by joe f on March 3, 2014, at 6:11:00
Joe,
I agree with what Christ_empowered said. I think that seeking a second opinion is indeed a personal decision, and I think that I would seek a second opinion on a medication regime only after I've thoroughly questioned my current doctor about what his rationales are for his prescribing decisions. I might also seek a second opinion if the rationales behind my doctor's prescribing decisions don't seem to line up with what other experts have to say. But again, I'd only seek a second opinion after having a good discussion with my doctor about why he prescribed what he prescribed and after gaining a full understanding of my doctor's rationales.
Having said what I've said, others may do things differently, and there may also be other reasons for seeking a second opinion regarding treatment decisions.
Tomatheus
Posted by phidippus on March 3, 2014, at 15:02:27
In reply to 2nd opinion, posted by joe f on March 3, 2014, at 6:11:00
If you're still not feeling well despite the medications you are currently on.
What is your diagnosis?
Eric
Posted by Phillipa on March 3, 2014, at 16:06:04
In reply to Re: 2nd opinion » joe f, posted by phidippus on March 3, 2014, at 15:02:27
Joe agree with all of above Phillipa
Posted by joe f on March 3, 2014, at 20:04:17
In reply to Re: 2nd opinion » joe f, posted by phidippus on March 3, 2014, at 15:02:27
diagnosis ocd -bipolar ....feel that benzos are doing 75% of the work (2.5 klonopin) and question what good the other meds are doing
Posted by LouisianaSportsman on March 3, 2014, at 20:15:15
In reply to Re: 2nd opinion, posted by joe f on March 3, 2014, at 20:04:17
> diagnosis ocd -bipolar ....feel that benzos are doing 75% of the work (2.5 klonopin) and question what good the other meds are doing
What other meds are you taking? That's a low dose of clonazepam, btw; seems like the other meds are pulling more weight than you think?
Posted by phidippus on March 4, 2014, at 1:47:54
In reply to Re: 2nd opinion, posted by joe f on March 3, 2014, at 20:04:17
You can trust me, benzos are not doing 75% of the work. What are you on?
Eric
Posted by joe f on March 4, 2014, at 5:52:18
In reply to Re: 2nd opinion » joe f, posted by phidippus on March 4, 2014, at 1:47:54
i'm also on Cymbalta 30 mg, tegretol 600 and lamictal 100
Posted by phidippus on March 4, 2014, at 19:19:48
In reply to Re: 2nd opinion, posted by joe f on March 4, 2014, at 5:52:18
You're taking a good dose of Tegretol, but I'm not quite sure why you're only taking 100 mg of Lamictal-you should be taking between 200-400 mgs. Tegretol and Lamictal are your 'main' medications and do the heavy lifting of keeping your mood stabilized.
The Cymbalta is in the mix to help treat depression and anxiety symptoms.
The benzos you are taking treat whatever anxiety you may be having.
Why do you feel the benzos are doing all the work?
Eric
Posted by joe f on March 4, 2014, at 19:57:19
In reply to Re: 2nd opinion » joe f, posted by phidippus on March 4, 2014, at 19:19:48
because after dosing a benzo I feel calmer and more focused.....shoud not the other meds be helping with anxiety at all?
Posted by phidippus on March 4, 2014, at 20:39:26
In reply to Re: 2nd opinion, posted by joe f on March 4, 2014, at 19:57:19
Tegretol and Lamictal don't really help with anxiety. They help by stabilizing your mood so you don't have severe mood swings.
Cymbalta could help with your anxiety if it were at a higher dose-60-120mg.
How do you feel after taking all your meds?
Eric
Posted by LouisianaSportsman on March 4, 2014, at 22:11:38
In reply to Re: 2nd opinion » joe f, posted by phidippus on March 4, 2014, at 20:39:26
Eric, once again you're completely on target here with your advice to Joe.
Although, I will disagree with you on one thing again, Eric.
I believe it might precipitate that clonazepam is indeed doing "75% of the work" in terms of alleviating main-line anxiety symptoms when you consider Joe's overall therapy; remember, his evaluation is more potent than ours.
Joe, like Eric pointed out in his post, carbamazepine and lamotrigine don't directly target the anxiety that is plaguing you right now; instead, they help indirectly by mood stabilization.
Like Eric pointed out, the only real potential you have on board for anxiety is duloxetine perhaps you should consult with your doctor about titrating to a higher dose? 60mg. is proven to be more efficacious in alleviating anxiety symptoms.
Is there a reason that you're currently on sub-therapeutic dosages of both lamotrigine (200mg. + is suggested) and duloxetine?
Best of luck with your treatment, Joe! Please stick around.
Posted by joe f on March 5, 2014, at 6:13:01
In reply to Re: 2nd opinion, posted by LouisianaSportsman on March 4, 2014, at 22:11:38
thank you for your concern...well I suggested I drop the Cymbalta from 60 to 30 thought I was getting to manic ...maybe a mistake..lamictal seems to mess with my memory....and I am paranoid that 2.5 of klonopin is to high.....I read to many benzo addiction sites....please respond
Posted by Phillipa on March 5, 2014, at 18:13:21
In reply to Re: 2nd opinion, posted by joe f on March 5, 2014, at 6:13:01
Don't read the sites after 40 some odd years on benzos and taking lower doses now. Phillipa
Posted by joe f on March 6, 2014, at 5:56:07
In reply to Re: 2nd opinion » joe f, posted by Phillipa on March 5, 2014, at 18:13:21
phillipa would you be nervous about 2.5 klonopin..1.5 is for sleep
Posted by Phillipa on March 6, 2014, at 9:21:46
In reply to Re: 2nd opinion, posted by joe f on March 6, 2014, at 5:56:07
Joe nervous about addiction? No if your doc feels this is working for you and you do as well continue taking it. And did you write you have bipolar? If so this is not a high dose of a med. And you don't take antipsychotics right? Phipplipa
Posted by joe f on March 6, 2014, at 11:33:54
In reply to Re: 2nd opinion » joe f, posted by Phillipa on March 6, 2014, at 9:21:46
yes bipolar and will not prescribe antipsychotics because of diabetes
Posted by phidippus on March 6, 2014, at 13:29:57
In reply to Re: 2nd opinion, posted by joe f on March 6, 2014, at 11:33:54
You may not need antipsychotics. Also, older typical antipsychotics don't carry the same blood sugar risks, so you may be able to take those-again only if you really need it.
If you're having a lot of difficulty with anxiety, I would increase the Cymbalta and got 100 more mgs on the Lamictal.
Eric
Posted by phidippus on March 6, 2014, at 13:47:33
In reply to Re: 2nd opinion, posted by joe f on March 5, 2014, at 6:13:01
Its better to increase your mood stabilizers or antipsychotics than to lower your antidepressant.
As I treat my OCD, I have to take high dosages of antidepressants, which does trigger mania, but I'm able to control the mania with antipsychotics.
You want to use the Cymbalta tocontrol depression and anxietyand that may require a high dose which may trigger mania-but you can get that mania under easy control with an antipsychotic. Not all antipsychotics have the same blood sugar risks.
Eric
Posted by Phillipa on March 6, 2014, at 18:50:06
In reply to Re: 2nd opinion, posted by joe f on March 6, 2014, at 11:33:54
Joe you have a winner. Just continue onward. Same med same dose!!! Phillipa
Posted by joe f on March 7, 2014, at 7:54:58
In reply to Re: 2nd opinion » joe f, posted by Phillipa on March 6, 2014, at 18:50:06
thanks a lot phillipa...maybe overanalyzing
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.