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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 52. This is the beginning of the thread.
Posted by qbsbrown on April 6, 2006, at 20:05:20
I'm just confused as all heck. I was on 600mg trileptal, which had lifted my depression and stabilized my mood greatly, and 10mgs of diazapam that i was withdrawing from.
The anxiety got to be too much for me. Doc said had nothing to do w/ withdrawals, but GAD and OCD, as my previous doc had said (and i might agree).So doubled my diazepam to 20, and put me on 20 of paxil, took away the trileptal, and i feel like all hell. Depression is back, and derealization is full effect, and anxiety is worse, and having emotional breakdowns that i wasn't having on Trileptal, and was having before trileptal.
Why take away trileptal when it had lifted my depression? Why add an SSRI when i don't respond to them?
My goal is/was to get off of meds. But now she wants to add seroquel for sleep.
She is being strict with me because i told her that i'm bad at taking meds, stopping, starting, and switching all the time. So i get that. But now she refuses to budge or alter, especially if it comes from me, because she just sees it as obsessions.
I still do have logic and can make correlations that trileptal, depression fine, no breakdowns, now gone, they're back.
What would you do?
I could see my GP. I still have trileptal left.The PDOC refuses to treat me unless i follow her strict orders for 6 months.
Much appreciated,
Brian
Posted by Phillipa on April 6, 2006, at 21:17:26
In reply to Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 6, 2006, at 20:05:20
You answered your own question take the trileptal and go to the other doc. Love Phillipa
Posted by TylerJ on April 6, 2006, at 22:18:58
In reply to Re: Would you listen to this doctor? Help please!!!!!! » qbsbrown, posted by Phillipa on April 6, 2006, at 21:17:26
> You answered your own question take the trileptal and go to the other doc. Love Phillipa
Yes, I totally agree with Phillipa. Man, I can't believe some of these Pdocs-they treat us like sh*t. As if we didn't have enough to worry about already. Really, go to your gp, and then look for a new pdoc immediatly. Good Luck.
Tyler
Posted by qbsbrown on April 6, 2006, at 22:47:01
In reply to Re: Would you listen to this doctor? Help please!!!!!! » Phillipa, posted by TylerJ on April 6, 2006, at 22:18:58
here's the thing; she was really cool, seemed very trustworthy, she actually talked to me for 1hr 45 minutes!!!!!
She even called my girlfriend to discuss the situation, she contacted my psychologist to touch base as well. Unprescedented of a PDOC i've ever experienced.
She allows me to email her everyday.Perhaps it is complete obsessional thinking, and i've never been on a high enough dosage of an ssri for OCD for long enough time.
I do for sure, as do many here on this board, obsess about meds all day long, instead of just letting them do what they are or aren't going to do. I didn't think about trileptal after i took it, and it worked.
So in that regard, im confused as to why it was discontinued. It wouldn't hurt ocd/anxiety disorders would it?It lifted depression, i was excited to do things, i used to loathe the day and weekends, and then i was looking forward to them. Now it's gone, and the loathing is back.
My GF is going to email her, perhaps she'll trust her because she can be more objective.
For those of us involved in this obsessional cycle of medications, can we be rational/logical? I say sometimes yes, most times no.
Trileptal, i knew right away it worked. The headaches suck, the hunger sucks, the light sensitivity sucks, the waking up at dawn sucks, but it was better than the alternative.
Posted by cecilia on April 7, 2006, at 2:18:43
In reply to Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 6, 2006, at 20:05:20
A pdoc who refuses to treat you unless you follow her strict orders for 6 months-I'd run like crazy!!!!!! Whose body is it anyway? Sometimes I think they must have courses in medical school like Arrogance 101, Insensitivity 102 and Ignoring Whatever Patients Say 103. Cecilia
Posted by qbsbrown on April 7, 2006, at 3:10:49
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by cecilia on April 7, 2006, at 2:18:43
Only thing is that I'm in Shanghai China, and she's one of the few PDOCS that actually speak english. Maybe i'll get past this freak out point and feel better, who knows.
To be honest, im more looking forward to CBT 3 times a week, which i've never done. I just don't wanna be derealized outta my head while im doing it, cause i won't hear a damn thing.
Regards,
Brian
Posted by Emily Elizabeth on April 7, 2006, at 10:11:10
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 7, 2006, at 3:10:49
Wow, that does make things complicated. Could you negotiate w/ her? Like you listen to her for 3 months and then you re-evaluate? It sounds like you think that she has a little bit of a point, but she is taking it too far? Also, could you and gfriend visit her together for an appt? Perhaps then you all could reach some clarity on the best course of treatment?
Maybe this is a malpractice/safety issue? She is concerned that you could harm yourself if you don't follow her instructions?
I guess I'm giving her the benefit of the doubt b/c she sounds like she really made an effort to figure out what was going on w/ you. And it sounds like you like her. It might make sense to try to work things out rather than leaving her. It sounds like your options are a little limited where you live.
Best,
EE
Posted by rvanson on April 8, 2006, at 16:26:17
In reply to Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 6, 2006, at 20:05:20
> I'm just confused as all heck. I was on 600mg trileptal, which had lifted my depression and stabilized my mood greatly, and 10mgs of diazapam that i was withdrawing from.
> The anxiety got to be too much for me. Doc said had nothing to do w/ withdrawals, but GAD and OCD, as my previous doc had said (and i might agree).
>
> So doubled my diazepam to 20, and put me on 20 of paxil, took away the trileptal, and i feel like all hell. Depression is back, and derealization is full effect, and anxiety is worse, and having emotional breakdowns that i wasn't having on Trileptal, and was having before trileptal.
>
> Why take away trileptal when it had lifted my depression? Why add an SSRI when i don't respond to them?
>
> My goal is/was to get off of meds. But now she wants to add seroquel for sleep.
>
> She is being strict with me because i told her that i'm bad at taking meds, stopping, starting, and switching all the time. So i get that. But now she refuses to budge or alter, especially if it comes from me, because she just sees it as obsessions.
>
> I still do have logic and can make correlations that trileptal, depression fine, no breakdowns, now gone, they're back.
>
> What would you do?
Dump her and find a new Pdoc.
Posted by Racer on April 8, 2006, at 19:28:45
In reply to Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 6, 2006, at 20:05:20
>
> She is being strict with me because i told her that i'm bad at taking meds, stopping, starting, and switching all the time. So i get that. But now she refuses to budge or alter, especially if it comes from me, because she just sees it as obsessions.
>
> The PDOC refuses to treat me unless i follow her strict orders for 6 months.
>While I do understand your concerns, I think you may have explained what's going on just by what you've written above: your doctor is being strict with you because you've told her that you're bad about taking meds. I'd bet that when she says you have to follow her orders for 6 months, she isn't saying stay on this particular combo for the whole time -- only that you follow her directions for the whole period.
And I think it would be good for you to give her a chance. What if all this that's going on for you right is really *is* "just obsessions?" What if she's on the track to getting you feeling so good you want to dance an Irish jig down the street? (And if you do this, give me a call. I'd like to watch. :-) ) What if this doctor really does know what she's doing?
Believe me, I know it's hard, sometimes. I've had a lot of trouble the past few years, and I don't think the doctors I've seen have really understood how bad it can be. I won't go into details, but it's taken a lot to stay on a couple of medications long enough to give them a fair trial. But there's no way to find out if a medication is going to help unless one stays on it long enough for it to kick in.
It really does help to trust your doctor won't try to keep you on a drug that's really awful. (That's really why I left my last pdoc. He wouldn't communicate with my T, and didn't believe me when I told him a drug wasn't working for me. He'd talk about raising the dose when I was saying I needed to stop it.) I don't quite trust the pdoc I'm seeing now, but she *has* done something helpful for me, which maybe you could talk to your pdoc about: she tells me what the next option will be ahead of time, which helps me stay on what we're trying. (And she talks to my T...) She does want me to stay on almost anything for at least 4 weeks before giving up, but it's a heck of a lot easier to do that knowing that there's something else if this doesn't work.
So, here's my dissenting opinion:
Give this pdoc a chance. Next time you see her, or even via mail before your next visit, let her know that you're wound up about this, and ask her if she can try to help you get through it, maybe by telling you what her thinking is about why one drug or another is a good choice, and what she thinks will be next on the hit parade. Just explain that you think it will help you stay compliant with the meds regimen she prescribes. Or ask your T to talk to her, for you, about all this.
Good luck.
Posted by Phillipa on April 8, 2006, at 20:30:27
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by rvanson on April 8, 2006, at 16:26:17
I have no clue where some of you find pdocs who accept e-mails or phone calls or even listen to you. I've asked and asked nureses other docs in Charlotte they say they are all the same talking is for therapists the docs role here is to only order meds. What can I say. Not just me. Even my neighbors. One is in Florida right now to get her prescriptions she's taken for years cause they won't prescribe them here. She teaches school Phd. Love Phillipa
Posted by qbsbrown on April 8, 2006, at 22:11:07
In reply to I think I *would* stick with this pdoc a while » qbsbrown, posted by Racer on April 8, 2006, at 19:28:45
I do understand that 90 percent of this is obsessional and probably psychosomatic.
That said, i am still a logical/rational/intelligent human being, at times, lol.I arrived in china 3 months ago, only on 25mg of diazepam, and was brutally depressed. I was weaning myself off of the diazepam.
I got down to 17mgs, but then added 600mgs trileptal. My mood lifted dramatically, i looked forward to the days, weekends, and work. Only problem was that obsessions and anxiety remained, as i had weaned down to 10mgs diazepam.
So i undertand her putting me on more diazepam, and adding paxil, but WHY take away the Trileptal?????
Now off of it, i am back in to my depression, where i don't want to go out or do anything, and the weather is beautiful. While on Trileptal, i was always planning my next weekend excursion.
Am i missing something? Am i being obsessional about that? I don't think so.
She doesn't think that 600mgs was enough to effect me. That's BS! I felt it immediately. I responded well to only 50mgs of lamictal. My panic disorder was cured by 10mgs of paxil. Some people respond to lower doses.
I have emailed her this, and asked to listen to me w/ an open mind, not filtering it through what she thinks is my "illness". I also emailed a more objective/logical family doc. We'll see what happens.
In the mean time, i have plenty of Trileptal sitting in my room, and i am tempted to take it. Part of me would feel guilty for doing it w/o her permission.What do you guys think?
Love,
Brian
Posted by Racer on April 8, 2006, at 23:13:44
In reply to Re: I think I *would* stick with this pdoc a while, posted by qbsbrown on April 8, 2006, at 22:11:07
I think I wouldn't take the Trileptal without asking her first. Truly -- she may be worried about a drug interaction, but my guess would be that she's trying to get a clean picture of what Paxil will do for you.
How this for a plan: try the Paxil on its own for a full six weeks, if it's still not making you dance, THEN talk to her or another doctor about restarting the Trileptal. I know it seems like a long time, but it really isn't, in the whole scheme of things...
Good luck.
Posted by Phillipa on April 8, 2006, at 23:25:01
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by Phillipa on April 8, 2006, at 20:30:27
Well you know your own body right?And you're saying you felt better on a lower dose of dizempam(some say it's depressing) and the trileptal was helping and you still have it. And I was on l0mg of paxil for anxiety and panic attacks with a benzo. I was sick for three months even on that low of a dose of paxil. Nausea, diarreah, couldn't do anything but lay in a hammock (it was summer) So I would suggest starting the trileptal again. I also took it for a time at low doses. didn't feel a thing l50mg a day supposed to go up to 300mg twice a day. So start low and go up and see how you feel. love Phillipa
Posted by Phillipa on April 8, 2006, at 23:31:58
In reply to Re: Would you listen to this doctor? Help please!!!!!! » Phillipa, posted by Phillipa on April 8, 2006, at 23:25:01
Besided trileptal is a mood stabalizer and when I tried 20mg of paxil my anxiety skyrocketed to horrible anxiety which my pdoc at the time said was too energizing for me and boy was he right. Not everyone can tolerate the SSRI's at conventional doses. We are all individuals with different body chemistry. Don't feel guilty I wouldn't and I'm a people pleaser. Love phillipa
Posted by qbsbrown on April 9, 2006, at 1:12:24
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by Phillipa on April 8, 2006, at 23:31:58
I hear and understand you racer. But with trileptal, i could be doing the irish jig in one week, and take a vacation to the phillipines.
There is nothing wrong w/ taking a mood stabilizer with a SSRI, actually becoming more and more common. There are no interactions.
My depression was fine, it was the anxiety that was killing me, and 10mgs of diazepam is nothing, and trileptal does nothing for it either.She doesn't think it benefits me (or i wasn't at a high enough dose), she doesn't want me tinkering and prescribing my own meds (although i was already on it for a month). I'm bed ridden today (mostly from seroquel last night), and im getting so much crap from my family for not going out and doing things. I've been so active the last couple of weeks. This is killing me. So not only do i feel like dung, i feel guilty for feeling like dung, and not going out, and having fun w/ my hubby.
Regards,
Brian
Posted by Racer on April 9, 2006, at 1:46:14
In reply to Re: Would you listen to this doctor? Help please!!!!!! » Phillipa, posted by Phillipa on April 8, 2006, at 23:25:01
> Well you know your own body right?And you're saying you felt better on a lower dose of dizempam(some say it's depressing) and the trileptal was helping and you still have it. ... So I would suggest starting the trileptal again.
Phillipa, I'm writing this as another poster on the board, not in any sort of quasi-official capacity. I think it might be wise to be careful writing things like this. It sounds as though you're prescribing medications for this poster, without a medical license. He's already told us that his doctor told him to stop the Trileptal, and you're telling him you think he should start it again. I'm not sure that's either wise or safe.Please be careful, and consider whether you feel that writing such things is appropriate here.
Thank you.
Posted by ed_uk on April 9, 2006, at 12:58:25
In reply to Please be careful here » Phillipa, posted by Racer on April 9, 2006, at 1:46:14
Brian,
I'm dismayed by your pdoc.
Ed
Posted by Phillipa on April 9, 2006, at 19:16:09
In reply to Please be careful here » Phillipa, posted by Racer on April 9, 2006, at 1:46:14
Well who prescirbed what Brian has been taking me? Sounds like a doctor did so how can I be presciribing for him. I have no license just like none of us does here. It's what I and I repeat I would do. I statements are civil. And people only want others opinions don't you think? Love Phillipa
Posted by Phillipa on April 9, 2006, at 19:33:52
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 9, 2006, at 1:12:24
Brian a real doctor did prescribe the trileptal for you?Love Phillipa
Posted by qbsbrown on April 9, 2006, at 20:08:03
In reply to Re: Please be careful here » Racer, posted by ed_uk on April 9, 2006, at 12:58:25
> Brian,
>
> I'm dismayed by your pdoc.
>
> EdWhy? How? Half of me understands what she is doing, the other half knows what is better for my body and how it is responding. But keep in mind that i haven't given an SSRI more than a 2 month trial in years.
Posted by Caedmon on April 10, 2006, at 0:14:52
In reply to Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 6, 2006, at 20:05:20
Could there be a cultural difference here? You're in China - are doctors there more inclined to be paternal and the patients should be more passive? I'm just wondering about that, and if you're any likelier to get better treatment from another doc. I mean, maybe, I'm just asking.
I am guessing your doc wants to try stuff that is in more classic Tx algorithms for OCD. So, Paxil, and maybe Seroquel. That's fine, but my opinion is often that if something works, then it works. Any drug can have any effect in someone. I don't know, I empathize, I wish you could have just stayed with the Trileptal and either monkeyed with that or added something to it, not take it away when it was obviously beneficial.
Would I listen to this doctor? Yes, I would listen, but then I would do what I thought was right for my body and mind. I've had a few times in my life where I had to comply to my pdoc's wishes despite my own, but those were times when I was verging on psychosis. The rest of the time I'm a very independent thinker.
BTW I'm not so sure I'd give up on this doctor, either; I'm impressed that you can have so much communication. I think your trick is going to be to communicate effectively your desire for Trileptal. Try not only the regular modes of communication, but also, do research and send her that research. Docs respond best when they feel valued and respected. So, journal articles, polite emails and letters, etc. Just a thought anyway.
- C
Posted by ed_uk on April 10, 2006, at 13:50:20
In reply to Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 6, 2006, at 20:05:20
Hi B :)
>I was on 600mg trileptal, which had lifted my depression and stabilized my mood greatly
I am not happy that she made you stop the Trileptal.
>So doubled my diazepam to 20mg
I thought diazepam was aggravating your depression?
>20mg of paxil
Paroxetine is pretty potent stuff. 20mg is too high a starting dose for some people. Starting at a lower dose is often a good idea.
>But now she wants to add seroquel for sleep.
Antipsychotics are not a first-line treatment for insomnia.
>The PDOC refuses to treat me unless i follow her strict orders for 6 months
I think that's awful. I really do. She is abusing her power.
Kind regards
Ed
Posted by qbsbrown on April 10, 2006, at 19:39:53
In reply to Re: Would you listen to this doctor? Help please!!!!!! » qbsbrown, posted by ed_uk on April 10, 2006, at 13:50:20
> Hi B :)
>
> >I was on 600mg trileptal, which had lifted my depression and stabilized my mood greatly
>
> I am not happy that she made you stop the Trileptal.
Here is her response, she seems not to believe me that it was working.
"Trileptal, even though it has been told it could have an antidepressant-like
effect, that would be with higher dosage and with longer time. It could be
beneficial as an adjunctive treatment for resistant depressions or OCD,
together with an antidepressant when this last one alone has proven
insufficient"
> >So doubled my diazepam to 20mg
>
> I thought diazepam was aggravating your depression?
it was/had, but my state of acute anxiety had grown so bad, it was necisarry. But remember on 17mgs of diazepam and trileptal, there was no depression anymore.
> >20mg of paxil
>
> Paroxetine is pretty potent stuff. 20mg is too high a starting dose for some people. Starting at a lower dose is often a good idea.I agree. I felt great the first 2 days on 10mgs paxil, and i still took my last doses of trileptal. Best i had felt in years. 20mgs threw me for an acid trip. I am on day 10 of 20mgs,so should just push through right? My anxiety/derealization is still way worse.
> >But now she wants to add seroquel for sleep.
>
> Antipsychotics are not a first-line treatment for insomnia.I brought this one up, wanting to stay away from the benzo like sleep pills.
I think now that my withdrawal wasn't necisarily withdrawal. Possibly more underlying anxiety, obsessing about WD, and some psycosomatic. So i probably should be on an SSRI while coming off the benzos.> >The PDOC refuses to treat me unless i follow her strict orders for 6 months
>
> I think that's awful. I really do. She is abusing her power.Mostly was saying that i had to remain on the antidepressant for 6 months minimum. That im not self prescribing, changing meds, switching doses constantly.
Oh yeah, im not supposed to look anything up on the internet regarding mental health.
WHOOPS.
I did write her a huge email expressing all of mine and your concerns. I'll let ya know how it goes.
Regards,
Brian
Posted by qbsbrown on April 10, 2006, at 21:00:16
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 10, 2006, at 19:39:53
How long is a fair trial to give paxil while it is greatly increasing my anxiety/derealization?
Plus depression is back since im not on the trileptal, now i don't look forward to teaching/tutoring, whereas before i was loving it.
Morning anxiety is killing me.
Gentlemen (women close your eyes), has it ever occured that the anxiety from a med is/was so bad, that your genital shrink up (adreneline rush), almost to receed in to your stomach? This happens non stop.Thanks,
Brian
Posted by Phillipa on April 10, 2006, at 21:57:43
In reply to Re: Would you listen to this doctor? Help please!!!!!!, posted by qbsbrown on April 10, 2006, at 21:00:16
For goodness sakes. Your doc in the US prescribed the trileptal right? If so follow what she or he prescribed til you get a new pdoc and cut down on the paxil if she/he in the US didn't prescribe it for you. Love Phillipa ps but remember do not prescribe for yourself . Can you phone your old pdoc even if it costs you money and tell him/her what is going on?
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