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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 conundrum on May 12, 2010, at 12:47:40
Right now I'm taking lamictal but I'm not sure it can help with my primary symptoms which are listed in my signature. My new pdoc thinks I have mood stability issues. I wanna try a noradrenergic drug since I noticed some benefit with pristiq and low dose prozac but not very robust. Any ideas? My pdoc is worried about hypomania or mania with TCAs but honestly thats what I need right now not a drug that quells feelings. I haven't been able to feel extremely deep sadness or anxiety. I can get upset but I somehow am detached from it. I would welcome something that makes me feel more.
Posted by Phillipa on May 12, 2010, at 16:08:21
In reply to How do you get them to prescribe the med you want?, posted by conundrum on May 12, 2010, at 12:47:40
So you prefer a TCA? If you felt something on pritiq maybe effexor? Know it's kind of the same med but aren't the dosing options different? Phillipa
Posted by conundrum on May 12, 2010, at 16:21:34
In reply to Re: How do you get them to prescribe the med you want? » conundrum, posted by Phillipa on May 12, 2010, at 16:08:21
Effexor does have more dosing options, but its still a stronger SRI than NRI and thats why I wanted to try a TCA. The NRI part of pristiq kicks in right away, it was stimulating and I couldn't sleep the first night but I felt better after a couple days. Then after a couple weeks the serotonin starts to increase and it does away with the noradrengeric benefits and starts to feel like another SSRI. 2nd generation TCAs aren't strong SRIs like the Effexor and pristiq.
Posted by linkadge on May 12, 2010, at 18:51:39
In reply to Re: How do you get them to prescribe the med you want? » Phillipa, posted by conundrum on May 12, 2010, at 16:21:34
Well, I wouldn't focus on the med you want. I would focus on the med that is logically most likely to help you.
The best you can do is present your case to the doctor and see what he thinks. I have made a lot of mistakes myself pushing for this med or that. In the end, the meds the doctor initially recomended were the best (although not optimal).
Linkadge
Posted by softheprairie on May 13, 2010, at 7:26:26
In reply to How do you get them to prescribe the med you want?, posted by conundrum on May 12, 2010, at 12:47:40
Is desipramine one that you are thinking of? It is really helping me (along with other meds). You could say why you are interested in it, and offer to try it with a mood stabilizer (or stay on Lamictal) to address the doctor's concerns about mania. You could also offer to start at a very low dose of the TCA and only raise it slowly. You could also offer to make more appointments during the start or check in more often by phone or email (if you are willing to do any of those things & can afford it). If you are not seeing a talk therapist and the pdoc wants you to, you could say you would be willing to try some sessions of that if it would make a difference in swaying his decision for the TCA.
(If he says the TCAs are too dangerous in overdose, and you are willing to put up with the hassle, and possibly increased expense, you could offer to have the perscription written so that you have to go to the pharmacy weekly and only get a small quantity at a time. Luckily I haven't had to do this; I'm just thinking it would help convey how much you are willing to work for it.) If no luck, you could ask him if he could recommend a colleague who is especially experienced in overseeing tricyclic usage.
Posted by conundrum on May 13, 2010, at 10:38:31
In reply to Re: How do you get them to prescribe the med you want? » conundrum, posted by softheprairie on May 13, 2010, at 7:26:26
I guess I should just relax and give lamictal a shot and then if that helps no worries and if it doesn't I can try some of the things you have suggested. I was just hoping to find something effective atleast for motivation before the summer ends. I want to go back to school and get my masters but I can't see myself doing that now. I have some prozac and I'm considering taking that clandestinely. I only need a small dose to improve motivation. I know tricyclics can work faster than lamictal which could take until the end of the summer to try all the different doses. Maybe like you said I could try a TCA along with the lamictal after I've been on it for awhile. I know my pdoc has other patients on TCAs but not that many. She said she has about 1 person taking each TCA.
Thanks for the input.
Posted by g_g_g_unit on May 13, 2010, at 11:21:12
In reply to How do you get them to prescribe the med you want?, posted by conundrum on May 12, 2010, at 12:47:40
i'm surprised you're finding difficulty having a TCA prescribed. my last GP thought they were the bee's knees.
Posted by conundrum on May 13, 2010, at 11:46:17
In reply to Re: How do you get them to prescribe the med you want?, posted by g_g_g_unit on May 13, 2010, at 11:21:12
"the bee's knees?" Why not just, "Geico, you could save 15% or more on your car insurance"?
But, seriously, how old is your pdoc? Mine told me she wasn't around when they were widely prescribed, although I don't know why she is hesitant about them. I think she just doesn't believe they can help my specific case. Maybe what linkadge says is right and they have a better idea about what could help than we do.
Posted by ed_uk2010 on May 13, 2010, at 13:32:41
In reply to How do you get them to prescribe the med you want?, posted by conundrum on May 12, 2010, at 12:47:40
>My new pdoc thinks I have mood stability issues. I wanna try a noradrenergic drug.......
Why does your pdoc think that you have mood stability issues? Have you ever has a manic or hypomanic episode?
Posted by conundrum on May 13, 2010, at 14:08:25
In reply to Re: How do you get them to prescribe the med you want? » conundrum, posted by ed_uk2010 on May 13, 2010, at 13:32:41
She said my experience on prozac sounded slightly below hypomanic and she said a lot of times when people have mood stability issues drugs stop working for them and don't "hold their moods."
Posted by bulldog2 on May 13, 2010, at 14:25:54
In reply to How do you get them to prescribe the med you want?, posted by conundrum on May 12, 2010, at 12:47:40
> Right now I'm taking lamictal but I'm not sure it can help with my primary symptoms which are listed in my signature. My new pdoc thinks I have mood stability issues. I wanna try a noradrenergic drug since I noticed some benefit with pristiq and low dose prozac but not very robust. Any ideas? My pdoc is worried about hypomania or mania with TCAs but honestly thats what I need right now not a drug that quells feelings. I haven't been able to feel extremely deep sadness or anxiety. I can get upset but I somehow am detached from it. I would welcome something that makes me feel more.
When there is depression and bi-polar my p-doc addresses the depression first than adds on a mood stabilizer. I like clomipramine as it is strong on both ne and se. Maybe more at se but it is a strong drug that will let you feel.For strong drugs that let you feel both there's nardil, parnate, clomipramine and immipramine..other than these you can mix nortriptyline with zoloft or another ssri...Than the mood stabilizer is added on.
Posted by linkadge on May 13, 2010, at 14:39:44
In reply to Re: How do you get them to prescribe the med you want? » conundrum, posted by bulldog2 on May 13, 2010, at 14:25:54
Somtimes the noradrenergic / dopaminergic drugs can actually help bipolar disorder more than SSRI's.
Bipolars apparently have hypoactive prefrontal cortex and medications that increase metabolism here can help curb impulsivity.
There are (more than one) case reports of amphetamines halting manic episodes for instance.
SSRI's can make bipolar impulsivity worse in that they tend to decrease prefrontal metabolism (fluoxetine being the exception).
Linkadge
Posted by ed_uk2010 on May 13, 2010, at 14:39:50
In reply to Re: How do you get them to prescribe the med you want? » ed_uk2010, posted by conundrum on May 13, 2010, at 14:08:25
>She said my experience on prozac sounded slightly below hypomanic and she said a lot of times when people have mood stability issues drugs stop working for them and don't "hold their moods."
Well maybe, but it sounds rather like a case of 'blame the patient' rather than admit that the drugs aren't always that great. You've not mentioned having hypomanic symptoms on any other antidepressants.
If I were you, I would want to try nortriptyline or desipramine. The initial dose should be low and you should increase gradually. If you see your pdoc regularly she will be able to monitor for hypomanic symptoms, although I doubt that you will have any.
Posted by conundrum on May 13, 2010, at 16:00:03
In reply to Re: How do you get them to prescribe the med you want?, posted by ed_uk2010 on May 13, 2010, at 14:39:50
Me either, and you're right I didn't have that reaction with any other drug. Lexapro and Wellbutrin didn't do anything, neither did ritalin, and pristiq made seemed only help a smidgen. I do think there is a lot of "blame the patient" in psychiatry. Rather than say drugs can make people happy a little more often than normal they say someone has a mood stability issue.
Now if lamictal doesn't work then my diagnosis will probably change so I don't really care. I actually think I like my pdoc and I think she is just as confused by the situation as I am.
Unfortunately, I'm more pharmacologically minded than most psychiatrist who do things by trial and error. I like to figure out what actions of the drug helped and which ones hurt through trials and research.
Posted by stargazer2 on May 13, 2010, at 22:56:17
In reply to How do you get them to prescribe the med you want?, posted by conundrum on May 12, 2010, at 12:47:40
I never heard of post-SSRI syndrome, what is that? Is it a standard diagnosis? And what is iatrogenic anhedonia...induced by medical causes?
Just curious about those things you list for your condition.
As I skim the posts related to your questions about getting a med you want, I am amazed by the number of different posts and advice on what meds might work, etc.
It tells me that even though depression is a disease of sorts, unlike other diseases, no two doctors will ever appraoch the treatment of depression the same. If you had them in one room answering your questions about different medications, all of their responses would be different.
No wonder it takes years for some of us to get to the root of the problem if we ever do. Nothing about this disease can be measured or scanned to verify a diagnosis or determine the effect of any medication. It relies solely on subjective information, which is never presented as accurately as it needs to be by the patient, and even if it was, the docs all interpret things differently, so the end result would never reach the same conclusion.
No wonder why we are on a search and find mission to come up with answers for ourselves. I wonder if patients do better when they listen and follow their docs advice or only if they push for their own choice of meds.
That is what many of us have resorted to doing in a desparate attempt to get to a solution sooner.
And I'm wondering how successful any of it is since depression is chronic for so many of us and will recur whether you take meds or not. So in the long run, I'm not so sure meds are really the answer, but when I tried to stop meds completely, things have gotten much worse, so you can't even prove this theory.I'm at a point that my doc will almost prescribe anything I ask him for because we've been on this mission for 20 years together and I do my homework and remind him of my reactions to meds I've taken that he's forgotten, so we respect each others opinion which helps.
Star
Posted by g_g_g_unit on May 14, 2010, at 0:39:53
In reply to Re: How do you get them to prescribe the med you want? » g_g_g_unit, posted by conundrum on May 13, 2010, at 11:46:17
> But, seriously, how old is your pdoc?oh no, this was just my GP, not my pdoc. and he was in his sixties, i believe.
Posted by conundrum on May 14, 2010, at 11:06:53
In reply to Re: How do you get them to prescribe the med you want?, posted by stargazer2 on May 13, 2010, at 22:56:17
None of those are standard diagnoses. I don't think any of the standard diagnoses fit. Iatrogenic anhedonia means that my current symptoms come from taking prozac earlier. This is what I believe. Psychologists, doctors, and pdocs have suggested, ADD, depression, ocpd, and mood stability as the issue. I'm sure once a medicine has been found that helps the docs will backwards rationalize and determine what I "have."
Atleast my current pdoc admits that these drugs can mess people up. She doesn't dismiss what I say but I guess she wants to try something different with lamictal. I'm just trying to be patient. I would like to try something noradrenergic before my girlfriend visits me this summer since Pristiq initially increased sensation and sexual interest for me, then the serotonergic part kicked in and numbed all that.
Yeh I wonder if the docs can prescribe things better than we can. The best drug combo I've tried in recent years is low dose prozac + buspar which our very own Brainbeard suggested. It definetly helped with motivation, sometimes I wish my trial was longer. I'd give it a 3 out of 10 with it being most effective for motivation, but not anhedonia so much. Maybe adding a TCA would help to augment it and do away with the serotonergic headache caused by it.
Posted by conundrum on May 14, 2010, at 11:11:22
In reply to Re: How do you get them to prescribe the med you want?, posted by g_g_g_unit on May 14, 2010, at 0:39:53
Ah my gp is really young and only feels comfortable with the SSRI and post SSRI drugs.
Posted by Dan_MI on May 14, 2010, at 16:04:15
In reply to How do you get them to prescribe the med you want?, posted by conundrum on May 12, 2010, at 12:47:40
Last month I went in to my pdoc's office with a list of medications I thought I should be on for ADD-like symptoms. Thankfully, he used his education and experience to override my internet-based know-it-all-ism, and gave me Inderal for test anxiety, not ADD.
I aced my two finals, and I truly believe I owe that to my doctor.
So, I'd research doctors instead of drugs if you're unhappy with the drugs your doctor prescribes, if I were you.
Posted by linkadge on May 14, 2010, at 16:14:36
In reply to Re: How do you get them to prescribe the med you want?, posted by Dan_MI on May 14, 2010, at 16:04:15
Thank you very much for sharing your story. As a a board we sometimes get tunnel vision here. Being on a stimulant if you don't need it is not a good idea.
There is some research to suggest that stimulant use in non ADHD can worsen cognition (in spite of providing subjective feelings of improved cognition).
For some people, whatever med you prescribe, the patient can make work - just to prove a point. But in some cases, the wrong med can be disasterous.
For instance, OCD people will often self diagnose ADD, but stimulants in OCD can make things much works.
Linkadge
Posted by Conundrum on May 14, 2010, at 17:03:14
In reply to Re: How do you get them to prescribe the med you want?, posted by Dan_MI on May 14, 2010, at 16:04:15
Hmm, well I've decided to be patient for the time being and give lamictal a try. My pdoc said its also an antidepressant not just a mood stabilizer. So she said it could help if depression is the problem as well. Also its low on side effects so far so I can't complain about that right?
Question, if I had mood stability issues wouldn't pristiq or lexapro have triggered mania? Like I've said elsewhere I'm less concerned with what they say I have than what they call it.
This is the end of the thread.
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