![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 32. Go back in thread:
Posted by Twinleaf on March 22, 2012, at 19:50:45
In reply to Re: Pdoc won't give me Alertec, posted by Twinleaf on March 22, 2012, at 16:50:32
Now that you are no longer depressed, you should be coming off the SSRIs very gradually - over several, or perhaps even many, months, so as to minimize the danger of relapse. There is no justification for your taking anti-depressants when you are no longer depressed, unless you find that you relapse when you don't take them. This is the time to find out If you can manage well without them. The cost to you in side effects is sounding very high to me.
Posted by SLS on March 22, 2012, at 20:31:28
In reply to Just to make my point clear.., posted by Twinleaf on March 22, 2012, at 19:50:45
> There is no justification for your taking anti-depressants when you are no longer depressed, unless you find that you relapse when you don't take them.
I think the decision to continue treating MDD with antidepressants depends on several factors, including the history of recurrence and chronicity along with family history. Unfortunately, Prozac is often less effective once it is discontinued and restarted. For me, it would not be justified to attempt to discontinue treatment simply because I reach a point where I am no longer depressed. Gosh, I hope I am fortunate enough to be confronted with this dilemma.
> This is the time to find out If you can manage well without them. The cost to you in side effects is sounding very high to me.
I tend to agree with you. However, I don't even know if the presence of MDD was ever ascertained. Not all self-descriptions of depression represent MDD. At such a young age, it is an attractive idea to perform the experiment of antidepressant discontinuation.
- Scott
Posted by Emily Elizabeth on March 22, 2012, at 20:58:47
In reply to Pdoc won't give me Alertec, posted by Deneb on March 22, 2012, at 1:08:30
I have been popping in and out lately, so I might be missing something here...
1. Are you still employed?
2. Are you sure you aren't depressed? Excessive sleeping and no motivation can be huge signs of depression.
3. Are you on any other meds other than the SSRI's?
4. (and I literally cannot believe I am saying this...) if you are unable or unwilling to do regular therapy, what about something like a "life coach"? They couldn't really deal with issues, but they maybe could be a consistent force in your life, cheering you on and kicking you in the butt.Best,
EE
Posted by Twinleaf on March 22, 2012, at 21:36:05
In reply to Re: Just to make my point clear.. » Twinleaf, posted by SLS on March 22, 2012, at 20:31:28
Yes - I was actually thinking of you as I was writing, and thinking how much what I was saying DIDN'T apply to you! I think it's just great about the addition of prazosin, and how much it is helping. I know every one of your meds has been evaluated very carefully, and you wouuldn't want to discontinue a single one.
But, as you indicated, this situation is quite different. If I were to guess, I'd put it on the spectrum of emotional dysregulation disorders. While medication can be very important in those, it is not as crucial as it is for you. I think Deneb probably remembers that, over the years, several of us have urged her to consider more therapy and less heavy reliance on medication. She seems to be feeling better enough to begin cutting down on her medication by herself - something she rarely did previously. I would definitely want to see someone as young as Deneb have a trial off SSRIs, but I would certainly like to see her psychiatrist offer a greater degree of flexibility and support.
Deneb is describing to us a life in which there are essentially no significant others. Medication can dull the extreme pain of this to an extent, but it is psychotherapy (plus medication as needed) which offers the way out.
Posted by kagome on March 22, 2012, at 22:01:31
In reply to Re: Pdoc won't give me Alertec, posted by Deneb on March 22, 2012, at 15:22:15
> Ugh, I slept in way late today again. It just feels so good to sleep and I'm so tired.
>
> I'll go outside for some exercise later though. I need to try to do some things on that list.I hear ya, sounds like me every day. The best thing I've found is baby steps. Not magic, but definitely helps the overwhelmed feeling to concentrate on the most important thing I need to do each day (take meds, exercise, etc.) until it sort of becomes a habit. And I live by the mantra, "I can't do everything, but I can do something."
I'm struggling now with getting my life back together and it feels pretty overwhelming, however, you're lucky to have the depression under control and what sounds like a great p-doc. Good luck!
-kagome
Posted by Shes_Initforthemoney on March 23, 2012, at 0:29:56
In reply to Pdoc won't give me Alertec, posted by Deneb on March 22, 2012, at 1:08:30
> I saw pdoc today. I told her I was doing well except that I'm sleeping a lot, sometimes about 15 hours a day. I go to bed around 5 am and sleep until 5 pm on days I don't work. I get up and surf the web and drink some water (being really dehydrated after sleeping for 12 hours) for a couple of hours. Then I crawl back into bed until about 10 pm. I eat and surf the web the rest of the night and go back to bed at around 5 am.
>
> I asked her if I could have some Alertec or something, but she said it wasn't going to solve my problem. My problem was not maintaining healthy habits.
>
> I asked if melatonin might help, but again she said it wasn't going to solve my problems.
>
> I think she's kind of worried about me. She said my parents are going to get sick one day and won't be able to take care of me.
>
> She wants me to be more independent. She said I don't need to move or anything, but I should do more adult things, like learning how to cook. She said I'm not mentally retarded or physically handicapped or anything. She said I can do things to be independent.
>
> She gave me some homework. It's kind of a lot. I'm supposed to write things down as I do them.
>
> These are the things I have to do:
>
> Wake up in the morning everyday.
> Eat regular healthy meals based on the food pyramid.
> Go outside at least once a day.
> Do some exercise for about 30 mins everyday.
> Decrease Celexa and remember to take Prozac every morning.
> Do things other than surf the Internet reading articles for 7 hours straight.
> Think about some things I want to do.
> Do things to become more independent, like cooks meals and clean the house.
>
> Pdoc said I should be gathering resources at this time in my life, whatever that means. I think it has to do with the fact that my parents won't be here forever. I think she's kind of worried that they'll die and then I'd be totally helpless.
>
> She said it's good my parents help me, but it's also bad because it prevents me from growing up. I'm not sure why I didn't just naturally grow up. I'm kind of stuck in adolescence I think. Well, but at least I'm over the moody phase lol.
>
> Also she wants me to stop drinking drinks with caffeine. She says it's bad for my delayed sleep. Time to switch to decaf I guess. Argh. LOL
>
> I should find an app to track all this stuff. I'm so glad pdoc is there is guide me through life. I'd be so lost without her!
>
> I hope it doesn't take another 10 years to reach my next stage of enlightenment. I grew out of my depression/moodiness and most of my anxiety at the end of my 20's.
>
> Hopefully I'll be more like an adult by my mid 30's.
>
> Is there anything else you can think of to make me sleep less and be more like an adult?
>
>
>
>
>
>
Deneb,Well, with what others have said, I have my own experience. I don't want to think all that has applied to me would apply to you.
But, I was Dx'd with MDD and GAD around 20 years of age. It took so many wrong Dx's, and a few insensitive psychiatrists, and one amazingly smart and compassionate doc to get where I am today. (By the way, I am 42...but I still feel 20..lol). We had to try every medication (well..almost every one...I don't think anyone has really tried EVERY medication) over all these years. I wound up taking the MOST unconventional med combo(s) ever. I don't want to mention exactly what, because we all react differently based on our genetics, etc.
But, folks have to realize taking two SSRI's is not a far-fetched idea, and the combo has worked for me. There is quite a difference within the SSRI classes themselves, as to what neurotransmitters each is more or less powerful on. I have to combine other drugs, which are in the same class as each other ( within each of anti-psychotics, and even mood stabilizers), in order to get a robust, consistent reaction.
I will say my life is still far from perfect, but the unconventional medication combos have been crucial to my recovery. Having said that, all of those seemingly 'small' things from eating right, to taking your vitamins, to exercise are also crucial to your well being.
I am looking to getting a therapist next, and that also is another option in possibly helping you along. I would highly suggest trying a bit of melatonin to set your sleep clock. Now, I work 12 hour shifts, so my sleep is often messed up.
If left untreated, mental illness can get both chronically and acutely worse. I believe you are educated in the life sciences, so if you have ideas for your doctor, research and print the most valid research out there, and show it to them. But, be confident and serious, to show them you are an adult.
This garbage about you "having" to live on your own, have your own apartment, support yourself, etc is not needed to be worried about. In this economy, I know of many people being forced to move back home...or what are the alternatives? Live in a car? Nooo. That is also a very, very sad fact (and reality for many) today too. People seem to only care about being 'independent', but as the good ole' (very caring) Humanistic psychologist Carl Rogers said, we are ALL inter-dependent on each other. This society is all about 'me me me', never about WE. And look where that has gotten us. I think the 1 in 3 statistic regarding mental illness just says it all. Or the 99 percent'er?
Good luck Deneb, and I think you will find your way well.
Jay
Posted by SLS on March 23, 2012, at 1:46:53
In reply to Re: Just to make my point clear.., posted by Twinleaf on March 22, 2012, at 21:36:05
Hi Deneb!
Hi Twinleaf!
I must apologize. I was a bit too reactive to seeing the word "unjustified" appear. It sounded overly generalized to me.
Your thoughts and feelings are so lucid and genuine. I have an enormous - and still growing - admiration of you. You definitely have some appealing traits that I do not. I learn more from you than just psych stuff.
> But, as you indicated, this situation is quite different. If I were to guess, I'd put it on the spectrum of emotional dysregulation disorders.
Absolutely.
I have not seen MDD in the writings of Deneb. Either her treatment has brought her into an extended remission of MDD, or she never had it.
> While medication can be very important in those, it is not as crucial as it is for you. I think Deneb probably remembers that, over the years, several of us have urged her to consider more therapy and less heavy reliance on medication.
Medication is much more convenient than psychotherapy.
> She seems to be feeling better enough to begin cutting down on her medication by herself - something she rarely did previously.
It doesn't seem to me that Deneb is consistent in her taking of medication. Deneb, please correct me if I'm wrong about this. It is quite possible that there is very little antidepressant effect to be had because of this. Perhaps she has unintentionally discovered that she no longer needs medication.
> Deneb is describing to us a life in which there are essentially no significant others. Medication can dull the extreme pain of this to an extent, but it is psychotherapy (plus medication as needed) which offers the way out.
Deneb, I agree with Twinleaf. Although you display a happy-go-lucky face here on Psycho-Babble - which is fun to see - it is hard to imagine that you are content with your current level of socialization. I am not a doctor, but I would say that there is something inherently pathological with the manner in which you deal with a lack of attachments to others. To me, it feels as if there is something "hollow" about your social interactions here. There is so much going on inside you that is kept hidden. Thus, we see an exterior but no interior. You are extraordinarily intelligent and bright. There is a wealth of quality experience in your future. You have certainly added a bright star for all to see and marvel at. You are a genuinely good person.
Deneb, this might be a good point at which to redirect this conversation to the Psychology board. If you allow it, this would be a great opportunity to revisit some issues in your life, and see how you have evolved in your navigating them. You will need to work hard to maintain an open mind and concentration on things that are both old and new. There are NO quick answers. You are still young enough to improve yourself in ways that will allow you to have the wealth and reward in life that I know are waiting for you. I believe your key to this world lies in your investment in psychotherapy. People with more knowledge than can suggest what types of therapy are most appropriate for you.
Good luck, Deneb!
Thanks for indulging me, Twinleaf.
One last thought for the sake of acknowledging the potential benefits of an eclectic treatment regime. Trileptal (oxcarbazepine) is an anticonvulsant drug that helps reduce impulsive thoughts and behaviors. It is good for behavioral and affective dysregulation. It is a clean drug that will not increase body weight. It normally does not dull the senses at all, and will not produce apathy and amotivation. I am not a doctor (still), but I would approach Deneb's doctor with the idea should impulsiveness and affective dysregulation remain such prominent features of her condition(s). Actually I could see starting the Trileptal sooner rather than later because it can reduce the intensity of the withdrawal symptoms from SSRIs discontinuation. Add Trileptal first, then discontinue the Prozac gradually.
What would an SLS post be without his talking about pharmacotherapy?
Deneb, would you consider redirecting this conversation to the Psychology board? I am so predictable. I wouldn't want to disappoint.
- Scott
Posted by SLS on March 23, 2012, at 1:52:27
In reply to Re: Pdoc won't give me Alertec » Deneb, posted by Shes_Initforthemoney on March 23, 2012, at 0:29:56
> (By the way, I am 42...but I still feel 20..lol)
By the way, I am 52...but I still feel 22..lol
This is so totally wonderful.
- Scott
Posted by Deneb on March 23, 2012, at 4:48:32
In reply to Re: Pdoc won't give me Alertec, posted by Twinleaf on March 22, 2012, at 16:50:32
> Is her plan to gradually discontinue the Celexa altogether? That would be a good decision I think. Prozac is quite stimulating when you first take it, but the stimulating aspect tends to disappear over the long term, with side effects like anhedonia and lack of motivation becoming much more prominent.
>
> I think you have the right idea, instinctively, in lowering your intake.. I think it would be great for you to see how you are off SSRIs, keeping in mind that it can take as long as two years to get back to the way you were prior to treatment. I also think your idea of a stimulant to help you through this period is an excellent one.I'm entirely sure, but it seems like it. Her main plan was to get me off the Risperdal and I've succeeded in doing that.
For whatever reason, I'm unmotivated when I'm not working and I just mostly want to stay in bed. I don't think pdoc thinks it's Prozac's fault.
Pdoc doesn't want to use Alertec (Modafinil) because I'm sleeping habits/eating habits/going outside habits are highly irregular and she doesn't think a med would solve my problems.
I'm pretty sure she does not want to add more meds at this point.
Posted by Deneb on March 23, 2012, at 4:50:44
In reply to Re: Just to make my point clear.. » Twinleaf, posted by SLS on March 22, 2012, at 20:31:28
> > There is no justification for your taking anti-depressants when you are no longer depressed, unless you find that you relapse when you don't take them.
>
> I think the decision to continue treating MDD with antidepressants depends on several factors, including the history of recurrence and chronicity along with family history. Unfortunately, Prozac is often less effective once it is discontinued and restarted. For me, it would not be justified to attempt to discontinue treatment simply because I reach a point where I am no longer depressed. Gosh, I hope I am fortunate enough to be confronted with this dilemma.>
> > This is the time to find out If you can manage well without them. The cost to you in side effects is sounding very high to me.
>
> I tend to agree with you. However, I don't even know if the presence of MDD was ever ascertained. Not all self-descriptions of depression represent MDD. At such a young age, it is an attractive idea to perform the experiment of antidepressant discontinuation.
>
>
> - Scott
>I'm not sure what I had, but I know I've been pretty miserable in the past and it was an off and on thing. It got pretty severe. I'm just going to do whatever pdoc recommends.
Posted by Deneb on March 23, 2012, at 4:56:04
In reply to Re: Pdoc won't give me Alertec, posted by Emily Elizabeth on March 22, 2012, at 20:58:47
> I have been popping in and out lately, so I might be missing something here...
>
> 1. Are you still employed?
> 2. Are you sure you aren't depressed? Excessive sleeping and no motivation can be huge signs of depression.
> 3. Are you on any other meds other than the SSRI's?
> 4. (and I literally cannot believe I am saying this...) if you are unable or unwilling to do regular therapy, what about something like a "life coach"? They couldn't really deal with issues, but they maybe could be a consistent force in your life, cheering you on and kicking you in the butt.
>
> Best,
> EEYes, I'm still employed and I'm doing quite well there. I'm a good worker. I'm very motivated when I'm at work and I like socializing with co-workers before work. The problem is when I'm not working, I don't have any urge to do anything but surf the web and chat with Babblers.
I'm not sure I'm not depressed. If I am, it is different from before because I don't want to kill myself.
I'm just on the SSRI's mainly. I do take propranolol for the days when work is going to be a bit more stressful.
Hmmmm....I think a life coach is a good idea. I'll look into that. The thing with therapy is that it is very expensive and I can't afford it and also I'm not very good with therapy. Often there is just nothing to talk about. Even with pdoc I just talk about my day. I'm just not very self aware at all.
Posted by Deneb on March 23, 2012, at 5:01:56
In reply to Re: Just to make my point clear.., posted by Twinleaf on March 22, 2012, at 21:36:05
> Yes - I was actually thinking of you as I was writing, and thinking how much what I was saying DIDN'T apply to you! I think it's just great about the addition of prazosin, and how much it is helping. I know every one of your meds has been evaluated very carefully, and you wouuldn't want to discontinue a single one.
Oh, I'm not on prazosin. I am on PRN propranolol though. Right now I'm supposed to be on 10 mg Celexa at night and 40 mg Prozac in the morning. I want to try out Alertec (Modafinil) because I read it is good for making people not sleep so much.
>
> But, as you indicated, this situation is quite different. If I were to guess, I'd put it on the spectrum of emotional dysregulation disorders. While medication can be very important in those, it is not as crucial as it is for you. I think Deneb probably remembers that, over the years, several of us have urged her to consider more therapy and less heavy reliance on medication. She seems to be feeling better enough to begin cutting down on her medication by herself - something she rarely did previously. I would definitely want to see someone as young as Deneb have a trial off SSRIs, but I would certainly like to see her psychiatrist offer a greater degree of flexibility and support.
>
> Deneb is describing to us a life in which there are essentially no significant others. Medication can dull the extreme pain of this to an extent, but it is psychotherapy (plus medication as needed) which offers the way out.I don't really think I would like a significant other to be honest, at least not be around them all the time. I need my space.
Posted by Deneb on March 23, 2012, at 5:07:17
In reply to Re: Pdoc won't give me Alertec » Deneb, posted by Shes_Initforthemoney on March 23, 2012, at 0:29:56
> Deneb,
>
> Well, with what others have said, I have my own experience. I don't want to think all that has applied to me would apply to you.
>
> But, I was Dx'd with MDD and GAD around 20 years of age. It took so many wrong Dx's, and a few insensitive psychiatrists, and one amazingly smart and compassionate doc to get where I am today. (By the way, I am 42...but I still feel 20..lol). We had to try every medication (well..almost every one...I don't think anyone has really tried EVERY medication) over all these years. I wound up taking the MOST unconventional med combo(s) ever. I don't want to mention exactly what, because we all react differently based on our genetics, etc.
>
> But, folks have to realize taking two SSRI's is not a far-fetched idea, and the combo has worked for me. There is quite a difference within the SSRI classes themselves, as to what neurotransmitters each is more or less powerful on. I have to combine other drugs, which are in the same class as each other ( within each of anti-psychotics, and even mood stabilizers), in order to get a robust, consistent reaction.
>
> I will say my life is still far from perfect, but the unconventional medication combos have been crucial to my recovery. Having said that, all of those seemingly 'small' things from eating right, to taking your vitamins, to exercise are also crucial to your well being.
>
> I am looking to getting a therapist next, and that also is another option in possibly helping you along. I would highly suggest trying a bit of melatonin to set your sleep clock. Now, I work 12 hour shifts, so my sleep is often messed up.
>
> If left untreated, mental illness can get both chronically and acutely worse. I believe you are educated in the life sciences, so if you have ideas for your doctor, research and print the most valid research out there, and show it to them. But, be confident and serious, to show them you are an adult.
>
> This garbage about you "having" to live on your own, have your own apartment, support yourself, etc is not needed to be worried about. In this economy, I know of many people being forced to move back home...or what are the alternatives? Live in a car? Nooo. That is also a very, very sad fact (and reality for many) today too. People seem to only care about being 'independent', but as the good ole' (very caring) Humanistic psychologist Carl Rogers said, we are ALL inter-dependent on each other. This society is all about 'me me me', never about WE. And look where that has gotten us. I think the 1 in 3 statistic regarding mental illness just says it all. Or the 99 percent'er?
>
> Good luck Deneb, and I think you will find your way well.
>
> Jay
>I want to try melatonin for my delayed sleep, but pdoc said it wouldn't solve my problems. She says I need to go outside and see the sun everyday. I often stay indoors without stepping outside for days at a time when I don't need to work.
Pdoc didn't say that I needed to move out. She said I can learn to be more independent while living at home. I think she's just worried about my future, a future without my parents. She's telling me that my parents will get older and they might not be able to take care of me on day. I'll need to take care of myself then and I think she just wants the transition to that to be smoother and not forced on me.
Posted by SLS on March 23, 2012, at 6:03:29
In reply to Re: Just to make my point clear.. » SLS, posted by Deneb on March 23, 2012, at 4:50:44
> I'm not sure what I had, but I know I've been pretty miserable in the past and it was an off and on thing. It got pretty severe. I'm just going to do whatever pdoc recommends.
Okay. Perhaps that is what's best.
Just make sure you take your medication exactly the way your doctor recommends. If I am not mistaken, you have been taking Prozac intermittently rather than every day. I apologize if I am misremembering.
I wish you the best of luck.
- Scott
Posted by SLS on March 23, 2012, at 6:15:31
In reply to Re: Pdoc won't give me Alertec » Emily Elizabeth, posted by Deneb on March 23, 2012, at 4:56:04
Deneb.
> Hmmmm....I think a life coach is a good idea. I'll look into that.
I think a life coach is a good thing, too. I might use one in the near future as I begin to recover from a lifetime of depression.
> The thing with therapy is that it is very expensive and I can't afford it and also I'm not very good with therapy. Often there is just nothing to talk about. Even with pdoc I just talk about my day. I'm just not very self aware at all.
I guess being aware that you are not very self-aware is a demonstration of at least some self-awareness. This is a good thing. You do seem to function quite well at work. Perhaps you don't have anything better to do at home but to sleep. What would you do at home if you had the same energy and motivation that you have at work?
- Scott
Posted by iforgotmypassword on March 23, 2012, at 6:48:11
In reply to Re: Pdoc won't give me Alertec » Deneb, posted by SLS on March 23, 2012, at 6:15:31
won't affect most, but as i am scared sh*tl*ss more or less, it s hard not to mention. eyes burn nose burn mouth burns breath burns body parts itch and quickly form reddish rashes that so far thankfully go away very quickly as i constantly contort to accomodate overheating body parts. sometimes it feels like i may as well be exhaling burning steam & broken glass. i am worried i am in the earlier "flu" stage of a sjs-type reaction. if i see any for sure blistering or any fluid gather anywhere it i go straight to the er. note that i was naive & smug, having taken modafinil so many times before, thinking i could use black pepper and grapefruit juice to compensate for the 3a4 induced by cyproterone that i attributed my earlier blunted response to. i thought i was just about taking 3a4 out of the game at the gut level, little did i know piperine has an 18hr half life.
i would pray if i were compatible mentally with the ability to gain calm & hope from doing so
Posted by Twinleaf on March 23, 2012, at 10:44:47
In reply to Re: Just to make my point clear.. » Twinleaf, posted by Deneb on March 23, 2012, at 5:01:56
Deneb, the first part of my post, about prazosin, was directed at Scott.
There is an almost complete absence of wishes and goals for your life in your posts. It seems as though other people - your pdoc and several posters, would love to see you have a full life, with important other people in it, and fulfilling work and activities. But you don't express any of the same wishes.
If you go back and look at your posts from several years ago, you had very strong and definite goals for both your work and your social life. What has happened? That is such a loss for you. Rather than just accept everything your pdoc tells you, why not become informed about possible downsides to SSRIs for you now, as well as the possibilities for other medications and for therapy, and have a truly adult discussion about all of them. No doctor is right 100% of the time; that is why she needs your informed input. If you don't give it, she has to end up treating you like a child.
A note on therapy: you can do it just as well as anyone if you want to. There is no right or wrong to it. Your pdoc's training is probably not so much in therapy as in medications. You have probably never had a real therapy experience. I think you would be surprised at how much you got out of it.
One further note on living arrangements: no-one is asking you to move out, but I think everyone is hoping you'll develop a fuller and happier life while you have the support of your parents. That is really what they are there for.
If you want to make changes in your life, you will really have to figure out what has made you lose your motivation. Everyone here will cheer you on, but no-one can do it for you.
Posted by Shes_Initforthemoney on March 23, 2012, at 11:48:10
In reply to Re: Pdoc won't give me Alertec » Shes_Initforthemoney, posted by SLS on March 23, 2012, at 1:52:27
> > (By the way, I am 42...but I still feel 20..lol)
>
> By the way, I am 52...but I still feel 22..lol
>
> This is so totally wonderful.
>
>
> - ScottHey Scott...
Yes, that is so wonderful indeed :) This goes off-topic a bit, but it seems age provides a bit of, a little bit of resiliency, but and a "I am going to be okay...just gotta take it one step at a time" feeling. And that is when being let down and kicked while you are down happen somewhat often. Just an abstract thought....
Jay
Posted by Emily Elizabeth on March 23, 2012, at 16:49:17
In reply to What counts is what you want, posted by Twinleaf on March 23, 2012, at 10:44:47
Twinleaf makes some excellent points.
While a physician's medical expertise is to be respected, you need to be an informed consumer and ask the right questions. Perhaps a 2nd opinion would even be warranted. My pdoc set me up for a second opinion with a colleague of his, just so we could be sure that we were truly looking at all the angles of the situation. It was helpful to get another POV.
Food for thought.
Best,
EE
Posted by papillon2 on March 23, 2012, at 17:14:59
In reply to Re: Pdoc won't give me Alertec » Shes_Initforthemoney, posted by Deneb on March 23, 2012, at 5:07:17
> I want to try melatonin for my delayed sleep, but pdoc said it wouldn't solve my problems. She says I need to go outside and see the sun everyday. I often stay indoors without stepping outside for days at a time when I don't need to work.
I have some form of delayed sleep onset syndrome (I also have early morning wakening, just to confuse things). The two most important factors improving this are:
1. Treating my depression. This is single most important aspect of all.
2. Melatonin and, originally, temazepam to reset my body clock. I believe your doctor is wrong about melatonin. Very wrong.Others which are helpful but less so:
1. Leaving a light on dimly overnight. I have nightmares and being able to see properly calms me down far quicker.
2. Being religious with the timings of my morning and evening meds.
3. Dragging myself out of bed in the morning for 30mins exercise in the sun, no hat or sunglasses. Even when I don't want to. Even when I can barely walk and someone is literally dragging me along. Even though I am still half asleep. There are times when I can't or won't do this due to depression, not beating myself up over this would probably help because when you feel crap about yourself your depression worsens.
4. A sleep psychology group may have helped a little.
5. Sleep hygeine (google search, but you no doubt already know) may have helped a little.An idea in addition to the above:
Seeing a sleep doctor and having a sleep study done to rule out any organic causes of your sleep dsyregulation. Even if nothing much is found, the sleep doctor may well recommend melatonin and short use of temazepam to reset your body clock, which would strengthen your case with your psychiatrist.I have been on melatonin for maybe four, five months. It's effects in resetting my body clock appear to be long-acting after being on it for some time. I recently ran out of melatonin for a week and found that, amazingly, my sleep did not worsen. I am still taking it though, as proper sleep is so good for depression and my depression can be severe. I also found that the dose doesn't matter so much for me. 3mg is just as effective as 4mg and 6mg.
Melatonin is a naturally occurring hormone. I don't see why your doctor doesn't want you to try it, even if it is just so she can say, "haha, told you so".
Posted by Deneb on March 23, 2012, at 19:38:07
In reply to Re: Pdoc won't give me Alertec, posted by papillon2 on March 23, 2012, at 17:14:59
I'm not certain, but I think my pdoc might have confused melanin with melatonin. She told me my body will make melanin when I'm out in the sun. I'm sure being out in the sun will affect melatonin levels but they are clearly not the same thing. I wonder if she just mis-said it. Melanin is a skin pigment thing, not the same as melatonin at all.
It just feels like my pdoc isn't all that up on the biology side of things, but then I think that she must be because she went to a really good university to learn her medicine. I mean, just getting into med school here in Canada is next to impossible here. It's harder to get into med school here than in the US.
Posted by Deneb on March 23, 2012, at 19:56:57
In reply to Re: Pdoc won't give me Alertec » Deneb, posted by SLS on March 23, 2012, at 6:15:31
> Deneb.
>
> > Hmmmm....I think a life coach is a good idea. I'll look into that.
>
> I think a life coach is a good thing, too. I might use one in the near future as I begin to recover from a lifetime of depression.
>
> > The thing with therapy is that it is very expensive and I can't afford it and also I'm not very good with therapy. Often there is just nothing to talk about. Even with pdoc I just talk about my day. I'm just not very self aware at all.
>
> I guess being aware that you are not very self-aware is a demonstration of at least some self-awareness. This is a good thing. You do seem to function quite well at work. Perhaps you don't have anything better to do at home but to sleep. What would you do at home if you had the same energy and motivation that you have at work?
>
>
> - ScottI think my problem is that I don't really have all that much self directed motivation. I'm motivated at work because people expect me to do well and there are immediate consequences of do doing well. Also there are many people who will think badly of me if I don't do things correctly.
When it's just up to me, it's hard to get stuff done when there are no immediate consequences. Also I think I'm just naturally very lazy. I'm not lazy at work, but that's because of the immediate consequences thing. Also I have a lot of people who depend on me.
I guess I'm still quite immature.
It's not that I'm immoral though. I'm finding more than ever that my morality is developing more and more. I'm much more empathetic now. I'll do everything I can to return a lost wallet to the appropriate authorities and I'll help random people out when I see they need help, but when it comes to doing things that help just myself and don't affect other people, I'm just very lazy about it.
If I have the same energy at home as I did at work I would clean my room, cook meals, vacuum, organize things, water the plants, make my bed, brush my teeth everyday before I fall asleep instead of just getting too tired to get up, do my taxes, volunteer, exercise, go out with friends, shopping etc.
I just want to be a normal person who is able to get more than one thing done in a day. I'm not sure I could handle a full time job. I remember some times when I worked full time hours and I was super tired and stressed out.
Posted by Deneb on March 23, 2012, at 20:08:48
In reply to What counts is what you want, posted by Twinleaf on March 23, 2012, at 10:44:47
> Deneb, the first part of my post, about prazosin, was directed at Scott.
>
> There is an almost complete absence of wishes and goals for your life in your posts. It seems as though other people - your pdoc and several posters, would love to see you have a full life, with important other people in it, and fulfilling work and activities. But you don't express any of the same wishes.
>
> If you go back and look at your posts from several years ago, you had very strong and definite goals for both your work and your social life. What has happened? That is such a loss for you. Rather than just accept everything your pdoc tells you, why not become informed about possible downsides to SSRIs for you now, as well as the possibilities for other medications and for therapy, and have a truly adult discussion about all of them. No doctor is right 100% of the time; that is why she needs your informed input. If you don't give it, she has to end up treating you like a child.
>Well I told my pdoc once that I wanted to drink caffeinated drinks despite the risks, but she just won't accept that. OK, she accepted it for a while, but then she saying I shouldn't drink caffeine drinks again. I'm not sure what I can do to convince her that caffeine is OK for me.
With the SSRI's, she agrees with the goal of eventually coming off them, but she said she wanted me to discontinue one at a time. I guess it's taking me off the Celexa first and then the Prozac. I guess she's being cautious. Going off more than one at a time complicates things I guess.
I think her goal is to have me be off all meds. I don't think she wants to start any with me.
I've never had strong goals for my social life. I did have high goals for my career, but then I discovered that I'm below average in being able to learn things quickly so I kind of just gave up on anything hard career wise.
I used to learn things quickly, but I think I'm going to be one of those people who get demented as they grow older because I'm getting slower.
Posted by Twinleaf on March 23, 2012, at 23:19:57
In reply to Re: What counts is what you want » Twinleaf, posted by Deneb on March 23, 2012, at 20:08:48
I remember when you had strong goals for your career. You showed us how intelligent you really were, and how strong your scientific interests were. People don't get dumb in the prime of life! Medications can "dumb you down", and severe disappointment and depression can do it too, I am very glad to hear that you are doing a very slow taper of your meds, as they may be causing the "dumbing" and loss of motivation,
I also remember that you were hoping for a boyfriend, and for more friends. Those are the most natural things in the world to want, but it looks like something happened there, too,
I think it was an especially hard time for you when the pdoc began seeing you less and was less involved in your life. It seemed like you sort of gave up on yourself around that time. I think you still need a therapeutic relationship in your life - as you know only too well by now!
What's wrong with a little caffeine?
Posted by SLS on March 24, 2012, at 6:17:57
In reply to Re: What counts is what you want » Twinleaf, posted by Deneb on March 23, 2012, at 20:08:48
> I remember when you had strong goals for your career.
I think Twinleaf's observation can't be overemphasized. Prozac and some of the other SSRIs can steal from one their motivation and vital energies. This can very easily be interpreted as a loss of interest and laziness. It is not inconsistent with this SSRI apathy and amotivation that one can function well at work. The need to keep up with the demands of work are motivating enough to require that one "perk-up" temporarily.
> You showed us how intelligent you really were, and how strong your scientific interests were.
Gosh, yeah. I am VERY impressed with Deneb. Her intelligence and academic accomplishments are obvious. I loved the youthful curiosity and motivation she previously displayed. Deneb, these things are still there, but they are likely being masked by SSRI apathy and amotivation. Again, this masking can lead one to conclude that they are lazy and without goals in life.
The obvious question is when were you first placed on Prozac? When did you begin to lose your interest, motivation, energy and subsequently feel lazy?
I could be wrong. I am just trying to help.
Regarding psychotherapy and personal growth, I agree with everything Twinleaf has presented to you. That you don't feel "self-aware" is a particularly compelling reason to explore your psyche.
I have profited a great deal from periodic psychotherapy. I actually healed my mind before healing my brain. It was a goal of mine to be fully prepared mentally for when my depression would remit and my life begin again. So far, so good.
Your quality of life might depend on discontinuing Prozac and committing to psychotherapy. If you do indeed need an antidepressant, there are others to choose from that are unlikely to produce apathy and amotivation.
"SSRI Amotivation Syndrome" exists.
Some of us might seem "pushy" with you right now. I know that I am. Perhaps I am guilty of wanting more for you than you want for yourself. You have decisions to make for yourself. No one is asking that they be making decisions for you. I am simply presenting you with facts, observations, and, of course, opinions. These things are for you to deliberate. You have to want it bad enough before you can actualize it.
Self-actualization is fun! Come join the party!
- Scott
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