![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by darcan on June 11, 2006, at 9:05:05
I have gone through 6 to 8 proviate psychiatrists over the past 6 years here in Southern California. Most were focused on making money or just took people like me (Severe atypical depression and anxiety) to supplement there true interests.
I have great insurance and am fortunate enough that paying the docs is not a problem. I can't find a good one.
I've been to UCLA and UCI. UCLA was actually pretty good but you get a resident and they leave every year.
Because of the nature of this disease, a true scientist is what I need. Someone that will monitor what the drugs are doing or are NOT doing.
I had one doc that kept adding drugs and never took any way.
Is there such a thing as a great doc? How do I find out if he is successful? If I were hiring a plumber, I'd call his references. In the doc biz you have to make an appointment and pay the guy just to interview him, and you can't get references.
I want someone that specializes in the treatment of depression and has a proven track record of helping patients. How do I find this person?
Posted by UgottaHaveHope on June 11, 2006, at 11:34:11
In reply to Finding a great psychiatrist?, posted by darcan on June 11, 2006, at 9:05:05
A guy who posts in here under the name of RobertDavid sees one of the top pdocs in the country, and he is based out of Southern California. I cant remember his name, but RD could tell you.
Posted by Phillipa on June 11, 2006, at 18:50:57
In reply to Re: Finding a great psychiatrist?, posted by UgottaHaveHope on June 11, 2006, at 11:34:11
Michael he's right. I'll E-mail him and ask him to check this post. maybe the two of you can hook up Love Phillipa
Posted by rvanson on June 11, 2006, at 22:26:22
In reply to Finding a great psychiatrist?, posted by darcan on June 11, 2006, at 9:05:05
> I have gone through 6 to 8 proviate psychiatrists over the past 6 years here in Southern California. Most were focused on making money or just took people like me (Severe atypical depression and anxiety) to supplement there true interests.
>
> I have great insurance and am fortunate enough that paying the docs is not a problem. I can't find a good one.
>
> I've been to UCLA and UCI. UCLA was actually pretty good but you get a resident and they leave every year.
>
> Because of the nature of this disease, a true scientist is what I need. Someone that will monitor what the drugs are doing or are NOT doing.
>
> I had one doc that kept adding drugs and never took any way.
>
> Is there such a thing as a great doc? How do I find out if he is successful? If I were hiring a plumber, I'd call his references. In the doc biz you have to make an appointment and pay the guy just to interview him, and you can't get references.
>
> I want someone that specializes in the treatment of depression and has a proven track record of helping patients. How do I find this person?
Find someone you trust who can vouch for thier doctor is the ONLY way, IMO.I have had exactly the same problems finding any good, competant Pdocs who do more then give you an Rx, shoving you out the door, yelling "Next", while they are doing it.
Most of them are working hard for early retirement, in this pre-SSRI side-effects lawsuit era, and could care less about you as long as you are bringing in the holy cashola.
Having said that, there are good Pdocs, but like a good fishing hole, they are hard to find and no one likes to tell on a good thing.
Posted by RobertDavid on June 12, 2006, at 0:02:42
In reply to Finding a great psychiatrist?, posted by darcan on June 11, 2006, at 9:05:05
See if you can get an appointment with Dr. Mark Hyman Rapaport, chaiman of the psychiatric department at Cedars-Sinai Hospital in Beverly Hills. He is an expert in resarch and treating anxiety disorters. If you want, google his name to read about him. I'm not sure if he will take new patients and if not, I know he would give you a quality referral. I've been seeing him for 12 years. He's great. Good luck. Rob
Posted by Bonnie_CA on June 12, 2006, at 18:36:39
In reply to Finding a great psychiatrist?, posted by darcan on June 11, 2006, at 9:05:05
Posted by Think1234 on June 13, 2006, at 20:10:33
In reply to Finding a great psychiatrist?, posted by darcan on June 11, 2006, at 9:05:05
I too have difficulty finding a good psychiatrist. As far as greed is concerned, such as their tendency to make unnecessary appointments. That seems to be the way with pretty much all doctors. I don't think the doctor are conscious of the fact that they are being greedy, they just believe thats the way they should practice. And the way they practice just happens to make them a lot of money. The fact that other doctors act the same way helps reinforce that pattern of behavior..
The real problem with doctors is groupthink. Let me give you several examples from psychiatry.
1. I have an uncle-in-law. He was a very successful engineer performing a very high pressure job. He did the engineering and financial managing of multibillion dollar construction projects for a very large construction corporation. (maybe you can guess which corporation)
During his time as an engineer he had an acute psychotic breakdown. If you know how psychiatrists think you can already guess what diagnosis he had been given. He was diagnosed with bipolar. He doesn't have bipolar in any way, but because that the only box the Pdocs can fit him into they (The hospital Pdocs) give him that label, and tried to prescribe him lithium, which he prudently refused. He instead takes Klonopin whenever he feels panicky, and that puts him right to sleep.
2.I have a friend who took ritalin. As a result of the ritalin he had hallucinations. Now the Pdoc find that this reaction to ritalin "uncovers" a previously undiagnosed bipolar disorder. He doesn't have bipolar. That the way they think. Hallucinatory reaction to ritalin combined with his past agrressive behavior = bipolar. Its not critical or scientific thinking its groupthinking.
3. I had a bad reaction to Wellbutrin. The reaction is difficult to describe. But its probably comparable to the electrical shock feeling that people who withdraw from paxil experience. (I took it for 4 days and the electrical shocks continued on for about 3 weeks) He tells me that it isn't a side effect of Wellbutrin. Why? Because that side effect isn't listed in his handbook. So he tells me to put a klonopin under my tongue whenever I get that hard to describe feeling. In other words because its outside of the box, he totally dismisses the reality of my experience with Wellbutrin and attributes it instead to my anxiety.
Pdocs have available to them a vast array of useful drugs. Sadly I think that have more privilege than their abilities warrant. They are beholden to groupthink, Big Pharm, and subconscious greed as are many doctors.
So. I would agree, a good Pdoc is hard to find.
> I have gone through 6 to 8 proviate psychiatrists over the past 6 years here in Southern California. Most were focused on making money or just took people like me (Severe atypical depression and anxiety) to supplement there true interests.
>
> I have great insurance and am fortunate enough that paying the docs is not a problem. I can't find a good one.
>
> I've been to UCLA and UCI. UCLA was actually pretty good but you get a resident and they leave every year.
>
> Because of the nature of this disease, a true scientist is what I need. Someone that will monitor what the drugs are doing or are NOT doing.
>
> I had one doc that kept adding drugs and never took any way.
>
> Is there such a thing as a great doc? How do I find out if he is successful? If I were hiring a plumber, I'd call his references. In the doc biz you have to make an appointment and pay the guy just to interview him, and you can't get references.
>
> I want someone that specializes in the treatment of depression and has a proven track record of helping patients. How do I find this person?
Posted by Deneb on June 13, 2006, at 21:03:56
In reply to PDocs aren't greedy, Just too much Groupthink., posted by Think1234 on June 13, 2006, at 20:10:33
Am I naive to think that pdocs aren't money-hungry pseudo-scientists?
Maybe it's different for me because I don't have to pay for my pdoc. My pdoc's my T. We talk for 30 mins every two weeks or so.
I do worry about how she handles my meds though...every session she just asks me if I take them and that's it. She's never given me something I've never taken before. She just continues prescribing whatever I was taking before.
Deneb*
Posted by notfred on June 14, 2006, at 10:58:33
In reply to Re: PDocs aren't greedy, Just too much Groupthink., posted by Deneb on June 13, 2006, at 21:03:56
> Am I naive to think that pdocs aren't money-hungry pseudo-scientists?
>I think it is not a good idea the generalize pdocs.
Ther are millions of them & any of us have just seen a small fraction.
Posted by pulse on June 15, 2006, at 6:20:16
In reply to PDocs aren't greedy, Just too much Groupthink., posted by Think1234 on June 13, 2006, at 20:10:33
absolutely, groupthink is at the heart of the matter. excellent post!
btw, i, too, was - at age 40 (14 yrs ago) - put in that same infamous bipolar box, when my original dx of major depression with several types of anxiety was and IS still correct.
far as finding a good pdoc, i've seen 14 in 26 yrs.
the 1st (i was 28) was a man in his late 60's, who'd practiced for years. he was well known for falling asleep during sessions, and being beyond eccentric. (he never fell asleep on me). i'd still (he's since, of course, died) rate him 5 stars. he KNEW his diagnoses, and had a real way with matching the correct med/s with the person. magical, in comparison to so very many, nowadays.
over these 14 yrs. of mis-diagnosis, let's see - i was:
bpI w/rapid cycling; then perhaps it was bpIII, never bpII..hmmm, and, finally - boy, they did NOT want to admit their error - bp NOS. i loved that one!the only other pdoc, and 20 yrs. later than the 1st, that i'd rate 5 stars, was a 30-something woman. mind, i was still in the bipolar box. in my case - i sincerely believe - that was simply because it got put on my record by a hospital on-call pdoc, whom i had the great misfortune to see for 5 minutes on 1 fateful night ONLY! however, unlike this idiot, this young woman, even though she still took 1 1/2 yrs., concluded, by REALLY listening and observing me, that i was right all along: not bipolar. mdd. 6 months later she moved away.
out of the remaining dozen, i'd rate one other 3 stars, at best. another comes in at 2 stars.
one was so bad in his 'treatment' of me that my therapist, who sits on the advisory board, got a black mark put against him, for all the good that may do - now. i'm sure that someday enough black marks will accumulate, and his license will be pulled.
i will never again go to a pdoc. so sorry that i must be this discourgaing. i have, quite simply, given up. i work with only my therapist and my gp.
good luck in your search!
pulse
Posted by Think1234 on June 15, 2006, at 19:15:25
In reply to re: finding good pdoc; Groupthink. » Think1234, posted by pulse on June 15, 2006, at 6:20:16
You found 14 good Pdocs. Well thats very encouraging. Where I live there aren't a lot of Pdocs. Maybe you live in a large metrapolitan area where there is more access to good Pdocs.
I wonder if the Bipolar label is used to skirt difficulties/issues/liabilities with using unconventional medications like Antipsychotics with nonpsychotic disorders.
The widespread use of of anti-psychotics, which are so horribly dangerous for nonpsychotic disorders. Is one example of the mass failure of psychiatry as a whole.
A recent study found the 1 in 5 children seen by a psychiatrist are given antipsychotics. Thats very scary.
> absolutely, groupthink is at the heart of the matter. excellent post!
>
> btw, i, too, was - at age 40 (14 yrs ago) - put in that same infamous bipolar box, when my original dx of major depression with several types of anxiety was and IS still correct.
>
> far as finding a good pdoc, i've seen 14 in 26 yrs.
>
> the 1st (i was 28) was a man in his late 60's, who'd practiced for years. he was well known for falling asleep during sessions, and being beyond eccentric. (he never fell asleep on me). i'd still (he's since, of course, died) rate him 5 stars. he KNEW his diagnoses, and had a real way with matching the correct med/s with the person. magical, in comparison to so very many, nowadays.
>
> over these 14 yrs. of mis-diagnosis, let's see - i was:
> bpI w/rapid cycling; then perhaps it was bpIII, never bpII..hmmm, and, finally - boy, they did NOT want to admit their error - bp NOS. i loved that one!
>
> the only other pdoc, and 20 yrs. later than the 1st, that i'd rate 5 stars, was a 30-something woman. mind, i was still in the bipolar box. in my case - i sincerely believe - that was simply because it got put on my record by a hospital on-call pdoc, whom i had the great misfortune to see for 5 minutes on 1 fateful night ONLY! however, unlike this idiot, this young woman, even though she still took 1 1/2 yrs., concluded, by REALLY listening and observing me, that i was right all along: not bipolar. mdd. 6 months later she moved away.
>
> out of the remaining dozen, i'd rate one other 3 stars, at best. another comes in at 2 stars.
>
> one was so bad in his 'treatment' of me that my therapist, who sits on the advisory board, got a black mark put against him, for all the good that may do - now. i'm sure that someday enough black marks will accumulate, and his license will be pulled.
>
> i will never again go to a pdoc. so sorry that i must be this discourgaing. i have, quite simply, given up. i work with only my therapist and my gp.
>
> good luck in your search!
>
> pulse
Posted by pulse on June 16, 2006, at 4:14:11
In reply to re: finding good pdoc; Groupthink. » pulse, posted by Think1234 on June 15, 2006, at 19:15:25
NO! i found only TWO good pdocs - 20 years apart - out of the FOURTEEN that i've seen, in coming up on THIRTY years.
i'd call that: VERY discouraging!
i lived in a rural area for the first 15 years of this, then out of state - also rural, then back here to the business district of my original home town, then, lastly, in a suburban area near said town - all an hour or more's drive from a major city.
i have no clue what 'they' are doing now with bipolar and the whole spectrum deal - nor why. earlier, i thought of the bipolar spectrum concept as novel, exciting, and with much promise; now i see it as just too much...an ever-increasing hodge-podge, to explain the unexplainable, with great promise for yet more garbage can diagnosing. bpII is the (current) dx du jour.
i don't doubt you have a point re: liability.
pulse
Posted by Think1234 on June 16, 2006, at 14:54:54
In reply to re: finding good pdoc; Groupthink. » Think1234, posted by pulse on June 16, 2006, at 4:14:11
My bad, I read through your post very superficially. 14 seemed peculiarly high. It was the first line "as far as finding a good pdoc, i've seen 14 in 26 yrs." That threw me. Yes 14, goes against common sense and would imply that you must have met a ton of Pdocs.
Its bipolar "mania" its seems for a lot of psychiatristics. So does that mean everyones' "manic" or are they the ones who are "manic"?
I wonder if its possible to arrange to have a good Pdoc by scheduling long distance phone calls. And having them send the prescription by phone. I'm sure its been done before, but I wonder how easy it is.
> NO! i found only TWO good pdocs - 20 years apart - out of the FOURTEEN that i've seen, in coming up on THIRTY years.
>
> i'd call that: VERY discouraging!
>
> i lived in a rural area for the first 15 years of this, then out of state - also rural, then back here to the business district of my original home town, then, lastly, in a suburban area near said town - all an hour or more's drive from a major city.
>
> i have no clue what 'they' are doing now with bipolar and the whole spectrum deal - nor why. earlier, i thought of the bipolar spectrum concept as novel, exciting, and with much promise; now i see it as just too much...an ever-increasing hodge-podge, to explain the unexplainable, with great promise for yet more garbage can diagnosing. bpII is the (current) dx du jour.
>
> i don't doubt you have a point re: liability.
>
> pulse
Posted by gardenergirl on June 16, 2006, at 20:25:27
In reply to re: finding good pdoc; Groupthink. » Think1234, posted by pulse on June 16, 2006, at 4:14:11
Pulse,
If you are in need of a new pdoc, email me or babblemail me, and I might be able to help. I love mine, although she's closer to downtown than she is to your neck of the woods. But I've also worked with some in our area, and I have opinions (of course!) about some of them.gg
Posted by linkadge on June 17, 2006, at 1:47:35
In reply to PDocs aren't greedy, Just too much Groupthink., posted by Think1234 on June 13, 2006, at 20:10:33
I agree with what you said. The worst thing for a psychiatrist is insult of the drugs. The drugs are seen as flawless. If there is a problem with somebody who takes a drug, it is the fault of the patient and not the drug.
This leads patients down the garden path. More drugs, more disability.
Linakdge
Posted by linkadge on June 17, 2006, at 1:58:54
In reply to re: finding good pdoc; Groupthink. » pulse, posted by gardenergirl on June 16, 2006, at 20:25:27
I don't understand it. Cocaine was once prescribed for nervous depression. The negitive effects were probably eventually less deniable due to its short half life and such.
Anyhow, back then, did we start to think that all of these people were latently psychotic, and that cocaine was just lifting it to the surface?
What is the principle action of cocaine? It's a serotonin reuptake inhibtor.
Some studies that are arising now are showing that SSRI's can activate some of the genes that are switched on in mania and by stimulants. PKC, CLOCK, GRK, etc. Theres enough people wondering about these substances that millions of dollers are put into studies to determine whether they can induce mania / rapid cycling etc.
I think they are a failure as a whole. Without the SSRI's though, psychiatry would fall to the ground. That is why every attempt is made to sweep all the dust under the carpet, and keep things all looking clean on the surface.
Linkadge
Posted by fuchsia on June 17, 2006, at 7:38:18
In reply to re: finding good pdoc; Groupthink., posted by linkadge on June 17, 2006, at 1:58:54
> I don't understand it. Cocaine was once prescribed for nervous depression. The negitive effects were probably eventually less deniable due to its short half life and such.
>
> Anyhow, back then, did we start to think that all of these people were latently psychotic, and that cocaine was just lifting it to the surface?
>
> What is the principle action of cocaine? It's a serotonin reuptake inhibtor.
>
> Some studies that are arising now are showing that SSRI's can activate some of the genes that are switched on in mania and by stimulants. PKC, CLOCK, GRK, etc. Theres enough people wondering about these substances that millions of dollers are put into studies to determine whether they can induce mania / rapid cycling etc.Sigh. My first second and third mixed episodes correlated exactly with antidepressant treatment. Now I'm bipolar II, rapid cycling. I haven't exactly been out of the house much these last 5 years.
Who is spending these millions of dollars? I wouldn't think that pharmaceutical companies would be keen to show that SSRIs caused a bipolar epidemic.
Posted by pulse on June 17, 2006, at 8:03:53
In reply to re: finding good pdoc; Groupthink. » pulse, posted by gardenergirl on June 16, 2006, at 20:25:27
thanks much, gg!
i may EMAIL you at some time, possibly soon. today, however, i have a bad sinus headache that i have no solution for.
i already have a great therapist with 2 nursing degrees (she whips out her latest copy of the nursing version of the pdr and we peruse together.) she is also a mentor. also, i have a great gp who has 300 psych patients, and who did volunteer work at a transitional living place for the severely menatlly ill. he knows more than than all but the 2 GOOD pdocs i mentioned i've ever had.
i WOULD love to hear some of your opinions.....perhaps more than anything else.
again, thanks. very kind of you.
pulse
Posted by pulse on June 17, 2006, at 8:20:46
In reply to Getting a good Pdoc by phone appointment? » pulse, posted by Think1234 on June 16, 2006, at 14:54:54
no biggie. i figured as much. i *think* i can see how my wording could have been read 2 different ways in that one line.
re: pdocs are the ones who are bipolar? dunno/ could be. do know that i call my gp tripolar and he loves it. he's a real card, and an old man, being that he's exactly 4 days older than me. we have alot in common, and i strongly suspect he's a 'work -cure' depressive. please see my above post to garden girl - if you feel like not reading it superficially, of course - for abit more about why my gp is my 'pdoc' solution of choice.
don' know about pdocs, but my therapist has already agreed to consult with me by phone, in the event that i move 3,000 miles away.
Posted by pulse on June 17, 2006, at 10:06:53
In reply to re: finding good pdoc; Groupthink., posted by linkadge on June 17, 2006, at 1:58:54
> I don't understand it. Cocaine was once prescribed for nervous depression. The negitive effects were probably eventually less deniable due to its short half life and such.
>
> What is the principle action of cocaine? It's a serotonin reuptake inhibtor.linkage, i had NO idea of this - cocaine's principle action is as a serotonin reuptake inhibitor???!!!
reason i ask is that i now believe i do have the nervous type of mdd - always have - just wrote my therapist email about this 2 days ago. what a timely post your's is.
my 'drug of choice' was cocaine. sorry, perhaps you'll view this as disgressing, but i'm now forced to go on yet another rant about rehab tx centers. you'll see why:
so often, they suggest/ PUSH wellbutrin as the best bet for ALL types of depressive cocaine 'addicts.' i do have a friend for whom it worked well, but alcohol is actually his 1st-line 'drug of choice,' that, then, inevitably (although that time frame varies) leads him in pursuit of cocaine. he only has dysthymia, compare to my mdd, and i now suspect, he has alot of sp, which is SO very common for those that self-medicate with alcohol, then unfortunately usually either become binge or daily drinkers. in contrast, i have no sp, whatsoever.
i've never craved alcohol, nor liked it's effects. also, quite simply, it makes no sense whatsoever, since alcohol is such a well-known depressant.
***so, so much for the gene theory, since alcoholism runs on both sides of my family*** (yes, i realize that it's been proven, but i simply don't believe this so-called proof. the studies have to be flawed).
my foremost point is - this tx center disease model/ 'thinking' led me directly down the dopamine ADs seeking trail. i feel so hood-winked, now, and yet again. one wonders how often CAN they believe the total opposite of what is truth/ what WILL work!
i know you hate the ssris, but for me, prozac was fabulous, and for many, many years, until i could no longer take the gi side-effects, that now never diminish - this being 'fairly' recently. so, this surely tends to strongly support your assertion re: cocaine being a serotonin reuptake inhibitor.
btw, ssris have never once induced one iota of mania/ nor hypomania in me. now, i wouldn't suggest putting anyone on prozac when they are 2 days off crack!, but that's a substantially different matter. the original paxil would be the best one, at that point, then a switch to prozac - in my opinion, backed up directly by my own experience.
thank you,
pulse
Posted by heaven help me on June 17, 2006, at 11:39:08
In reply to bear with me... » linkadge, posted by pulse on June 17, 2006, at 10:06:53
nm
Posted by linkadge on June 17, 2006, at 21:46:50
In reply to bear with me... » linkadge, posted by pulse on June 17, 2006, at 10:06:53
Yeah, I believe cocaine inhibits the uptake of all three monoamines, serotonin norepinephrine and dopamine.
But, I do believe it is a slightly stronger serotonin uptake inhibitor than dopamine or norepinephrine reuptake inhibitor.
Wellbutrin, otoh is really only a very weak dopamine uptake inhibitor, that is why it probably lacks abuse potential.
To kick cocaine, you might do well on prozac and methyphenidate. (Even methylphenidate is not as reinforcing/rewarding as cocaine, since it has minimal serotonin uptake inhibition). Methylphenidate does not consistently or readily substitiute for cocaine.
It is seeming that the rewarding properties of cocaine are a combination of its serotonin and dopamine uptake inhibition.
Linkadge
Posted by pulse on June 17, 2006, at 21:58:33
In reply to Ive been DX BP2 and its meds work for me, am I?nm, posted by heaven help me on June 17, 2006, at 11:39:08
not sure if you meant in subject line >> it's << ...or 'if.'
sure, you can have BPII. it's just so often over-dxed these days. that's all i meant by my 'dx du jour' comment. it can STILL be borderline personality disorder only, instead.
some may have both.
i believe it's far too often happening, as a result of a payback pdocs are getting throttled with by their borderline only clients. then, said pdocs finally say, 'enough - UNCLE.'
it's gotten so bad, it's likely that the new dsm will re-name borderline pd - get this - 'emotional dsyregulation syndrome.' medicalizing a behavioral disorder, with all the negative ramifications to safety/ other for our society that this change will have, is sure to end up - a big step...backwards.
when there are hundreds of net sites FOR bpds, but only a couple for their victims or targets, any rational person would have to conclude things are sorely out of balance.
if meds do work for you, don''t fix what's not broken.
pulse
Posted by Deneb on June 17, 2006, at 22:08:53
In reply to Re: Ive been DX BP2 and its meds work for me, am I » heaven help me, posted by pulse on June 17, 2006, at 21:58:33
Posted by Caedmon on June 18, 2006, at 9:29:23
In reply to Re: PDocs aren't greedy, Just too much Groupthink., posted by Deneb on June 13, 2006, at 21:03:56
> Am I naive to think that pdocs aren't money-hungry pseudo-scientists? >
No, I don't think this is naive at all. I've had good experiences with pdocs, although my n is only 3. When I read some of what "online" pdocs write, I'm impressed by their thoughtfulness.
Believe me there are some cruddy PCPs out there too.
Part of the problem is the generalizations here.
- Chris
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