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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 55. Go back in thread:
Posted by SLS on May 4, 2011, at 6:09:38
In reply to Re: School and psychiatric illness, posted by mtdewcmu on May 3, 2011, at 23:53:07
> > More alarming is that, after accidents, suicide is the most common cause of death among medical students.
>
> That statistic is not that alarming, because accidents and suicide are the leading killers of everyone at that age (http://www.cdc.gov/injury/wisqars/pdf/Death_by_Age_2007-a.pdf). I don't mean to rip on your article, Scott, but I hate dumb statistics.I understand. I guess the statistic that I found pursuasive was:
"Depression is even more common in medical students and residents, with 15-30% screening positive for depressive symptoms"
This is in comparison to 10% of the general population. What we don't know is if the statistic described by the article is either:
1. Lifetime prevalence.
2. 12 month prevalence.http://www.nimh.nih.gov/statistics/1MDD_ADULT.shtml
Despite debatable statistics, I really believe (at least for now) that the chronic stress of medical school and residency precipitates MDD at a greater rate than what is seen in the general population.
- Scott
Posted by SLS on May 4, 2011, at 6:14:06
In reply to Re: School and psychiatric illness » mtdewcmu, posted by SLS on May 4, 2011, at 6:09:38
> > > More alarming is that, after accidents, suicide is the most common cause of death among medical students.
> >
> > That statistic is not that alarming, because accidents and suicide are the leading killers of everyone at that age (http://www.cdc.gov/injury/wisqars/pdf/Death_by_Age_2007-a.pdf). I don't mean to rip on your article, Scott, but I hate dumb statistics.
>
> I understand. I guess the statistic that I found pursuasive was:
>
> "Depression is even more common in medical students and residents, with 15-30% screening positive for depressive symptoms"
>
> This is in comparison to 10% of the general population. What we don't know is if the statistic described by the article is either:
> 1. Lifetime prevalence.
> 2. 12 month prevalence.
>
> http://www.nimh.nih.gov/statistics/1MDD_ADULT.shtml
>
> Despite debatable statistics, I really believe (at least for now) that the chronic stress of medical school and residency precipitates MDD at a greater rate than what is seen in the general population.It occurs to me that the statistic cited by the article is latitudinal, not longitudinal. I believe this is a valid criteria for comparing populations.
- Scott
Posted by mtdewcmu on May 4, 2011, at 11:03:28
In reply to Re: School and psychiatric illness » mtdewcmu, posted by SLS on May 4, 2011, at 6:09:38
> "Depression is even more common in medical students and residents, with 15-30% screening positive for depressive symptoms"
>
> This is in comparison to 10% of the general population. What we don't know is if the statistic described by the article is either:
> 1. Lifetime prevalence.
> 2. 12 month prevalence.
>That one is surprising and significant. They probably administered a questionnaire to med students as a screen, asking about current symptoms. So it's probably closer to 12 month prevalence.
> http://www.nimh.nih.gov/statistics/1MDD_ADULT.shtml
>
> Despite debatable statistics, I really believe (at least for now) that the chronic stress of medical school and residency precipitates MDD at a greater rate than what is seen in the general population.
>No, I agree. You can sort of reverse-engineer these articles and figure out what went into them. It was probably written by a writer who is not an epidemiologist and was using mostly canned statistics. It doesn't mean that all of them are useless, or that the main thrust of the story is off-base. But, of course, I would double-check the statistics.
Posted by mtdewcmu on May 4, 2011, at 11:17:21
In reply to Re: School and psychiatric illness » mtdewcmu, posted by SLS on May 4, 2011, at 6:09:38
Thinking about it some more, the writer of that article must have been looking at a statistic for the prevalence of suicide among medical students. So the statistic itself may have been meaningful, but the writer missed the significance of it.
Posted by linkadge on May 4, 2011, at 16:38:37
In reply to Re: School and psychiatric illness, posted by mtdewcmu on May 3, 2011, at 23:39:14
Higher status jobs are often associated with higher pay. Perhaps the high pay acts as a buffer against stress.
Linkadge
Posted by Phillipa on May 4, 2011, at 19:48:33
In reply to Re: School and psychiatric illness, posted by SLS on May 3, 2011, at 23:32:00
SLS read the article. There are those organizations for docs and nurses as well. Some and will speak of RN's only are discovered abusing drugs or diverting them and go before a state Nursing Board who may revoke their license for a period of time or put restrictions on what meds they can dispense to patients controlled meds no for a period of time while they go though a program designed for medical professions and at completion go back to work some still can't dispense controlled substances for a period of time. I worked with one RN instructor that was in said program and succeeded and when back to teaching, My own boss in psych lost his license twice for narcotic and alchohol abuse. When he returned we just helped him out. Interestingly these RN's were given Supervisory jobs and not penalized after completing the programs. A similar one is available for Docs also. I heard dentists had the highest suicide rate of medical professionals. When working estimately more than half the RN staff was on some sort of med for depression or anxiety. Just my experience. When I myself made my first med error ever and took narcotic keys home by mistake I stopped workining and went on disability as I thought too much of my patients to think I could be a risk to their healthcare. I'm just happy that I did have 15 years of charge nurse experience the highlight of my life for sure as never thought I could do it. And I did. For that I'm grateful. During Nursing school since had anxiety my pdoc said I shouldn't do it but I wanted to and did it graduating magna c*m laude. With scholarships for last year of RN School. Phillipa ps in no way am I even suggesting you made the wrong decision for you as we are all different and we should know our limits.
Posted by SLS on May 4, 2011, at 20:54:40
In reply to Re: School and psychiatric illness » SLS, posted by Phillipa on May 4, 2011, at 19:48:33
Phillipa.
I don't understand your post. I find it difficult to parse. Is it your contention that your long history of MI issues has nothing to do with the early stresses of going to nursing school and working as an RN? It seems to me that you are the ideal example of how chronic stress can precipitate a MI. I'm glad you are happy with your choices. One could make the argument that you have traded your mental health for a career choice. This is precisely what my doctors at the NIH had warned me about.
- Scott
> SLS read the article. There are those organizations for docs and nurses as well. Some and will speak of RN's only are discovered abusing drugs or diverting them and go before a state Nursing Board who may revoke their license for a period of time or put restrictions on what meds they can dispense to patients controlled meds no for a period of time while they go though a program designed for medical professions and at completion go back to work some still can't dispense controlled substances for a period of time. I worked with one RN instructor that was in said program and succeeded and when back to teaching, My own boss in psych lost his license twice for narcotic and alchohol abuse. When he returned we just helped him out. Interestingly these RN's were given Supervisory jobs and not penalized after completing the programs. A similar one is available for Docs also. I heard dentists had the highest suicide rate of medical professionals. When working estimately more than half the RN staff was on some sort of med for depression or anxiety. Just my experience. When I myself made my first med error ever and took narcotic keys home by mistake I stopped workining and went on disability as I thought too much of my patients to think I could be a risk to their healthcare. I'm just happy that I did have 15 years of charge nurse experience the highlight of my life for sure as never thought I could do it. And I did. For that I'm grateful. During Nursing school since had anxiety my pdoc said I shouldn't do it but I wanted to and did it graduating magna c*m laude. With scholarships for last year of RN School. Phillipa ps in no way am I even suggesting you made the wrong decision for you as we are all different and we should know our limits.
Posted by Phillipa on May 4, 2011, at 21:44:36
In reply to Re: School and psychiatric illness » Phillipa, posted by SLS on May 4, 2011, at 20:54:40
Scott the exact opposite as if I'd stayed home and done nothing I would have always felt I'd done nothing to improve myself or give to society, be able to support myself and my children, move to another state with them buy a big house, boat, pool in back yard all paid for by me. I was fine off benzos for a long time until menopause, lymes disease all found at the same time. I was 50 or so by then. Oh the hasimotos thyroidistis same time period. As my then current pdoc said too much going on now. Why not get out of nursing. Did biggest mistake of my life as if I'd stayed in and fought would have my self reliance. And as I worked each day I became stronger. Was my physical body that broke down. Now 65 but can see what I did and know I accomplished something worth while. Otherwise what an icky life I would have had as was soooo happy when working. Darn getting old and body systems breaking down including my back. Phillipa hope it's clearer now. Reduced to working ebay not my cup of tea. But it keeps my mind and creativity flowing at least.
Posted by mtdewcmu on May 4, 2011, at 23:49:42
In reply to Re: School and psychiatric illness » Phillipa, posted by SLS on May 4, 2011, at 20:54:40
> Phillipa.
>
> I don't understand your post. I find it difficult to parse. Is it your contention that your long history of MI issues has nothing to do with the early stresses of going to nursing school and working as an RN? It seems to me that you are the ideal example of how chronic stress can precipitate a MI. I'm glad you are happy with your choices. One could make the argument that you have traded your mental health for a career choice. This is precisely what my doctors at the NIH had warned me about.
>Scott,
Your understanding of Phillipa's career seems to be that it would have some kind of cumulative effect and worsen her MI over time. I worked in nursing. I never achieved the level of nurse, as I took a job as a nurse aide with the plan of going to nursing school and then moving up, and after finishing school I changed my plans. But I experienced the flow of it and got to know the nurses. If you are a bedside nurse, each shift is self-contained. You don't take any responsibility or stress from one shift to the next. So there is no buildup of stress from the work. It gets exciting when your patients have emergencies or a lot of orders, and then there is stress in the moment, but you either deal with it or not in that shift and then your responsibility ends. So I did not find it to be the kind of job where the stress would eat away at you and precipitate MI. The only source of that is your relationships and politics with the staff (which was my downfall).
I think most of the time a career as a doctor involves the kind of stress that lingers and eats away at you to one degree or the other. It's probably better in emergency medicine. But most of the time doctors have the same patient for a span of time, and they are more responsible for the outcome. That, and I'm sure there is paperwork and other responsibilities. So, being a doctor is probably a different ballgame. But the feeling you have after working a heavy rotation in nursing is somewhere between finishing up a triathlon and coming back from combat, where your side didn't take any casualties. It's generally a positive feeling.
Posted by SLS on May 5, 2011, at 5:18:44
In reply to Re: School and psychiatric illness, posted by mtdewcmu on May 4, 2011, at 23:49:42
Yes. Thanks for the explanations.
A friend of mine didn't become depressed until after she enrolled in the nursing program and UNC. She had become sick enough to prompt her doctors to administer ECT.
At this point in time, it seems that we can't predict who will become ill and who will remain healthy when the same psychosocial stress is applied. Soon, though, I imagine genetic testing will be able to quantify risk.
- Scott
Posted by mtdewcmu on May 5, 2011, at 12:25:51
In reply to School and psychiatric illness » Phillipa » mtdewcmu, posted by SLS on May 5, 2011, at 5:18:44
> Yes. Thanks for the explanations.
>
> A friend of mine didn't become depressed until after she enrolled in the nursing program and UNC. She had become sick enough to prompt her doctors to administer ECT.
>
Nursing school is something else entirely. It can be a miserable experience. I guess sort of like how military training tries to expose you to some measure of the stress of combat. You deal with your weaknesses in school so you don't have to discover them when the stakes are high.I would have most likely had a far better time in nursing school if I had had Dexedrine though. What made it a struggle was leaving things to the last minute, or past the last minute. I took a lot of advantage of the late policy. With effective treatment, I should have breezed through.
Med school is probably even harder, though, because the material is at a level of detail and pace to challenge people who were already highly successful in high school and undergrad. It must be everything nursing school is, plus more. And the atmosphere is more competitive. Nursing students have more of a team mentality. The sheer thought of having to excel in college for 4 years, then get through another 4 years of med school, then be ready for more years of punishment in residency -- while spending monumental sums with no guarantee of any return -- that scares me.
Posted by Phillipa on May 5, 2011, at 19:18:12
In reply to Re: School and psychiatric illness, posted by mtdewcmu on May 5, 2011, at 12:25:51
I took my time with RN school started in Associates Program made Dean's List but didn't like that others were being cut for staying home with sick kids as an example. So my decision was to finish my college courses drop the RN program and then take Nursing by itself which I did. First Class of RN for Diploma in hospital setting. They were very tolerant of absenses due to above. Only had to attend three days a week so wasn't stressful. We had a great time met our patients the night before doing our clinicals. When graduated given a choice as second best to work in L&D or full time Psych Days at another hospital. I chose that. But decided might lose my skills so switched to a Union Hospital and worked three days evenings 3-11 and got full time benefits all paid for. If we got sick the ER promptly saw us and provided free care. If I needed more money I asked at the beginning of my shift if another was needed later and always was so got Double time and hence full time pay. I also floated different floor each time worked and didn't have to get involved in the Politics. I had half a floor to be responsible for. But two years later moved to VA and there only had 4 patients a piece of cake after having about 24. So for me RN work was easy. I had learned to carry a heavy load in CT and then wow what a surprise a very nice one!!! Phillipa
Posted by Phillipa on May 5, 2011, at 19:31:44
In reply to Re: School and psychiatric illness, posted by Phillipa on May 5, 2011, at 19:18:12
Wanted to add my kids were almost also grown. And my only regret is I graduated one year to late to go to PA school. As if had graduated one year earlier only two years to become a PA. My up the street friend studied with her husband was the head of cardiology at a hospital and had a private practice with some others and begged me to get into cardiology. Ended up getting certified twice in Telemetry. Reading EKg's the measuring of PR's, Qrs's and All heart arrythymias with calipers when they used them now all done by machine. I loved school and studying and test taking guess was a Nerd. Phillipa
Posted by floatingbridge on May 6, 2011, at 3:03:47
In reply to PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by jmb2012 on April 30, 2011, at 20:21:15
You might have your scrip and be trialing Lyrica right now. If so, I hope it's working for you.
>
> THE GOOD:
> Profound improvement of mood and a slowing of my brain. I felt normal, above normal, I felt good. I was able to focus, socialize and enjoy pretty much whatever I was doing. I was the best, most functional, most charming, considerate and peaceful version of my self. If I could be like that all the time, I thought, I could face anything. It was incredible. I had never felt so normal and able to enjoy life. In other words I was on a drug. I wish my brain naturally was more like this. Alas. Over time the extremely short active life of GP began causing a roller coaster effect during the day. I would take it, 1-2 hours later I felt the lift of mood and increase of happiness/positivity. 2-3 hours after that I felt myself begin to plunge back into my normal state of blah/moodiness/keyed up adrenaline response. So I'd take it again and the cycle continued. A moderate tolerance developed but it was ok. Getting tears in my eyes while working the pediatric unit in the hospital had is drawbacks.
>
> THE BAD: Psychological, physical, both or otherwise- dependence has developed. I have NEVER been addicted to anything. I understand the process and condition much better now. You are free of your defective mind when high. The better part of you is able to rise and express itself. GP gets you functionally high. I get it now when junkies say " I'm sick man. I need my medicine". While I have not experienced any serious somatic (body) symptoms- jitteryness, some dizziness maybe-- I have DEFINITELY experienced psychological ones. It's either the contrast between my natural, base, mental state and my GP elevated state, straight up physical withdrawal symptoms or a combo of both but when that stuff wears off I am not happy. Everything comes rushing back in with the force of a torrent breaking through a dam.If you've struggled since childhood, relief in a pill seems like a miracle. It's smart of you to recognize your tendency to be preoccupied with it. Others have commented on this. I'm not convinced that neurontin is necessaryily a no-no yet. After years of enduring, maybe you are giddy. And maybe a longer acting version is warranted. Psychological dependence is influenced by frequency of dose. More pills reinforce the mentality of dependency.
The yo-yo effect you describe is not good and will introduce significant stress as you already know. This could reinforce the dependency /addiction model as well.
>
> *Briefly*: the mechanism of GP is still somewhat in question right? Recent studies however have identified it's activity on voltage gated ion channels- exerting a membrane potential and anti-"kindling" stabilizing effect. They also discovered it acts on a number of enzymes, the net result of which supposedly reduce GLUTAMATE synthesis and release while increasing GABA production and slowing or inhibiting its breakdown. GP's activity on glutamate metabolism strikes the strongest note with me. IT FEELS, no proof, that when the GP wears off the brain compensates for it's reduced glutamate load. That or like benzos the brain becomes unable to
properly regulate the GABA/GLUTAMATE inhib/excitatory balance. AGAIN THIS IS ALL SPECULATION. PLEASE SOUND OFF ON THIS IF ANY ONE CARES.
I don't quite understand this action. I'll need to look up glutamate. My gp
supplemented me with gaba and glutsmate during a lyrica trial that failed. I'm not sure she was aware of what you are speculating. I believe her decision was more random, like, you're stressed and fatigued. Here, take this, too.> FINAL: I am in love with this drug. I am
in love with the way it brings out my
best. It's like meditation/happiness in a pill. I will not be able to tolerate it's kinetics though so I am doing two things: 1. Getting an rx for Lyrica. This is not something I do lightly. I know that I am going to have the same if not worse dependence issues on pregab as I am
having with GP. BUT I cannot function
without some effective form of brain brakes. I have ordered some Dilantin in a last ditch effort to avoid going on a gaba drug. The scant evidence for low dose ( 100-150mg) efficacy in brain impulse control is appealing but un-conclusive.
We will see.
>
> That's it really. PLEASE comment or ask me questions. This is a huge post and I only burden this site with it because I have not seen many detailed GP/Agitated depression experiences posted.
>
> I pray that that the road I have traveled
so far can offer some assistance to others. If you are walking a similar path in similar shoes please comment. This is an incredible, horrible drug but I seem to need it.
> Thanks and blessings to those who listened. Our modern life is not natural. It puts stresses on our system we have
not had time to evolve into. I pray that peace comes to all of us.
>Unlike some other posters, I'm not sure Lyrica may be a good substitute. Yes, you could take less because it is more potent, but it is not identical to neurontin. For me to contribute more fully, I would need to have tried it. I will say Lyrica had severely compromised by cognitive function. Really.
As you weigh your treatment options, would you consider talking anonymously to a good addiction specialist or anyone qualified to address your *love* of neurontin. It could be it isn't right for you. It could be that it will work if you work with it with fuller awareness.
Btw, the gp I see became addicted to meds and wrote her own scrips. She survived, dried out, and is thriving.
Best of luck with everything. I like to think that there are doctors out there who can empathize with their patients enough to do a good job, and find the ways to remain strong in their own lives to continue to work and be reasonably happy. You are remarkably honest.
Good luck, and prayers sent back your way.
Posted by mtdewcmu on May 6, 2011, at 10:48:36
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression » jmb2012, posted by floatingbridge on May 6, 2011, at 3:03:47
> >
> > *Briefly*: the mechanism of GP is still somewhat in question right? Recent studies however have identified it's activity on voltage gated ion channels- exerting a membrane potential and anti-"kindling" stabilizing effect. They also discovered it acts on a number of enzymes, the net result of which supposedly reduce GLUTAMATE synthesis and release while increasing GABA production and slowing or inhibiting its breakdown. GP's activity on glutamate metabolism strikes the strongest note with me. IT FEELS, no proof, that when the GP wears off the brain compensates for it's reduced glutamate load. That or like benzos the brain becomes unable to
> properly regulate the GABA/GLUTAMATE inhib/excitatory balance. AGAIN THIS IS ALL SPECULATION. PLEASE SOUND OFF ON THIS IF ANY ONE CARES.
>So you favor an explanation involving glutamate over one involving GABA? Judging by the type of effect it causes, and the fact that other GABAergics have a similar effect, but there are no drugs with a well-established glutamatergic mechanism with a similar effect, I would lean toward GABA. And I'm not sure that digging into the (speculative) mechanism is the best way to explain the crash as the good effect wears off. Just like in chemistry, where Le Chatelier's principle explains everything, probably the vast majority of drugs that alter some natural equilibrium in the body tend to cause an overshoot in the opposite direction as they wear off. When the ups and downs affect your mood, it's usually a sign of a bad drug (for you at least).
Posted by creepy on May 8, 2011, at 0:26:09
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression » jmb2012, posted by B2Chica on May 2, 2011, at 12:39:27
I have agitated depression too. It feels like depression with somatic symptoms. general body pain and restlessness. I get really irritable especially when I have to do something I dont want to.
lexapro at 20mg did a good job on the agitation, but it made me totally apathetic. Zoloft has been really good on that but some of the depressive symptoms remain.
The only other drug that touched the anger was topamax.
Posted by SLS on May 8, 2011, at 6:18:32
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by creepy on May 8, 2011, at 0:26:09
> I have agitated depression too. It feels like depression with somatic symptoms. general body pain and restlessness. I get really irritable especially when I have to do something I dont want to.
> lexapro at 20mg did a good job on the agitation, but it made me totally apathetic. Zoloft has been really good on that but some of the depressive symptoms remain.
> The only other drug that touched the anger was topamax.Yes. I have seen Topamax work miracles on angry mixed-states and agitated depression; the two conditions being separate illnesses in my opinion. Trileptal or Tegretol might also help. Tricyclics have been noted to be particularly good for agitated depression in the absence of bipolar disorder. If the agitation is due to a mixed-state, a tricyclic can make the condition worse by triggering a manic reaction or inducing rapid cycling. Zoloft was a good choice, as it is known to ameliorate anger and hostility. I'm sorry it didn't work out for you. You are, of course, combining medications, right?
- Scott
Posted by floatingbridge on May 8, 2011, at 11:58:42
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression » creepy, posted by SLS on May 8, 2011, at 6:18:32
Scott and Creepy,
Topamax is being used (among other things) for ptsd, neuralgia, and fibromyalgia, the latter in cases of lyrica intolerance. I just looked it up and was surprised--. I'll bring it up with my own doctor.
The side effects seem relatively benign, yes? Cognitive impairment noted.
Posted by creepy on May 9, 2011, at 11:56:48
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression » creepy, posted by SLS on May 8, 2011, at 6:18:32
Yup, Im on 150mg zoloft, 150mg wellbutrin. Just raised zoloft back to 150 and I cant go higher on wellbutrin due to anxiety.
Trying to get doc to put me back on desipramine instead of wellbutrin but I dont think thats going to happen. Part of my problem is body pain and allergies and that med was really helpful.
I might ask about topamax again. The carb cravings have come back with a vengeance.
Posted by creepy on May 9, 2011, at 12:01:36
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression » SLS, posted by floatingbridge on May 8, 2011, at 11:58:42
I liked topamax a lot. The appetite reduction is a bug not a feature so it may not hit you. It helps with pain a bit and it can knock out irritation and rage for some folks.
Its used for PTSD which is why I was interested in it. But I never got to the dose level where it helped with hyperarousal since it made me cycle terribly.
The side effects I got were temporary paresthesia in the feet and I was pretty stupid at doses 50mg and higher. It didnt seem to mess with my reflexes but I had coordination issues.
My doc thinks Im making it up but I really do react to small doses of meds like this. It can be a PTSD trait apparently.
Posted by floatingbridge on May 9, 2011, at 16:19:20
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by creepy on May 9, 2011, at 12:01:36
Creepy, luckily I have docs who believe me about the med sensitivity. Maybe yours does, too, but still seems surprised by your sensitivity or just stumped. Is he helpful, regardless? I mean, I hope he kind of believes you. Isn't it crazy-making!
The whole ptsd/fibromyalgia/whatever shebang is really pushing doctors out of
their educational envelope. There are just too many folks presenting w/variations within a certain spectrum for doctors to remain completely blinded by skepticism.Jeez, I am still looking for a sane way to address pain. What is it you are doing now? I'm sorry I've lost track. Does anything help you with hyperarousal?
fb
Posted by mtdewcmu on May 9, 2011, at 16:26:55
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression » creepy, posted by floatingbridge on May 9, 2011, at 16:19:20
> The whole ptsd/fibromyalgia/whatever shebang is really pushing doctors out of
> their educational envelope. There are just too many folks presenting w/variations within a certain spectrum for doctors to remain completely blinded by skepticism.Fibromyalgia is just not well understood. You can't blame the docs' education for something where there's just not that much to teach. Isn't it rheumatologists that deal most closely with fibro? Anyone that claims to have all the answers on fibro has something to sell.
Posted by floatingbridge on May 9, 2011, at 18:00:12
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression » floatingbridge, posted by mtdewcmu on May 9, 2011, at 16:26:55
MtDew,
I don't see any problem with being pushed past one's envelope a bit. I've been required to do this many times. I think it's good practice.
The veterans coming back are what have really helped focus attention on what is a mysterious syndrome. That medicine
doesn't have the tools to deal is one thing. I don't expect miracles. But I am glad that the caseloads coming in have prompted new questions and new research. That's progress.On a personal level, I prefer that a doctor think something like, "How very curious. That woman can actually feel ill at the half the dose of flexeril that I regularly hand out to all my patients. Maybe there is another medication or approach that would be of
benefit?"I have also encountered, (highly condensed), "Now you're being ridiculous! All my patients take twice as much and in fact I have some abusing it! Say, you aren't abusing it, are you? Hmmmmm. Well I guess you are just too
sensitive to take medication. See me in six months."The two attitudes elicit different
results. Personally, I look for the
curiousity factor in a provider. That's usually a sign of a potentially good working relationship. If it were not for doctors and nurses plus other providers and medical intervention, I'd be dead, so I hope I do not sound ungrateful.
Posted by floatingbridge on May 10, 2011, at 0:01:05
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by creepy on May 9, 2011, at 11:56:48
Why the doc's thumbs down to desipramine?
> Yup, Im on 150mg zoloft, 150mg wellbutrin. Just raised zoloft back to 150 and I cant go higher on wellbutrin due to anxiety.
> Trying to get doc to put me back on desipramine instead of wellbutrin but I dont think thats going to happen. Part of my problem is body pain and allergies and that med was really helpful.
> I might ask about topamax again. The carb cravings have come back with a vengeance.
Posted by creepy on May 10, 2011, at 17:54:18
In reply to desapramine? Creepy » creepy, posted by floatingbridge on May 10, 2011, at 0:01:05
well initially she said it might be responsible for weight gain (uhh.. no). But the other day she expressed a dislike of polypharmacy so Im assuming thats what this is really about, she doesnt like multiple meds for multiple symptoms.
The only meds that might treat the pain and fatigue are the SNRIs with the extra NRI effect, but I am not going near those with a 10' pole.
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