![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 40. This is the beginning of the thread.
Posted by g_g_g_unit on October 17, 2011, at 5:07:02
so nearly 3 weeks after my relatively unspectacular 'cry for help', I saw a psych professor for a second opinion today. surprisingly, his sentiments echoed every other stuffy, close-minded psychiatrist I've encountered - namely, despite your lifelong, evidently comprising difficulties with attention, you don't have ADHD (??), but you do suffer from OCD and depression.
anyway, I thank God for my primarily psychiatrist - who recognizes my attentional difficulties, but who's now out of prescribing ideas.
I'm taking 15mg of Lexapro and 500mg of Depakote. I feel numb, dissociated and can't really read or focus. Stimulants kinda help but increase anxiety too much. The professor recommended I increase the Lexapro to 20mg, switch the Depakote for 10-15mg of Zyprexa and stay completely away from psychostimulants.
I know part of my is just being an uncompliant jerk, but I just fail to see how Zyprexa is going to help my social anxiety (which he insisted it will), or my anhedonia, apathy and disastrous executive function. I kinda figured it would just make all that stuff worse? he also said it's "highly unlikely" that I experienced akathisia on only 25mg of Seroquel.
2 weeks 'til my doc gets back. haven't left bed since I got home from the appointment 5 hours ago. there just doesn't seem to be any end in sight..
Posted by g_g_g_unit on October 17, 2011, at 5:21:15
In reply to what a jip, posted by g_g_g_unit on October 17, 2011, at 5:07:02
the guy also said he didn't think MAOIs were a good idea because they can cause low blood pressure (as opposed to being concerned about a hypertensive crisis...!). the guy was like 70-something years old .. I would've thought MAOIs would be right up his alley.
Posted by SLS on October 17, 2011, at 5:53:48
In reply to what a jip, posted by g_g_g_unit on October 17, 2011, at 5:07:02
> so nearly 3 weeks after my relatively unspectacular 'cry for help', I saw a psych professor for a second opinion today. surprisingly, his sentiments echoed every other stuffy, close-minded psychiatrist I've encountered - namely, despite your lifelong, evidently comprising difficulties with attention, you don't have ADHD (??), but you do suffer from OCD and depression.
What symptoms of ADD/ADHD do you experience?
- Scott
Posted by g_g_g_unit on October 17, 2011, at 6:10:46
In reply to Re: what a jip » g_g_g_unit, posted by SLS on October 17, 2011, at 5:53:48
as a child:
severe addiction to video games, no tolerance for ordinary play activities (sports, etc.), tried to pick up e.g. guitar but would never practice until like an hour before my next lesson, arduously slow reader
I have no recollection of my subjective academic experience prior to high school; I (was) academically gifted, so I don't doubt I could have slipped through the cracks, at least until high school where I was increasingly dependent on others to fill me in on what happened during lessons, fell behind in lit. assignments because I could barely get through entire books, couldn't concentrate for more than 30-45 minutes, finished all my homework in the car on the way to school, had no impulse control, etc.
things got even worse in college, and I only had my first outbreak of OCD at 19, so I don't see any other logical explanation .. my mother is a fullblown (undiagnosed) case, ditto with grandfather, and all my brothers show sx. the professors tenuous theory was that bullying contributed to social (and hence intellectual) withdrawal, which is an exaggeration of how I described my social difficulties.
I'm disappointed because I was hoping he would create some regime that took psychostimulants (or hell, even Reboxetine or Strattera) into account.
Posted by Christ_empowered on October 17, 2011, at 6:32:39
In reply to Re: what a jip » SLS, posted by g_g_g_unit on October 17, 2011, at 6:10:46
hey man. Please realize that psychiatry isn't exactly a science. I was told at a mental hospital/detox facility that I wasn't bipolar. I overheard workers talking about my case during the night, and apparently the theory was that I was narcissistic and "trying to be cool" by...being bipolar. I still don't get it, honestly. A couple years later, I was hospitalized and told I was (wait for it...wait for it) Bipolar I w/ Psychotic Features.
I don't get the zyprexa either. I take Abilify because I hear voices. I think some sort of psychosis should be required for docs to justify long term use of neuroleptics. They are tranquilizers, though (old psychiatric text books refer to their actions on patients as one of "de-activation", marked by apathy and indifference, along with some sedation with lower potency drugs), so he might just be trying to get you to calm down and care less. Maybe he thinks a dose of apathy will do you good? I personally wouldn't take it, especially if you're already on depakote. That's like a bipolar I/schizoaffective combo right there, and those combos can make you feel like crap (trust me on that one).
Stimulants can help OCD. Stimulants can help depression. Its weird to me that they won't at least try wellbutrin or straterra or something. Maybe they're afraid of triggering anxiety?
I'd find somebody else. Personally, I prefer female shrinks with lots of experience. They're not as ego-driven and hard to work with as male shrinks, and they tend to be more willing to listen to your ideas. Younger shrinks in general tend to be all about the atypicals and their own egos, so avoid them.
Posted by SLS on October 17, 2011, at 6:39:51
In reply to Re: what a jip » SLS, posted by g_g_g_unit on October 17, 2011, at 6:10:46
> as a child:
>
> severe addiction to video games, no tolerance for ordinary play activities (sports, etc.), tried to pick up e.g. guitar but would never practice until like an hour before my next lesson, arduously slow readerAll of this was true of me as well. Depression hit me at a very young age, and most definitely was responsible for the symptoms you describe. Your doctor might be right.
There are some good psychometric tests that can tease out true ADD/ADHD. Perhaps you should be evaluated using one.
- Scott
Posted by g_g_g_unit on October 17, 2011, at 6:58:45
In reply to Re: what a jip » g_g_g_unit, posted by SLS on October 17, 2011, at 6:39:51
the thing is I don't really recall experiencing any of these symptoms in conjunction with a low mood .. I was reasonably happy as a kid, sporadic bullying not included ..
I have had psychometric testing done while responsive to an AD and it showed an incongruously low processing speed (bottom 20th percentile) and very poor executive functioning, which my psychologist at the time thought was highly indicative of ADHD.
>
> All of this was true of me as well. Depression hit me at a very young age, and most definitely was responsible for the symptoms you describe. Your doctor might be right.
>
> There are some good psychometric tests that can tease out true ADD/ADHD. Perhaps you should be evaluated using one.
>
>
> - Scott
Posted by SLS on October 17, 2011, at 7:20:08
In reply to Re: what a jip » SLS, posted by g_g_g_unit on October 17, 2011, at 6:58:45
> > All of this was true of me as well. Depression hit me at a very young age, and most definitely was responsible for the symptoms you describe. Your doctor might be right.
> >
> > There are some good psychometric tests that can tease out true ADD/ADHD. Perhaps you should be evaluated using one.> the thing is I don't really recall experiencing any of these symptoms in conjunction with a low mood .. I was reasonably happy as a kid, sporadic bullying not included ..
Bullying really sucks. I had my share, too.
> I have had psychometric testing done while responsive to an AD and it showed an incongruously low processing speed (bottom 20th percentile) and very poor executive functioning, which my psychologist at the time thought was highly indicative of ADHD.
ADD/ADHD is sometimes comorbid with OCD, so I don't doubt that you can have both. Did you ever present your doctor with the results of psychometric testing?
- Scott
Posted by Chairman_MAO on October 17, 2011, at 7:38:04
In reply to oh yeah, posted by g_g_g_unit on October 17, 2011, at 5:21:15
> the guy also said he didn't think MAOIs were a good idea because they can cause low blood pressure (as opposed to being concerned about a hypertensive crisis...!). the guy was like 70-something years old .. I would've thought MAOIs would be right up his alley.
You mean the low blood pressure which psychostimulants can correct? I do not expect most doctors to ever work with this combination, but it can be a lifesaver and it is not nearly as dangerous as it is made out to be.
I do not see how Zyprexa could increase someone's capacity to feel pleasure.
Best of luck.
Posted by Chairman_MAO on October 17, 2011, at 7:43:53
In reply to Re: what a jip, posted by Christ_empowered on October 17, 2011, at 6:32:39
> I'd find somebody else. Personally, I prefer female shrinks with lots of experience. They're not as ego-driven and hard to work with as male shrinks, and they tend to be more willing to listen to your ideas. Younger shrinks in general tend to be all about the atypicals and their own egos, so avoid them.I have not noticed much of a gender difference. What I have noticed is that I have a good rapport with those not born in this country, in their 60s or older, and who call themselves psychopharmacologists and not psychiatrists.
I live in the county I live in mainly in order to be able to see this guy at a charity care clinic. (he is a professor at the affiliated university)
I don't know what I'd do without him.
Posted by g_g_g_unit on October 17, 2011, at 7:59:11
In reply to Re: what a jip, posted by Christ_empowered on October 17, 2011, at 6:32:39
> hey man. Please realize that psychiatry isn't exactly a science. I was told at a mental hospital/detox facility that I wasn't bipolar. I overheard workers talking about my case during the night, and apparently the theory was that I was narcissistic and "trying to be cool" by...being bipolar. I still don't get it, honestly. A couple years later, I was hospitalized and told I was (wait for it...wait for it) Bipolar I w/ Psychotic Features.
>
> I don't get the zyprexa either. I take Abilify because I hear voices. I think some sort of psychosis should be required for docs to justify long term use of neuroleptics. They are tranquilizers, though (old psychiatric text books refer to their actions on patients as one of "de-activation", marked by apathy and indifference, along with some sedation with lower potency drugs), so he might just be trying to get you to calm down and care less. Maybe he thinks a dose of apathy will do you good? I personally wouldn't take it, especially if you're already on depakote. That's like a bipolar I/schizoaffective combo right there, and those combos can make you feel like crap (trust me on that one).Sorry to hear about your crazy run-ins with the world of psychiatry .. Trying to be cool? That's whack!
I know .. this is kinda turning into sob-story-of-the-week with me, but yeah, I don't particularly get Zyprexa either. I must admit, my OCD is *crippling* and I have to be on something to treat it. But his justification, in part, for Zyprexa was that it would help treat social anxiety. Maybe if you were strung out and paranoid? but since most of my SA is due to just not really having much to say to anyone, I didn't see how Zyprexa could help that.
Lexapro alone controls my anxiety enough. The problem is that I can't tolerate stimulants even while on it, but that issue wasn't really addressed today.
> Stimulants can help OCD. Stimulants can help depression. Its weird to me that they won't at least try wellbutrin or straterra or something. Maybe they're afraid of triggering anxiety?
Yeah, he said my response to Dexedrine was too erratic (sometimes sleepy, sometimes anxious) to bother using it. I made a list of all my responses to various drugs .. Strattera had some +s, but it did cause a lot of agitation like all the stims do .. but he never really read it very thoroughly.
>
> I'd find somebody else. Personally, I prefer female shrinks with lots of experience. They're not as ego-driven and hard to work with as male shrinks, and they tend to be more willing to listen to your ideas. Younger shrinks in general tend to be all about the atypicals and their own egos, so avoid them.
>I was just there for a second opinion. My primary psych. isn't ego-driven at all .. he's a psychotherapist, so quite the opposite in fact. But he is very intent on me being in psychotherapy with him - nevertheless, I'm hesitant because meds often get pushed aside for therapy and my day-to-day life quality is so poor right now. Regardless, he's the only one I've met who's listened to my story about attentional issues (rather than too-quickly writing them off as OCD-related.
It's good you brought that up though, because I'd been wondering if I'd be better off seeing someone younger .. I saw one young guy prior to immigrating who was great - very professional, easy-to-talk-to, knew his stuff (put me on Nardil after 2 other meds failed .. didn't leave me on the SSRI-go-round).
I've seen one woman in her 50s who was similar (knew her stuff, not afraid of prescribing limitations), but a total egomaniac. Also saw an older woman who ran a private hospital, but she was very prim and humorless and misdiagnosed me with schizophrenia .. so yeah ..
Posted by g_g_g_unit on October 17, 2011, at 9:06:03
In reply to Re: what a jip » Christ_empowered, posted by Chairman_MAO on October 17, 2011, at 7:43:53
> those not born in this country,
Why do you think this makes a difference? (FWIW, the ego-maniac who I saw was Russian, though like I say, she did seem highly knowledgeable, albeit somewhat ruthless, in her clinical method).
Posted by Phillipa on October 17, 2011, at 10:49:12
In reply to Re: what a jip » Christ_empowered, posted by Chairman_MAO on October 17, 2011, at 7:43:53
Hope you are right about older as have been seeing a pdoc in 70's for year kind of let me say what I'd like to try. Now she's retiring and see a new pdoc here Wednesday and scared he's 65. Hope he is not benzo phobic as over 41 years on them is a long time and will not take an ap. Diabetes in family. Phillipa
Posted by Chairman_MAO on October 17, 2011, at 15:52:15
In reply to Re: what a jip » Chairman_MAO, posted by g_g_g_unit on October 17, 2011, at 9:06:03
> > those not born in this country,
>
> Why do you think this makes a difference? (FWIW, the ego-maniac who I saw was Russian, though like I say, she did seem highly knowledgeable, albeit somewhat ruthless, in her clinical method).Because they aren't as indoctrinated about which drugs are "good" or "bad". I'm sure I'm making too broad a generalization, but it has been my overall experience.
The guy I see is definitely not an ego-maniac, and he will prescribe MAOI + psychostimulant, but will not do long-term benzo (or that is the story as of now at least). He does not have a problem prescribing benzos PRN. He used to give me lorazepam 2mg #30 (for unwinding before bed and sleep) no problem.
Honestly, I don't like being on a benzo if I don't have to be; they dull my cognition. I kinda regret getting dependent on clonazepam again, although I wish he'd just let me reduce the dose instead of eliminate it completely. We'll see, I'm not sure that it's set in stone ...
Being physiologically dependent on benzos is something I'd like to avoid if possible because you never know when circumstances might change and someone will cut you off.
Posted by Phidippus on October 17, 2011, at 17:25:18
In reply to what a jip, posted by g_g_g_unit on October 17, 2011, at 5:07:02
>despite your lifelong, evidently comprising difficulties with attention, you don't have ADHD (??), but you do suffer from OCD and depression.
ADHD is so hard to diagnose on a dime. OCD and depression, are easier to spot.
> I'm taking 15mg of Lexapro and 500mg of Depakote. I feel numb, dissociated and can't really read or focus.
Lexapro is kinda low. Needs to be in the 40 mg range. You're that spaced out from Depakote? Don't be a baby.
>Stimulants kinda help but increase anxiety too much.
This is not always true. I take a nifty little drug called Vyvanse. Doesn't cause me any anxiety at all.
>The professor recommended I increase the Lexapro to 20mg, switch the Depakote for 10-15mg of Zyprexa and stay completely away from psychostimulants.
> I know part of my is just being an uncompliant jerk, but I just fail to see how Zyprexa is going to help my social anxiety (which he insisted it will), or my anhedonia, apathy and disastrous executive function.Zyprexa may help a little with the Anhedonis
>he also said it's "highly unlikely" that I experienced akathisia on only 25mg of Seroquel.
I agree
You have the wrong Idea. Sampling new medications is fun!
P
Posted by jono_in_adelaide on October 17, 2011, at 19:38:57
In reply to what a jip, posted by g_g_g_unit on October 17, 2011, at 5:07:02
Can I suggest that you try taking Lexapro in whatever dose your doctor recomends, and add to it Edronax (reboxetine) 4mg twice a day.
It is a noradrenalin reuptake inhibitor, helps restore drive and pleasure and improves social functioning..... for me it was lifesaving in combination with an SSRI.
Posted by creepy on October 17, 2011, at 19:41:08
In reply to what a jip, posted by g_g_g_unit on October 17, 2011, at 5:07:02
I also have depression that overlaps ADD and its anyones guess which is causing the problems.
I do well on stims but the anxiety sucks.Have you tried all of the common ADD meds? strattera, ritalin, adderall, dexedrine? I found dexedrine was a little easier on anxiety.
Posted by jono_in_adelaide on October 17, 2011, at 19:45:40
In reply to Re: what a jip, posted by creepy on October 17, 2011, at 19:41:08
www.reboxetine.com
"....Reboxetine (Edronax) is a relatively well-tolerated, relatively selective "noradrenergic" agent. Crudely, whereas serotonin plays a vital role in anxiety and mood, noradrenaline is essential to maintaining drive, self-assertiveness and the capacity for reward. There's a fair bit of evidence that chronically depressive people have dysfunctional and atypical noradrenergic systems - particularly their alpha 2- and beta-adrenoceptors
Posted by jono_in_adelaide on October 17, 2011, at 19:57:43
In reply to Re: what a jip, posted by jono_in_adelaide on October 17, 2011, at 19:45:40
Also, dodnt write off Zyprexia until you've tried it..... I'm not psychotic, just "neurotic", but found that a low dose (1mg at night)of risperidone helped me through a bad patch by reducing anxiety and stopping the intrusive negative thoughts.
I would realy push for a trial of Edronax, (you're in Australia, right?) or Bupropion
Posted by Chairman_MAO on October 17, 2011, at 20:49:42
In reply to Re: what a jip, posted by creepy on October 17, 2011, at 19:41:08
Dexedrine tends to calm me down overall, but it's much better still with an MAOI (Nardil is the one I combined it with). The drug was more effective and there was hardly any anxiety at all.
I am dysthmic, ADD/ADHD, and have suffered from social phobia/anxiety since age 0.
I am very lucky that I have someone willing to prescribe this combination. I went off of Nardil and am now beginning with Marplan, so I have to have the Dexedrine started off low and raised again over many months ... ugh, but I'm not complaining [too much], at least I have someone willing to do it.
I share all this because the MAOI + Dexedrine is literally the only thing that every worked 100% for me.
Posted by g_g_g_unit on October 18, 2011, at 2:22:44
In reply to Re: what a jip » g_g_g_unit, posted by Phidippus on October 17, 2011, at 17:25:18
> ADHD is so hard to diagnose on a dime. OCD and depression, are easier to spot.
Sure, but that shouldn't be grounds for immediate dismissal, especially when I've been working with my current pdoc (an ADHD specialist) for 5+ months now.
>
> > I'm taking 15mg of Lexapro and 500mg of Depakote. I feel numb, dissociated and can't really read or focus.
>
> Lexapro is kinda low. Needs to be in the 40 mg range. You're that spaced out from Depakote? Don't be a baby.I don't think it's the Depakote. All SSRIs space me out and worsen my inattentiveness.
> This is not always true. I take a nifty little drug called Vyvanse. Doesn't cause me any anxiety at all.
Pity, 'cos it isn't available where I hail from.
> >he also said it's "highly unlikely" that I experienced akathisia on only 25mg of Seroquel.
>
> I agree
>
Based on what? I'm well familiar with akathisia at this point; it was unmistakable.> You have the wrong Idea. Sampling new medications is fun!
I suppose, though I'd rather be like reading new books and stuff.
Posted by g_g_g_unit on October 18, 2011, at 2:25:56
In reply to Re: what a jip, posted by jono_in_adelaide on October 17, 2011, at 19:38:57
> Can I suggest that you try taking Lexapro in whatever dose your doctor recomends, and add to it Edronax (reboxetine) 4mg twice a day.
>
> It is a noradrenalin reuptake inhibitor, helps restore drive and pleasure and improves social functioning..... for me it was lifesaving in combination with an SSRI.I asked my GP about Edronax today. He said it can be pretty agitating, and I have a really bad track record with NE-ergic drugs. That said, your idea of maybe trying a higher SSRI dose and then adding a stimulant seems most logical, though I hate the lack of deep sleep SSRIs cause - I do feel more dissociated the higher I raise the dose.
Did the SSRI counter the anxiety from Edronax?
Posted by g_g_g_unit on October 18, 2011, at 2:31:57
In reply to Re: what a jip, posted by jono_in_adelaide on October 17, 2011, at 19:57:43
> Also, dodnt write off Zyprexia until you've tried it..... I'm not psychotic, just "neurotic", but found that a low dose (1mg at night)of risperidone helped me through a bad patch by reducing anxiety and stopping the intrusive negative thoughts.
>
> I would realy push for a trial of Edronax, (you're in Australia, right?) or BupropionI haven't completely written off APs. I was angry because I went to see this guy for a supposedly 'comprehensive' review of my meds and sx., which should have taken the attention issues into account.
If I was strictly going to treat anxiety, I'd just stick with the Lexapro and not bother with an AP, since it's doing an okay job on its own; the problem though is that I currently have a 5 year old's attention span and can't read much, keep track of conversations, or finish anything. Plus, I made notes on all my med reactions, including problems like RLS and akathisia I frequently experience, which were the precise reasons my psych is hesitant to just try a high SSRI dose and which this guy just ignored. It was a waste of time. $400 to be told to just add Zyprexa.
Posted by bleauberry on October 18, 2011, at 5:27:04
In reply to what a jip, posted by g_g_g_unit on October 17, 2011, at 5:07:02
I'm always a bit hesitant with "academia" types. That's just me. I prefer the "real world" types.
Anyway, I can easily see how the meds you are taking...all by themselves...would cause the very problems you are complaining of. A flood of serotonin (lexapro) aint gonna help cognition in any way. Depakote certainly is going to worsen it.
I like the zyprexa idea except with one catch. That is, lexapro needs to be switched out for prozac. In my own experience, zyprexa+prozac was excellent for cognition, ADHD stuff, ADD stuff, obsessions, depression, anxiety. The only fogginess I had from it was early in treatment and first thing in the morning. Lexapro + zyprexa did not have those same qualities for me. There is something special about the prozac/zyprexa team which cannot be duplicated with other SSRIs.
If your doctors are not going to help with stimulants, and you are not willing to find new doctors, then you still have choices. They are in the botanical medicines, not man made medicines. Ones I am thinking of include:
Rhodiola Rosea
Eleuthero root (siberian ginseng, not a true ginseng)
CordycepsSmall amounts of DLPA or tyrosine could be helpful and are cheap enough to experiment to see if good or bad. They will lead to more production of the same neurotransmitters the stimulants increase.
Of all the options, including meds, the one I favor the most is Rhodiola. Another one, not very well known, and not usually thought of in terms of psychiatric stuff or your particular symptoms is Resveratrol (the kind from Japanese Knotweed, not the kind from grapes). Perfect brand is the 40mg version yellow bottle from Source Naturals. I mention this one because it does a ton of stuff to help...anti inflammation, soaks up toxins, potent antioxidant, on and on.... A friend of mine started taking it just for general brain/heart health and said for the first time in his life he can now remember where he set his car keys every day. It has cleared up a lot of my lyme brain fog. And it's a very good antimicrobial too, so you might not every catch a cold or flu again. Dittos for Rhodiola the same.
Adrafanil. You can study up on and order this one by yourself. I was on it for a few years and I can say from my own experience it is a good choice for what your complaints are. It increased my anxiety for about a week and then after that things just got better and better as the weeks and months went by. And that was with only 150mg starting dose and 300mg maintenance dose, which is only 1/3 of the full dose.
So anyway, in this post are some solid ideas for you to work with. No need to feel trapped or jipped.
> so nearly 3 weeks after my relatively unspectacular 'cry for help', I saw a psych professor for a second opinion today. surprisingly, his sentiments echoed every other stuffy, close-minded psychiatrist I've encountered - namely, despite your lifelong, evidently comprising difficulties with attention, you don't have ADHD (??), but you do suffer from OCD and depression.
>
> anyway, I thank God for my primarily psychiatrist - who recognizes my attentional difficulties, but who's now out of prescribing ideas.
>
> I'm taking 15mg of Lexapro and 500mg of Depakote. I feel numb, dissociated and can't really read or focus. Stimulants kinda help but increase anxiety too much. The professor recommended I increase the Lexapro to 20mg, switch the Depakote for 10-15mg of Zyprexa and stay completely away from psychostimulants.
>
> I know part of my is just being an uncompliant jerk, but I just fail to see how Zyprexa is going to help my social anxiety (which he insisted it will), or my anhedonia, apathy and disastrous executive function. I kinda figured it would just make all that stuff worse? he also said it's "highly unlikely" that I experienced akathisia on only 25mg of Seroquel.
>
> 2 weeks 'til my doc gets back. haven't left bed since I got home from the appointment 5 hours ago. there just doesn't seem to be any end in sight..
>
>
Posted by SLS on October 18, 2011, at 5:45:43
In reply to Re: what a jip, posted by creepy on October 17, 2011, at 19:41:08
> I also have depression that overlaps ADD and its anyones guess which is causing the problems.
> I do well on stims but the anxiety sucks.
>
> Have you tried all of the common ADD meds? strattera, ritalin, adderall, dexedrine? I found dexedrine was a little easier on anxiety.
>I would add desipramine to this list.
- Scott
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