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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Jet on January 26, 2002, at 22:43:59
A rather long post - but please read – I need the help before I see my doc this Tuesday!
I am a woman in my 40’s and have struggled with depression and hormonal problems since I was in my teens. In the past few years I have been diagnosed with ADD and dysthmyia by my pdoc. I have been taking Dexedrine for a few years and have tried many different AD’s over the last 15 years of which none have worked. The only one that even came close to helping at all was Wellbutrin. The only positive thing that came out of that medication was that I quit smoking (8 years ago)! And that was years before they used it for that reason. Anyway, the stims help me to focus and function on a daily basis when I am not in my down time.
A few months ago, I told my pdoc that I could not feel myself going into my “down times” which vary in length, but usually last anywhere from 7-14 days, but I could always feel myself pulling out of them. It was as though my thoughts would begin to change and become more positive and my head would clear. He then thought that I was bi-polar and started me on Topamax. That was 3 months ago and I must say that I have improved. I did have to keep increasing my dosage though because I did have 2 really bad times along with many livable mini bad times in between. I am now up to 350-mil daily and will go to 400 and stay there for a while. I take this along with my dex, although I don’t always take the dex 3 times a day because my heart gets to beating irregularly and I blame it on the dex. So, I try to just take it once in the morning and then only again in the afternoon if I am having a tough time focusing or am feeling really bad.
After reading these boards I became very interested in the idea of treating depression with opiates or pain meds. Whenever I have taken pain meds (usually Percocet) I have gotten such a calm, normal feeling from them. I have often wondered, “If I could just take this, instead of all the other stuff, I would be able to live a normal life”. So, I asked my pdoc the other day if he would prescribe them to me and he looked at me as if I was nuts. I then told them how “normal” they made me feel. He informed me that it was because of my ADD! I didn’t get that at all and he didn’t explain. He just told me that wherever I had gotten them in the past, I would have to continue to get them there. What troubles me is: I have been seeing him for 15 years and nothing else has worked for me and he knows it! I have been depressed for most of my adult life and I have never given up trying to find a way to crawl out of my depression – so why should he give up on me? I told him that it was not my fault that my brain is this way! He didn’t seem to care. Why should he? His brain is fine and he makes a lot of money off my brain not working! He may be up on the latest meds, but the only thing that he has shared with me in 15 years that has worked for me is Topamax! Pathetic. Why must we have to become our own doctors? They are getting the $$$ per hour to treat us and be the experts! This just is not right! It is time for me to move on to a new pdoc that will work with me to help me feel better and not just take my $$$. I am sick of being sick!!!
I am now going to ask my medical doc for the meds and need some advice from you Elizabeth, since you seem to be the most knowledgeable on this issue. How should I approach her? She is from Europe and I am hoping is more open-minded than he was. She gave them to me in the past for an injury, so I am hoping that she will do so for this. I don't know if she will be brave enough to prescribe me Buprenorphine, but I am going to ask her anyway. I am going to ask her if she will call Dr. Bodkin. Do you think he will talk with her? I really would appreciate your input here. I see her next Tuesday. I know that these are only your opinions and I promise to take them as such. The questions I have for you are:
Do you think that I should try the Buprenorphine or stay with the Percocet?
What is Buspar?
Will my doc be able to prescribe the Buprenorphine from a regular pharmacy?
Can I take Buprenorphine on a “as needed” basis?
What is the best dopamine agonist in your opinion?
Will the Buprenorphine mix ok with Topamax and Dexedrine?
If I can’t get the opiates, I may have to try the other meds to try to stay on an even keel and keep from going into the black hole. I am open to any advice from all of you smart, self-educated, well-read, wonderful people on this board. TSAWest has already given me a start in the right direction, thank you very much! I have been researching the drugs you suggested and did ask my pdoc about the Mirapex – his negative response is below.
The Topamax (this week anyway) is working ok, but I am also in my “normal” time at the moment. I never have Big highs, just break even enough to let the meds work is how I see it. But when the lows come, the meds don’t even touch me. I drag myself around by the seat of my own pants, wishing I were in bed sleeping. My head feels like it weighs as much as a 16-pound bowling ball. I could go on, but you all seem to know how it feels. When the Topamax works too well sometimes, it makes me feel jittery/nervous and over-aggressive. Other Topamax side effects include: sex drive is now non-existent, vision is blurry and my eyes look like my mothers all of the sudden – and she is 72, I’ve lost 25 pounds (which was ok), hands, feet, face very sensitive to cold, hand & feet get pins & needles sometimes, this feeling has improved with time though.
I asked my pdoc about adding Mirapex and he said that it could cause psychosis or psychotic-like behavior. I am so leery of that type of reaction and side effects. I work a full-time job and am afraid of experimenting with these types of drugs when I don’t know what kind of reaction I’ll have to them. At least with the opiates, I know how my body will react.
I find all of you on this board so amazing! Thanks for taking your valuable time to help people on this board. I have learned more from reading this board than I did going to my pdoc for 15 years! Any advice and/or suggestions will be appreciated. Bless all of you.
Posted by TSA West on January 27, 2002, at 1:12:23
In reply to Buprenorphine or Percocet? , posted by Jet on January 26, 2002, at 22:43:59
On Mirapex and the risk of psychosis:
"Age appears to increase the risk of hallucinations attributable to pramipexole. In the early Parkinson’s disease patients, the risk of hallucinations was 1.9 times greater than placebo in patients younger than 65 years and 6.8 times greater than placebo in patients older than 65 years. In the advanced Parkinson’s disease patients, the risk of hallucinations was 3.5 times greater than placebo in patients younger than 65 years and 5.2 times greater than placebo in patients older than 65 years."
Posted by Elizabeth on January 30, 2002, at 14:28:59
In reply to Buprenorphine or Percocet? , posted by Jet on January 26, 2002, at 22:43:59
> What troubles me is: I have been seeing him for 15 years and nothing else has worked for me and he knows it!
My guess is that he's scared to prescribe opioids. They're not "normal" for a pdoc to prescribe, and many doctors are afraid that if they prescribe the "wrong" drugs or "too many" of the controlled drugs that are labelled for psychiatric indications (like amphetamines and benzos) then the state medical board will get wind of it (perhaps through some well-meaning pharmacist). He might also be concerned that since you have ADD and perhaps bipolar disorder, you might be at risk for addiction.
> I have been depressed for most of my adult life and I have never given up trying to find a way to crawl out of my depression – so why should he give up on me?
I know how you feel. :-(
> How should I approach her?
I never know how to answer that question (although I've posted in response to some other people who asked it in the past so evidently I did come up with an answer at some point -- you might want to check the archives). I think some doctors are just too rigid to be convinced, even when it is the only right thing to do. If they're not, just telling them what you've said here might be enough, I think -- how you need opioids to feel "normal" and to function normally, how you've tried all sorts of other things with no success and now are having only limited success with Topamax, how you feel like your pdoc is "giving up" on you.
> I don't know if she will be brave enough to prescribe me Buprenorphine, but I am going to ask her anyway.
Mention its advantages compared to other opioids. The main disadvantages are the difficult formulation (people have found ways around that, and she could always show you how to give yourself an IM injection) and the fact that retail pharmacies don't normally carry it (they would have to special-order it, which they can do).
> I am going to ask her if she will call Dr. Bodkin. Do you think he will talk with her?
He seems to have been willing to talk to people's doctors about this, so I would guess yes.
> I really would appreciate your input here. I see her next Tuesday.
I'm not sure which Tuesday you mean here -- am I too late?
> Do you think that I should try the Buprenorphine or stay with the Percocet?
Percocet isn't a good choice, since it has Tylenol in it. You'd want something that has only oxycodone in it (such as OxyContin). I think it's better to try buprenorphine first; if it doesn't work or causes problems you can't manage, discontinuing it is likely to be less troublesome than discontinuing oxycodone would be.
> What is Buspar?
A serotonin type 1a receptor partial agonist. Labelled for anxiety, has a reputation for being ineffective.
> Will my doc be able to prescribe the Buprenorphine from a regular pharmacy?
Yes, although the pharmacy will have to order it (which can take a couple of days).
> Can I take Buprenorphine on a “as needed” basis?
Yes.
> What is the best dopamine agonist in your opinion?
Direct, or indirect? (If you're including indirect agonists, I'd say Dexedrine.)
> Will the Buprenorphine mix ok with Topamax and Dexedrine?
Should be fine.
I hope this helps. Let us know how it goes and what you decide.
-elizabeth
Posted by MB on January 31, 2002, at 1:45:57
In reply to Re: Buprenorphine or Percocet? » Jet, posted by Elizabeth on January 30, 2002, at 14:28:59
My dog had surgery years ago and was given butorphanol (not the Stadol spray, but a sick tasting syrup). I decided to give it a try. Boy was it weird. I wonder if it would have any antidepressant effects??
Posted by Elizabeth on February 1, 2002, at 23:30:01
In reply to Is this off topic? Has anyone tried Stadol?, posted by MB on January 31, 2002, at 1:45:57
> My dog had surgery years ago and was given butorphanol (not the Stadol spray, but a sick tasting syrup). I decided to give it a try. Boy was it weird. I wonder if it would have any antidepressant effects??
I wouldn't expect so. It might for some people, though -- who knows?
-elizabeth
This is the end of the thread.
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