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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 29. Go back in thread:
Posted by rjk on July 25, 2002, at 11:10:42
In reply to have not you posted this several times - oracle, posted by BekkaH on July 25, 2002, at 5:33:07
> Oracle,
>
> I see nothing wrong with rjk's re-posting the message. RJK is obviously in great distress and is looking for help as well as warning us about drug combinations. Some of us do well on drug combinations; unfortunately, I am not one of them. I have serious problems with almost all drug interactions, not just psychotropic drugs. This is probably due to genetic polymorphisms of the liver enzymes that metabolize these medications. Some people can become deathly ill on medication combos that don't bother others, and unfortunately, there are still many doctors out there that are unaware of the importance of learning about the potential dangers of drug interactions.
>
> BekkaYou are right on both counts. I feel absolutely terrible and dare not take any more meds. I also would hate to hear of someone else suffering in the way that I have due to some irresponsible quack! For people who are truly resistant to conventional treatment I am sure that combining meds can be a life saver, but for me it has wrecked my life.
Posted by cybercafe on July 26, 2002, at 1:29:07
In reply to have not you posted this several times - oracle, posted by BekkaH on July 25, 2002, at 5:33:07
>This is probably due to genetic polymorphisms of the liver enzymes that metabolize these medications. Some people can become deathly ill on medication combos that don't bother others, and unfortunately, there are still many doctors out there that are unaware of the importance of learning about the potential dangers of drug interactions.
is there anything a doctor can do to test a patient or know ahead of time?
Posted by rjk on July 26, 2002, at 5:51:48
In reply to Re: have not you posted this several times - oracle, posted by cybercafe on July 26, 2002, at 1:29:07
> >This is probably due to genetic polymorphisms of the liver enzymes that metabolize these medications. Some people can become deathly ill on medication combos that don't bother others, and unfortunately, there are still many doctors out there that are unaware of the importance of learning about the potential dangers of drug interactions.
>
> is there anything a doctor can do to test a patient or know ahead of time?
>
I don't know, but I don't think that was my problem. The problem was that I was not treatment resistant and I am convinced that it is simply a case of that combination of drugs being too strong for my brain to cope with and something had to give, which it did.
Richard
Posted by cybercafe on July 26, 2002, at 11:56:57
In reply to Re: How psychiatry wrecked my life. » cybercafe, posted by rjk on July 26, 2002, at 5:51:48
> > is there anything a doctor can do to test a patient or know ahead of time?
> >
> I don't know, but I don't think that was my problem. The problem was that I was not treatment resistant and I am convinced that it is simply a case of that combination of drugs being too strong for my brain to cope with and something had to give, which it did.hmmm... is this frequent at all? should other people beware of this specific combination? and is there anyway the doctor could have known that combining these medications can be so dangerous ?
Posted by rjk on July 26, 2002, at 13:41:44
In reply to Re: How psychiatry wrecked my life., posted by cybercafe on July 26, 2002, at 11:56:57
> > > is there anything a doctor can do to test a patient or know ahead of time?
> > >
> > I don't know, but I don't think that was my problem. The problem was that I was not treatment resistant and I am convinced that it is simply a case of that combination of drugs being too strong for my brain to cope with and something had to give, which it did.
>
> hmmm... is this frequent at all? should other people beware of this specific combination? and is there anyway the doctor could have known that combining these medications can be so dangerous ?
>
I don't think that most pdocs actually ever consider the possible risks. The one who advised me to take that combo has told me "there is no reliable scientific evidence that A/Ds or combos of A/Ds can cause any long term adverse effects". That is because there is no scientific evidence or research to say whether combos can or can't! The fact of the matter is that whenever a pdoc suggests a combo of drugs he is both experimenting and putting his patient at risk. A leading pharmacologist has actually written to me expressing his concern about the way pdocs combine drugs.
Posted by cybercafe on July 26, 2002, at 20:46:27
In reply to Re: How psychiatry wrecked my life. » cybercafe, posted by rjk on July 26, 2002, at 13:41:44
>me to take that combo has told me "there is no reliable scientific evidence that A/Ds or combos of A/Ds can cause any long term adverse effects". That is because there is no scientific evidence or research to say whether combos can or can't!
oh... does that mean you can sue the drug companies for not doing sufficient research? ... that's something i'd definately be interested in ;)
Posted by LostBoyinNC1 on July 27, 2002, at 20:32:46
In reply to Re: have not you posted this several times - oracle, posted by cybercafe on July 26, 2002, at 1:29:07
> >This is probably due to genetic polymorphisms of the liver enzymes that metabolize these medications. Some people can become deathly ill on medication combos that don't bother others, and unfortunately, there are still many doctors out there that are unaware of the importance of learning about the potential dangers of drug interactions.
>
> is there anything a doctor can do to test a patient or know ahead of time?
>
No. There are no tests in psychiatry
Posted by LostBoyinNC1 on July 27, 2002, at 20:51:11
In reply to Re: How psychiatry wrecked my life. » cybercafe, posted by rjk on July 26, 2002, at 5:51:48
> > >This is probably due to genetic polymorphisms of the liver enzymes that metabolize these medications. Some people can become deathly ill on medication combos that don't bother others, and unfortunately, there are still many doctors out there that are unaware of the importance of learning about the potential dangers of drug interactions.
> >
> > is there anything a doctor can do to test a patient or know ahead of time?
> >
> I don't know, but I don't think that was my problem. The problem was that I was not treatment resistant and I am convinced that it is simply a case of that combination of drugs being too strong for my brain to cope with and something had to give, which it did.
> RichardIt could have been anything. There is no way for anyone on this group to diagnose you or give you specifics about what wrong. Only guidance. I can tell you that if you were not on any anti-psychotic drug at the time you can eliminate EPS or movement disorder symptoms, which can sometimes mimic as drug interaction when combined with antidepressants. The liver enzyme thing, thats iffy no way to tell for sure.
Id suggest you get a second opinion from a decent psychiatrist, probably a "psychopharmacologist" who lives at least 100 miles away from your former psychiatrist's office. Get someone who listens, dont get a know it all Pdoc. And who does not personally know the guy who rx'ed you the combo you say gave you a hard time. If you get a second opinion, dont go to a guy who is in the same town your first psychiatrist lives in, cause all these guys know each other at the local level, and psychiatry isnt competitive in say, the way sports medicine is competitive. In other words, psychiatrists as a group are kind of like cops...they tend to cover for each other and sometimes wont admit what really happened in order to cover their buddy. Psychiatry is not very competitive, most Pdocs dont try to outdo each other very often.
Where your problems might have come from is a total misdiagnosis. You might be bipolar and simply not able to tolerate a heavy duty antidepressant combination like Remeron plus Effexor. A second opinion might be helpful. Or you could have been experiencing severe antidepressant activation and akathisia that was driving you up the wall. Maybe some benadryl to relieve initial antidepressant akathisia (agitation) or a benzo like klonopin would have helped you.
BTW, for unipolar treatment resistant depressives the Remeron plus high dose Effexor combo is well established. Read some of Stephen Stahl's psychopharmacology books under "unipolar treatment resistant depression" to see for yourself.
I myself found I had severe trouble doing polypharmacy starting when I tried combining a low dose atypical anti-psychotic with the antidepressant Remeron. For years after I tried combining various psych meds, unsuccessfully. I would just get agitated feeling after a week and feel more depressed. Finally after four years I discovered anti-EPS meds and discovered I could EASILY do polypharmacy if I took a parkinsons med like Cogentin or Amantadine, even though these meds have pain in the ass side effects which are hard to tolerate.
If I do the polypharmacy thing now, if I just combine a bunch of psych meds I feel better for a few days, then soon I "numb up" and start feeling like crap. I develop akathisia and worsened depression and feel like I want to climb the walls due to this physical agitation feeling I get. But throw in some Amantadine or Cogentin into the combo, and suddenly with a day Im fine.
>
Posted by rjk on July 28, 2002, at 12:19:52
In reply to Re: How psychiatry wrecked my life., posted by cybercafe on July 26, 2002, at 20:46:27
> >me to take that combo has told me "there is no reliable scientific evidence that A/Ds or combos of A/Ds can cause any long term adverse effects". That is because there is no scientific evidence or research to say whether combos can or can't!
>
> oh... does that mean you can sue the drug companies for not doing sufficient research? ... that's something i'd definately be interested in ;)
>
Probably not, because they do at least have to prove they are safe to get them licensed. However, according to my lawyer, when a pdoc advises a patient to combine drugs, they are exposing that patient to additional risk and unless there is very good reason to do so the pdoc can be deemed to be negligent.
Posted by rjk on July 28, 2002, at 12:21:48
In reply to Re: have not you posted this several times - oracle, posted by LostBoyinNC1 on July 27, 2002, at 20:32:46
Posted by LostBoyinNC1 on July 28, 2002, at 15:31:59
In reply to Why not? (nm) » LostBoyinNC1, posted by rjk on July 28, 2002, at 12:21:48
Most of the posters on this board are patients and consumers, not medical professionals. It would be impossible for anyone on here to definitively and decively tell you what exactly what wrong with your polypharmacy adventure. The best thing you can do is like I mentioned above. Get a second opinion from someone geographically outside your area who doesnt know your Pdoc. And contact an attorney who specializes in medical malpractice...maybe an attorney could direct you to more specialized help but its doubtful.
Psychiatric malpractice cases are notoriously subjective as I mentioned before and I hate to bust your bubble, but the odds are not in your favor. I know so, as Ive tried to do it myself.
Have you heard about Bush's recent speech here in Greensboro, NC? He came here to support Elizabeth Dole (Republican) in her upcoming NC Senate race. Jesse Helms is retiring in two years and Dole wants his spot in the NC Senate. Anyway, Bush specifically proposed tightening down the existing medical malpractice laws in the USA! He claims most medical malpractice suits are "junk" lawsuits and drive up the cost of medicine. What a crock. What really drives up the cost of medicine is the greedy insurance companies, who Bush is in bed with.
If you are a patient/consumer, things are not all red and rosy when it comes to medical malpractice lawsuits. The irony of it all is its extremely easy to get sued for things outside of medicine. But doctors and hospitals are pretty much protected thru layers of insurance industry anti-malpractice legislation.
Im not trying to criticize you or put you down, Im just trying to give you a realistic appraisal of the medical malpractice lawsuit situation in the USA. Its hard to do and even harder to win.
Posted by oracle on July 28, 2002, at 20:54:34
In reply to Re: have not you posted this several times - oracle, posted by LostBoyinNC1 on July 27, 2002, at 20:32:46
> > >This is probably due to genetic polymorphisms of the liver enzymes that metabolize these medications. Some people can become deathly ill on medication combos that don't bother others, and unfortunately, there are still many doctors out there that are unaware of the importance of learning about the potential dangers of drug interactions.
> >
> > is there anything a doctor can do to test a patient or know ahead of time?
> >
>
>
> No. There are no tests in psychiatry
There are lots of tests in psychiatry. Just none
for genetic polymorphisms of the liver enzymes or other
tests to match meds to a persons genetic structure.
At least not that are ready for clinical use.
Posted by LostBoyinNC1 on July 28, 2002, at 21:04:40
In reply to Re: have not you posted this several times - oracle, posted by oracle on July 28, 2002, at 20:54:34
> There are lots of tests in psychiatry. Just none
> for genetic polymorphisms of the liver enzymes or other
> tests to match meds to a persons genetic structure.
> At least not that are ready for clinical use.
>Name one test in psychiatry. There are no medical diagnostic tests in clinical psychiatry. None. Psychiatry has a few tests available to measure the amounts of some drugs in your system, like lithium level tests, tricyclic blood level tests but thats about it. They dont have any brain scans or blood tests available to help diagnose your dx. No psychiatrist has any tests to look at your brain and say "yep...your depressed cause this part of your brain is underactive and this part is overactive."
The only medical test I know psychiatrists do is checking lithium levels and sometimes TCA levels. Some, if you push them hard will check your thyroid but thyroid tests are not per se "psychiatric tests" they are endocrine tests developed originally by endocrinologists and internal medicine doctors.
Psychiatry is 50 years behind that of general medicine.
>
Posted by cybercafe on July 28, 2002, at 23:06:09
In reply to Re: have not you posted this several times - oracle, posted by LostBoyinNC1 on July 28, 2002, at 21:04:40
Tests? I thought they could test for metabolites in blood, urine, CSF...
... i thought they could test your response to various drugs... (cortisol suppression test?) ...... there is no one test that will tell them everything about you... but it can narrow things down...
Posted by LostBoyinNC1 on July 29, 2002, at 0:13:37
In reply to Re: have not you posted this several times - oracle, posted by cybercafe on July 28, 2002, at 23:06:09
> Tests? I thought they could test for metabolites in blood, urine, CSF...
> ... i thought they could test your response to various drugs... (cortisol suppression test?) ...
>
> ... there is no one test that will tell them everything about you... but it can narrow things down...Really? I was told repeatedly that there are no tests available in psychiatry which could really aide diagnosis. The cortisol suppression test, thats also called the dex something or other suppression test does have some value and was used back in the eighties a lot. But its been since been proven to not be exact or as useful as originally hyped. I never had a psychiatrist offer it to me before, probably it costs too much.
I wish psychiatry would develop some real tests to improve accurate diagnosing. Its sorely needed. Of course there are a few purely psychological tests like the Rorsach test (inkblot test) which is used to rule out psychosis. However its what is known as a "projection" test and is a subjective test developed by psychologists, not by Medical Doctors. Its not a medical test and is not objective. There are also other psychology tests to test cognition, these are called "neuropsychological" tests. Psychiatrists sometimes order neuropsychological testing to rule out dementia in certain patients. But again they are psychology tests developed by psychologists and dont really tell a psychiatrist anything he already didnt know by just talking to the patient.
The functional neuroimaging technology is probably the closest thing to real medical testing psychiatry has ever developed. Yet its not being used at the clinical levels of psychiatry, only at the elite teaching hospitals involved in advanced research. The average mental patient never gets one of these scans and even then, they are not perfected yet.
Ive been going to a psychiatrist for almost five years now and have yet to have one real medical test ordered by a psychiatrist, other than a routine EKG with blood drawn for a standard physical. If you want to call that testing for psych illness, well be my guest.
Posted by cybercafe on July 29, 2002, at 1:58:33
In reply to Re: have not you posted this several times - oracle, posted by LostBoyinNC1 on July 29, 2002, at 0:13:37
Hmmm... I wonder if a simple test could involve starting with an SSRI, if that doesn't work try a DRI and if that doesn't work try a NRI ... if you find two that work somewhat, up the dose or combine them ....of course now that i find there are at least very standard sequences of treatment for those who don't respond to their first med, i have a lot more confidence (i have seen quite a few similiar flow charts set out by different psychiatric associations)
Posted by oracle on July 30, 2002, at 0:02:08
In reply to Re: have not you posted this several times - oracle, posted by LostBoyinNC1 on July 27, 2002, at 20:32:46
here is what was said:
"No. There are no tests in psychiatry"
No one said anything about specific or medical. Seems everyone just proved there are tests.
MMPI is a test.All y'all do is spew hate.
Posted by cybercafe on July 30, 2002, at 0:17:41
In reply to Re: have not you posted this several times - oracle, posted by oracle on July 30, 2002, at 0:02:08
> All y'all do is spew hate.
i also have been known to eat pizza
Posted by LostBoyinNC1 on July 30, 2002, at 0:22:13
In reply to Re: have not you posted this several times - oracle, posted by oracle on July 30, 2002, at 0:02:08
> here is what was said:
>
> "No. There are no tests in psychiatry"
>
> No one said anything about specific or medical. Seems everyone just proved there are tests.
> MMPI is a test.Whats that? Some BS psychology test? A personality test or something? LOL Thats not a real test.
>
> All y'all do is spew hate.
Well there are a lot of serious problems in psychiatry. Someone's gotta get mad about it. If psychiatrists are going to go around telling their patients that severe depression "causes changes in their brains" they damn well better start getting some real medical tests made available. Diagnosis sucks in psychiatry...cause there arent any medical tests. These are brain diseases we are dealing with. We need some good objective type medical tests. Psychiatry needs to be brought into line with the rest of medicine. The rest of medicine relies heavily upon various medical tests. Psychiatry has nothing. Thats why people get misdiagnosed so often in this field.Subjective psychology tests, developed by psychologists doesnt cut it.
Posted by rjk on July 30, 2002, at 6:42:39
In reply to Re: Why not what rjk?, posted by LostBoyinNC1 on July 28, 2002, at 15:31:59
> Most of the posters on this board are patients and consumers, not medical professionals. It would be impossible for anyone on here to definitively and decively tell you what exactly what wrong with your polypharmacy adventure. The best thing you can do is like I mentioned above. Get a second opinion from someone geographically outside your area who doesnt know your Pdoc. And contact an attorney who specializes in medical malpractice...maybe an attorney could direct you to more specialized help but its doubtful.
>
> Psychiatric malpractice cases are notoriously subjective as I mentioned before and I hate to bust your bubble, but the odds are not in your favor. I know so, as Ive tried to do it myself.
>
> Have you heard about Bush's recent speech here in Greensboro, NC? He came here to support Elizabeth Dole (Republican) in her upcoming NC Senate race. Jesse Helms is retiring in two years and Dole wants his spot in the NC Senate. Anyway, Bush specifically proposed tightening down the existing medical malpractice laws in the USA! He claims most medical malpractice suits are "junk" lawsuits and drive up the cost of medicine. What a crock. What really drives up the cost of medicine is the greedy insurance companies, who Bush is in bed with.
>
> If you are a patient/consumer, things are not all red and rosy when it comes to medical malpractice lawsuits. The irony of it all is its extremely easy to get sued for things outside of medicine. But doctors and hospitals are pretty much protected thru layers of insurance industry anti-malpractice legislation.
>
> Im not trying to criticize you or put you down, Im just trying to give you a realistic appraisal of the medical malpractice lawsuit situation in the USA. Its hard to do and even harder to win.I live in England and I know that it is not that easy here, but the advice that I have been given so far is that I have a good case. I am not suggesting that combining meds is not right for some people, but in my case I was clearly incorrectly diagnosed. At the end of the day, if I succeed then I will probably be doing everyone a big favour for two reasons. Firstly, because I want to prove the point that combining meds does have a risk attached to it. Secondly, it may make psychiatrists a little more responsible towards their approach to combining meds and mine was positively irresponsible!
Posted by rjk on July 30, 2002, at 6:45:03
In reply to Re: have not you posted this several times - oracle, posted by LostBoyinNC1 on July 28, 2002, at 21:04:40
> > There are lots of tests in psychiatry. Just none
> > for genetic polymorphisms of the liver enzymes or other
> > tests to match meds to a persons genetic structure.
> > At least not that are ready for clinical use.
> >
>
> Name one test in psychiatry. There are no medical diagnostic tests in clinical psychiatry. None. Psychiatry has a few tests available to measure the amounts of some drugs in your system, like lithium level tests, tricyclic blood level tests but thats about it. They dont have any brain scans or blood tests available to help diagnose your dx. No psychiatrist has any tests to look at your brain and say "yep...your depressed cause this part of your brain is underactive and this part is overactive."
>
> The only medical test I know psychiatrists do is checking lithium levels and sometimes TCA levels. Some, if you push them hard will check your thyroid but thyroid tests are not per se "psychiatric tests" they are endocrine tests developed originally by endocrinologists and internal medicine doctors.
>
> Psychiatry is 50 years behind that of general medicine.
> >
>
I recently read that somewhere in the USA they are using fMRI scans to diagnose mental illness.
Posted by cybercafe on July 30, 2002, at 6:52:19
In reply to Re: Why not what rjk? » LostBoyinNC1, posted by rjk on July 30, 2002, at 6:42:39
>incorrectly diagnosed. At the end of the day, if I succeed then I will probably be doing everyone a big favour for two reasons. Firstly, because I want to prove the point that combining meds does have a risk attached to it. Secondly, it may make
dude i suppose having gone the multi-med route many times i am less empathetic of your plight than i should be, but i would be very very happy if you proved that doctors could be held responsible... and of course i would be very happy if you could start to put your life back together again... the thing is... i wonder why really serious stuff -- like people who are given ECT and get brain damage... or lobotomies... havn't gotten some serious compensation???????
Posted by rjk on July 30, 2002, at 7:15:38
In reply to Re: Why not what rjk?, posted by cybercafe on July 30, 2002, at 6:52:19
> >incorrectly diagnosed. At the end of the day, if I succeed then I will probably be doing everyone a big favour for two reasons. Firstly, because I want to prove the point that combining meds does have a risk attached to it. Secondly, it may make
>
>
> dude i suppose having gone the multi-med route many times i am less empathetic of your plight than i should be, but i would be very very happy if you proved that doctors could be held responsible... and of course i would be very happy if you could start to put your life back together again
>
> ... the thing is... i wonder why really serious stuff -- like people who are given ECT and get brain damage... or lobotomies... havn't gotten some serious compensation???????Good question. I think that they should, but with ECT, patients are warned in advance about the possible loss of memory. As far as I am aware, they also have to sign a consent form.
The thing is, what has really pissed me off is the arrogant, bigoted attitude of the shrink who advised me to take that combo. I have had enormous problems with meds since then and he has done nothing other than tell me that what I have been telling him cannot be true. Two years on it is now blatantly obvious that everything I have been telling him was true and he no longer wants me as a patient.
Posted by Dr. Bob on July 31, 2002, at 7:42:15
In reply to Re: have not you posted this several times - oracle, posted by oracle on July 30, 2002, at 0:02:08
> All y'all do is spew hate.
I know some people can be frustrating, but please don't post anything that could lead them to feel accused or put down. Thanks,
Bob
PS: Follow-ups regarding posting policies, and complaints about posts, should be redirected to Psycho-Babble Administration.
Posted by cybercafe on August 1, 2002, at 2:24:08
In reply to Re: Why not what rjk?, posted by rjk on July 30, 2002, at 7:15:38
> Good question. I think that they should, but with ECT, patients are warned in advance about the possible loss of memory. As far as I am aware, they also have to sign a consent form.
... i think that only applies to outpatients though....
> The thing is, what has really pissed me off is the arrogant, bigoted attitude of the shrink who advised me to take that combo. I have had
i totally hate that... i wish they would at least give you options...
>enormous problems with meds since then and he has done nothing other than tell me that what I have been telling him cannot be true. Two years
... you could definately get him in trouble for this (not addressing your concerns, but instead calling you a liar)
>on it is now blatantly obvious that everything I have been telling him was true and he no longer wants me as a patient.
in canada you cannot stop seeing a patient unless arrangements have been made for him to see another doctor
This is the end of the thread.
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