![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by jay on July 31, 2003, at 23:41:30
Well, I went to a 'professional' psychiatric evaluation today, that lasted about 2.5 hours, and there where two excellent psychiatrists. (Both youngish women, who I seemed more comfortable than with older men. They where both clincians and researchers.) We eventually got to talk of benzos, and the doctor who was the clinic director (and a world reknowned researcher) and I got talking about benzos. She refered heavily to reaserch, and 'observable, objective facts.' She said the only *real* concern with benzos is in people who have absued other substances. Even then, she said, they are often underutilized in a 'total treatment regiment' (that often includes a number of medications along with therapy of some sort) by doctors who often have little experience in research and modern medicine.(And that *includes* many, many psychiatrists!) Any good doctor can eventually pick up signs of abuse, she said, with the proper pre-cautions.
I then told her I had an 'excellent' response to even below-average doses and use of Xanax, and she mentioned some of the previous research that suggest Xanax seems to have an 'anti-depressant' like quality, and even if it's modes of action are similar to other benzos, it's immediate and powerful affect may in itself help work with the system of obliterating the psychic anxiety of a depressed person. (She also mentioned that there is a fair amount of research pointing to anxiety and depression possibly being 'two heads of the same coin'. But she did flatly state outright that for the most part, anxiety has to be treated, often separately, from depression, and not many things work as well as benzos. She said one of the most powerful tools, besides an MAOI, to treating both is med-to-high dose of an SSRI with a high-dose benzo.) She *also* mentioned that Effexor, despite what the drug companies say, is quite often very difficult in anything above 150 mg's for a very anxious person. (C'est moi!) That explains my really, really difficult time with this drug. She said out of all of the medications, the ones that work also powerfully on the norepinephrine system can sometimes cause problems with a highly anxious person, even despite the 'regulation' explanation.
It was both empowering, and made me feel really positive and good, to speak to and get help from some cutting edge clinicians. I will be starting possibly a few different types of therapy within a few weeks, and they are going to send the information above with their medication recomendations, to my doctor. My 'cocktail' of Prozac(20mg's), Klonopin(.5 mg's 3x daily), and Zyprexa (5mg's daily) has caused some fairly positive changes in me over the past six months..."touch wood"...please. :-) (I was on the above, with Effexor for about 5 years, instead of Prozac, before.) So, we will likely ramp-up and go onto Xanax at a good, theraputic dose, as well as play around with bumping up the Prozac and Zyprexa doses. If problems arise, there is obviously room to change around a few things. They did ask about my reaction to tricyclics, and I stated that they caused 'a tad of improvement sometimes, but the negative side-effects often cancelled out the benefits.) They also asked me about MAOI's, and I told them if things got *much worse* instead of better, I would consider it. It is just my lack of discipline to a diet that I am fearful of. (I do once-in-awhile 'binge' on large amounts of anything with cheese of all types, as well as many of the 'no-go's' on the needed diet. But if Prozac wasn't working, I wouldn't be closed to using an MAOI.)
If anyone from Ontario, Canada wishes for info on the clinic I went to, please let me know and I can pass the info onto you. I also looked at the board they had up about research trials, and they had everything from one on 'diet and mental health' to "TMS", as well as uses both of off-label medications and not-yet-released meds. The other nice thing about this all is being in Canada, none of this costs me a single penny!
So, I wish someone to get some kind of help, hope, and or info from this.
Thanks!
Jay
Posted by jlo820 on July 31, 2003, at 23:47:56
In reply to Some hope and help for an anxious-depressive...., posted by jay on July 31, 2003, at 23:41:30
Posted by Dinah on August 1, 2003, at 2:55:29
In reply to Some hope and help for an anxious-depressive...., posted by jay on July 31, 2003, at 23:41:30
I'm glad you had a positive experience, and got some useful ideas for your medication management.
What they said about NE certainly holds true for me. I appear to have about as much NE as my body can stand. Any medication that targets it immediately makes me unbelievably agitated.
Good luck!
Posted by jay on August 2, 2003, at 2:06:42
In reply to Sounds like a great meeting! Best of luck. (nm), posted by jlo820 on July 31, 2003, at 23:47:56
Hey thanks very much! There is something very theraputic in allowing not only your story to be told in a detailed manner, but in professionals analyzing both your situation and medication.
Jay
Posted by jay on August 2, 2003, at 2:38:27
In reply to Re: Some hope and help for an anxious-depressive.... » jay, posted by Dinah on August 1, 2003, at 2:55:29
> I'm glad you had a positive experience, and got some useful ideas for your medication management.
>
> What they said about NE certainly holds true for me. I appear to have about as much NE as my body can stand. Any medication that targets it immediately makes me unbelievably agitated.
>
> Good luck!Hey thanks very much Dinah. As I said above, there is something very therapeutic about 'purging' you story, and having professionals inquire deeply into it. Plus, the medication analysis was really awesome, very "evidence based", which seems to be a key word in most good high quality research centers. There was very little room for a prejudice judgment, and very open minds using the arts of science and empathy. An amazing combination, for sure. It sure beats my last two psychiatrists (whom I don't see anymore...as my GP looks after my medication 100's of times better than those arrogant, condescending old men.) And yes, I wish there was more research about possible problems with norepinephrine targets and certain meds. Hopefully, it may be something folks can keep in mind, and maybe use this as a guide. I have had problems with both Zoloft and Paxil, and I remember reading that Paxil in particular has some norephinephrine based qualities. I honestly suspect that may be why for it's indication of 'Anxiety States' and 'Social Phobia' haven't worked out in terms of massive amounts of people praising Paxil. Zoloft had this up/down effect that someone else mentioned, on me. I think it may have something to do with it's short half-life, as well as it's effect on Dopamine. If you can imagine say a small amount of dopamine receptor stimulation spread through a short half-life, plus it's powerful effect on Serotonin, that could have many different, uneaven effects during the day. Maybe they need a Zoloft ER/XR?
It also reminds me to say, folks, if you are unhappy with your current treatment and mental health provider, you *deserve* much *better*...you deserve *the best*. Fire them, and don't stop seeking further help until you feel you are getting the best. I am actually quite stunned of the deeply restrictive and paternalistic, demeaning attitude of many psychiatrists. Not only should they take some time in each session to ask *you* how you feel, but should lose the attitude when it comes to your treatment. What I don't understand, in particular about treatment with benzos and even opioids, is there *is* some research that extends their validity in psychiatry. I find it *really* sad that doctors in the U.S. have to submit their paperwork to another government agency. It further creates an atmosphere of judgment, fear and even shame. For the most part, *good* doctors are by nature most likely to use excellent judgment when it comes to prescribing benzos and narcotics. Just because the rare ones can be 'bought' doesn't mean everyone should suffer. I'd really like to hear from others about mental health treatment in Europe, besides the U.K., as those countries general 'openness' and progressive social systems may offer even further great benefits.
Thanks....
Peace,
Jay :-)
Posted by jemma on August 2, 2003, at 11:37:14
In reply to Some hope and help for an anxious-depressive...., posted by jay on July 31, 2003, at 23:41:30
Hi Jay -
I'm in Toronto, and I'd be very interested to know more about your clinic. It sounds very positive. I'm glad you found some doctors who can really help you.
- Jemma
> If anyone from Ontario, Canada wishes for info on the clinic I went to, please let me know and I can pass the info onto you. I also looked at the board they had up about research trials, and they had everything from one on 'diet and mental health' to "TMS", as well as uses both of off-label medications and not-yet-released meds. The other nice thing about this all is being in Canada, none of this costs me a single penny!
>
> So, I wish someone to get some kind of help, hope, and or info from this.
>
> Thanks!
>
> Jay
Posted by jay on August 6, 2003, at 0:49:21
In reply to Re: Some hope and help for an anxious-depressive.... » jay, posted by jemma on August 2, 2003, at 11:37:14
> Hi Jay -
>
> I'm in Toronto, and I'd be very interested to know more about your clinic. It sounds very positive. I'm glad you found some doctors who can really help you.
>
> - JemmaHi Jemma:
Well, I went to one of the 'Mood Disorders Clinics', this one at St. Joseph's Hospital in Hamilton. They have many, though, all over Ontario, and actually a few in Toronto. You can go here, http://www.mooddisorders.on.ca/clinics.htm for a complete list. You need an initial referral from your family doctor or pdoc, and it may take a month or two, but it is absolutely *worth* the wait! I have never even heard of, and certainly never experienced such amazing care. You also get info on many cutting-edge research projects that you can participate in, (Some of the best research in the world comes out of Toronto and Hamilton) and it is all free to Canadian citizens. I am going to get into one of the rTMS (sp?) trials, as well as a very interesting one on "Mood and Diet". The clinician there told me about trials for some of the other unreleased meds mentioned on here also. I call it the "Porsche" of mental health care.
Any more questions...please ask away!
Best wishes,
Jay
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.