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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Shy_Girl on May 4, 2005, at 22:23:36
I'm quite amazed at how people seem to know how they are reacting to a particular med not long after using it.
I seriously have no idea whether or not the 40mg of Celexa I take does anything whatsoever.
I was on Zoloft for more than a year I think and I remember I still got quite suicidal at times whenever something bad happened to me. I stopped it and I was ok for several months.
I got pretty anxious again and now am on Celexa because my gp said she just likes Celexa more because it causes fewer side effects. I still get suicidal when I'm upset. If Celexa isn't doing anything, why should I be on it?
Do SSRI's really help BPD? My pdoc doesn't seem very interested in meds at all...that probably means my problems are psychosocial in nature. Am I just wasting money??
Posted by cache-monkey on May 5, 2005, at 2:56:11
In reply to How do I know if my meds are working?, posted by Shy_Girl on May 4, 2005, at 22:23:36
Hello,
I think that quite a few of psychiatrists/psychologists consider BPD as an Axis II disorder. I.e. more "character" based rather than "temperament" (read biological). Consequently they think meds are a waste of time and therapy is the route they prefer. I think that others would disagree.
And even so, there are a lot of comorbidities like depression, anxiety, dysphoria, etc that can (and I think should) be treated via pharmacotherapy. I don't know if you've already visited this site before, but check out http://www.biologicalunhappiness.com/bpd.htm . It's maintained by a pdoc who specializes in BPD.
He lays out his ideas for medication-based treatment of BPD at http://www.biologicalunhappiness.com/HowBPD-Y.htm . The first line recommendation seems to be Prozac + Tegretol. (He thinks that Prozac is the most effective of the SSRIs for BPD.) Various other med options are laid out on that page as well, which might be useful.
In terms of therapy, though, have you tried anything specifically targeted toward BPD, like dialectical behavior therapy? That might be also be a useful avenure to persue.
Good luck! I know how frustrating this can be.
Best,
cache-monkey
> Do SSRI's really help BPD? My pdoc doesn't seem very interested in meds at all...that probably means my problems are psychosocial in nature. Am I just wasting money??
Posted by PM80 on May 5, 2005, at 8:01:27
In reply to How do I know if my meds are working?, posted by Shy_Girl on May 4, 2005, at 22:23:36
Only you can tell if a med is helping you. If the Celexa has had no effect for you while you were depressed or does not not raise your mood otherwise, then I agree, don't take it. BUT given that you do become suicidal, you should keep trying different meds to see what woks for you. Is therapy an option? Although you may have chemical imbalance in your head that can be helped with meds, therapy can still help A LOT, while you are on meds or even if you decide not to take any(but talk that part out with your doc). It's your life, so it is always your decision.
Posted by stargazer on May 5, 2005, at 8:18:44
In reply to Re: How do I know if my meds are working?, posted by PM80 on May 5, 2005, at 8:01:27
Several ways...
First, you record how you were feeling before taking a med and then record your responses, both good and bad, the dosages and anything else important to remember, since you will not remember once you're feeling better or once you switch to another med or add another med to the mix.
Secondly, when I'm feeling better, I know it. You may have some side effects but they do not become the primary symptoms and make your life more miserable than before you started taking them.
Thirdly, if you're not sure, your doctor should be able to tell you if you seem better, worse or too close to call. Seems obvious? Hopefully you can rely on your doctor's judgement but this isn't always the case.
Lastly, by stopping the med, although if you have discontinuation symptoms, this method can be the worse choice. The times I've only stoppedmeds was if I felt too terriblt to continue taking them. YOU are the only one who can judge when enough is enough. I stopped Zoloft when I started having suicidal thoughts more and more often.
SG
Posted by Shy_Girl on May 5, 2005, at 22:12:03
In reply to Re: How do I know if my meds are working? » Shy_Girl, posted by cache-monkey on May 5, 2005, at 2:56:11
I'm not sure I've really had a real major depressive episode. All my "depressions" only last at most a couple of days. I wonder if those are enough to cause hippocampal atrophy?? I'm scared of hippocampal and frontal lobe atrophy. Maybe the SSRI's can prevent this.
I'm pretty darn sure my pdoc will not give me anything other than an SSRI. It would be nice to just take sometime when I feel really really upset, but I have a feeling things don't work like that. I just have to learn to deal with things.
I don't think there is DBT offered where I live, also I'm not sure I'm disordered enough to need it.
Thanks for the info
Posted by cache-monkey on May 6, 2005, at 0:56:10
In reply to Re: How do I know if my meds are working? » cache-monkey, posted by Shy_Girl on May 5, 2005, at 22:12:03
Hmm. You're right, that doesn't really sound like depression. From that perspective you might not really need a strong antidepressant like an SSRI.
Learning to cope with intense emotions is essential, you are right. But you might also benefit from a mood stabilizer.
As far as your concern about atrophy, Lithium is supposed to have certain neuroprotective properties. (See: http://www.psycheducation.org/depression/meds/ManjiLithium.htm .) So a moderate (or even "therapeutic") dose of Lithium might also help.
Tegretol, which was recommended by the doc in the link I posted about BPD, could be an option. The drawback there is that frequent blood monitoring is required just in case of a very rare side effect. That's with frequent use. I only skimmed that link, but it seemed that the doc was recommending using it on an as needed basiss. I've also heard that Zyprexa can be used PRN for dysphoria, as well. And it is supposed to be quite effective when thing are just raging crazy.
If your pdoc is worth his/her salt, he/she would definitely be amenable to at least talking about mood stabilizers.
Best,
cache-monkey> I'm not sure I've really had a real major depressive episode. All my "depressions" only last at most a couple of days. I wonder if those are enough to cause hippocampal atrophy?? I'm scared of hippocampal and frontal lobe atrophy. Maybe the SSRI's can prevent this.
>
> I'm pretty darn sure my pdoc will not give me anything other than an SSRI. It would be nice to just take sometime when I feel really really upset, but I have a feeling things don't work like that. I just have to learn to deal with things.
>
> I don't think there is DBT offered where I live, also I'm not sure I'm disordered enough to need it.
>
> Thanks for the info
>
Posted by cache-monkey on May 6, 2005, at 0:58:19
In reply to Re: How do I know if my meds are working? » cache-monkey, posted by Shy_Girl on May 5, 2005, at 22:12:03
Oh, and Lithium is also supposed to be very effective for suicidal emotions/ideation for people who cycle in their mood.
~cache-monkey
Posted by Shy_Girl on May 7, 2005, at 16:27:23
In reply to Re: How do I know if my meds are working? » Shy_Girl, posted by cache-monkey on May 6, 2005, at 0:56:10
I get dangerously upset very easily. I don't know if my mood swings are due to biology or psychology...but it sure would be nice if a mood stabilizer could mellow me out.
My pdoc does not think I need any mood stabilizers or anything else. She believes I need counselling. She knows about my horrible dysphoria and suicidal rages. She tells me that it is my decision whether or not to end my life. I don't think she cares whether I live or not. She doesn't inquire about how suicidal I am or if I have the means because she just doesn't want to get into it and doesn't have time to listen. It doesn't matter now, she's on maternity leave and I no longer have a pdoc.
I really don't understand how people here can get access to so many different types of meds. I have three things to deal with...recurring depressions, social anxiety and BPD, and yet no doctor has ever suggested anything other than an SSRI for me. I guess they believe I should suffer or that nothing can help me.
Posted by cache-monkey on May 7, 2005, at 22:41:50
In reply to Re: How do I know if my meds are working? » cache-monkey, posted by Shy_Girl on May 7, 2005, at 16:27:23
Wow. Your pdoc sounds pretty unhelpful, if not downright harmful for you. Of course it's understood that you have some control over your emotions. But the problem with these disorders is that once they become endogenous, it turns into a viscious cycle of actions affecting chemistry affecting beliefs affecting actions.
Meds can play a powerful role in cutting this feedback loop. You need to have balance before you can move forward.
I don't know if this is an option for you, but you might want to consider getting a new pdoc. I made the mistake of just settling for about 3 years with whoever I first went to. I came to realize how detrimental this was to me, as my mental health only deteriorated under on his unempathic, unknowledgable care.
I ended up getting to see someone much better, based on the recommendation of a friend. If you don't have anyone to get a recommendation from, you might want to try seeing a couple different pdocs and then picking the one the best meets your needs. I hope this is an option for you.
Good luck,
cache-monkey> I get dangerously upset very easily. I don't know if my mood swings are due to biology or psychology...but it sure would be nice if a mood stabilizer could mellow me out.
>
> My pdoc does not think I need any mood stabilizers or anything else. She believes I need counselling. She knows about my horrible dysphoria and suicidal rages. She tells me that it is my decision whether or not to end my life. I don't think she cares whether I live or not. She doesn't inquire about how suicidal I am or if I have the means because she just doesn't want to get into it and doesn't have time to listen. It doesn't matter now, she's on maternity leave and I no longer have a pdoc.
>
> I really don't understand how people here can get access to so many different types of meds. I have three things to deal with...recurring depressions, social anxiety and BPD, and yet no doctor has ever suggested anything other than an SSRI for me. I guess they believe I should suffer or that nothing can help me.
>
>
This is the end of the thread.
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