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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Meri-Tuuli on March 20, 2006, at 5:00:15
Hey there,
Well I haven't been doing too well recently, well pretty badly in fact. I just generally hate myself and have thoughts about self harm and suicide -- its kinda a feeling of I want to die in general, rather than I plan to do it this afternoon.
Anyway I'm seeing my totally useless GP tomorrow, and see what he says. I have supposedly been referred to be seen by a pdoc, although that was in November and I haven't heard a peep from them.
So I'm wondering what medication I could try. I'm on St John's Wort at the mo - I don't know if this has pooped out, or whether its not cutting it for more serious depression.
Well anyway I really know what the GP can/will prescribe - I get the feeling its limited to the SSRIs /TCAs .....
Anyone had any experience of a plain GP prescribe them anything 'stronger' or more exotic???
None of the drugs I have tried so far seem to help, although they were just sort of plain ones, like effexor, wellbutrin, celexa, prozac, reboxetine.
The trouble is SSRIs (and effexor) make me sleepy and apathic so I won't even touch a TCA, Prrozac didn't make me sleepy, but it gave me bad anxiety. Same with Wellbutrin, although that gave me a weird rash too. Reboxetine sort of made me on edge all the time, heart beating fast, although it did improve my concentration, but it gave me acne, stopped my periods, and didn't help the depression.
So whats left to try????
ARghhhhhhh - I'm so frustrated because I know the GP won't or can't prescribe anything to augument SSRIs so I didn't feel sleepy, or to counter the anxiety. Or anything exotic. Its makes me mad!! Stimulants are completely out of the question, although I still might ask, as is provigil as is any benzos to help the anxiety.....
I look at some of the drugs that people in North America can get prescribed for them (and which help them!!) and I just feel so angry and frustrated and sad that people here in the UK can't get access to them (unless perhaps, they go to a pdoc, but then on the NHS? Maybe you could do it privately, but I ain't got that cash!!)
I just don't know what to do anymore.
Posted by xbunny on March 20, 2006, at 6:59:22
In reply to Help guys, seeing my useless GP tomorrow-, posted by Meri-Tuuli on March 20, 2006, at 5:00:15
Hiya,
> Anyone had any experience of a plain GP prescribe them anything 'stronger' or more exotic???
my GP will prescribe pretty much anything that he can find in the BNF so long as it seems to make sense. I have to tell him about it though and be subtle about suggesting it like saying my pharmacist suggested it, rather than I found in on google or here lol. Another thing which also works for me is to get the GP to phone a psychiatrist and get advice whilst I am are there.
>
> None of the drugs I have tried so far seem to help, although they were just sort of plain ones, like effexor, wellbutrin, celexa, prozac, reboxetine.
>
> The trouble is SSRIs (and effexor) make me sleepy and apathic so I won't even touch a TCA,
>
> So whats left to try????
>The next drug I would try going by what you are saying is mirtazapine, the GP wont have any problems prescribing that, its a common drug. Also I think trying a TCA is worthwhile too there are lots of them and not all of them are sedating.
Good luck, Bunny
Posted by Meri-Tuuli on March 20, 2006, at 7:57:23
In reply to Re: Help guys, seeing my useless GP tomorrow- » Meri-Tuuli, posted by xbunny on March 20, 2006, at 6:59:22
Hey there,
Well thank you for giving me some hope! I guess once you build up a rapport with your GP and they thrust you then it is good....trouble is, I have moved around alot so its difficult to get to know my GP. The one I am seeing tomorrow is particulry nasty, I tried explaining to him my symptoms and things and he said he couldn't help me because it was my 'charactor'!!!!! I then completely brokedown and explained my self harm etc etc and he agreed to refer me to a pdoc for an asessment. On the upside he is the most senior out of the bunch of them. And I'm hoping my breakdown will have helped build a rapport....
Thank you for your suggestion of mirtapritze (ie remeron - thats easier to spell!) but I would really really like to stay away from any drug that has 'drowsiness' as a listed side effect, not to mention weight gain, and anxiety. My major problems seen to be apathy, amotivation, and I fight the need to sleep all the time and I'm eating too much along with the obvious depressed mood, suicidal feelings etc.
I may have atypical depression, but this has never been diagnosed by anyone other than myself.
At the moment in an ideal world, I would love to try a stimulant, but I then I guess pigs might fly.....other than that a MAOI, although again, from a GP?? I might ask for moclobemide which doesn't have the dietary restrictions etc. but I have a feeling that I will have to get to know this GP better, and also we may have to trial something more conventional first. Plus I seem to be really scared to take anything.
Oh well. I'm nearly at the end of my tether.....
Thanks for the post.
Meri
Posted by greywolf on March 20, 2006, at 8:07:38
In reply to Help guys, seeing my useless GP tomorrow-, posted by Meri-Tuuli on March 20, 2006, at 5:00:15
I've got a great GP. He's rx'd me basically anything that's available short of lithium and things like tegretol, etc. We've run through the ssri, snri, ndri categories, a number of TCAs, and an MAOI.Now, we've both come to the conclusion that some stronger stuff is needed, but he's very open about not being comfortable supervising the lithium cocktails necessary to handle my BP and OCD. I totally understand his reluctance, and I appreciate a doctor who takes the time to pleasantly discuss why he will or will not do something.
Posted by deniseuk on March 21, 2006, at 6:53:34
In reply to Help guys, seeing my useless GP tomorrow-, posted by Meri-Tuuli on March 20, 2006, at 5:00:15
Hi Meri,
I live in the UK like you and can relate entirely with your frustration with GPs and Psychiatrists entirely, very few of them will try anything new or innovative. They stick rigidly to the book which infuriates me. The best ones tend to be the onese that work privately but then as you say money is an issue here.
I doubt very much you'll get your GP to presribe an MAOI, I was told they weren't allowed and I had to go and see about 3 psychiatrists before I could find one who was willing to let me try Nardil (Phenelzine). He was a private psychiatrist and then it took a lot of persuading.
I'd suggest that you tell your GP you want to try an MAOI and that if he won't prescribe it then you want to see and NHS psychiatrist who is not adverse to prescribing MAOIs, put your foot down. Tell your doctor that you want to see a psychiatrist and that before you are referred to any specific one you want to know that they are not against MAOIs.
There is a psychiatrist at the Woodbourne Priory who was very good and very willing to let me try what I wanted, her name was Dr Brownell, I had to see her privately though. Maybe you could book one or two private sessions and then ask to be referred back on the NHS.
Also, I find Zyprexa (an antipsychotic helps me), most psychiatrists in the UK seem to be willing to prescribe these drugs for depression.
Denise
Posted by Meri-Tuuli on March 21, 2006, at 7:19:20
In reply to Re: Help guys, seeing my useless GP tomorrow-, posted by deniseuk on March 21, 2006, at 6:53:34
Hi Denise!
Thanks so much for the reply. I cheered me up, gave me a little grain of hope!! :o)
Well I saw the GP today, he's a nasty old little man, totally clueless about mental health.
He said that 'antidepressants are not appropriate in your case'!!!!
I couldn't believe it actually - I have only tried the SSRIs, SNRIs!!!. Although I didn't argue with you him because I'm not assertive enough. But it shows his bad knowledge on the subject - there are lots left to try!
But there has been a mix up - apparently the NHS mental health team or whatever, has referred me to a 'community mental health practitioner' and sent a letter to the nasty little GP saying so, only he never got it. And he doesn't actually know what a 'community mental health practitioner' is anyway. So he is going to follow it up - we'll see what happens!!
I'm trying to find a pdoc privately (and rough idea the cost?), any ideas how you go about it? I tried the local branch of 'the priory' but the one here where I live only deals with alcohol/drug problems.
Oh well.
> Hi Meri,
>
> I live in the UK like you and can relate entirely with your frustration with GPs and Psychiatrists entirely, very few of them will try anything new or innovative. They stick rigidly to the book which infuriates me. The best ones tend to be the onese that work privately but then as you say money is an issue here.
>
> I doubt very much you'll get your GP to presribe an MAOI, I was told they weren't allowed and I had to go and see about 3 psychiatrists before I could find one who was willing to let me try Nardil (Phenelzine). He was a private psychiatrist and then it took a lot of persuading.
>
> I'd suggest that you tell your GP you want to try an MAOI and that if he won't prescribe it then you want to see and NHS psychiatrist who is not adverse to prescribing MAOIs, put your foot down. Tell your doctor that you want to see a psychiatrist and that before you are referred to any specific one you want to know that they are not against MAOIs.
>
> There is a psychiatrist at the Woodbourne Priory who was very good and very willing to let me try what I wanted, her name was Dr Brownell, I had to see her privately though. Maybe you could book one or two private sessions and then ask to be referred back on the NHS.
>
>
> Also, I find Zyprexa (an antipsychotic helps me), most psychiatrists in the UK seem to be willing to prescribe these drugs for depression.
>
>
> Denise
Posted by CareBear04 on March 21, 2006, at 7:42:02
In reply to Re: Help guys, seeing my useless GP tomorrow- » deniseuk, posted by Meri-Tuuli on March 21, 2006, at 7:19:20
Hi Meri,
I don't live in the UK, so I can't quite relate to the problems you're having, but I have to say that you're being quite brave and persistent, which I really admire. Don't listen to that nasty GP! Keep your spirits up!
CB
Posted by xbunny on March 21, 2006, at 10:21:17
In reply to Re: Help guys, seeing my useless GP tomorrow- » deniseuk, posted by Meri-Tuuli on March 21, 2006, at 7:19:20
Hi there, Me again!
> But there has been a mix up - apparently the NHS mental health team or whatever, has referred me to a 'community mental health practitioner' and sent a letter to the nasty little GP saying so, only he never got it. And he doesn't actually know what a 'community mental health practitioner' is anyway. So he is going to follow it up - we'll see what happens!!
A Community Mental Health Practitioner is the new name for a Community Psychiatric Nurse. CPN's (or I guess CMHP's now) are pretty useful people to see. They usually have a lot longer to talk to you than a consultant psychiatrist, can visit you at home, tend to be more sympathetic and often just as knowledgable, they cant however prescribe, or at least they couldnt when I last saw one - other health practioners like those for diabetes can prescribe and the government is trying to move in that direction so things may have changed. Regardless a CPN can say try this and you can get the gp to prescribe it. Seeing a CPN is a good first step, he/she can often get a good overview of your symptoms and goto the psychiatrist with you making life easier. A CPN can also help find you an NHS therapist and guide you into other resources which your community mental health may have, such as groups, crisis numbers and the like.
Like GP's and consultants, the quality of CPN's varies, I had a brilliant one for about 2 years, then the one I had after that was poo. Now I have none which I really regret.>
> I'm trying to find a pdoc privately (and rough idea the cost?), any ideas how you go about it? I tried the local branch of 'the priory' but the one here where I live only deals with alcohol/drug problems.The one and only time I went private I saw a psychiatrist at a Florence Nightingale Hospital which is a chain of private psychiatric hospitals similar to The Priory. Im not sure how many there are, there are several in London and one in my local area. The cost was £80 for a 45minute consulatation.
Hope this is of some help and I Hope you feel better soon,
Bunny
Posted by deniseuk on March 21, 2006, at 10:56:17
In reply to Re: Help guys, seeing my useless GP tomorrow- » deniseuk, posted by Meri-Tuuli on March 21, 2006, at 7:19:20
Hi Meri,
How would your Doctor know whether antidepressants were appropriate or not for you?
Unfortunately private psychiatrists charge about £100 per hour (staggering isn't it, considering what they actually do in that time).
I myself when going back on the NHS was referred to an NHS Psychiatrist and as I hadn't heard anything I rang the Mental Health Center and found out who I'd been referred to, they told me that my case had been sent back to a Community mental health practitioner, I was really annoyed because a) nobody had bothered to tell me and b) I didn't want to see a mental health practitioner as I wanted to try a new drug and only a psychiatrist can prescribe them, I already know I'm depressed after all, I didn't need another assessment.
Having said that like the other poster said it will probably be good for you to see a community mental health practitioner because they will be able to fight your corner for you and may be able to get more info for you.
One more thing, if you do arrange to see any psychiatrists, what I have done now through seeing quite a few of them and going through the same old questions, is to type up a standard letter with all my med history, family history, parents divorce, my mums type of pregnancy, my symptoms etc, get the psychiatrist's secretary's email and then send them all my details asking them to pass the info onto the psychiatrist.
This gives the psychiatrist a chance to familiarise themselves with your history before you see them.
I hope you find a good psychiatrist, let me know if you do :-)Denise
Posted by Meri-Tuuli on March 21, 2006, at 11:35:54
In reply to Re: Help guys, seeing my useless GP tomorrow- » Meri-Tuuli, posted by xbunny on March 21, 2006, at 10:21:17
Ahhhhhh......Thanks for the reply buns.
Makes sense now!!! I've seen a CPN before - at the height of my first depression I was assigned to one, who well, I don't know. I didn't seem to make any progress, but I was so new to the condition, and I was so nervous and at that time in my life, he was there just to make sure I was eating/sleeping/functioning okay. Although he was rather nice, and I'm sure would have been more helpful had I not been so 'new' to the condition.....plus it was where I was a student (up in St Andrews, Scotland) so I couldn't really travel up there during holidays so I just let it slip. Plus now that I'm a seasoned user....
Anyway well I'm open to see a CPN. I quite liked my previous one. Although, as you say, they can't prescribe meds....which is a real pain. I got the feeling from mine old one that he was really on my side..... which is good.
Hmmm...
Thanks for the advice.
Meri
Posted by Meri-Tuuli on March 21, 2006, at 11:48:10
In reply to Re: Help guys, seeing my useless GP tomorrow-, posted by deniseuk on March 21, 2006, at 10:56:17
Hey there Denise!!
> How would your Doctor know whether antidepressants were appropriate or not for you?
I have no idea, hence my conclusion that he is a nasty little man!! That, and on my first visit, he claimed my depression was a 'charactor flaw'!!!! I mean, c'mon, please, this is the 21st Century....
>
> Unfortunately private psychiatrists charge about £100 per hour (staggering isn't it, considering what they actually do in that time).Yup, I emailed the Priory Woodborne, and they quoted me £220 for an intial consultation with Dr Brownell, and £110 thereafter. I'm broke as it is...
> I myself when going back on the NHS was referred to an NHS Psychiatrist and as I hadn't heard anything I rang the Mental Health Center and found out who I'd been referred to, they told me that my case had been sent back to a Community mental health practitioner, I was really annoyed because a) nobody had bothered to tell me and b) I didn't want to see a mental health practitioner as I wanted to try a new drug and only a psychiatrist can prescribe them, I already know I'm depressed after all, I didn't need another assessment.
Sounds like EXACTLY what has happened to me......my GP referred me to a pdoc, then they refered me back to the 'community mental health practitioner' and they didn't tell me or my GP - which slightly annoyed my GP!!! I'm hoping the nasty GP is rooting for me to see a pdoc (he promised me a consultation with a pdoc!) although I don't know whether that will happen. On the plus side, he is the most senior of his practice, but hey - I'm hoping that will mean something.
> Having said that like the other poster said it will probably be good for you to see a community mental health practitioner because they will be able to fight your corner for you and may be able to get more info for you.
And thanks soo much for your advice re: writing to private pdocs - a long time ago another poster was adamant that you email all prospective pdocs with specific questions and your history etc....its good to know. £220 is alot of money!!
Thanks again,
Meri
Posted by deniseuk on March 22, 2006, at 8:54:10
In reply to Re: Help guys, seeing my useless GP tomorrow- » deniseuk, posted by Meri-Tuuli on March 21, 2006, at 11:48:10
Hi,
I didn't finish off the story, when I spoke to the mental health section and found out what psychiatrist I was due to see, I spoke to his secretary and demanded that he fit me in for an appointment instead of passing me back to a mental health practitioner. I was very insistent and managed to get an appointment the next week.
It's worth harrassing them even if it means find getting the number of your health trust, ringing the manager and making a complaint. There's a new NHS site called choose and book and you can get the number of your local health trust from there.
I hope you get the treatment you need, I really do, because I know what it's like.
Denise
This is the end of the thread.
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