![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 38. Go back in thread:
Posted by Phillipa on August 19, 2006, at 19:53:59
In reply to Re: On sleep, posted by jealibeanz on August 19, 2006, at 17:32:53
Seroquel is an atypical antipsychotic used a lot for sleep and anxiety. Hope that helps. Love Phillipa
Posted by jealibeanz on August 19, 2006, at 20:40:17
In reply to Re: OK, I'm over my self-imposed leave... update » jealibeanz, posted by Jost on August 19, 2006, at 17:35:41
Whoaa... must apologize for the incredibly long post up-front, but I assure, it's an easy read!
Yeah, I think that since it's a fairly busy office, (They're overcrowded/overbooked... as a coincidence, this week, my father and I both had 1PM appts w/ the same doc! It's supposed to be every 15 min or so, plus my was a full physical, not a quick med check!) He may not reschedule unless it's something completely new and he really feels the needs to checkup on the patient for safety/compliance issues. I know enough to call and leave a message or get myself an appt if I feel it's necessary, as proven in the past. Although, I tend to wait til things are on the brink of causing a meltdown! So early and often checkups would be good for my over-reactive personality and ever changing disorders (in relation to their relevance in my life).
I really don't have a problem asking him when he wants me to come back. Like I said, I know he is aware of the fact that I'm not local, and can usually only come on the half-day Saturdays, which he rotates with his partners. He just figures if there's a major problem I'll call and tell him.
Strange how my PA doesn't feel that way. He does have more flexibility and time just to do med check ups, but aren't doc's supposed to bedoing this as well? (i.e. my Wellbutrin example- me, with 4 refills and no rechecks, as an uninformed 18 yr old!- This was before the careful monitoring of teens and AD's though,(But was I a teen or, part teen/part "college student who wants to be in the adult category")?.
MY PA checked up on my Lunesta at least every couple months (and what ever meds I was supposed to be taking at the time, but prob wasn't cause I like to control and D/C myself when I feel the need... and I'm psycho and have moved on to a different subcatergory of my illnesses... Anxiety/Insomnia/Depression/ADHD which needs to be treated).
Hmm... maybe my goal at my next appt. will be treat all 4 at once! This would be a better approach than collectively deciding than one or two have subsided for the moment and the other, more serious and prominent matters at hand need to be stabilized. While I realize polypharmacy is difficult when starting new meds- you don't know what's contributing to side effects, all my conditions are chronic and DO need to be medicated for me to be at my best.
i.e.
1. Insomnia would lessen if depression and anxiety were controlled. We need to move past the fact that I don't like SSRI's and just therefore treat only other symtoms w/o lessening the depression itself. I need to be sure to tell him it's recurrent since high school. It may go away, but will certainly come back. It's been building over the past year, with the exception of my Effexor trial, which saved my life, but was unwilling to continue.
I neeeed a long term tolerable med. This means not going through SSRI's like he would I'm a typical patient. I'm not his typical patient. Although modest, I'll admit that I'm more intelligent than most, as demand to live a high quality life. Although I haven't been presenting any examples of meds, it's obvious I know there are atypical treatments out there for all my disorders, as well as unorthodox methods of treating side effects. This ultimately is what I will need to achieve success.
I also, probably due to my high anxiety nature and very intolerant to adverse effects, while some patients might just put up with them or not even correlate the occurances to meds. So sticking me with the lastest and greatest from the drug rep might not work out, esp. b/c I want better/more specific treatment!
2. Improved sleep would result in less depression, anxiety, moodiness, and better concentration and energy levels overall to be at my best and most productive.
3. If ADHD were controlled, I wouldn't always be frantically scrambling to study and catch up on classes lectures, while at home, that went way over my head b/c I wasn't listening in the first place due to my ADHD. (I have the inattentive subtype- I'm horrible at listening to lectures and internalizing verbal directions, although on a personally level, one on one, I'm the best and most empathetic friend/listener you'll ever meet!-- often recruited as mediator or counselor to good friends)
4. If the ADHD didn't have me scrambling, I'd certainly have much less anxiety, annnd more free time, to relax, and thus decreases anxiety.
4. And of course, depression worsenes if any of these factors is out of balance b/c I feel bad that I can't control my life and that I was born with my "messed up" brain. None/most of my friends don't have these issues. They don't have severe problems w/ classes, studying, emotionally, and socially that just pop up out of nowhere when my brain goes slightly wacky and meds are correcting the balance. I do realize evenyone struggle to some degree with these issues, but mine are related to clinical disorders, making it a little more difficult to manage and cover up.We're getting there though... My doc is beginning to realize this. It's good that I'm sticking with just one practitioner now. It's also helping that he's beginning to see me more and more as a peer (in training!) every time he sees me. He realizes that I'm able to assess and report my symptoms well. And he can describe certain things to me in detail that he wouldn't do for most patients.
I'm glad I stuck with him! Even though I don't feel like I'm emotionally better or made and great improvements with meds, if I'm persistent, we may reach the finishline together someday.
Posted by jealibeanz on August 19, 2006, at 20:45:03
In reply to Re: On sleep » jealibeanz, posted by Phillipa on August 19, 2006, at 19:53:59
Yes, Phillipa, I thought so. That scares me and I'd rather not go that route right now!
Posted by Phillipa on August 19, 2006, at 20:58:28
In reply to Re: On sleep, posted by jealibeanz on August 19, 2006, at 20:45:03
Me either and despite our age difference we're a lot alike symptom wise med wise. Love Phillipa
Posted by jealibeanz on August 19, 2006, at 21:50:57
In reply to Re: On sleep » jealibeanz, posted by Phillipa on August 19, 2006, at 20:58:28
I'd like to stick to meds FDA approved for sleep right now. The only off label med I'd consider is a benzo, but not Xanax since I take it during the day. I just don't see that as a good plan to be 24/7 Xanax'd!
You think we're similar? Maybe you're confusing me with someone else, or I with you. I'm not so sure if I remember correctly. Haven't you had meds that you responded to for a while?
As for depression:
I did respond a little to the Effexor, maybe Wellbutrin, but never gave the Paxil or Buspar a fair trial. They all induced extreme apathy and weight gain. Effexor made me nauseous.
Anxiety:
Klonopin was depressing slightly and very sedating. Made me feel drunk too. Xanax is much better. I don't slur my words, it's not depressing, and not too sedating. Xanax actuallys calms me, while Klonopin just knocked me out to the point where nothing could bother me.
ADHD:
You don't have this do you? Mine is inattentive, caused by anoxia from a collapsed lung at premature birth. The combo of Klonopin + Adderall induced terrrrble depression. Can never be sure which is was. I think it was the combo. I've taken the small amounts that I had of each left at separate times and never had such a horrible reaction, just a slight decline in mood.
Straterra did seem to help with the ADHD symptoms dramamtically at first. After a while it was less noticeable. Maybe I should have titrated past 60 mg since I had been on it for 6 months. But I also think it contributes to anxiety, insomnia, and depression. We have since stopped this med.
Posted by Phillipa on August 19, 2006, at 22:37:36
In reply to Re: On sleep, posted by jealibeanz on August 19, 2006, at 21:50:57
No I don't have AdHD at least I don't think so. But the benzos and anxiety was what I was referring to. At one time I did take xanax at bedtime for sleep. Four hours later lmg more. But I slept. Now its's valium. Love Phillipa
Posted by UgottaHaveHope on August 20, 2006, at 10:02:59
In reply to Re: On sleep, posted by jealibeanz on August 19, 2006, at 20:45:03
Even though Seroquel is classfied as an Anti-Psychotic drug, doctors are now using it ALSO as a treatment for anxiety (you can ask your professors to confirm).
When it is used for AP, it is prescibed in much higher doses (600-900mg). For anxiety, it's more like (25-200mg). For your insomnia, I would try 25 mg or even cut it in half at 12.5 mg. Again, the good thing is that you will know THE FIRST DAY whether or not it helps.
If you are taking other meds, I cant say whether or not it will help you (you will have to find out by experiment). However, if you are taking nothing else, I can assure you it will make you sleep, which goes against my "every med affects everyone differently" mantra. It's like taking a Benedryl on steriods!
Posted by jealibeanz on August 20, 2006, at 11:16:54
In reply to Re: Have no fear of Seroquel, posted by UgottaHaveHope on August 20, 2006, at 10:02:59
Yes, but I do fear drugs I don't understand and don't have experience with. Atypical antipsychotics? Tricyclics? MAOI's? (although intrugued by EMSAM). Yikes!!!! I'd like to put on my running shoes and sprint away as fast as I can!
Remember, I'm the one who's always concerned with the potential for weight gain, since if it's a possible side effect (even when NOT "possible" Re: Wellbutrin), my metabolism gets wacked and this happens to me! (I'm still working a little on getting back to my norm after what Effexor did. I don't want to make life more difficult than it already is.) Plus I'm afraid of any other odd side effects that may occur with such complex medications.
Since Lunesta was so great before, I think I actually may be OK with a medication with less "punch" than Seroquel. My body has just grown accustomed to the Lunesta and needs to be tricked back in to sleeping. I was going through a very busy and stressful time (at the same intensity that I'm currenty dealing with) last year when I began Lunesta, and even then it was a wonderful Godsend and cure to my sleep issues.
BTW... if it's annoying anyone to death that I use so many parentheses in my posts, I'll gladly stop. I don't want to add to the irritability than many of us face. It's just my way of posting in a manner that makes sense to me, as if it were a speech, not a written essay.
Posted by jealibeanz on August 20, 2006, at 11:59:37
In reply to Re: Have no fear of Seroquel, posted by jealibeanz on August 20, 2006, at 11:16:54
As a side note... my depression is now manifesting in a new manner.
I've gone from the anxious, fearful, teary-eyed, hopeless depression to the hypersomnia type. I'm usually extremely active and athletic. Right now, I'm glued to my computer because I'm too tired to move. This could be due to my lack of sleep for months. This could be due to withdrawal from Straterra, which is activating. However, based on past experience, this is not the case.
During my freshman year in college I was sooo depressed that basically hibernated. I slept a good 15-18 hours a day and was alllways tired and sleepy. I had slight insomnia, but it was just occassional waking, and would fall back to sleep.
It was my reaction to the overwhelming stress, anxiety, and depression I was faced by my new environment. I actually had no idea at the time, because I was basically a walking zombie. I wish I or someone around me had reacongnized this incredible abnomality. I seriously was in need of an antidepressant and stimulant.
I Didn't care about life. Didn't care about anything. I hated school and everyone around me (distorted thinking... these are the people who are now my very good friends!). I just wanted and desperately needed to sleep at all times of the day. This is how I feel right now.
Posted by UgottaHaveHOPE on August 20, 2006, at 14:48:57
In reply to Re: Have no fear of Seroquel, posted by jealibeanz on August 20, 2006, at 11:16:54
Jelly, again, Seroquel may or may not be good for you. The good thing about it is that you will know the first day whether or not it will help you. You won't have to wait 4-6 weeks like with an SSRI. If it doesn't help. dont take it again, and it will be out of your system quickly.
They give away Seroquel in samples for free at the doctor's office. Id get the 25mg tab and cut it in half.
PS You do a great job of expressing your feelings on here. Thanks for sharing and hope you feel better soon.
Posted by jealibeanz on August 20, 2006, at 16:14:27
In reply to Re: One day, Jelly, posted by UgottaHaveHOPE on August 20, 2006, at 14:48:57
Thanks to everyone for their input and support. It really helps to be able to bounce ideas off others. It's like therapuetic journaling, but with more purpose.
This is such a pivotal point in my life. I really do need to become much much more stable within the next year to continue with my professional course. Part of me wants to stop all treatment though. My doc did have to document a "positive" on my physical form on the emotional treatment line. He just wrote insomnia/anxiety. While it was barely noticeable and no description provided, I worry that in the future, disclosure of current treatment will hurt me.
However, I don't think I'm soooo far off that remission is out of the question, but I do believe medication needs to play a big part. (not spirituality/therapy/ect- although I admire those who can recover on such resources alone/in conjunction w/meds. I don't believe that's the optimal route for me.)
I'm young enough that my life can be turned around for the better. But this really needs to occur sooner, rather than later.
Posted by Jost on August 20, 2006, at 21:43:18
In reply to Re: One day, Jelly, posted by jealibeanz on August 20, 2006, at 16:14:27
One thought, Jelly.
Seroquel sounds a lot worse than it is. It's used a lot for anxiety and especially for sleep. My pdoc is very cautious and doesn't take chances. There's a lot of fear surrounding the concept of APs, but it's an atypical AP with the lowest chance of causing problems.
A low dose like 25 mg, or even half that, might help you get sleep. It's effective and very simple. Even if you needed more (say 50 mg), it's a very low dose, of a drug where even much higher doses are unlikely to cause problems.
Even if your mood wasn't great, you might be much more effective and able to study, and work.
I'm glad anyway that you're determined not to let your life be stymied. You'll figure it out, I'm sure.
Jost
Posted by jealibeanz on August 21, 2006, at 0:03:48
In reply to Re: One day, Jelly, posted by Jost on August 20, 2006, at 21:43:18
I'm not terribly concerned about the sleep right now. I'm most likely going to take some time off. Relax as much as possible, and obviously pursue a new career path since, they don't allow you to start and stop midyear. It probably was a poor choice given my tendencies toward minor, but chronic mental health problems. I'm thinking I need something a little less challenging, less stressful, and with more flexibility. Because right now I've gone into sleepy apathetic mode when I need to be into focused passionate overdrive!
Posted by UgottaHaveHOPE on August 21, 2006, at 1:28:57
In reply to Re: One day, Jelly, posted by jealibeanz on August 21, 2006, at 0:03:48
Jost brough up a great point that I had forget to make the whole time: The 25 or 12.5mg of Seroquel is just a minor, minor dose, like 1/32 of the dose it is given for AP issues.
Wishing you well, Michasel
Posted by jealibeanz on August 21, 2006, at 16:43:02
In reply to Re: JB, in context, posted by UgottaHaveHOPE on August 21, 2006, at 1:28:57
Alright, I'm little less frightened of Seroquel if it's only needed in a miniscule amount for insomnia.
At the moment, I wondering what issues I actually want to bring up to my doctor. I still have insomia problems, although not quite as bad as before when I was sleeping 2-3 hours a night. However, I also am now sleeping a good portion of the day, and when I'm awake I feel horribly drained of energy and want to crawl back into bed.
I'm afraid that if I tell him I'm sooo tired during the day he'll take away the Xanax (which does cause some drowsiness, but not to extreme extent that I'm currently experiencing). He may also tell me that I'm not going to be sleeping well at night if I nap during the day. While I understand this is true, I simply cannot function well enough to be anywhere near my normal level of activity during the day right now. I don't feel my insomnia is ever due to lack of need for sleep, rather, it's caused by anxiety.
At any other point in my life I'd be willing just to wait for things to get better. I've experienced these symptoms before when going through depression, eventually I do stop sleeping sooo much, but it certainly doesn't happened overnight! Right now I can't even afford to have one week when I'm at such a poorly-functional state.
I don't want to be one of those psycho hypochondiac patients they dread b/c new illnesses pop up every week or two. However, I am admitting that I am one of those psycho patients- my main problem is anxiety and it's clear that it's the central cause of all my ancillary issues.
So, I guess I'm just wondering if it does seem logical (from a doctor's point of view) for a patient to from the agitated, energetic, anxious state right to the fatigued, depressed state (while experiencing the anxiety/depression/insomnia at all times, but resulting in different physical presentations.) I don't want to have to lie to my doctor to get what I want/need, but I'm afraid of complicating things by showing up two weeks later with completely different complaints.
I'd love a stimulant right now (I like Provigil, but he's not usually one to prescibe it, so am willing to settle for Ritalin or Adderall). I'd also like a sleep med that works, to continue with my Xanax, and have an AD that I tolerate. While some of these meds basically contraindicate with each other to some degree, it's what I need. Is this too much to ask of him?
Posted by UgottaHaveHOPE on August 21, 2006, at 21:57:20
In reply to Re: JB, in context, posted by jealibeanz on August 21, 2006, at 16:43:02
Go to your pdoc with 1 issue per visit. If you try to address all of these things at once, then your world could be turned upside down by all the changes he makes. Thats just me though. Do what is best for you. Michael
Posted by jealibeanz on August 21, 2006, at 23:12:47
In reply to Re: 1 at a time, posted by UgottaHaveHOPE on August 21, 2006, at 21:57:20
Although it's an ideal approach, it's not very helpful unless I plan on seeing him every week or two, which isn't possible. Plus, all the problems are interrelated, so just bring up only one at a time seems to me like I'm holding back important diagnostic information.
But again, I worry that if I mention the enormously overwhelming fatigue me Xanax may be D/C'd. If I bring up the need for a stimulant or stimulating AD, that also affects the insomnia. Yet, I think he'd like to know about all of them, then we'd address the most dire and easiest to treat.
That's actually what we just did. My depression and ADHD went untreated b/c we were unsure about how to go about making so many changes at once and whether or not each of those conditions were exacerbated by sleep deprivation and medication.
We did decide to continue treating the anxiety with Xanax and the insomnia with an increased dose of Lunesta.
So, my next appt... concerns will be a follow up on the Lunesta, better, but really not strong enough to allow me to ever sleep more than 2-3 hours a night at a time. However, I am able to get back to sleep and am now getting at about 4-5 hours at night, an improvement.
I'd assume he'd want to know how the mood levels have been since D/Cing the Straterra. I will say that they have not improved, actually worse. Coffee is really the one thing that helps the sad feelings and tears. It's not because it's giving me a kick of energy that I need. I actually don't feel too stimulated by caffeine. It's very calming and produces a serene feeling. Is this completely abnormal or do others understand this too?
And now I am beginning to feel so overwhelmed that I feel the new to sleep constantly, which I don't believe is related completely to the insomnia. It's a totalllly different type of tiredness.
Insomnia tired is kinda cranky, achy, disoriented, but almost easily able to get through the day without stopping.
Depression tired is like a huge heavy weight on your body. You can barely get out of bed. You can barely muster up the energy to complete normal everyday tasks. In the end, you neeeed a nap, maybe several, if you day allows it. The extra sleep doesn't alleviate the fatigue though, nothing does.
OK, I suppose I just answered my own questions. I could leave things out, however I'm really hesistating to do so.
But does this seem to make sense to others? Is this a fairly clear presentation of symptoms of my already diagnosed disorders? They aren't new, they just now need to be treated differently as my life, circumstances, body, and neurotransmitters get misaligned. Right?
Posted by Phillipa on August 21, 2006, at 23:15:48
In reply to Re: 1 at a time, posted by jealibeanz on August 21, 2006, at 23:12:47
Write the post down while it's fresh in your mind and give it to you pdoc. Love Phillipa
Posted by jealibeanz on August 21, 2006, at 23:36:59
In reply to Re: 1 at a time » jealibeanz, posted by Phillipa on August 21, 2006, at 23:15:48
No pdoc... he's my GP:)
But actually last time I was very good at remember exactly what I needed to address, the details, and my personal input and concerns on the matter. I'm not about to solidify what I wrote because a lot can change within the next couple of weeks, especially with classes starting up again. Plus, I'm still withdrawing and adjusting to meds.
Thanks for the advice though Phillipa. I just wanted to see if anyone else could relate to the odd type of fatigue, along with insomnia. Plus, I think the caffeine issue is of note, but still want to know how many of you pick up on its worthiness, as an indicator of where my doc might go with that bit of info.
Posted by jost on August 22, 2006, at 11:53:16
In reply to Re: 1 at a time, posted by jealibeanz on August 21, 2006, at 23:12:47
Jelly,
I'm not a pdoc, and if you could find a good one (not one who says you don't need any help, and who is compassionate), I'd really want you to ask that person rather than me.
However, given that, your tiredness could be part of atypical depression--which is characterized more by hypersomnia and possiby overeating than insomnia and not eating. However, atypical depression complicated by anxiety--as in my case--can lead to the symptom cluster that you have, ie insomnia and daytime sleepiness, that leaden, weighted-down feeling.
Certainly, I've had that, so it can. That doesn't mean there aren't other possibilites (again, I'm not a pdoc). However, IMH, non-pdoc O, you might do well on an Maoi, which I know you've been thinking about for a long time.
I really really think, especially in the absence of some other idea, you should take some basic information to your GP and start to educate him about maois, especially the exaggerated concerns about food and drug interactions. Of course, the concerns are real, and you need to be careful at the beginning, and all that-- but it's greatly over-drawn.
As you know, there are parnate (more activating), nardil (very good for anxiety, esp social anxiety, but with some tendency to be tiring), and ensam (more activating, possibly good for social phobia, but with possible insomnia--also good because no food interactions esp. at lower doses).
First of all, though, don't make life-changing decisions now. You would be acting impulsively and out of depressed fears and then avoidance of painful possibilities that may not happen, if you get treatment. Selling yourself short, when you don't need to isn't necessary. Just wait on any decision-making.
There's lots of information, either on psychobabble and/or online. Taking it to your GP may make him much more confident about supervising your taking an Maoi. Or can he consult with a pdoc of his own choosing, and still supervise you himself?
You can augment the maoi with xanax, provigil, tiny doses of seroquel, and probably later (it's not a problem for me, although this varies), adderall or ritalin. That's after you choose (or you and your GP together choose) an Maoi and take it for a while, to gauge the effect.
There are lots of options, once you choose a path. Your instincts seem very good to me, and not at all unreasonable. Plus, there are other paths, if the first path doesn't seem great. But you've got to go down one, first. :)
Jost
Posted by jealibeanz on August 22, 2006, at 17:32:21
In reply to Re: 1 at a time » jealibeanz, posted by jost on August 22, 2006, at 11:53:16
Thanks Jost, I truely respect you opinion.
Haha, is it possible to have atypical-atypical depression? By this, I mean that I seem to fit both typical and atypical categories, sometimes concurrently. I've alllways been one to sleep an extreme amount when depressed, however, the last few months I wasn't sleeping much at all, and now I am again. I don't have emotional eating tendencies, so I can't say that I ever noticeably overeat or undereat when depressed.
I know I shouldn't make any important decisions right now. I'd definitely regret such a life-altering choice down the road.
I like your ideas... do you happen to have a prescription pad in your back pocket you'd care to use?! :) Xanax and Provigil (I'm never gonna get this one though!) are pretty mild in my opinion, and happen to be basically the only meds I've ever had success with and tolerated. But if I were to try either EMSAM or Parnate (hesitant of this one), plus get decent sleep, I may not need a stimulant, although it would be nice.
As for food restrictions... I can't believe people complain about this! If I had the potential to rid my depression, I'd eat or not eat annnything! I'd gladly vow to memorize all contraindicated meds, and go even go without pain medication, cough syrup, ect., to avoid the possibility. I do understand the doctor's concern regarding this issue though.
I just got my new books for next week, including 2 of interest, pharmacology and psychiatry (not the most current resource though, published in 1998!). Maybe I'll read up a little, then think of citing those as information sources, rather than the internet. The internet is a little shady and untrustworthy in my opinion. (I honestly do value the info I get here and other sites, but one has to be careful) I wouldn't really like it if a patient came in quoting message boards of all things. (It's somewhat disrespectful, IMO.)
Thanks again to all who read and respond to my lengthy posts! :)
Posted by jealibeanz on August 23, 2006, at 22:21:31
In reply to Re: 1 at a time, posted by jealibeanz on August 22, 2006, at 17:32:21
OK, so I was reading my pharmacology book, copyright 2006. It mentions the use of MAOI's Nardil and Parnate for depression and phobias'anxiety (that's me!). This book doesn't really make them out to be terrible, just notes that there are dietary restrictions and possible orthostatic hypotension. (no mention of weight gain for MAOI's or SSRI's, only TCA's... so I consider that an error!)
Selegiline is in the book, but as a medication for Parkinson's. There's no mention of it's use for depression.
Provigil is mentioned there as a stimulant, approved for Narcolepsy, but with the potential for ADHD. It says there's no potential for addiction or abuse. It also cited nausea, headache, and a few others as side effects, but I've never had these.
I didn't look up any sleeping meds, except that it was noted in the benzo section that some can be used to induce sleep.
So, I actually feel confident in making suggestions based on my readings. However, EMSAM isn't in the book. Would it be wrong of me to say it is? I mean, it was approved in February. Anyway, I was surprised there was no mention of the possibility of its approval since it's been in the works for years now.
Could I even say the book is copywrite 2007? That's possible, right, kinda like next year's cars coming out in August?! :)
I don't want him to be suspicious of the fact that EMSAM would be in any book. Although he's certainly NOT the type of person to be suspicious about anything! This was a horrrrible, rock bottom day, but reading that book tonight actually makes me feel soooo much better because I might take another chance in getting help for myself!:)
I know I may be taking a risk asking my GP, but he's all I got, he's really concerned about me and cares about my well-being, and I like the guy! I should mention the fact that I may just drop out of school, because the insomnia, fatigue, and depression are getting to be too much to handle and are interferring with my life significantly. It's true. I think about it everyday. This would certainly help in getting some optimal care from him because that's the last thing he wants for me... dropping out of PA school for health reasons?! That's his specialty. He can fix that for me! :)
Posted by jealibeanz on August 26, 2006, at 7:05:57
In reply to OK, I'm over my self-imposed leave... update, posted by jealibeanz on August 17, 2006, at 14:22:21
I've decided I NEED to make another appointment with my doctor.
I will tell him that my Lunesta actually is helping increase my total hours sleeping at night, but am nooowhere near 7-8 hours that one needs. I never sleep more than 2 hours continuously. I'm going to demand I find a better solution myself. Ideally, I wouldn't be dependent on meds, but apparently this world we live in isn't ideal!!!
I need to address the depression as a major complaint, not just a tiny side note. My current symptoms aren't just sadness and crying. They also involve hypersomnia and huge lack of energy and motivation.
I need to tell him that I'm worried because this has happened to me before, my 1st year at college. (I had no doctor then, so he doesn't know about this.) I basically slept non-stop, all day, every day. I never felt well, was always terrible groggy/tired, and couldn't concentrate because I was always nodding off in class, thinking about how I need to take nap #3.
He knows this will be a major problem in terms of my schooling this year. I can't get through 2 hard semester like this, and shouldn't have to try, physically or emotionally. It's not normal or healthy. I can't just settle for "just getting by" in life. I want quality.
So, he's already fully aware of my distaste for the serotonergenic meds. I need to present ideas...
I really want to bring up EMSAM. Why? Because I believe it could be a great help to me. Also, if I don't I'll just regret it for months and months and months. I can tell him I found information in my texts and then looked up the prescribing info online.
This is going to be a big risk asking a GP to prescribe it for me, I feel. If he's a little uncomfortable and suggests seeing a psychiatrist (which I doubt will happen, they don't refer out for much at that office, surprisingly), I'll explain why I'm against it. I'll explain my former terrible run ins with psychiatrists, other doctors, counselors, and therapists. I'm either treated without respect, like a dysfunctional/hopeless being with no chance of getting better, or ignored, with people telling me I'm very successful and have a great life. Either way, I've always felt very offended and uncared for by any mental health specialist.
So, I'm not comfortable with seeing anyone else. It's either him or nobody! I've been scarred and hurt. Maybe I'll get over it in 10-20 years and reconsider. Right now, it won't happen. I'm sure he'll understand that because he knows my personality a little bit. I'd rather go completely untreated than see another doctor. Sad, but true.
I think one of the biggest obstacles would be that it causes insomnia, but I'm gonna bet he doesn't know much of anything about EMSAM, so it may not be an issue. If it is, I'll have to reiterate how lathargic and fatigued I am right now (I'm currently sleeping up 18 hours a day and not sure how the 8-12 hours of classes next week is going to work out!). Although sleeping well at night is an issue, so is getting through the day at a functional level!
The help I've received from him medication-wise has always been the direct result of my requests. I asked for a medication for social anxiety and received Paxil. I then asked to switch when it wasn't going well. I asked for Klonopin + Adderall. I asked for Xanax. I asked for an ADHD med. I asked for a sleep med and changes with it. I know nothing will come about unless I spell out exactly what I want. He's really happy to write prescriptions though. I've only had a couple of suggestions turned down, most are honored without much thought or question. But ahhh!!! An MAOI? I'm getting toward my risky requests here!
Posted by Jost on August 27, 2006, at 23:13:12
In reply to Re: OK, I'm over my self-imposed leave... update, posted by jealibeanz on August 26, 2006, at 7:05:57
Sounds like a plan, to me, Jelly.
Sorry I can't pull out the prescription pad. (I've been out of town, which is why I haven't been posting, by the way.)
Sleep could be an issue. So far, I remove the Emsam patch around midnight (or whenever I go to bed, or a little before). Then, since I wake up a few times, I put one on several hours before I get up. It hasn't been as disruptive for me, that way.
Ambien or xanax, and sometimes Sonata, help to get to sleep, esp. Sonata, when I wake up close to when I have to be up for good. Maybe Lunesta and something, if Lunesta works well, once your mood improves. (Didn't work for me, and caused a bad taste-- a known side effect.)
Are you calling your GP this week? Esp. since your classes start so soon....?
With any luck, you'll have a fairly rapid response to Emsam.
One other thought: you might need 9 mg, if you take the patch off at night, because the overall amount absorbed is less. You don't want to go below 6 mg-- esp.l since many people need more than 6 mg. (I've been using the 12 mg, so as to achieve about a 9 mg dose.)
Remember, MAOI's are anti-depressants: a good thing, not a bad thing. You have no reason to apologize for wanting it.
Jost
Posted by jealibeanz on August 28, 2006, at 5:51:45
In reply to Re: OK, I'm over my self-imposed leave... update » jealibeanz, posted by Jost on August 27, 2006, at 23:13:12
This is me in a super-bad mood right now, so I apologize for the whining ahead of time.
I've had about 2.5 weeks of vacation. I slept non-stop, about 18 hours total, yet never than a few hours consecutively. I always felt like I could sleep more, too, but made myself get up for a few hours a day. Basically, i was comatose and miserable.
So, I would have thought I'd sleep some last night, since that's all I've been dping lately. Nope, only 1.5 hours. Why? Because I start classes today! Each day is between 8-12 hours straight. I may very well die today because I'm used to sleeping all day, which I can't do, and I didn't even sleep last night.
Yeah, I'm calling my doctor. Hopefully he's working this Saturday, if not, I'll have to wait for the next weekend he's on. I still question whether I should bring up EMSAM, since he may be very much against MAOI's, orrr he might not know much about it at all. That would be awkward. Me trying to act all smart and tell him what I've looked up, him having no experience with patients on it obviously... not a good thing. I'm sure the drug reps haven't visited.
I wonder if I can contact the company and see if the drug reps are making their visits yet, although I know the GP's won't be the first ones hit. Oh well, no meds for me.
This is the end of the thread.
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