Posted by Racer on July 9, 2004, at 14:55:03
In reply to end of rope, posted by platinumbride on July 9, 2004, at 1:41:35
Hey, darling star, I'm fully behind Scott in saying that your pdoc really doesn't seem to have a lot of motivation towards getting you well in a timely manner. Here are a few things that struck me about your post, and I'll end with an example of something that worked for me in dealing with doctors.
1. Sometimes when a med poops out, a vacation from it can restore its potency for you. In fact, I read recently that that's actually what's prescribed for MAOI poop-out -- a week off, then go back on it. Seems to work for many people. The mixed news about it all is that SSRIs and other newer ADs seem to have more of a problem with poop-out. The TCAs and MAOIs seem to be more stable in that regard.
2. As someone already said, Nardil is known for reducing blood pressure. The hypertensive crisis is the Big Deal side effect, so a lot of doctors kind of gloss over the hyPOtensive effects, or even forget that they exist, so all MAOIs are not out for you.
3. TCAs can cause weight gain, but that doesn't mean that they always *do* -- your mileage will vary on that one, so you might give one a try.
4. There's a lot of conflicting literature about weight gain and ADs, with a lot of people saying exactly what DanielJ said: "Oh, it's not the drug itself, it's food cravings and sluggishness." I've been told that myself, and even quite recently, by people who really *should* know better in the first place, and who really should have known better than to say it to me even if it were true. I think you know enough about my history to know this, but one drug I was on started the weight gain before the AD effects kicked in. I was working out 2 1/2 hours per day, lots of aerobic exercise, lots of weights, and eating about 500 calories per day. Gaining weight under those circumstances was, as you can imagine, devastating. And the doctor's response -- "Oh, you must be eating more because you're feeling better!" -- was even worse. Afterwards, though, it did at least relieve me to realize that it wasn't just that I was greedy and lazy and that's why I was gaining the weight. Yes, the drugs themselves, to one extent or another, can cause weight gain directly. If you can't talk to this pdoc about the weight gain openly, can you find another doctor who will take it seriously as a real concern? There really are some mitigating tactics that can be tried, now that some research studies about the mechanisms of that weight gain have started to be done. Some of the options are probably not gonna seem a whole lot better than the problem itself, but a good, engaged pdoc can help you find a solution that you can live with.
5. Just so that it's perfectly clear: I'm with Scott in being angry at your pdoc. He is playing it safe in his choices, and maybe if he got a little more aggressive, you'd get a bit more relief. Can you change to another? (I seem to remember that you've got limited choices there, though, so it may not be possible for you. In that case, forget I said this and read down to my example at the end.)
6. On almost every drug I've ever taken that worked, it took a dosage about 150% to 200% of what the doctor expected. It's possible that you haven't had much success lately because your dosages have just been too low. You might try some of the same drugs again at higher dosages, to see if that helps.
Now for my example:
I was on 225mg of Effexor XR, and crying, and hysterical and suicidal and just miserable. The pdoc for the county (I'm uninsured, remember) said that she was "satisfied with the way the drugs are working -- you're just not responding appropriately." She also said that no one was ever given more than one AD at a time, and a bunch of other absolute rubbish. At any rate, she then kicked me out of the psychiatric program to the GP program for medication management -- meaning that the doctor I saw there would just continue the drug that the pdoc had prescribed. Imagine how I felt, right?
First appointment with the GP, I went with a spreadsheet of all the drugs I'd been on, the side effects from each, the effectiveness of each, etc. I also went armed with a suggestion: since I'd had a good response to the one SSRI I'd taken, but the side effects had been problematic at the very high dose, and the Effexor at the time was working a bit, but without side effects, how about adding a low dose of an SSRI to the Effexor and see whether that would bring about remission?
So, I had the history for her to see; I had a suggestion for a possible solution; and I got what I wanted twofold -- the GP listened and thought it was worth a shot, and the combination did provide remission. Which, after about a year pooped out. {sigh} Yeah, it happens. I can't advise you there. The best I can say is to approach the pdoc as much like a scientist as you can without stepping on his toes. Tell him what you've told us, about the drugs that have worked best for you over the years, and see if just presenting it as a sort of list might help give him some new ideas.
Another thing that has helped me was Scott's list of medications and which neurotranmitter systems they hit. That led me to do some more research on the matter, and *all* the drugs that have helped me have hit the same systems. Knowing that helps me figure out which drugs are worth a shot and bring it up with my doctor. If you haven't checked it out, do. I don't have the URL, but I'm sure Scott will post it for you.
Best luck. You know you're a charm for me, right? Since my wedding band wouldn'tbe the same without you?
poster:Racer
thread:364276
URL: http://www.dr-bob.org/babble/20040704/msgs/364453.html