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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by janet on February 27, 2000, at 21:28:18
I tried to follow advice about sounding out pdocs about their policy on stimulants.All without exception were very wary. As the terms Adderall, Cyert, Dexedrine, etc. came tripping lightly off my tongue they got even more suspicious, convinced they had a foreign middle -aged speed junkie on their hands and I couldn't get a nay or yay out of any of them. Perhaps they thought I was part of undercover investigation...?
Anyhow, I would like to print out JohnL's bangbang procedure and show it to my doc.But how do I present it to him without affronting him? Because basically I'm saying that, as I have known all along, this 6 wks business sucks. On the rare occasions I have reacted positively, it has always been within a few days. I've resented wasting time and money on medications that I know aren't working. Who draws up these 6 wk guidelines ? The drug companies? But who am I to tell him, that on the basis of a few weeks on a message board, he should change his approach ? How have others gone about it? Jan
Posted by saint james on February 28, 2000, at 3:15:05
In reply to The results of following advice..., posted by janet on February 27, 2000, at 21:28:18
Who draws up these 6 wk guidelines ? The drug companies? But who am I to tell him, that on the basis of a few weeks on a message board, he should change his approach ? How have others gone about it? Jan
james here.....No one draws up the 6 wk guidelines it is a fact of biochemistry, it just takes that long for this to start working. Actually we don't really know totally why it take that long...but it does.
j
Posted by JohnL on February 28, 2000, at 5:01:21
In reply to The results of following advice..., posted by janet on February 27, 2000, at 21:28:18
I find that when I print out my research for the pdoc to read in black and white, it makes my case much stronger. It's hard for the pdoc to argue against what other physician's are having success with. Dr Bob's Tips are loaded with printable ammunition to support your case. Look up stimulants in 'Tips', print out what you find. I also print testimonials of patient success stories. WayneR and Naltrexone for example. There are other testimonials here of stimulant success stories.I think it's worth noting that suggestions and advice on this board are sometimes helpful, but sometimes not. It's ultimately up to the patient and the doc to weigh pros and cons. Each patient has unique chemistry. What works for one won't work for another. But I find it helpful to accept advice from others, especially when I'm up against a dead-end. It never ceases to amaze me that there was something else I hadn't thought of. Advice and suggestions give me hope. Many times simply having hope restored is the magic link that allows me to get through another day when it otherwise seemed impossible.
Too often I think many pdocs become entrenched in treating depression with antidepressants. They think too much in terms of symptoms and diagnosis, but not enough in terms of understanding the unique underlying chemical imbalance of the patient. What those pdocs fail to realize is that the depression might not have anything to do with low serotonin. Identical symptoms can be caused by a variety of chemical imbalances, some of which have nothing at all to do with serotonin. My pdoc explained to me how stimulants closely resemble NE/dopamine in molecular structure, and he thus views stimulant treatment as NE/dopamine replacement. That's how the body interprets it. He explained how Tegretal closely resembles the tricyclics. If someone does poorly on a tricyclic, he can predict fairly that Tegretal would not be a good match for that patient.
In the old days we had few drugs to choose from, and thus it became reality to wait 6 weeks for a trickle down effect. Today we have many choices to more directly target the unique chemistry of each patient. The purpose of quick trials is to identify superior matches in a drug class and to weed out inferior ones. Once the superior drug has been found, then we can continue with a longer trial. We want to be sure the patient is on the best match within a drug class. The best match makes itself known by quick response and minimal side effects. The body likes it at a molecular level.
We've seen patients experience profound improvement in a short amount of time. Clearly their drug was on target. We've seen people get well in longer trials. Clearly their med was off target, working indirectly through a trickle down process. Rarely do we see someone who has a minimal improvement in the first couple weeks get a miraculous improvement at 6 weeks. It happens, but not very often. If the drug is off target, it can still work, but not as well and not as fast as one that is on target. Quick trials allow us to weed out inferior matches before committing to longer trials.
Sorry to go so long here. Basically I just wanted to reiterate that stimulants do have a valid role in treating depression, as they have since even before the first antidepressants were invented, and that printing out research helps me make my case to my pdoc. He can doubt me, but it's a lot harder to doubt dozens of other physicians in black and white. JohnL
Posted by CarolAnn on February 28, 2000, at 8:50:40
In reply to Re: The results of following advice..., posted by JohnL on February 28, 2000, at 5:01:21
Janet, I don't understand your Pdoc's trouble with stimulants. I've had two Doctors, both of whom had no problem with using stimulants to augment antidepressants. In fact, my current Pdoc assured me that "it is very common practice" to do this. JohnL is right about compiling research, you may also see if you can get any info from other psychiatry practices in your area, which advocate stimulants, then you can actually ask your Pdoc to talk with the other doctors.CarolAnn
Posted by Paul S. on February 29, 2000, at 1:43:59
In reply to The results of following advice..., posted by janet on February 27, 2000, at 21:28:18
Janet, if you've taken many medications in the past without long term success, your pdoc should be willing to try a stimulant. When I mentioned it to my doctor, he said in no uncertain terms that he would not try them. Solution:..I got a new doctor. Stimulants weren't successful for me but it didn't take long to test them out. I agree with the frustration of having to take a med for 6 weeks to see if it works; and 6 weeks more after that at an increased dose, etc, etc..
Six weeks can stretch out into years with all the drugs they try people on....or at least it has in my experience.
Anyways, if you have worked with your pdocs previously by taking your meds they should be responsive to your suggestions.
Best of luck.
Paul S.
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