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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by ShelliR on February 21, 2001, at 17:24:47
Today I saw my pdoc and she gave me an ultimatum--if I continue to take codeine at all, she won't be my doctor.
I am taking nardil and lamictal and she wanted to add zyprexa. I have already gained 15lbs from the lamictal and then how much more could I expect from the zeprexa?
I haven't been able to tolerate any antipsychotic so far anyway.So, I feel very alone. She has been my pdoc for over ten years; she has stuck with me through my hospitalizations and is always available to me by phone.
But truely, in both my mind and heart, I think I have tried enough medications and the codeine seems to work, and I seem not to increase it. And there are doctors on the internet that have given patients with refractory depression hydocodeine in small amounts like I'm taking.
If I started to see an increase, I would detox immediately.I could take the vicidin by myself, but who would prescribe the nardil and lamictal? I have e-mailed several of the internet docs who feel okay about this, but they are on the other side of the country.
How does one find a pdoc that prescribes codeine. I can get it myself, but I think it would be good to still have collaboration with a psychopharmacogist around that and all my meds. Do I ask over the phone, "How do you feel about....." 99 out of 100 are going to say "no way", so how do I find that one?
I feel scared and fairly hopeless about getting the treatment I think is best for me. Shelli
Posted by kazoo on February 21, 2001, at 19:52:09
In reply to Feeling Really Alone re Meds, posted by ShelliR on February 21, 2001, at 17:24:47
> Today I saw my pdoc and she gave me an ultimatum--if I continue to take codeine at all, she won't be my doctor.
> I am taking nardil and lamictal and she wanted to add zyprexa. I have already gained 15lbs from the lamictal and then how much more could I expect from the zeprexa?
> I haven't been able to tolerate any antipsychotic so far anyway.
>
> So, I feel very alone. She has been my pdoc for over ten years; she has stuck with me through my hospitalizations and is always available to me by phone.
>
> But truely, in both my mind and heart, I think I have tried enough medications and the codeine seems to work, and I seem not to increase it. And there are doctors on the internet that have given patients with refractory depression hydocodeine in small amounts like I'm taking.
> If I started to see an increase, I would detox immediately.
>
> I could take the vicidin by myself, but who would prescribe the nardil and lamictal? I have e-mailed several of the internet docs who feel okay about this, but they are on the other side of the country.
>
> How does one find a pdoc that prescribes codeine. I can get it myself, but I think it would be good to still have collaboration with a psychopharmacogist around that and all my meds. Do I ask over the phone, "How do you feel about....." 99 out of 100 are going to say "no way", so how do I find that one?
>
> I feel scared and fairly hopeless about getting the treatment I think is best for me. ShelliShellyR:
It's understandable how a doctor, any doctor, would be hesitant about giving you the drug combination you say you need to help you. I do believe you when you say the codeine supplements the other medication; however, most doctors use conventional wisdom (as well as the PDR) and know that codeine (as a RULE) is for pain management. I feel badly for you, and for anyone else in this position, because what this leads to is "doctor shopping"; i.e., finding someone who will listen to you and is willing to continue your current drug protocol. And despite the fact that you use the codeine judiciously, doctor's will look at you with askance and label you as one habituated to drug. This is an awful position to be in, I know.
Since there is no reasoning with the current doctor, what you may have to do is to go to a regular M.D. and feign a back injury, or something, just to get a supply of codeine. I realize I'm going to catch hell for recommending this, but I say this because I've been in your shoes, and was forced to do the same. You know what's best for you, yet someone else tries to undo this. Such medicine!
If you do find an M.D. that will give you codeine, and you do decide to stay with your current psychiatrist, just don't share the information with either of them.
Good luck in all future endeavors.
(a sympathetic) kazoo
Posted by SalArmy4me on February 23, 2001, at 0:42:41
In reply to Feeling Really Alone re Meds, posted by ShelliR on February 21, 2001, at 17:24:47
Zyprexa will be good for you. For Zyprexa has been proven to have effects on serotonin, thus it can augment antidepressants. Another study confirmed that last year.
Here are the advantages of Zyprexa, as opposed to most antipsychotics and antidepressants:
--It will calm you down all day; when I took it, I thought it was better than a benzo.
--It has no anticholinergic effects.
--It has no sexual side-effects.
--It will definitely help you sleep.
--Zyprexa is convienient because it is taken only once at night.
--It is covered by insurance, generally.
--It augments antidepressants.
--Despite what rumors go around, Tardive Dyskinesia on Zyprexa is rare.I took 10 mg of it at bedtime, and I had no drowsiness in the morning. I didn't have any weight gain either.
Posted by Steffany on February 24, 2001, at 20:04:48
In reply to Feeling Really Alone re Meds, posted by ShelliR on February 21, 2001, at 17:24:47
i feel really sympathetic to your concerns about finding a psychiatrist whom you could be honest with about using codeine to supplement your other medications (they're maoi's, right?) while i've never tried taking vicodin on a regular basis for depression per se, i've always enjoyed it as a sedative/mild high/painkiller. i really wish more doctors took a more flexible approach to unorthodox uses of the "dread narcotics," but unfortunately, even when they're open to it, their hands are often tied by the DEA, which keeps track of these sorts of prescriptions and could possibly investigate a doctor who prescribed vicodin for a psychiatric condition.
i'm not sure how long you've been using the combination you described--has it been long enough that you're truly sure the benefits outweigh the risks? any long-term opiate use will result in some level of chronic constipation and eventually a tolerance buildup. from my own experience in using opiates as antidepressants (which was admittedly a lot less judicious than yours, since i used 'small amounts' of heroin) i found that within about three months i had a rebound depression more profound than before. withdrawal will also precipiate depression, so if/when you decide to stop the vicodin, even if you've been taking very small doses, taper off slowly. you may want to substitute tylenol-3's, which are easier to obtain from doctors b/c they contain plain codeine (hydrocodone is a stronger form). also, vicodin contains quite a large amount of acetaminophen, which long-term can cause a lot of kidney and liver damage.
but if you're really sure about this, i wish you good luck, and really hope you are able to find an open-minded psychiatrist who can give you honest advice.
Posted by ShelliR on February 24, 2001, at 23:30:03
In reply to Re: Feeling Really Alone * But you're not. » ShelliR, posted by kazoo on February 21, 2001, at 19:52:09
Thanks for your support, Kazoo. So far I still have enough codeine for another six months to a year, so that is not really my concern. I hate lying to doctors who know me, so it's just seems more complicated to me than getting codeine and continuing with my pdoc.
Posted by ShelliR on February 24, 2001, at 23:32:37
In reply to Re: possibly Zyprexa, posted by SalArmy4me on February 23, 2001, at 0:42:41
Thanks for the list of advantages of zyprexa. It is, however, very rare not to gain weight on that medication. Also I've tried other other antipsychotic with bad results, so I'm not interested in trying another.
But it's great that it's working so well for you.
Shelli
Posted by ShelliR on February 24, 2001, at 23:49:45
In reply to Re: Feeling Really Alone re Meds, posted by Steffany on February 24, 2001, at 20:04:48
Steffany, thanks so much for your thoughtful note. So far it's been three years since I have supplemented with hydocodeine with no increase or withdrawal feels. (I was in the hospital for a week last summer to get topomax up high really fast, and felt no longing or any physical sensations without the vicidin. But then again, most of that week the topomax just knocked me out.)
I plan to call two local psychiatrists who have been around for a really long time just to see what their feelings are about it. I am not expecting them to supply it to me; just want to talk it over with a doctor who was practising when tricyclics and MAOIs were all that was available
And thanks for the information about acetaminipen--I'll have to look into that; with all the doctors giving me such a hard time about it, no one has even mentioned that. Shellie
Posted by SalArmy4me on February 25, 2001, at 14:28:12
In reply to Re: possibly Zyprexa » SalArmy4me, posted by ShelliR on February 24, 2001, at 23:32:37
You're going to turn down a medicine that has a great chance of helping you because of the chance of weight gain? Concern yourself only with your mental health and well-being. If _I_ knew there was something out there that was as tolerable as Zyprexa and could help with my illness, I wouldn't care if it made me as fat as the Nutty Professor.
Posted by Cindylnc on February 26, 2001, at 17:27:56
In reply to Re: possibly Zyprexa, posted by SalArmy4me on February 23, 2001, at 0:42:41
> Zyprexa will be good for you. For Zyprexa has been proven to have effects on serotonin, thus it can augment antidepressants. Another study confirmed that last year.
>
> Here are the advantages of Zyprexa, as opposed to most antipsychotics and antidepressants:
>
> --It will calm you down all day; when I took it, I thought it was better than a benzo.
> --It has no anticholinergic effects.
> --It has no sexual side-effects.
> --It will definitely help you sleep.
> --Zyprexa is convienient because it is taken only once at night.
> --It is covered by insurance, generally.
> --It augments antidepressants.
> --Despite what rumors go around, Tardive Dyskinesia on Zyprexa is rare.
>
> I took 10 mg of it at bedtime, and I had no drowsiness in the morning. I didn't have any weight gain either.Hey go to key word Panic Disorder Institute and read what Dr. Shipko and people who post there have to say about the SSRI's. I would never take one.
Posted by Cindylnc on February 26, 2001, at 17:32:37
In reply to Re: possibly Zyprexa » ShelliR, posted by SalArmy4me on February 25, 2001, at 14:28:12
> You're going to turn down a medicine that has a great chance of helping you because of the chance of weight gain? Concern yourself only with your mental health and well-being. If _I_ knew there was something out there that was as tolerable as Zyprexa and could help with my illness, I wouldn't care if it made me as fat as the Nutty Professor.
Excuse me!! You need to read all the studies on SSRI's before you make a comment like that. There are long term side effects of SSRI's. Go to the Paxil Board and read on.
Posted by Cindylnc on February 26, 2001, at 17:35:32
In reply to Feeling Really Alone re Meds, posted by ShelliR on February 21, 2001, at 17:24:47
> Today I saw my pdoc and she gave me an ultimatum--if I continue to take codeine at all, she won't be my doctor.
> I am taking nardil and lamictal and she wanted to add zyprexa. I have already gained 15lbs from the lamictal and then how much more could I expect from the zeprexa?
> I haven't been able to tolerate any antipsychotic so far anyway.
>
> So, I feel very alone. She has been my pdoc for over ten years; she has stuck with me through my hospitalizations and is always available to me by phone.
>
> But truely, in both my mind and heart, I think I have tried enough medications and the codeine seems to work, and I seem not to increase it. And there are doctors on the internet that have given patients with refractory depression hydocodeine in small amounts like I'm taking.
> If I started to see an increase, I would detox immediately.
>
> I could take the vicidin by myself, but who would prescribe the nardil and lamictal? I have e-mailed several of the internet docs who feel okay about this, but they are on the other side of the country.
>
> How does one find a pdoc that prescribes codeine. I can get it myself, but I think it would be good to still have collaboration with a psychopharmacogist around that and all my meds. Do I ask over the phone, "How do you feel about....." 99 out of 100 are going to say "no way", so how do I find that one?
>
> I feel scared and fairly hopeless about getting the treatment I think is best for me. Shelli
Shelli,
Go to the Panic Disorder Institute Board. Use Keyword Shipko to get there. That stands for Dr. Shipko the director of the Institute. I wouldn't take an SSRI and you probably will be better educated after reading the posts from several people who have taken them. Good luck.
Posted by judy1 on February 26, 2001, at 18:36:52
In reply to Feeling Really Alone re Meds, posted by ShelliR on February 21, 2001, at 17:24:47
We've posted back and forth about this before, and while I admire your honesty about communicating with your pdoc to me you have 2 choices. One, kazoo's advice- keep the pdoc and 'lie' about your use or dump the pdoc. Since she has been so supportive in many other ways, and that's a lot of years you've spent establishing that relationship- my instinct would be to keep her and omit the narcotics use. I truly feel you know what is best for you, and unless you are psychotic, forget the zyprexa. My pdoc told me he knows that many of his patients lie about their substance abuse, so he tries not to make judgements and is very open to his patient's desires on their drug regimens. But it took me a dozen to find him. You take such a small amount, don't sweat it. Take care, Judy
Posted by ShelliR on February 26, 2001, at 19:32:09
In reply to Re: Feeling Really Alone re Meds, posted by Cindylnc on February 26, 2001, at 17:35:32
Hi CindyInc (I love the name) and Judy,First, Cindy, zyprexa is not an SSRI, it's an anti-pychotic. But as far as I'm concerned, they both can cause a lot of damage. But then again, so can depression. For some people it's definitely worth it, because depression is a horrible way to live.
Everybody's got to make their own choices. And mine is to chose not to take an antipsychotic when there are other choices available to me, including codeine. Incidently, I e-mailed Shipko and asked where he practises--Southern California.
Judy, I think I could keep the codeine separate from my pdoc; but I'm really bothered now by the fact that she keeps pushing anti-pychotics, even though they make me feel weird, and I don't feel comfortable about them. I sort of feel like saying to her--yea you try being depressed and on these meds--you try gaining 40 lbs and see how you feel or waking up and being really stiff and not talking
clearly and feeling really scared. I get the feeling that while she cares about me, she's more interested in finding the right chemical element, rather than the quality of my life. So it may be time to part ways at this point, anyway. (By the way are you also in California? Northern or Southern?)Anyway, thank you both for your feedback.
Posted by judy1 on February 26, 2001, at 20:47:39
In reply to Re: Feeling Really Alone re Meds, CindyInc Judy, posted by ShelliR on February 26, 2001, at 19:32:09
Hey Shelli,
I'm in So. California and can make suggestions here. If you are in Northern CA, are you close to Stanford? I hear they have an excellent mood disorders program and may be worth the phone call to the head of psychiatry's secretary with the question who would you send your mother/daughter/sister to? You MUST tell your shrink your concerns with zyprexa- weight was huge for me and as I mentioned before I have had struggles with bulimia. If she is not receptive to your concerns, dump her. If you are not psychotic why would you put yourself at risk for TD too? Dr. Shipko mentioned some of the older shrinks are more receptive to opiates as AD's- afterall morphine was the #1 AD for many years. To me it's like benzos, you know exactly what's going on in your brain, they both have been around for years and years- unlike atypical APs and SSRIs, etc (which, guess what, have a hell of a withdrawal problems too). Well I guess you can see you are not alone in this quest, a few of us feel very strongly about the benefits of hydrocodone. Take care, Judy
Posted by Cindylnc on February 27, 2001, at 21:23:17
In reply to Re: Feeling Really Alone re Meds, CindyInc Judy, posted by ShelliR on February 26, 2001, at 19:32:09
>
> Hi CindyInc (I love the name) and Judy,
>
> First, Cindy, zyprexa is not an SSRI, it's an anti-pychotic. But as far as I'm concerned, they both can cause a lot of damage. But then again, so can depression. For some people it's definitely worth it, because depression is a horrible way to live.
>
> Everybody's got to make their own choices. And mine is to chose not to take an antipsychotic when there are other choices available to me, including codeine. Incidently, I e-mailed Shipko and asked where he practises--Southern California.
>
> Judy, I think I could keep the codeine separate from my pdoc; but I'm really bothered now by the fact that she keeps pushing anti-pychotics, even though they make me feel weird, and I don't feel comfortable about them. I sort of feel like saying to her--yea you try being depressed and on these meds--you try gaining 40 lbs and see how you feel or waking up and being really stiff and not talking
> clearly and feeling really scared. I get the feeling that while she cares about me, she's more interested in finding the right chemical element, rather than the quality of my life. So it may be time to part ways at this point, anyway. (By the way are you also in California? Northern or Southern?)
>
> Anyway, thank you both for your feedback.
I live in AZ and am going to move to NM. I think Shipko charges to much but his website is great. I think people with depression would be better off with a TCA instead of SSRI.Good luck.
Posted by ShelliR on March 5, 2001, at 18:17:04
In reply to Re: Feeling Really Alone re Meds, CindyInc Judy, posted by Cindylnc on February 27, 2001, at 21:23:17
I finally had a good experience with a doctor--my gynocologist (who I've just started with last year and right from the beginning thought she was wonderful). I had never mentioned the hydrocodone to her before. She actually listened to me when I told her how much it helped me both emotionally and physically with pms. And how I hadn't increased in two and a half years.She also made me realize how closely doctors are monitored when they give out too many narcotics and it is one of the reasons that doctors have lost their licenses.
Anyway, she said she didn't know why a small amount of hydrocodone worked so well for me, but she believed me and would proscribe 10 a month for me. She didn't want me to have to get it illegally off the internet.
I feel good that someone is supervising me on it, and if it ever starts getting out of hand she will be there to talk to about it. I will also let my new pdoc know, when I change, and that will partially determine if they are the right pdoc for me.
By the way, she also prescribed a very very low dosage birth control pill with both estogen and progesterone in it to see if it helps me with PMDD. She felt the estradiol patch had too much estrogen in it and might make me more depressed.
Anyway, since I was so discouraged after seeing my pdoc last time, I wanted to share an "up". shelli
Posted by judy1 on March 5, 2001, at 18:48:35
In reply to Followup: feeling really alone re meds, posted by ShelliR on March 5, 2001, at 18:17:04
Dear Shelli,
Thank you for posting your success story; I guess you never know what specialty will be receptive to our own observations. But she sounds like a wonderful doctor, and I'm happy for you that you were comfortable enough to discuss this with her and she was open enough to understand. I hope I'm not making a generalization here, but as a specialty I have found psychiatrists to be a fairly close minded group; I don't know if it's a ego thing where they don't appreciate their educated patients presenting their ideas or another reason. But I wish you well in your quest, and I'm sure this has come as a relief. Let us know how the birth control pills work with your mood regulation. Take care, Judy
Posted by ShelliR on March 5, 2001, at 21:48:06
In reply to Re: Followup: feeling really alone re meds » ShelliR, posted by judy1 on March 5, 2001, at 18:48:35
Judi, I agree about psychiatrists. They either seem incompetant or inflexible. They do have a lot of responsibility if something goes wrong (like drug reactions or addiction) and probably are afraid of being sued. So maybe they are a bit frightened to be creative. My pdoc seemed creative to me, mixing MAOIs and stimulents, but it's only because she goes to all the APA meetings, where the concensus is that the mixture is now acceptable. At least I have to give her credit for going to the meetings, so at least she is on top of "conventional", accepted medication treatments, even including studies of alternative treatment, such as omega oils.
But anything outside of those meetings is definitely out.
I heard some of the "old-timers" who have stayed on top of new information are some of the best doctors. That will probably be my next route.
This is the end of the thread.
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