Psycho-Babble Medication Thread 492737

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What Should I Do? Any Opinions Welcome

Posted by TomG on May 2, 2005, at 14:23:06

I haven't been an avid poster recently, but I've been mentioning Selegiline to my doctor for the last two or three meetings. Each time he confusingly looks at me and asks how to spell it and he then types it into his PDA. I have to tell him its a Parkinson's drug that increases dopamine. He looks up from his PDA and says, "Oh yes its an MAO-B inhibitor." like he is clueless about it. Whats up with this? From what I see on this board it is being widely used to treat depression with good results here on PB and even better in some of the studies I've read. I'm very interested in seeing what an increase in dopamine will do to my broken brain. I'm going on 10 years trying to find a drug that works for me. A low dose of Geodon worked excellently for me for two months and then pooped.

I have tried Wellbutrin, but I believe that I don't do well with increases in norepinephrine. I'm embarassed to say that I only recently made it two days on a trial of 30mgs of Cymbalta. It tensed my entire body, felt like I was in a wind tunnel, and I couldn't eat a bite. Two days was all I could take. My short trial with Wellbutrin over 5 years ago was similar to this. I also don't think Wellbutrin holds a candle to Selegiline when increases in dopamine are considered, so I'm more interested in trying Selegiline, but will not eliminate Wellbutrin as a future option. I also like the fact that Selegiline is exclusive to its activity on dopamine.

One word that would describe my primary symptom is that I have no *zeal*. I don't communicate with people very well and I have no confidence and seem to lack emotion (happiness or sadness). I feel slowed down a feel like my speech is slow.

I'm very concearned about what to do about a doctor that doesn't know about a drug such as Selegiline. I have to drive an hour to see this guy, but I am 5 minutes away from a pdoc that was trained at Mass General/Mclean/Harvard known to be the best here in the U.S. at least. I have seen him before three years ago, but I didn't like his personality. He was very liberal with drugs though and I believe even mentioned Selegiline. Nardil was one of the first drugs he prescribed me. I wonder if I should go back. My current doctor is an old pioneer and the prospective doctor is a hotshot right out of medical school. My doctor today said that the psychiatric community needed more evidence and data of it being effective in mood disorders. Blah blah. What to do? Sometimes I think my base knowledge of medicines is greater than his. Opinions welcome


P.S. I am currently taking 100mgs of Seroquel and will increase in two weeks based on response. He also told me to take 200mgs of Provigil, because I recently did an experiment with an old prescription. I took 1000mgs Provigil within one hour, because 200mgs had previously really done nothing for me. I know 1000mgs is excessive, and I wouldn't recommend it, but man did that dose work. For about 6-7 hours the effects were virtually the same as a dose of MDMA. I also didn't sleep for over 36 hours with no signs of sleepiness whatsoever. It had no impact on mood really, but the focus was unbelievable; more than any stimulant I've ever taken. I will start titrating at 200mgs this time and see if going up to a comfortable dose improves my sedentary lifestyle.

Sorry to be long,
Tom

 

Re: What Should I Do? Any Opinions Welcome » TomG

Posted by PM80 on May 2, 2005, at 16:11:20

In reply to What Should I Do? Any Opinions Welcome, posted by TomG on May 2, 2005, at 14:23:06

First, what is your dx?

Second, it does not sound like your current doc (the one an hour away) has enough knowledge to fully help you here. You only mention that there are 2 doc's you can see. Are there more in your area or do you really live far away from, well, modern "civilization" (don't take that the wrong way)? If you must choose between the two, it may be better to see the guy that is more liberal, and it seems, better informed, about pdrugs today. To be a bit dramatic, great strides have been made with pdrugs in the last 10-15 years. And not all of these strides are "FDA-approved" due only to the cost of FDA studies and NOT to the efficacy of the drugs for off-label uses. Therefore a pdoc that is "hotshot" right out of med school may have significantly more knowledge than your more old-school doc.

One more thought on your choice of docs: It may be better to have a doc that is willing to over-prescribe pdrugs. That way you can experiment on your own and find what actually works for you. You do not have take (or continue to take) everything he offers.

Upping the dose of Seroquel may not help your blah-ness. Seroquel can be sedating; thus, it may make you even more blah. On the other hand, Seroquel works as an antidepressant for some people (it didn't for me). SO I would definitely pay attention to how you are feeling as you change meds and doses. If it makes things worse or has no effects after the necessary time (1wk-6wks, depending on the drug), don't stay with it. Find something that WILL work.

 

Re: What Should I Do? Any Opinions Welcome

Posted by TomG on May 2, 2005, at 17:12:51

In reply to Re: What Should I Do? Any Opinions Welcome » TomG, posted by PM80 on May 2, 2005, at 16:11:20

No offense to anybody living in Mississippi, but I'm pretty sure I live far away from civilization. The health care in this state is horrendous. I had to move here awhile back from the L.A. area so you can imagine my surprise. Surprisingly, the liberal psychiatrist with the credentials lives in my town (population 21,000). He is the only psychiatrist here. I travel an hour away to Memphis to my older current doctor.

There is a university teaching hospital in Memphis, and the number of psychiatrists is high. I could try my luck at a new doc in Memphis, but I think you might be right that I should go back to the doctor here. I at least know how he operates. The reason I left him was because I felt like he was almost insistent that I try to work. I want to work, but at the time I had just lost my job because of my symptoms, and had to move all the way across the United States. That doctor thought that I was bipolar, because I was cycling from depression to hypomania I think because of stress from the job and the move. I have also gotten hypomanic from other drugs. I sort of felt like that he was saying, "get a job or I won't treat you.". However, that was probably from paranoia and lack of communication. I still feel like my symptoms are too bad to be able to hold a job. I have a hard time saying what I should. Before we could figure out if I was bipolar I switched to my current doc. I have not had an episode of hypomania in three years or anything that really resembles it. My current doctor thinks I am in the schizophrenic realm. It's not exclusive to schizophrenia, but I have never lost touch with reality or heard voices, but thats his opinion.

Tom

 

Re: What Should I Do? Any Opinions Welcome » TomG

Posted by Phillipa on May 2, 2005, at 19:11:57

In reply to Re: What Should I Do? Any Opinions Welcome, posted by TomG on May 2, 2005, at 17:12:51

That's a tough choice to have to make. Could you check out some of the other pdocs credentials on the internet. I know we at least looked to see if they had pending lawsuits. My current pdoc has a lot websites about her and her work with addiction, and other problems, she also reviews for the American Psychiatric Association. So look a few of them up and maybe one will stand out. Good luck. Fondly, Phillipa


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