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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by g_g_g_unit on August 19, 2011, at 9:45:47
i was wondering if anyone could help provide a perspective on whether i'm being irrational.
i was referred to a new psychiatrist at the start of the year, after just about being ready to wipe my hands clean of the profession. anyway, he turned out to be a lovely, thoughtful guy - he's discerning, listens intently to what i have to say, yada yada.
he was also pretty flexible - prescribed dexamphetamine after the first consultation, asked me what i'd like to try as far as ADs go, etc.
but lately, i find when i complain about a problem (with the conviction that it's somehow a 'chemical' issue), he seems to put a psychological spin on it and then i get angry and feel like i'm being blamed for something not in my control. by way of an example: i complained i was feeling so apathetic on lexapro i could barely summon the effort to do things like walk up the road to the library, but that things were easier to do when someone else initiated them and took control (e.g. my mom inviting me to the mall), and he said i needed to question why i couldn't act as my own 'agent' .. whereas i thought most psychs would just see that as a side-effect of SSRIs.
today i was complaining about the constant torment i've been feeling over depersonalization symptoms (which have lasted over 2 years now), which i expected would prompt some discussion about medication, but he said i needed to expose myself to the feelings and realize that they're harmless ..
i'm really not trying to complain about him or paint him as incompetent, since he has been anything but. i'm just wondering if maybe steering me away from meds is a good thing, or if he's overly analytical (i am also seeing him for weekly psychotherapy). it's just that i complain when a psychiatrist's too med-happy, now i feel this guy isn't med-happy enough .. i donno what i want .. i just know that i've been leaving our sessions feeling really frustrated lately and i'm wondering if that frustration's valid or the product of unrealistic expectations.
Posted by Phillipa on August 19, 2011, at 10:57:25
In reply to need an outside perspective, posted by g_g_g_unit on August 19, 2011, at 9:45:47
I kindda know what you mean as only see mine once every few months but her advice it initiate things on your own. I know she's right but find my self powerless to follow through. My husband calls himself an enabler and that he has allowed me to depend on him for all initiation of all things. It just seems that those I know are better off their meds. One girl that was addicted to pain meds then given psych meds is now going twice a day to NA and getting off them all. Do you think the pdocs are realizing their meds can't "fix a lot of people" me included. Phillipa
Posted by mellow on August 19, 2011, at 14:26:03
In reply to need an outside perspective, posted by g_g_g_unit on August 19, 2011, at 9:45:47
My doc does this sometimes and it annoys me. He was hell bent on certain med combos and now he is playing therapist all the time. In fact we didn't really discuss meds at my last session. He started talking about my spiritual life.
It was all chemical a year ago and now unless I'm completely in crisis he basically tells me everything is fine and I need to look inward for strength. I hate how pdocs flip flop. They can deal with mania, they just dope you up, but if you talk about depression or OCD it's all in your head.
mellow
Posted by sigismund on August 19, 2011, at 15:30:54
In reply to need an outside perspective, posted by g_g_g_unit on August 19, 2011, at 9:45:47
He Rxd you dexamphetamine in, if I am not mistaken, Australia. Comorbid ADHD and OCD is just the sort of thing not treated here.
In your shoes I would be endlessly patient as a result.
You could take a little less SSRI perhaps?
I don't think this
>he said i needed to question why i couldn't act as my own 'agent'
is silly at all, though I don't know what conclusions you can possibly come to. What I mean is, I am familiar with this myself. When you care enough, you just do it.
Posted by emmanuel98 on August 19, 2011, at 18:58:42
In reply to Re: need an outside perspective, posted by sigismund on August 19, 2011, at 15:30:54
There is only so much psych meds can do. If you feel incapable of walking alone, but capable of walking with others, then your capacity for action isn't the problem, is it? The social context is the issue and you need to look at that. I had depersonalization problems for a while after I started therapy (with my p-doc) and he did not see this as a problem meds could solve. I needed to work through the emotional issues and learn to be alone without freaking out.
I think you're lucky to have a p-doc willing to do therapy and not reduce everything to a med issue. Meds are effective for some things -- out-of-control anxiety, bipolar manias, schizophrenia, major depression. But not for others. Other problems require honest self-examimation, a trusting relationship with a therapist who knows you well.
Posted by g_g_g_unit on August 19, 2011, at 23:43:37
In reply to Re: need an outside perspective, posted by emmanuel98 on August 19, 2011, at 18:58:42
> There is only so much psych meds can do. If you feel incapable of walking alone, but capable of walking with others, then your capacity for action isn't the problem, is it? The social context is the issue and you need to look at that.
Sure, but it's far easier meeting externally-imposed invitations/obligations than acting on your (higher) self-interests in this context. I have a capacity for action insofar as I'm not physically disabled, but it's well-known that SSRIs blunt reward and are capable of inducing apathy. Going to the library isn't vital to my survival (like eating and going to work are) and it becomes much harder to summon the effort to pursue interests, concentrate, etc. I can force myself - and have certainly tried, for weeks now - but it never becomes effortless. And I know it's not 'laziness' because I have a reasonable comparison point from when I was 'healthy'.
>I had depersonalization problems for a while >after I started therapy (with my p-doc) and he >did not see this as a problem meds could solve. >I needed to work through the emotional issues and >learn to be alone without freaking out.
Yeah, I'm not so sure about that .. there are posts from SLS in the archives claiming that a successful remission from anxiety and depression should potentially result in a remission from depersonalization. Maybe he can correct me if I'm wrong on that point. I know that certain meds have certainly made the problem worse for me.
> I think you're lucky to have a p-doc willing to do therapy and not reduce everything to a med issue. Meds are effective for some things -- out-of-control anxiety, bipolar manias, schizophrenia, major depression. But not for others. Other problems require honest self-examimation, a trusting relationship with a therapist who knows you well.
Posted by g_g_g_unit on August 20, 2011, at 0:03:39
In reply to Re: need an outside perspective, posted by sigismund on August 19, 2011, at 15:30:54
> He Rxd you dexamphetamine in, if I am not mistaken, Australia. Comorbid ADHD and OCD is just the sort of thing not treated here.
Yeah, I'm in Australia. Hmm, maybe I should count my blessings then ..
>
> In your shoes I would be endlessly patient as a result.
>
> You could take a little less SSRI perhaps?
>
> I don't think this
>
> >he said i needed to question why i couldn't act as my own 'agent'
>
> is silly at all, though I don't know what conclusions you can possibly come to. What I mean is, I am familiar with this myself. When you care enough, you just do it.No, I don't think it's silly either. But I just feel like there's a threat of falling into fanciful intellectual exercises in this context. I think that mental agency can only override biological limitations to a certain extent.
Posted by bleauberry on August 20, 2011, at 13:05:06
In reply to need an outside perspective, posted by g_g_g_unit on August 19, 2011, at 9:45:47
The pdoc isn't the problem.. The meds are. Lexapro in particular, along with all the ssris, do what you are complaining about a lot. For one, whatever dose you are on, it is too high. Two, there needs to be an equal and opposite force along with it....norepinephrine and dopamine, not just serotonin. Dex can sort of do that on a hit and run basis, but you need it on a constant basis since Lex is constant. That said, think milnacipran, think nortriptyline, and consider lowering the dose when one of those is added. Personally I liked ritalin a whole lot beter than dex for purposes you mentioned, but mileage varies.
In the plant world, try adding rhodiola to lex. A pdoc in NYC does that because it's what ended up curing his wife when meds failed to do so. More basic trials could include tyrosine or dlpa or lpa.
Too much serotonin That's the problem. It isn't your thoughts. It isn't in your head. It's too much serotonin at the expense of the other crucial neurotransmitters. Sure, maybe one chemical deficiency was corrected...or over-corrected...and now there is a new one. Simple as that.
IMO
This is the end of the thread.
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