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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by g_g_g_unit on March 28, 2012, at 9:50:27
Hi Scott,
I posted this in an earlier thread and thought you may have missed it. I was seeing my psychiatrist tomorrow (12 hours from now), so was wondering if you might be able to offer any advice:
Scott, my psychiatrist wasn't comfortable prescribing Prazosin because he'd never used it before (ditto with Memantine), which is why he went with Clonidine.
He has never been outright vindictive or cruelly withholding, but he certainly has a strong will and well-defined boundaries regarding what he does/doesn't like prescribing, i.e. at this point I've heard him express hesitancy in using a) high-dose SSRIs (due to withdrawal issues), b) Effexor (ditto), c) Ativan (tolerance issues and the subsequent need for dose escalations), and d) Klonopin (no reason given).
He is certainly no dunce; he comes recommended as one of the best specialists in my city. I wonder if his training as a psychotherapist contributes to his lack of yielding to demand (which I have found in certain psychiatrists).
As someone who (I imagine?) has worked with strong-willed, highly capable professionals, do you have any advice for negotiating with psychiatrists? Due to social anxiety, this is something I find somewhat difficult.
Posted by g_g_g_unit on March 28, 2012, at 23:51:13
In reply to question for SLS, posted by g_g_g_unit on March 28, 2012, at 9:50:27
I saw my psychiatrist today and told him that I was experiencing anxiety and overstimulation on my current dose of Parnate (5mg 3x a day).
I've suspected that raising the dose - thus allowing for increased MAO inhibition - might help offset these side-effects, but was too scared to suggest as much. His opinion was that higher dose = more side-effects.
I did, however, note that I found the Parnate-induced stimulation far more tolerable during instances where I combined it with Valium. So thankfully he's decided to prescribe Valium 5mg 3x a day in the hope that I can now reach a therapeutic dose of Parnate.
My only qualm is that, despite complaining that Clonidine was causing next-day flatness, reduced mood etc., he's said that this is something I'll "simply have to put up with for now". It is interfering with my social life because I'm a lot more sedated and inert and uninteresting, so I was kinda disappointed with his decision.
Posted by SLS on March 29, 2012, at 3:31:14
In reply to update, posted by g_g_g_unit on March 28, 2012, at 23:51:13
> I saw my psychiatrist today and told him that I was experiencing anxiety and overstimulation on my current dose of Parnate (5mg 3x a day).
>
> I've suspected that raising the dose - thus allowing for increased MAO inhibition - might help offset these side-effects, but was too scared to suggest as much. His opinion was that higher dose = more side-effects.
>
> I did, however, note that I found the Parnate-induced stimulation far more tolerable during instances where I combined it with Valium. So thankfully he's decided to prescribe Valium 5mg 3x a day in the hope that I can now reach a therapeutic dose of Parnate.
>
> My only qualm is that, despite complaining that Clonidine was causing next-day flatness, reduced mood etc., he's said that this is something I'll "simply have to put up with for now". It is interfering with my social life because I'm a lot more sedated and inert and uninteresting, so I was kinda disappointed with his decision.
I'm frustrated to hear this. It is not as if you are relying upon clonidine to reduce dangerously high blood pressure. It is being used psychiatrically. The whole idea is to feel better, not worse. Obviously, clonidine has failed to achieve the desired outcome. It has not produced a dissipation of the undesirable effects of Parnate, otherwise he would not have prescribed Valium.Perhaps I am missing something?
I am not advocating that you use prazosin, but I am suggesting that your doctor is unusually lazy to not open a few books or talk to other doctors to learn about prazosin and how benign a drug it is. If he is uncomfortable using it because he is unfamiliar with it - well then, GET familiar with it! It is one of the best PTSD drugs out there. I should hope any psychiatrist would want to familiarize himself with prazosin for exactly that reason.
Really, this is nothing more than me ranting. Perhaps your doctor is better than I currently give him credit for. Obviously we all want the best for you. I'm just not sure that you are getting it.
Don't worry. Things may be painful for awhile, but I do believe that there are answers out there for you. I will be impressed if you get well using Parnate. I don't think I would have had the fortitude that you have shown to persist with the side effects you are experiencing. Most impressive is your tolerance for discomfort and the drive you demonstrate to take care of yourself. You are a survivor. Now, we just have to make you a healthy and happy survivor.
:-)
- Scott
Posted by g_g_g_unit on March 29, 2012, at 5:25:21
In reply to Re: update » g_g_g_unit, posted by SLS on March 29, 2012, at 3:31:14
> I'm frustrated to hear this. It is not as if you are relying upon clonidine to reduce dangerously high blood pressure. It is being used psychiatrically. The whole idea is to feel better, not worse. Obviously, clonidine has failed to achieve the desired outcome. It has not produced a dissipation of the undesirable effects of Parnate, otherwise he would not have prescribed Valium.
Well, I said that Clonidine was helping me fall asleep, which is true, though the results have been a little hit-and-miss. Some nights its made things worse, though that's potentially my fault for messing around with supplements at the same time. So, in his opinion, it is fulfilling its purpose (i.e. relieving insomnia) and therefore the next-day lethargy etc. is the price I pay. Ideally I would have like to try something like Klonopin instead, since it might help me fall asleep and relieve anxiety the next day, though, again, I was too shy to ask.
>
> Perhaps I am missing something?
>
> I am not advocating that you use prazosin, but I am suggesting that your doctor is unusually lazy to not open a few books or talk to other doctors to learn about prazosin and how benign a drug it is. If he is uncomfortable using it because he is unfamiliar with it - well then, GET familiar with it! It is one of the best PTSD drugs out there. I should hope any psychiatrist would want to familiarize himself with prazosin for exactly that reason.
>
> Really, this is nothing more than me ranting. Perhaps your doctor is better than I currently give him credit for. Obviously we all want the best for you. I'm just not sure that you are getting it.Hmm, yeah. Admittedly, he did read up on Prazosin before deciding against it. And I should also credit him for things like consulting Stahl's prescribing guide and agreeing to go by the American (rather than Australian) dosing guidelines for Parnate. He is normally quite sensitive to my needs, so I'm not sure why he suggested I continue with Clonidine. Maybe if the Parnate insomnia disappears, I could eventually go without it. I may order some Prazosin anyway.
Again, he comes highly recommended, but I also know that his background (as an ADHD specialist) is in child psychiatry, so I worry that may limit his experience. For example, I kept emphasizing that Parnate was purely acting like a stimulant at this dose (i.e. 2-3 hours of relief, followed by withdrawal) in the hope that he'd realize that I wasn't receiving sufficient MAO inhibition, and that doing so might relieve anxiety (which I believe it in fact did when I tried Parnate last time -- though as I've said before, he isn't aware of that fact, because I was worried he might refuse to prescribe it to me again).
>
> Don't worry. Things may be painful for awhile, but I do believe that there are answers out there for you. I will be impressed if you get well using Parnate. I don't think I would have had the fortitude that you have shown to persist with the side effects you are experiencing. Most impressive is your tolerance for discomfort and the drive you demonstrate to take care of yourself. You are a survivor. Now, we just have to make you a healthy and happy survivor.
>
> :-)Wow, I take that as a huge compliment. Thank you Scott.
Posted by creepy on March 30, 2012, at 11:38:45
In reply to question for SLS, posted by g_g_g_unit on March 28, 2012, at 9:50:27
My experience with pdocs is that theyre pretty busy and getting them to prescribe a med theyre not familiar with and without a previous prescription isnt likely to happen. Too much trouble.
You may have to change docs to change meds. thats been my experience several times now.
Posted by phidippus on March 30, 2012, at 13:42:48
In reply to question for SLS, posted by g_g_g_unit on March 28, 2012, at 9:50:27
I would put my foot down and ask for Prazosin, nothing more. Tell him your not budging on the subject and that you have many friends that are finding success with the drug.
Eric
Posted by g_g_g_unit on March 30, 2012, at 18:48:16
In reply to Re: question for SLS » g_g_g_unit, posted by phidippus on March 30, 2012, at 13:42:48
> I would put my foot down and ask for Prazosin, nothing more. Tell him your not budging on the subject and that you have many friends that are finding success with the drug.
>
> EricWell I spoke to Sigismund and it doesn't sound so great for sleep onset, which is a big part of my problem on Parnate.
Anyway, I would never in a million light years have the gusto to behave towards (an older male) authority figure like that. I'm just far too timid.
Posted by sigismund on March 30, 2012, at 19:46:16
In reply to Re: question for SLS » phidippus, posted by g_g_g_unit on March 30, 2012, at 18:48:16
I have heard at least one person say that Parnate insomnia was unremitting.
You stopped sleeping well a couple of years ago?
Parnate won't help with that, as you know.
Posted by g_g_g_unit on March 30, 2012, at 20:28:05
In reply to Re: question for SLS » g_g_g_unit, posted by sigismund on March 30, 2012, at 19:46:16
> I have heard at least one person say that Parnate insomnia was unremitting.
>
> You stopped sleeping well a couple of years ago?
>
> Parnate won't help with that, as you know.
>
>I don't know. That's kind of my dilemma at the moment. With the 5mg of Valium, it seems like I can finally tolerate taking 10mg of Parnate at once. The Clonidine helps me fall asleep, though I don't feel all that rested. So maybe I am in a position to reach a higher (or therapeutic) dose now. 60mg is my psychiatrist's target. I would hope to no longer need the Valium and (please God) the Clonidine at that point. My sleep-disturbances are the result of major depression, so my psychiatrist hopes that remission might help correct that.
I know insomnia is an unremitting problem at middling doses. However, there are reports on here from people who found that the insomnia disappeared at 60mg+ (bulldog2, Maxime, SLS? come to mind). Maybe that contradicts what you've read? Anyway, I'm holding on to that possibility out of desperation/hope.
It's just an incredibly frustrating process. Between the Valium and Clonidine I feel too dull and sedated to do much. I'm an incredibly impatient person and hate feeling out-of-control.
Posted by sigismund on March 31, 2012, at 17:01:29
In reply to Re: question for SLS » sigismund, posted by g_g_g_unit on March 30, 2012, at 20:28:05
>bulldog2, Maxime, SLS?
No that's right, as against Chairman Mao.
The idea that the AD (parnate) should improve your sleep be helping your depression remit sounds linguistic to me. It might though, what do I know.
I actually had a proper sleep last night. You know that thing where you check your clock and hope that sleep time is over because it is such hard work? I have kind of had that for 15 years. 2mg prazosin and 12.5 of trimipramine. I'm not recommending it, just fyi.
This is the end of the thread.
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