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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 Christ_empowered on February 15, 2015, at 13:58:56
Less than 1 month in. I'm on the old school, SR Wellbutrin...just 100 x 2/day. I feel so much better! I'm smoking a bit less already, I'm more rational about my food intake, I can concentrate a little bit better, and...
...and its everything I liked about low dose Ritalin, without all the bad stuff.
So, I'm wondering...what gives? Like, my previous shrink (its a community health clinic, so docs come and go) was trying to get me on amoxapine, stat. I resisted because I'm scared of amoxapine, and she put me on Prozac. She also recommended a low dose of PRN Haldol (!). I don't get it...
...so, can you base a diagnosis on response to meds? I do well on Abilify (30mgs) plus I need a mood stabilizer. In my case, I'm on 1200 Trileptal and just 100 Lamictal. Now the Wellbutrin SR has recently been added, and I'm doing much, much better, or at least I feel considerably improved. To be fair, I wonder if maybe I need wellbutrin because of the meds (especially the 2 anticonvulsants).
If the AAP is the main medication I absolutely must have, and the anticonvulsants are secondary, I didn't do well on Depakote, Trileptal alone didn't control the agitation...is that schizoaffective? And if Wellbutrin SR is a huge help, is that depression? Negative symptoms? Counteracting the ill effects of other meds?
My PRN meds are low dose Neurontin and low dose Risperdal.
Posted by ed_uk2010 on February 15, 2015, at 16:46:09
In reply to diagnosis based on reaction to meds?, posted by Christ_empowered on February 15, 2015, at 13:58:56
Hey,
Glad to hear you're still doing well. That's really encouraging.
>She also recommended a low dose of PRN Haldol (!). I don't get it...
Haloperidol is widely used as a PRN. It may be tolerable for you at the occasional low dose, but I can see no reason to switch since you already have Risperdal for this purpose and it helps.
> ...so, can you base a diagnosis on response to meds?
Unfortunately... no. There isn't enough evidence of a correlation to make that possible.
>...is that schizoaffective?
Schizoaffective disorder is diagnosed based on symptoms and on the course of the illness over time, so you cannot use med response to diagnose.
>And if Wellbutrin SR is a huge help, is that depression? Negative symptoms? Counteracting the ill effects of other meds?
It could be any of the above, to be honest. On the bright side, if it helps, I don't suppose it matters too much! I know it would be nice to understand more but.....
Posted by Louisiana Sportsman on February 17, 2015, at 6:37:52
In reply to diagnosis based on reaction to meds?, posted by Christ_empowered on February 15, 2015, at 13:58:56
> Less than 1 month in. I'm on the old school, SR Wellbutrin...just 100 x 2/day. I feel so much better! I'm smoking a bit less already, I'm more rational about my food intake, I can concentrate a little bit better, and...
>
> ...and its everything I liked about low dose Ritalin, without all the bad stuff.
>
> So, I'm wondering...what gives? Like, my previous shrink (its a community health clinic, so docs come and go) was trying to get me on amoxapine, stat. I resisted because I'm scared of amoxapine, and she put me on Prozac. She also recommended a low dose of PRN Haldol (!). I don't get it...
>
> ...so, can you base a diagnosis on response to medes? I do well on Abilify (30mgs) plus I need a mood stabilizer. In my case, I'm on 1200 Trileptal and just 100 Lamictal. Now the Wellbutrin SR has recently been added, and I'm doing much, much better, or at least I feel considerably improved. To be fair, I wonder if maybe I need wellbutrin because of the meds (especially the 2 anticonvulsants).
>
> If the AAP is the main medication I absolutely must have, and the anticonvulsants are secondary, I didn't do well on Depakote, Trileptal alone didn't control the agitation...is that schizoaffective? And if Wellbutrin SR is a huge help, is that depression? Negative symptoms? Counteracting the ill effects of other meds?
>
> My PRN meds are low dose Neurontin and low dose Risperdal.Glad you gave us an update! Hope you're doing well.
Hey, as I told you before no changes, besides changing doses on current meds to fit your needs, are needed.
Amoxapine acts as an AP in some ways and you already have Abilify covering that. But it is a fast-acting AD that won't send you into mania. If you're still depressed, I would have simply increased the bupropion. Amoxapine would probably help with sleep, but you have good PRN meds on board.
Haldol can be used PRN, but if risperidone works, I would have assumed to leave it alone. Haloperidol comes with a lot more side effects, and it is a bit more powerful.
OK, so now you're on Prozac? But only 200mg. of Wellbutrin? You know taking your Neurontin, not PRN, but say TID could help with anxiety underneath your depression to where you may not need another medicine to augment. I'm not against adding the Prozac, depression hurts your quality of life, but I think the amoxapine may have been better choice than the Prozac, IMO.
Good luck and please keep us updated!
Posted by Lamdage22 on February 17, 2015, at 8:32:08
In reply to diagnosis based on reaction to meds?, posted by Christ_empowered on February 15, 2015, at 13:58:56
I think the diagnosis should help you find the right meds. I never heard it the other way around.
What do you need this diagnosis for if you know what makes you feel well?
Posted by phidippus on March 2, 2015, at 13:47:53
In reply to diagnosis based on reaction to meds?, posted by Christ_empowered on February 15, 2015, at 13:58:56
Normally psychiatrists prefer diagnosing based on symptoms presenting and self-inventory tests such as the MMPI.
For instance, a person may become manic on an antidepressant, but that does not mean they will be diagnosed as bipolar-the DSM excludes mania caused by medication as a criteria for a diagnosis of bipolar disorder.
Eric
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