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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Squiggles on April 17, 2007, at 7:54:33
Some drugs (not lithium) have such unbearable side effects that people stop taking them or reduce the dose to below-therapeutic-levels. The consequences of this problem are socially devastating and often lead to suicide or violence. I know that some anti-psychiatry types think that this is a good thing, but i don't.
So, what do doctors think? What can be done? More importantly, what do drug companies do?Squiggles
Posted by Larry Hoover on April 17, 2007, at 8:45:09
In reply to Non-compliance, posted by Squiggles on April 17, 2007, at 7:54:33
> Some drugs (not lithium) have such unbearable side effects that people stop taking them or reduce the dose to below-therapeutic-levels.
Yes! lithium. I have never felt so suicidal as when I was on lithium.
> The consequences of this problem are socially devastating and often lead to suicide or violence.
Non-compliance is a management issue. It speaks to the relationship established between the doctor and patient. No patient should ever feel that non-compliance should be concealed.
> I know that some anti-psychiatry types think that this is a good thing, but i don't.
I question the relevance of this comment. Who cares what critics think?
> So, what do doctors think? What can be done?
Establish and maintain supportive management of the patient.
> More importantly, what do drug companies do?
What does this have to do with drug companies?
Lar
Posted by Squiggles on April 17, 2007, at 9:01:28
In reply to Re: Non-compliance » Squiggles, posted by Larry Hoover on April 17, 2007, at 8:45:09
> > Some drugs (not lithium) have such unbearable side effects that people stop taking them or reduce the dose to below-therapeutic-levels.
>
> Yes! lithium. I have never felt so suicidal as when I was on lithium.
>As far as i'm concerned, lithium is a miracle drug-- at the right dose. Monitoring is required for blood level safety. I am referring to imipramine.
> > The consequences of this problem are socially devastating and often lead to suicide or violence.
>
> Non-compliance is a management issue. It speaks to the relationship established between the doctor and patient. No patient should ever feel that non-compliance should be concealed.I agree.
>
> > I know that some anti-psychiatry types think that this is a good thing, but i don't.
>
> I question the relevance of this comment. Who cares what critics think?The relevance is important. Because when people get harmful side effects they are likely to fall for the irresponsible propaganda from the anti-psychiatry camps, who while encouraging people to get off their drugs offer little alternative, except perhaps suicide.
>
> > So, what do doctors think? What can be done?
>
> Establish and maintain supportive management of the patient.
>
Yes, I agree.
> > More importantly, what do drug companies do?
>
> What does this have to do with drug companies?They can work on drugs that are tolerable to take, or even just give opiates and monitor the dependence.
Squiggles
>
> Lar
>
>
Posted by Phillipa on April 17, 2007, at 9:50:22
In reply to Re: Non-compliance, posted by Squiggles on April 17, 2007, at 9:01:28
Squiggles no doc in the US is going to give opiates there are detox from opiod clinics all over. If in pain here physical theraphy is what's used and if you say your depression was helped by an opiod they laugh. Love Phillipa
Posted by Squiggles on April 17, 2007, at 10:18:51
In reply to Re: Non-compliance » Squiggles, posted by Phillipa on April 17, 2007, at 9:50:22
> Squiggles no doc in the US is going to give opiates there are detox from opiod clinics all over. If in pain here physical theraphy is what's used and if you say your depression was helped by an opiod they laugh. Love Phillipa
Hospitals used to use opiates before chlorpromazine and thorazine (i think they were called the phenothiazines), and it worked to some extent--
being a CNS depressant (as well as a euphoric), a stimulant would probably be needed as an adjunct.The tricyclics are multi-targeters-- I think that leaves the patient with maximum unpleasant side effects, and for major depression the SSRIs are too weak. The MAOIs *may* be appropriate if you can watch the diet. And the new anti-psychotics are dangerous. As I understand it, there are so many people who have depression now, that the medical profession welcomes any drug the pharms can come up with, just to keep the patients self-reliant.
I think they've made a fine mess. Maybe opiates in the form of Oxicontin? Would a dr. agree to that?
Squiggles
Posted by Racer on April 17, 2007, at 14:01:53
In reply to Re: Non-compliance, posted by Squiggles on April 17, 2007, at 10:18:51
> >
>
> The tricyclics are multi-targeters-- I think that leaves the patient with maximum unpleasant side effects, and for major depression the SSRIs are too weak. The MAOIs *may* be appropriate if you can watch the diet. And the new anti-psychotics are dangerous. As I understand it, there are so many people who have depression now, that the medical profession welcomes any drug the pharms can come up with, just to keep the patients self-reliant.
>I think that's a little over generalized. There are some people with major depression for whom SSRIs were adequately, with minor side effects if any.
The medical profession is such a varied entity, I don't think it's possible to say that it welcomes anything for any reason -- many people within the profession, though, do welcome every new drug that hits the market, because it provides one more tool for treating patients. You're right, there are side effects for all the drugs out there, and some people have a hard time tolerating those side effects. The more choices available, the more chance of finding an effective, tolerable treatment for those patients.
The bottom line, as Larry pointed out, is that the best solution to non-compliance is an honest, supportive relationship between patient and doctor. That can be hard to find, but it's remarkable how much of a difference it can make.
Thank you for letting me have my say.
Posted by Squiggles on April 17, 2007, at 15:15:09
In reply to Re: Non-compliance » Squiggles, posted by Racer on April 17, 2007, at 14:01:53
Thank you. Your message has a tone of
optimism. I'm rather resigned to the
possibility that no matter who arranges
your smarties, they always come up with the
same, dismal results.Squiggles
Posted by Phillipa on April 17, 2007, at 19:53:52
In reply to Re: Non-compliance, posted by Squiggles on April 17, 2007, at 10:18:51
No oxycontin unless you have a doc who is liberal and you have some pain as in arthritis or disc problems. I'd have to order somewhere to get any. As far as noncompliance I always tell when I stop a med or start one never have hidden a thing or lied not in my personality. Love Phllipa ps you may have a good relationship but that doesn't increase the docs knowledge.
Posted by Squiggles on April 17, 2007, at 20:10:59
In reply to Re: Non-compliance » Squiggles, posted by Phillipa on April 17, 2007, at 19:53:52
Thank you Phillipa, Larry, and Racer and
everyone. Maybe some idea will come up.
There is also the possibility that there
are limits to psychopharmacology.Thanks again for your responses.
Squiggles
Posted by notfred on April 17, 2007, at 23:24:43
In reply to Non-compliance, posted by Squiggles on April 17, 2007, at 7:54:33
I have never had any doc of any kind I saw ask me if I was compliant. They ask about side effects but never ask questions to see if I am taking them on schedule or missing doses.
OTOH, I am the kind of patient one would expect to be compliant.
Posted by Squiggles on April 18, 2007, at 7:47:50
In reply to Re: Non-compliance, posted by notfred on April 17, 2007, at 23:24:43
> I have never had any doc of any kind I saw ask me if I was compliant. They ask about side effects but never ask questions to see if I am taking them on schedule or missing doses.
>
> OTOH, I am the kind of patient one would expect to be compliant.I think it should be part of monitoring, especially on the first initiation into treatment. The patient may assume that he or she can skip a dose or two whenever it makes him feel ill. But that can be a very dangerous practice, especially with some psychiatric drugs. The interim and the reinstatement of the dose may actually bring on a variety of psychotic symptoms, or even cardiac, cerebral and vascular-type crises. The doctor should tell that to the patient, so the patient knows that it is better to report his reason for non-compliance than to self-medicate.
Posted by Squiggles on April 18, 2007, at 15:12:43
In reply to Re: Non-compliance » Squiggles, posted by Larry Hoover on April 17, 2007, at 8:45:09
Anyone find a change in sleep patterns
these past couple of years? I suppose
statistics would indicate a virus, but
I have not heard of any outbreak in the
West, at least. I have read of encephalitis
lethargica in Africa where the tsetse fly
would be responsible.Squiggles
Posted by Squiggles on April 18, 2007, at 22:34:17
In reply to Re: Non-compliance » Squiggles, posted by Larry Hoover on April 17, 2007, at 8:45:09
It's become a kind of crusade for me to
discover the cause of my "bipolar" dx.
Unlike others', it was very sudden, I had
no previous flat affect, or serious depression,
or any psychological disorder really that
wasn't at least related to taxing situations.So, I am always going over the sequence of
events, the diets, the stresses, etc. And
I am always wondering which could have started
such a sudden crisis. Exam stress, overwork,
relationship stress, withdrawal from prescribed
Valium, pollution, etc.I just remembered one more-- i was sharing an apartment with students while attending college.
We had a very bad case of cockroach infestation. We had to call in an exterminator. Could the pesiticide have been it?I just can't believe that something like that could happen so suddenly due to genes.
Not that it matters, i suppose, from a therapeutic perspective.
Squiggles
Posted by Phillipa on April 18, 2007, at 22:57:10
In reply to And Now For Something Completely Different, posted by Squiggles on April 18, 2007, at 22:34:17
I've always felt that enviornmental toxins caused many diseases so you think it caused your mental illness? Love Phillipa
Posted by Racer on April 18, 2007, at 23:22:47
In reply to And Now For Something Completely Different, posted by Squiggles on April 18, 2007, at 22:34:17
Personally, I'd have had a case of the crazies just from the bugs! (Sorry, I'm phobic about bugs, so that's not nearly as flip as it sounds.)
Seriously:
It might, but it might not. Yes, genes can be responsible for sudden onset, although there's virtually always a precipitating factor. In your case, it is possible it was related to the pesticides. Or maybe not. There's no way to tell, and you're right -- makes little difference to what you do about it now...
Good luck. And sorry about your former bugs.
Posted by Squiggles on April 18, 2007, at 23:34:13
In reply to Re: And Now For Something Completely Different » Squiggles, posted by Phillipa on April 18, 2007, at 22:57:10
> I've always felt that enviornmental toxins caused many diseases so you think it caused your mental illness? Love Phillipa
Of course I don't know. Nobody really knows how
these illnesses happen. But I would have expected a prodromal course, which in my case was short (about 1-3 yrs).Squiggles
Posted by Squiggles on April 18, 2007, at 23:42:26
In reply to Re: And Now For Something Completely Different, posted by Racer on April 18, 2007, at 23:22:47
> Personally, I'd have had a case of the crazies just from the bugs! (Sorry, I'm phobic about bugs, so that's not nearly as flip as it sounds.)
Ah, I did not consider that, lol. Yup, they were all over the kitchen counter if you turned on the lights at night for a drink of water. And they would crawl away as soon as they saw the light. The bathroom was another favourite hang-out, so you really had to be careful when you went back to bed. :-)
>
> Seriously:
>
> It might, but it might not. Yes, genes can be responsible for sudden onset, although there's virtually always a precipitating factor.Hmm. Is that so? Is it like a clock? -- like puberty. I find that so hard to believe. Are there statistics on this?
In your case, it is possible it was related to the pesticides. Or maybe not. There's no way to tell, and you're right -- makes little difference to what you do about it now...
Yes, I think doctors when presented with such cases, have to deal with treatment and just skim the background.
>
> Good luck. And sorry about your former bugs.That's OK - those were the "good ole days". You should have seen the electric eels when I was withdrawing from clonazepam. Now that's fodder for Alien IV. Maybe whatshisname went into just such a kitchen when he wrote "Naked Lunch".
Squiggles
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