![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by AMD on August 4, 2005, at 9:59:50
Maybe I'm not on the right meds.
What could help me out here?
Current regimen (daily, all in morning):
- Lamictal 200 mg
- Celexa 40 mgWould Lithium regrow any lost brain cells, and help with concentration?
Is the concentration simply a symptom of extreme depression?
What is filling my brain now is that after a year of Lamictal having worked for my mood, now that I had a four-day gap during which I didn't take it, taking it again will no longer work. Isn't this a possible effect?
amd
Posted by Lorne on August 5, 2005, at 15:03:03
In reply to meds?, posted by AMD on August 4, 2005, at 9:59:50
Anyone who gives you advice, on-line, about medication should be ignored, blocked if possible, and beaten if met in person.
If you have questions about your meds, see a pschyiatrist, MD, or psychopharmacologist.
Lorne
Posted by Sonya on August 5, 2005, at 15:25:00
In reply to Re: meds?, posted by Lorne on August 5, 2005, at 15:03:03
> Anyone who gives you advice, on-line, about medication should be ignored, blocked if possible, and beaten if met in person.
>
Wow, beaten??? That's not nice. People here are just trying to be supportive and helpful. Just because advice is given, doesn't mean it has to be "taken".
Posted by AMD on August 5, 2005, at 15:40:55
In reply to Re: meds?, posted by Lorne on August 5, 2005, at 15:03:03
Lorne,
I venture to say you are nearing the line of what is constituted appropriate expression on dr-bob.org. Your last posting, addressed to me, I could take. But this one is more general, and takes a slap at anyone here who's shared his (or her) advice about medicine as well as his experiences with them.
Come on, buddy: you should know that how psychotrophic medicines work are hardly an exact science. Third-party experiences are as helpful as doctorly advice.
With regard to what sounds like a generally negative outlook on your part, I would say only that people go through hard times, and the words of others, even though they're "just" words, can be of supreme benefit. I say, talk all you want about the medicines you're taken, the guilt you feel, the agony, slips, falls, and recoveries you've endured -- as long as it's helping you win your battle against the demons that haunt you.
amd
Posted by Declan on August 6, 2005, at 2:45:41
In reply to Re: meds?, posted by Lorne on August 5, 2005, at 15:03:03
Hey AMD
I feel inspired. But what to say? Well I'm going to say something and since I always talk about deprenyl, I'll recommend that. And it might be good for you. You seem to wanna take coke, maybe you could do with having your dopamine levels elevated. On the other hand you are pretty obsessive and it may make that a shade worse. But that must be a problem on coke, you must(?) get obsessive on that toward the end. What other advice can I give? Give up the psych drugs comes from the heart (this is the substance use board? never mind). Any more of this kind of stuff and someone will beat me up.
Declan
Posted by Lorne on August 6, 2005, at 22:20:32
In reply to Re: meds? » Lorne, posted by AMD on August 5, 2005, at 15:40:55
Third party experiences are not "Doctorly advice", unless that third person is a doctor.
Let me put my cards on the table, I work in the Mental Health profession and I've seen quite a few clients die as a result of street corner psychopharm advice. While I'm sorry if I came across as sharp to you, I'm trying to keep you from being the next chart review someone has to do.
Medications are selected based on a clients unique medical, psychological and situational variables. To do it correctly requires extensive clinical training and experience, not just an internet connection.
See your doctor if you want to discuss your meds. It will save your life.
Lorne
Posted by Lorne on August 6, 2005, at 22:35:24
In reply to Re: meds?, posted by Sonya on August 5, 2005, at 15:25:00
Dear Sonya,
Let me give you an example of what I'm speaking about.
Someone comes on line and says they have a history of episodic schizophrenia, they are HIV positive, and smoke. They've heard about a new atypical anti-psychotic called Clozaril that dosen't have the nasty side effects of some other anti-psychotics. Should they take it?
Sure, who would say not take it? Side effects are a bummer and who needs them? Of course you never hear from this guy again, because he dies quickly. Clozaril drops your white blood cell count, and smoking slows its absorbtion rate into the system.
Is this an extreme example, not really. First generation anti-depressants can interact with certain foods and can cause fatal reactions, lithium can be toxic, certain anti-anxiety drugs, such as klonopine, can kill you if you stop taking them suddently. The theraputic range on a drug can be close to its toxic level, or a drug below its theraputic range can be worthless.
We all recognize that a clinician offering medical or psychiatric advice on-line is not offering informed advice, because he has not assessed the client. Why can't we say the same thing when a lay person does it?
As far as being supportive, I'm trying to save the guys/gals life. Thats good support no matter how you look at it.
Lorne
Posted by Sonya on August 7, 2005, at 11:09:58
In reply to Re: meds?, posted by Lorne on August 6, 2005, at 22:35:24
I agree that an individual's dr must be consulted for final treatment decisions. If a dr is knowledgeable, he would know which drugs his patient can and can't take. I see no harm in the patient suggesting a drug that worked for someone else. Personally speaking, even if I went to my dr and insisted on him prescribing me a certain drug, my dr wouldn't do so if he knew it wouldn't work for me. Doesn't this make sense?
What I particularly took issue with was your language that people on this site who are trying to be helpful should be beaten. And I'm surprised that Dr. Bob hasn't given you a PBC.
Posted by gardenergirl on August 7, 2005, at 14:41:23
In reply to Re: meds?, posted by Lorne on August 6, 2005, at 22:20:32
Hi Lorne,
I work in the mental health field as well, so I think I can relate to your desire to warn others about potential dangers.That said, I also think you might want to read the FAQ about civility rules for this site. Here is a link. http://www.dr-bob.org/babble/faq.html#civil
I would hate to see you lose the ability to provide support and education, as is this site's mission, by not familiarizing yourself with the site rules.
Kindly,
gg
Posted by Racer on August 7, 2005, at 17:21:29
In reply to Re: meds?, posted by Lorne on August 6, 2005, at 22:35:24
Let me give you another example, one which explains why I think it's worth exchanging information on this site:
I was uninsured for ten years, while working in a situation that did not have health insurance benefits. During that time, I got to see the doctors available to "medically indigent adults" under the county system. Aside from things like the PA who apparently missed the huge neon pink label on my chart showing that I was allergic to PCN (leading to a night in the ER), I also had doctors who apparently figured "informed consent" only mattered for *paying customers,* so they didn't bother talking about side effects, etc. Just a simple, brusque, "Take one of these every day. Don't ask any questions, just do it."
Obviously, I can check the PDR online, or rxlist.com, but that only gives me the basic list of "any or all of these may happen." And we all know that those lists are never complete. It may not tell me what I'll experience on a medication, but at least it helps me get a better picture of which side effects might be more likely than others to occur. It also helps ease my fears of these medications to know that others have taken them successfully.
What's more, while we can discuss medications here, WE CANNOT PRESCRIBE TO OURSELVES! There will always be a doctor involved, and if the medication is not appropriate for us, we will not be given a prescription for it.
While your stated intention, to "save lives," is laudable, a little more understanding and gentleness would be quite appreciated.
Peace
Posted by Dr. Bob on August 8, 2005, at 1:10:06
In reply to Re: meds?, posted by Lorne on August 5, 2005, at 15:03:03
> Anyone who gives you advice, on-line, about medication should be ignored, blocked if possible, and beaten if met in person.
Please don't post anything that could lead others to feel put down or suggest that they be harmed.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above post, should of course themselves be civil.
Thanks,
Bob
Posted by Lorne on August 8, 2005, at 8:37:48
In reply to Re: meds?, posted by Sonya on August 7, 2005, at 11:09:58
Being supportive takes many forms. The one most everyone associates with being supportive is sympathy, or as Carl Rodgers would call it, unconditional postive regard.
Offering somone sympathy FEELS good, and it FEELS good to to know someone is sympathetic with your feelings. However, thats one of sympathy's downfalls, it feels good. Sooner or later you get used to it, its almost addictive.
It also cost nothing to give or recieve sympathy. These days, more often than not the worse you behave the more of it you get (thank you 4th wave movent).
Sympathy is also passive, not-future oriented, non-energizing, non-directional and indiscriminate.
"Beating up" on someone in need of help or who asks for direction is nothing more than ego building at someone else's expense. However, not telling someone what you know to be the truth, or wise, or practical because they want "sympathy" is patronizing and infantilizing, which I'm not going to do either.
Lorne
Posted by Lorne on August 8, 2005, at 9:06:20
In reply to Re: please be civil » Lorne, posted by Dr. Bob on August 8, 2005, at 1:10:06
Dear Dr. Bob,
One of the reasons I got out of the profession was the inability to speak the truth.
The example that sticks in my mind: during rounds at my last clinical position the lead clinician was talking about the importance of being empathetic with a specific drug addicted client. I knew the client and said that I thought we were past empathy and needed to look at what we could do so save his life.
I got a real dressing down in front of the rest of the staff. Empathy, I was told, was the be all and end all. Empathy alone, maybe with a smidge of technique, was all you needed, (Rogerians...Oy).
The following morning I was notified the client was dead. He OD'D that night.
We had mortality meeting the next day, and I asked the one question no one wanted to be asked, "did anyone tell this guy he was going to die of he kept this up”? Dead silence, I swear you could hear crickets in the background. This patient had been attending a partial hospital program for two years, twice a week, and while he received sympathy by the bucket no one had told him he was killing himself and to knock it off.
Within the year I gave up clinical work for teaching and some government work. I sleep better now.
As a fellow professional you must recognize that the exchange of incomplete information is dangerous, doubly so when it pertains to meds. You must also recognize that axis II clients are not helped by sympathy, because over time it makes the behaviors they use to obtain sympathy more severe. You must also recognize that sympathy is not the same as empathy, and its one off from pity.
That being said, this is your site and not mine. I'm unlikely to swim with the fishes here, so I recuse myself.
Thank you for your time and allowing me to speak my piece.
Lorne
Posted by AuntieMel on August 8, 2005, at 16:52:47
In reply to Re: please be civil Dr. Bob., posted by Lorne on August 8, 2005, at 9:06:20
I get your point.
The place I went into recovery didn't pull punches. They flat out said that if you keep it up you'll be dead or in prison.
However there are ways to say the same thing and keep in the site's boundaries. It by no means that you have to just be huggy and can't say the truth as you see it.
Babblemail me if you would like to discuss offline.
Posted by Jakeman on August 8, 2005, at 19:57:17
In reply to Re: please be civil Dr. Bob., posted by Lorne on August 8, 2005, at 9:06:20
I put myself in AMD's place (and I've been there) and found your responses to be chastising.
warm regards, Jake
Posted by Jakeman on August 8, 2005, at 20:25:36
In reply to Re: please be civil Dr. Bob. » Lorne, posted by Jakeman on August 8, 2005, at 19:57:17
> I put myself in AMD's place (and I've been there) and found your responses to be chastising.
>
> warm regards, JakeTough love, no problem...my experience has been that when you talk down to people they don't listen.
~ Jake
Posted by Dr. Bob on August 8, 2005, at 21:58:11
In reply to Re: please be civil Dr. Bob., posted by Lorne on August 8, 2005, at 9:06:20
> As a fellow professional you must recognize that the exchange of incomplete information is dangerous, doubly so when it pertains to meds.
1. There are potential risks, but also potential benefits.
2. What information is complete?
3. Posting something that could lead others to feel put down or suggesting that they be harmed can also be "ego building at someone else's expense".
> That being said, this is your site and not mine. I'm unlikely to swim with the fishes here, so I recuse myself.
Different points of view are fine, and in fact encouraged, here. Just don't be a shark? :-)
Bob
Posted by Declan on August 9, 2005, at 0:36:40
In reply to Re: please be civil Dr. Bob., posted by Lorne on August 8, 2005, at 9:06:20
Lorne, I'm probably alone on this but I've got a problem with 'tough love'. It sounds like 'collateral damage' or the 'wrathful lamb', that is it feels like a political concept and I know, I know, lots of people I too have known are dead because of...etc etc. But anyway 'tough love' doesn't cut it with me. Sounds too much like the war on drugs and similar operations. I'll settle for a bit of kindness and real concern, they can be rare enough to have an impact, and are not that easy to practice in my experience and not to be confused with the synthetic Carl Rodgers thing.
Maybe though you are genuinely upset by what you have seen, and anyone who uses 'recuse' deserves a pat on the back.
Declan
Posted by chemist on August 10, 2005, at 0:52:40
In reply to Re: meds?, posted by Lorne on August 6, 2005, at 22:20:32
hello there, chemist here...your cards are not being counted properly: you claim here to work in the ``Mental Health profession,'' yet a few posts down the way, you detail why exactly you no longer do so. please clarify in re: your status. do you, or do you not, work in the Mental Health profession? it is germane if only to establish whether or not anything else you pen - inclusive of your generous directive to physically harm persons who, such as i, promote the use of medications - is actually true and/or worthy of note.
second: clozapine has a 30+ year literature base detailing the characterization of ADMET and clinical efficacy in treatment of psychosis. your hypothetical HIV-positive, cigarette-smoking sufferer of self-reported ``episodic schizophrenia'' disappearing from our radar due to clozapine is not likely: an unpaid bill to the ISP will also result in immediate loss of communication. while reduced WBC is a real issue with clozapine, it is not an atypical antipsychotic, nor would it be prescribed by any physician for a patient with co-morbid HIV. period. further, self-reported episodic schizophrenia is in the same league as jumbo shrimp and military intelligence.
third: the metabolism of clozapine is reduced when nicotine is brought on-board, not the converse, as you report.
fourth: S-nicotine has been long-established as an effective drug in allevation of at least some of the positive and negative affect of schizophrenia. thus, while not a foregone conclusion, the slowed metabolism of clozapine and intake of nicotine are likely going to aid the patient, although breathing-related issues remain with cigarettes, to say the least.
finally: the rubber meets the road as noted by many others when the patient and physician get together and prescriptions are dispensed. the internet is hardly a repository of reliable or even somewhat helpful medical insight - the clozapine example and questionable employment position(s) are two issues that immediately come to mind - and most people in this forum appear to be well aware of that fact.
all the best, chemist
> Third party experiences are not "Doctorly advice", unless that third person is a doctor.
>
> Let me put my cards on the table, I work in the Mental Health profession and I've seen quite a few clients die as a result of street corner psychopharm advice. While I'm sorry if I came across as sharp to you, I'm trying to keep you from being the next chart review someone has to do.
>
> Medications are selected based on a clients unique medical, psychological and situational variables. To do it correctly requires extensive clinical training and experience, not just an internet connection.
>
> See your doctor if you want to discuss your meds. It will save your life.
>
>
> Lorne
Posted by sunny10 on August 10, 2005, at 9:12:19
In reply to Re: meds? » Lorne, posted by chemist on August 10, 2005, at 0:52:40
you wrote, "self-reported episodic schizophrenia is in the same league as jumbo shrimp and military intelligence."
As shrimp are very emotionally fragile when it comes to their size, please be civil by not teasing them about it...
The military intelligence I won't touch with a ten foot pole...
Just kidding; couldn't help myself...
Good to hear from you again.
-sunny10
Posted by sleepygirl on August 10, 2005, at 21:04:09
In reply to Re: meds?, posted by Lorne on August 8, 2005, at 8:37:48
Can you not give sympathy or more appropriately empathy and also tell the truth?
I think one without the other is diminished. Substance abusers usually need both. (heck doesn't everyone?)
Posted by chemist on August 10, 2005, at 22:33:03
In reply to Re: meds? » chemist, posted by sunny10 on August 10, 2005, at 9:12:19
> you wrote, "self-reported episodic schizophrenia is in the same league as jumbo shrimp and military intelligence."
>
> As shrimp are very emotionally fragile when it comes to their size, please be civil by not teasing them about it...
>
> The military intelligence I won't touch with a ten foot pole...
>
> Just kidding; couldn't help myself...
>
> Good to hear from you again.
>hello there, sunny!...likewise a pleasure to hear from you, too...i do hope all is well...and let us save the shrimp for cocktails in lieu of ethanol, yes? all the best, c
> -sunny10
>
Posted by sunny10 on August 16, 2005, at 8:59:08
In reply to Re: meds? » sunny10, posted by chemist on August 10, 2005, at 22:33:03
This is the end of the thread.
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