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Confronted Pdoc With Internet Info


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I told my Pdoc about what I had read on psycheducation.com (Dr. Phelps' site). Phelps says that docs should never prescribe anti-depressants for folks who have BP1. Of course many docs do prescribe them (all of mine have and I have seen many), so apparently there is somewhat of a "controversy" within the pdoc community. I told my doc about this, but I did not give the name of the website. He got sort of angry since I was questioning him and said:

"In a perfect world, yes, what he says might work, but we don't live in a perfect world and you dont have anyone there to watch over you 24/7 to make sure you dont cut your wrists because you are thrown into the depths of depression after I took you off your AD."

In other words, my Pdoc thinks Phelps is full of shit, or at least he strongly disagrees with him on the issue of AD's and BP1.

I feel bad, now, having questioned him -- nothing good came from it. Docs have big egos, it seems, and tend to think we patients are total fools. Many of us might be, but unfortunately I am not. Often I wish I were.

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Most pdocs really don't like their Brilliant Knowledge questioned even slightly. Nearly 2 years ago I was still struggling with a new BP dx (shocked the hell out of my system) and was abusing opiate painkillers, as many as I could get my hands on. The pdoc called my husband into the session and made me sit there and listen to him talk about his current "experiences" of me. Husband has heroin abuse in his past but was maintaining by using suboxone. Both he and I knew that this wasn't a drug well-known or well-used in this country, so he brought all the information packs and internet downloads he could find to show the pdoc. She freaked! Practically dragged him out the room. Then turned to me to say I was an incorrigible addict, was never going to get my BP balanced, and there was no point in her "helping" (ha bloody ha) me anymore.

That night I sat on our bed (after nearly crashing the car and killing the two of us on the way home), calmly took out a blade and slashed a deep 10 inch long hole in my arm. (fun explaining THAT to the ER). When I went to my GP for the stitches to be removed, I told her the story and she was livid. She loathes specialist doctors who aren't sensitive enough to actually listen to where their patients are coming from. She referred me to my current pdoc - along with a note sayin "LISTEN".. and that at last was a positive step towards getting properly treated.

Sorry, long story there. But hearing that you feel bad having questioned him just got my back up. You are ENTITLED to research both your treatment and disorder, and the damn doctors should be grateful for it. Even if he genuinely (without the addition of a nasty smelling shitload of ego) didn't agree with Phelps, he should have explained WHY and not fobbed you off like a child. I believe very strongly that the patient-pdoc relationship should form a team, and that we as patients or clients should have access to the latest info and be able to discuss it. Time constraints and ego's be screwed.

PS my pdoc knows that I research meds and BP extensively and is always willing to discuss things with me. I hope I'm not just one of a very small minority who got this lucky with a fantastic doctor.

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It works better if you can bring in journal articles. If you're going to research stuff to convince your doc of something, treat it like you're writing a research paper. Give citations for everything and make sure they are from authoritative sources.

It's mostly the SSRIs you want to not touch with a ten foot pole. Wellbutrin and strattera are usually OK. Effexor has a better track record than the pure SSRIs.

If whatever you're on hasn't made you batshit manic yet, you're probobly going to be OK with it.

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my pdocs have all had different views on treating me with paxil (an SSRI) being a bp1, and i don't think the paxil, taken with my mood stabilizers, has ever led to a mania. without mood stabilizers or enough mood stabilizers yes, but not while covered enough.

when first out of the hospital after my 3rd time my very respected pdoc (can't go there anymore because he's private, expensive, and i owe him tons of money, but he's really super good) had me on seroquel, WB, paxil, and lamictal. that stabilized me and i stayed on those for a long time. it was only at my request several months ago that i got off of paxil, and that was because i felt "addicted" to it in some physical way, not because it was making me manic (or so i thought). now i'm on WB.

the literature seems to point, as far as i've read, to the relative "safety" of paxil in people with bp1. it seems less likely than the other SSRIs to cause disruptions. even when having a depressive episode out of the blue, my pdoc would ask me on the phone to take any SSRI in the house and see him at the earliest time he had available. he didn't seem to concerned about the SSRI family surprisingly. and he's someone i respect for getting me out of what was one of my worst episodes ever- a psychotic mixed/depressed episode, so it is odd to me as well that his opinion is at odds with some of the other opinions i respect. he knew my high potential for mania as well and had me on such heavy mood stabilizers that he didn't worry about it - in his opinion it was fine.

i guess you get all kinds of opinions, gained from that pdocs practice, and that other pdocs may have had different reactions in patients and therefore may have different opinions. for example, i've had pdocs who worship abilify and some who don't bother rxing it because it doesn't work. i personally don't think it works.

loon

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