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depression treatment - not sure what to do next


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As suggested by many people I finally saw a pdoc!!!   I had to give a full history (from childhood) which was stressful and difficult.  The doctor thought my previously diagnosed Social anxiety & OCD might actually be some traits of aspergers which I can't ever 'cure', but he wasn't totally sure.  I have to read up on it and go back with a list of my symptoms that fit the criteria for adult autism spectrum.   :o

 

For my chronic depression & suicidal thoughts I was hoping to try different medications and get referred for therapy.   He said no to the meds I wanted to try, 'too dangerous' apparently.  He wants me to add an SSRI to my current combination.  I feel disappointed because I stated before even meeting the doctor that  I don't want another SSRI as none of the others helped me, most made me feel worse.  I felt he was dismissive of my SSRI bad experiences and said side-effects will 'wear off in time' (not my experience) or 'have to be tolerated' (sigh).  

 

It also appears the SSRI+currrent med combo is actually seriously contraindicated, so I need to call up to clarify that.  If that is the case it doesn't give me any confidence in his ability to manage medications. 

 

he was nice, talked to me like an adult, friendly, seemed to 'get' my OCD and social anxiety symptoms before I even explained them.   he said he would 'look into' what therapy was available (socialised system here), which doesn't fill me with confidence.  I have a follow up appointment in about 8 weeks; he wanted to make it 4 weeks but I said 8 because I couldn't face doing that all over again so soon. 

 

I don't know what to do -  demand as second opinion? Try the SSRI he recommended (if not contraindicated)?  Give up completely and accept it will never get better? 

 

thanks for reading. 

Edited by crazyguy
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I think it's a good idea to call them for clarification and to make your concerns known. Is your pdoc aware of what meds you are currently taking?

 

Beyond that, I would follow the advice of the pdoc. If he is aware of the meds you are taking and still wants you to take the SSRI, I'd trust his education and experience. I'm not telling you what to do; I'm just saying what I would do.

 

I would never under any circumstances give up.

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I think it's a good idea to call them for clarification and to make your concerns known. Is your pdoc aware of what meds you are currently taking?

 

Beyond that, I would follow the advice of the pdoc. If he is aware of the meds you are taking and still wants you to take the SSRI, I'd trust his education and experience. I'm not telling you what to do; I'm just saying what I would do.

 

I would never under any circumstances give up.

Hi, yes they are aware of what I'm on already.   I just believe a mistake has been made, this combination is completely contraindicated due to the risk of serotonin syndrome. I checked with a pharmacist today and he said not to take it until I had called for clarification; he showed me from his medication book and it clearly stated do not start new med within 2 weeks of current med.   MAOI + SSRI = bad on every source I can find.  

 

I find it hard to trust doctors because I've had a few very bad experiences over the last few years, not just with MH issues but physical issues too. (botched surgery, etc). 

 

Of course being Christmas nobody is open so I have to wait until next week to clear up this issue now.  On the positive side I have survived Christmas.  

Edited by crazyguy
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I agree to not give up, and after voicing your concerns to your pdoc, if he doesn't listen to you (etc, anything that makes you very uncomfortable and that you clam up, so that you don't even want to say anything), then I would give him a chance. 

 

Sometimes it is a little awkward at first when meeting a new pdoc because you are both getting to know each other, at least it was for me ... I worried if he'd listen, believe me, etc.  After a few appts when I got to know them better I was able to judge based on how we interacted, whether he listened, took what I said seriously.  I had one pdoc for 5 years before he stopped listening to me, broke HIPAA rules ... then I found another one once hospitalized in 2003, and have seen him for 11 years now.

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I agree with Melissa - it can take time to develop a relationship with a pdoc. This seems like he has potential? I know you were hoping to try parnate or another irreversible MAOI. As you know, lots of docs get worried about those meds. Give his suggestions a try before jumping to conclusions that he's going the wrong direction. Remember that meds can work differently/be more beneficial in a cocktail than on their own. Also, in some systems there may be rules about what meds he has to try with you first (regardless of past experiences).

 

That said, it is important to raise concerns about drug interactions. Absolutely don't take the new meds until you've heard from his office. This is a good example of a reason to work with the same pharmacy. They will catch that kind of thing too and sometimes the doc office will respond better/faster to a pharm call than a patient call.

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Not a professional here, but I've taken MAOIs, and not only could I not take an SSRI with one, taking them together was so risky that I needed a long period of washing out the MAOI before I could be switched to the SSRI and vice versa. Just to make sure there was no possibility of an interaction.

So, yeah - I would definitely double and triple check with the doctor, and if he still says it's OK maybe even get a second opinion. I'm that dubious.

I'd also be disappointed about being prescribed another SSRI after having a lot of bad experiences with them. It's not like there aren't a lot of other options.

Last, therapy is huge for all three of your diagnoses. It would be a real pity if you got short changed on that.

But you do need to communicate your feelings to your psychiatrist. If he listens he may end up being a really good match.

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I agree with Melissa - it can take time to develop a relationship with a pdoc. This seems like he has potential? I know you were hoping to try parnate or another irreversible MAOI. As you know, lots of docs get worried about those meds. Give his suggestions a try before jumping to conclusions that he's going the wrong direction. Remember that meds can work differently/be more beneficial in a cocktail than on their own. Also, in some systems there may be rules about what meds he has to try with you first (regardless of past experiences).

 

That said, it is important to raise concerns about drug interactions. Absolutely don't take the new meds until you've heard from his office. This is a good example of a reason to work with the same pharmacy. They will catch that kind of thing too and sometimes the doc office will respond better/faster to a pharm call than a patient call.

Thanks. 

Part of me thinks there is potential but another part of me thinks this doc just RX'd a combo that could well cause a fatal drug-drug interaction; that doesn't inspire me with confidence.  :unsure:

 

You are right I was hoping to try parnate or similar.  I'm not fixated on the idea, but I was disappointed at how it was dismissed with no explanation or discussion. The cocktail then prescribed is more dangerous than parnate on its own for sure, which is ironic.  SSRIs are something I really didn't want to try again and I'm disappointed with myself for not being firmer.  There are many other meds I would be happy to try:  tricyclics, mood stabilizers, stimulants, lyrica, etc. 

 

Anyway I'm trying to stay positive because 1 good thing did come out of the appointment. Reading up about aspergers / autism  it does seem I could fit into that category - that would explain a lot of things and also explain why meds don't really work for my "social anxiety".  I need to find out about how I get formally assessed for that. 

Edited by crazyguy
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Not a professional here, but I've taken MAOIs, and not only could I not take an SSRI with one, taking them together was so risky that I needed a long period of washing out the MAOI before I could be switched to the SSRI and vice versa. Just to make sure there was no possibility of an interaction.

So, yeah - I would definitely double and triple check with the doctor, and if he still says it's OK maybe even get a second opinion. I'm that dubious.

I'd also be disappointed about being prescribed another SSRI after having a lot of bad experiences with them. It's not like there aren't a lot of other options.

Last, therapy is huge for all three of your diagnoses. It would be a real pity if you got short changed on that.

But you do need to communicate your feelings to your psychiatrist. If he listens he may end up being a really good match.

Yep I am going to write a letter or send an email about this next week.  

 

What you say about the wash-out period - that is my understanding too.  :huh:       And thank you for getting what I am saying about the SSRIs;  after paxil, zoloft, celexa, prozac and effexor (okay it is supposed to be an SNRI but it's pretty much is an SSRI), I just can't see the point.  I know what will happen: shit loads of agitation, restlessness, teeth grinding, sexual dysfunction, emotional blunting, etc. 

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