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BusuB

I think my doc is ghosting me....

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Since my last post on the 2nd, I've been trying to get in touch with my pdoc about the crazy anxiety I'd been having with Rexulti and wanting to switch to something to get my anxiety under control.  I emailed him the details of what I'd been going through on Thursday, and he didn't respond until late Friday night that I needed to schedule an appointment to see him.  I know he doesn't discuss details in emails for privacy reasons, so I wasn't too concerned about the short response, but since I emailed him back on Friday night, he hasn't responded at all to my email, nor my follow up email today, 5 days later.  I made it clear that I have been struggling with tons of anxiety and insomnia, which for me, are big precursors to a dip in mood (so far so good) and no word yet.  He's historically been very good at responding to emails in the past, so it kind of makes me feel like he's ignoring my emails or refusing to answer them.  I've also had no success with his answering service, as the only open appointment slots were only editable by him only (I know he keeps these slots open for emergency visits).  I know I'm a difficult patient when it comes to side effects, but he didn't mention anything to me about that in the past.  Does any of this sound like a possibility?? Or am I just being paranoid?  Is there another way I could try to reach out short of arriving at his office without an appointment (of course I know this is a bad idea)?

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Sometimes I have to call my pdoc  and leave messages a few times for him to get back to me, other times he calls back that day.  I don’t think it has anything to do with me.  Maybe he is forgetful, I don’t know.  He does not give out an email. 

Be persistent is my advice. If he does not respond to emails, call.

 

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It can be hard to get through to your doc. And don’t forget that they’re people, too, who get the flu or suddenly need root canals etc. Keep try!

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I’m in an HMO so a different situation but my pdoc has a nurse(who does what, I have no idea) who has responded to my calls or emails when he can’t. My previous pdoc didn’t have that but had a secretary and a tdoc in the office. If a phone message or email doesn’t work, is there anyone else, like a nurse, in the clinic?  You might try asking them how best to proceed. My HMO has a secured email system so I’ve been able to communicate a lot that way. I think it’s probably not deliberate ignoring you and probably there’s a way to get through. I’d ask about it when you see him next if time allows. 

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On 5/7/2019 at 7:44 PM, BusuB said:

Since my last post on the 2nd, I've been trying to get in touch with my pdoc about the crazy anxiety I'd been having with Rexulti and wanting to switch to something to get my anxiety under control.  I emailed him the details of what I'd been going through on Thursday, and he didn't respond until late Friday night that I needed to schedule an appointment to see him.  I know he doesn't discuss details in emails for privacy reasons, so I wasn't too concerned about the short response, but since I emailed him back on Friday night, he hasn't responded at all to my email, nor my follow up email today, 5 days later.  I made it clear that I have been struggling with tons of anxiety and insomnia, which for me, are big precursors to a dip in mood (so far so good) and no word yet.  He's historically been very good at responding to emails in the past, so it kind of makes me feel like he's ignoring my emails or refusing to answer them.  I've also had no success with his answering service, as the only open appointment slots were only editable by him only (I know he keeps these slots open for emergency visits).  I know I'm a difficult patient when it comes to side effects, but he didn't mention anything to me about that in the past.  Does any of this sound like a possibility?? Or am I just being paranoid?  Is there another way I could try to reach out short of arriving at his office without an appointment (of course I know this is a bad idea)?

Curious. When did you start Rexulti, and how did you titrate? And are you taking it morning or night?

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5 hours ago, browri said:

Curious. When did you start Rexulti, and how did you titrate? And are you taking it morning or night?

I started with half a mg for 2 weeks, 1mg for two, 2mg for one then back to 1mg.  I’ve since switched back to seroquel but still dealing with the anxiety a week later.  I think I need to wait for the Rexulti to leave my body.

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16 hours ago, BusuB said:

I started with half a mg for 2 weeks, 1mg for two, 2mg for one then back to 1mg.  I’ve since switched back to seroquel but still dealing with the anxiety a week later.  I think I need to wait for the Rexulti to leave my body.

A couple things though. It's possible that coming off Seroquel may have brought up some anxiety. It's a potent norepinephrine reuptake inhibitor which has anxiolytic effects. So it would only make sense to feel anxious coming off of it. Even more so, Rexulti is known itself for having really potent anti-anxiety effects. It just can be hard to adjust to in the beginning. However, Seroquel also is known for anti-cholinergic effects that can make withdrawal difficult.

Based on my experience with Rexulti, I would say the titration up was too fast. I started on 0.5mg for 2 weeks and actually went DOWN to 0.25mg for 6 weeks before increasing back up to 0.5mg. I'll tell you what, those first two weeks on 0.5mg were ROUGH, but after a week or two on 0.25mg I started to feel A LOT better. And it improved even more when I went back up to 0.5mg, which felt completely different the second time around. It was only several months into Rexulti that I went to 1mg. I've been on it now since September 2017 I believe, and I haven't taken more than 1.5mg.

Rexulti takes a LONG time to build up in your system because it has such a long half-life, but pair that with Seroquel which has a really short half-life and therefore leaves your system more quickly than Rexulti can accumulate in your system, you could have a roller coaster of a ride. Dr. Stahl says that the -pines (e.g. Seroquel [quetiapine], Zyprexa [olanzapine] Clozaril [clozapine]) should have at least 2 weeks of overlap with the new antipsychotic as titration occurs. If you were to try it again, it would probably make sense to talk with your pdoc about starting the Rexulti at 0.25mg WITH the Seroquel at your normal dose and slowly decrease the Seroquel over the course of 2-4 weeks like 50mg at a time while you increase the Rexulti to a target of 1mg. After that, I think it starts to become stimulating.

How much Seroquel were you on before your pdoc decided to switch you to Rexulti? Knowing that would more accurately guide how to titrate up on Rexulti.

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