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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by S. Howard on December 4, 2000, at 20:11:44
Friends-
Presently I'm taking 500 mg depakote, 100 mg seroquel and cutting back on 30 mg paxil to 0, since it's turning me into an asexual balloon with no visible improvement in social skills. These meds were prescribed by my pdoc.
I also take Norvasc for hypertension, prescribed by my family doctor. He doesn't prescribe or advise on psych
meds.
I spent Thanksgiving week in the hospital after a possible seizure, although I have no history of seizure. I believe it was an overdose of painkillers
and psych drugs (unintentional, just carelessness)although I was never treated as anything but a seizure patient, even after several blood tests. Also, I was perfectly honest about my psych history and occassional
substance abuse. Thank God I was spared the charcoal routine, but it wasn't necessary anyway- after bouncing around in the ambulance, I threw up everything I had eaten in the last week or more once I got to the ER. (Forgive me if it's time for your dinner.)I was referred to the hospital neurologist.My tests were all normal; EKG, EEG, CT of the skull. I
was given Dilantin in the hospital and it always knocked me out cold, which is okay in the hospital but not in real life. I was given an Rx for Dilantin before I left but I didn't want to take it, because I still don't believe I had a seizure. The neurologist told me it was just a precaution. He said, "What if you have a seizure while you're driving?"This really scared me. Immediately before my (possible)
seizure, I felt fine. I wasn't sick or dizzy at all, there was no warning. If I had been driving, it's almost certain that I would have killed or seriously injured myself and other people. Since leaving the hospital, I've been home from my job and haven't driven myself anywhere. But now I have to go back to work and I'm afraid to NOT take the dilantin.The trouble is, the depakote and seroquel already have me sedated for most of the day, and I'm worried I won't be able to function on all three drugs. I asked the pharmacist if she thought it would be safe to quit taking the depakote and she said, absolutely not, not without my doctor's advice. My family doctor won't advise (that chicken-head)and my pdoc is, like usual,
unavailable. I'm not supposed to take any kind of stimulant to "wake myself up" because of my blood pressure, which is borderline even with the medication I take for it (Norvasc).Incidentally, I'm clean right now. No painkillers and no meds beyond what's prescribed. I haven't taken any dilantin yet. If anybody has any information or even an opinion I would surely appreciate it, and I realize that it's not a substitute for an MD's advise, but right now I'm flying blind.
Thanks-
Gracie
Posted by JohnL on December 5, 2000, at 4:51:35
In reply to This is madness, I tell you, posted by S. Howard on December 4, 2000, at 20:11:44
"This is madness, I tell you". Well said, I agree. I empathize with you very much. I'm not sure there is any more frustrating thing to happen in life than having weirdness with drugs, especially when they aren't working very well to begin with.
It sounds to me like it might be a good idea to see the doc ASAP and start from scratch. If Depakote and Seroquel aren't helping very much, then I see no sense at all in continuing with them. There is always a much better choice that will turn out to be a superior match for you. Ditch the inferior ones, keep searching for superior ones. Sampling, probing, trial and error, it's the only way.
If your doc is unwilling or unavailable, it also might be a good idea to invest the time and trouble to find a more compatible doc.
In the meantime, I do empathisize with you. Hang in there. I know you are doing the best you can, you just need a doctor who will do the same.
I'm wishing you a smooth day.
John
Posted by medlib on December 5, 2000, at 22:20:07
In reply to This is madness, I tell you, posted by S. Howard on December 4, 2000, at 20:11:44
> Friends-
> Presently I'm taking 500 mg depakote, 100 mg seroquel and cutting back on 30 mg paxil to 0,Gracie---
I believe that your instinct not to begin Dilantin may be a good one--at least, not without consulting a *competent* psychopharmacologist, or at least, a neurologist.
All 3 of the meds you mentioned have the potential to interact with one another. Dilantin can increase the clearance of Seroquel. (Because S. would leave the body faster, a larger dose would be needed to maintain the same therapeutic blood level.) Dilantin and Depakote can interact to increase the effects of Dilantin and decrease the effects of Depakote. Dilantin has a relatively small "therapeutic window"; a 10% dosage increase may produce toxic blood levels. Both Depakote and Dilantin are anticonvulsants; typically, one does not take 2 different anticonvulsants together. (Dilantin is an older drug, thus cheap; many newer ACs have fewer side effects, but cost more.)
Dosage of anticonvulsants for seizure control usually is greater than for psych purposes. A serum blood level of the drug is compared to the therapeutic index measured in mg.s/kg of body weight. For seizure control purposes, taking less than a therapeutic level of an anticonvulsant is pointless; *almost* just doesn't cut it.
Re evidence of seizure: If you "woke up" with a severe headache and bitten tongue, you had what once was called a grand mal, now a tonic-clonic, seizure. By the time that many hospitals get around to administering an EEG, brain wave patterns may have returned to normal, hence the test is "clear." Believe me, seizures are nothing to mess around with. In many states, doctors are required to report seizures they suspect may be evidence of a recurring pattern to the DMV, which often suspends licenses for 2 or more seizure-free years. (On the other hand, you can be just as dead from falling asleep at the wheel as from seizing.)
Depakote is most frequently prescribed for "absence" or partial seizures. Even a therapeutic level of it may fail to prevent, or sometimes *cause*, other types of seizures. It (like all other anticonvulsants) should never be abruptly discontinued; it must be tapered down, lest it cause what it's meant to prevent.
Please forgive me if this sounds preachy (or morbid), but the meds you have been prescribed are "heavy hitters." It's worth using 7 day pill cases and avoiding casual or recreational drug interactions--death is not necessarily the worst potential outcome of many types of accidents.
Well wishes from a former rehab hospital patient-----medlib
Posted by Noa on December 6, 2000, at 18:59:26
In reply to Re: This is madness, I tell you » S. Howard, posted by medlib on December 5, 2000, at 22:20:07
I like the idea of the pill organizer to make sure you don't miss a dose or take too much of something. Consulting a neurologist also makes a lot of sense. Good luck.
Posted by S. Howard on December 6, 2000, at 20:00:13
In reply to Re: This is madness, I tell you » S. Howard, posted by medlib on December 5, 2000, at 22:20:07
Well, I've got the pill organizers. Now I just have to find out what to put in them.
To confuse things even further, it's that wonderful time when we have to choose a new medical insurance, and our choice is HMO or HMO
8-(
But your letters did give me an idea...while I was in the hospital I was under a neurologist's
treatment. He didn't suggest that I see him again and I suppose I've been discharged from his care.
(He was in and out of my hospital room so fast I barely remember him). However, he prescribed the dilantin so possibly he'll answer a couple of questions over the phone. It's certainly worth a try.
Thanks, Gracie
Posted by medlib on December 7, 2000, at 3:08:19
In reply to Re: This is madness, I tell you-medlib, noa, posted by S. Howard on December 6, 2000, at 20:00:13
Gracie---
If you DO succeed in talking with God, Jr. himself (as neurologists are sometimes referred to by nurses), you may want to ask him if he was aware that you are already taking Depakote and Seroquel. If he was, ask him why he's not concerned about the drug interactions reported in the pharm lit. If he wasn't aware on either Q, that's your cue to find a different doc, IMHO. (I would anyway.)
Re HMOs (AKA Managed Care--As little care as we can manage.):
If your employer did not supply you with the HEDIS data on the 2 plans, you can find it at http://www.ncqa.org under "Health Report Card". If both plans are reported on, you can create a custom report comparing just those 2. One of the report categories is AD pharm. mgmt. Or, you could always just choose the best psych benefits, assuming either plan offers any.Well, that's enough unasked-for information/advice for tonight. Good luck, and please update us on your choices.
Well wishes---medlib
> Well, I've got the pill organizers. Now I just have to find out what to put in them.
> To confuse things even further, it's that wonderful time when we have to choose a new medical insurance, and our choice is HMO or HMO
> 8-(
> But your letters did give me an idea...while I was in the hospital I was under a neurologist's
> treatment. He didn't suggest that I see him again and I suppose I've been discharged from his care.
> (He was in and out of my hospital room so fast I barely remember him). However, he prescribed the dilantin so possibly he'll answer a couple of questions over the phone. It's certainly worth a try.
> Thanks, Gracie
Posted by S. Howard on December 7, 2000, at 21:37:52
In reply to Re: This is madness, I tell you-medlib, noa » S. Howard, posted by medlib on December 7, 2000, at 3:08:19
Medlib-
Well you just made me spit out this drink I am drinking when you referred to neurologists as
God Jr. Being a medical person myself, I've had my own experiences with them and they can be bas-
um, surly. But can't we all.I probably wouldn't get to see this neurologist again anyway as we're changing primary
physicians along with insurance so I'd have to be referred. Maybe I'll
find a family doc that isn't so terrified of venturing an opinion on psych drugs. I can respect that he doesn't feel qualified enough to write scripts for them, but for heaven's sake, learn enough about them to answer a couple of questions!
Oh well, maybe he had a bad experience. I used to work for an orthopedic surgeon who was like that
about his OWN profession. He'd say, "Get the radiologist on the phone, let me find out what he thinks. Get the physical therapist on the phone,
I want to know what she says. Ask Dr. Jones to come in here and look at this."
I mean, you just wanted to shake the guy.Anyway, I digress. What I would like to do now, particularly since I've committed myself to trying the amisulpride/adrafinil combo - which sounds tailor~made for
my symptoms- is to get off the seroquel and depakote completely. Besides making you asexual
and lethargic, the weight gain is unacceptable.
How can you be happy when you're blowing up like the blueberry kid in Willy Wonka. Also, everyone I've talked to (including some raised eyebrows on an ER doc) thinks the meds I'm taking are excessive. Again...500 mg depakote, 100 mg seroquel (down from 150) and now 300 mg dilantin
a day. No wonder I require an espresso IV.
-Gracie
This is the end of the thread.
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