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zon

My Doctor Is Useless.... (First Post)

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Hi, this is my first post on this forum. I know the advice from people online should not replace a doctor but I would love to hear from opinions from people with more experience and knowledge than me.

 

So in a nutshell, last year a bunch of stressful things happened and I haven't been able to get over it. I'm mildly depressed, demotivated, lacking confidence in all areas and have become unable to deal with stressful situations (panic attacks?)

 

I went to a phychologist to try and get some help, although I am starting to think that the doctor is either extremely stupid, or just doesn't give a ****... I'm still not sure.

 

At first he gave me 10mg Imipramine per day. Which from what I have read online, 10mg is absolutely tiny, and it did basically nothing for me except giving me weird dreams and disturbing my sleep, so after about a month I stopped taking them. Maybe this was wrong to do but I was getting less motivated from not getting good sleep than I was before, and for some reason the doctor hadn't prescribed me enough to reach my next appointment anyway...

 

My second appointment was today and I told him about my experience with imipramine and asked to try something else. I've heard SSRIs are more affective with less side affects so I suggested something like this. He said ok and gave me a prescription for 2x 37.5mg (a quite large first dose) Venlafaxin (effexor) per day.

 

Thankfully I like to research things before I take them, because I found out that Venlafaxin is not an SSRI but an SNRI, and is actually considered the hardest anti depressant (maybe not counting benzos) to get off of.... I actually googled "hardest antidepressant to stop" and out of the 100s of meds out there guess which one comes up first and the most? On top of this many people claim that it makes them feel numb and emotionless, something I definitely do not want to feel. I should just mention that this doctor never told me ANYTHING about this drug at all, not to mention he indirectly told me it was an SSRI not a SNRI...

 

So right now I am feeling extremely angry, frustrated and unsure what to do. I know I am not as bad as many people on here might be but I still spend every day struggling to motivate myself to do at least half of the tasks I need to do, on top of dealing with panic attacks every time I have a bad day. But on the other hand I do not want to feel "numb" or emotionless.

 

Does anyone have any advice for me?

 

I am considering to ask to give TCAs another try in a larger dose, although if the sleep problems also increase with the dose I doubt they would be worth taking. Or to ask again for an SSRI, although I am worried they can also be difficult to quit, or could make me feel numb. Or just give up on getting help and try to deal with things alone.... All I know is I definitely don't want to take a drug that could potentially take me months of pain to get off of.

Edited by zon

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Finding the right antidepressant can be frustrating. I am currently on a tricyclic and an SSRI both. They help a little. I have treatment resistant depression. I had no luck with imipramine either. I am very quiet and my posts tend to be brief, but in all of my experience with antidepressants, I at least have never had any trouble stopping one, including Venlafaxine, although I wasn't on it long. I hope this is of some help to you. And welcome to the forums!

Edited by mulberrypie

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Hi Zon,

 

     I'm sorry that you are suffering and that things do not seem to be helping and may even be counter-productive. That's really awful!    Sadly, I do not really know what to say or what advice to give. 

 

     I have been on four antidepressants in my life [imipramine, Zololf, Lexapro, Celexa].  None has been ideal in terms of side effects but all have keep me alive and allowed me to experience the joy of life.  I have always tried to get the best possible antidepressant yielding the best possible outcome and the least side effects.  Unfortunately I have no direct or indirect experience with the one you mention. 

 

    I personally do not worry about side effects much or going off the medications.  I feel that unipolar major depression or the nomeclature it goes by in some circles is so bad that I am happy when anything works.    I think of depression as like epilepsy or Parkinson's which require chronic treatment.  None of this is advice!  I won't give advice for fear of making others worse than they already are.  Maybe I am wrong.  I am certainly wrong frequently!    I can only speak for what works for me.  I am resigned to the fact that this makes my words perhaps useless to you, for which I am sorry.  Mostly I am sorry that you have been afflicted with the scourge of depression.  I am 61 years old today and depression has been the worst illnesses I ever suffered.  I think you are very heroic to be fighting against it and can only look up to you.  Hopefully others will have more helpful words for you than mine.

 

      I know that a person can get a second medical opinion if they want more guidance than they feel they are getting from one physician.  But other than that, I am really at a loss.  I hope you get better and better and attain the best of all possible outcomes in your battle against depression.

 

Respectfully,  Epictetus

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I was trying to persuade my doctor to switch to imipramine the other day but as I haven't had positive experiences with TCAs, she disagreed because of side effects...

Everyone is different...

mulberrypie, dear, I have TRD too! ((((mulberrypie))))((((zon))))

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Hello, Zon:

 

Stay on the generic venlafaxine (name-brand Effexor) and give it sufficient time to take effect.  Usually that's 4 to 6 weeks, but could take as long as 8 to 12 weeks.

 

I have one friend and two family members who did very well on Effexor.

 

You said a psychologist prescribed the meds to you, but if you are in the U.S. it's my understanding that only a medical doctor can prescribe meds.  Is your doctor actually a psychiatrist, not psychologist?

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I have never heard someone getting a TCA as a first line treatment for any mental illness in the past 10 years, let alone imipramineI would be wary of any doctor who isn't competent enough to prescribe enough meds to last inbetween appointments.  I sense some sociopathy in his behaviors and it doesn't sound like he will give a crap about any side effects or withdrawal you will have to go through.  He was already dishonest to you when you asked to try an SSRI and got an SNRI instead.  That is another red flag.  From what you wrote, he doesn't even seem to be the least bit interested keeping you involved and informed of your treatment so that you can make an informed decision of your own.  Every med is going to have its side effects, some more frequent and more common than others depending on which med you take.   You just need to decide what trade offs you are willing to make.  

 

I would be very wary of taking Effexor from someone who can't even give you enough meds to make it between appointments as you are correct, Effexor has the worst withdrawals of any anti-depressant out there.  It has a really short half-life which can trigger withdrawals if you miss your dose even by like 2 to 3 hours.   The drug certainly has its place.  Effexor works on different receptors at different doses, so the positive effects and the side effects can be entirely different depending on which dose you are on.  

 

In the end, if he screws up your prescription or the pharmacy does and you run out, it will be YOU who will suffer the consequences, not him.  When it comes to doctors, you should not even expect an apology, let alone responsibility on their part, so you must ALWAYS advocate for yourself and stand up for your own interests when it comes to your treatment, because doctors are unlikely to do that for you.  The problem isn't so much with discontinuing Effexor when you want to try something else, because you can always taper off it slowly, withdrawal is more problematic my skipping or missing a dose.  Always taper off on YOUR pace, NOT your doctors toi avoid experiencing withdrawal.  Doctors won't be the one to go through withdrawal, you will be, and in my experience, if it doesn't **** you, most doctors don't care about your comfort.

 

Honestly, there are enough red flags in just two appointments that if I were you, I would seek treatment from another doctor instead of him.

Edited by NC86

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I think if you are not comfortable with the dosage/drug that your doctor has prescribed for you, I would hold off, and return to him and discuss that.

 

 Your concerns are totally valid, and it could be that he could suggest another drug, or a lower dosage.

 

 But I would not start taking such a strong drug at a relatively high dose without first discussing with him.  

 

It used be a top-down, doctor knows best approach, and patients who balked or questioned things were viewed as non-compliant, but fortunately I think it has shifted to a more egalitarian respectful relationship between doctors and patients, in which they work in a partnership to explore pharmacologic treatments that that both see as reasonable and workable.

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Thanks for all the opinions. Yes I definitely don't think I should take an SNRI, and I really believe the TCA had more negative affect than positive so I think SNRIs are the middle ground, easier to quit if/when needed and less side effects than TCAs.

 

Does anyone know where I could find a good detailed list of the general characteristics/side effects of different SSRIs? I think I should do my research and try to pick which one I think will suit me best myself as my doctor clearly can not do it for me. And also try to find a new doctor as fast as possible.

 

Oh and in reply to the last comment by ellemint, I TOTALLY agree. No one should ever take a doctors advice without doing their own research. I generally research any condition I have and try to have a good idea before visiting a doctor. I've believed that since I was old enough to think and I think that belief has really helped me dodge a bullet today.

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I think it depends on how in depth you are going to go with your own research. Psychiatrists have a huge in depth knowledge on the subject that we cant get with a few hours of reading. It wont make us drs. What is important is that we listen to ourselves if we feel uncomfortable about the treatment we are getting or if their are red flags. I think if I was you would see another pdoc for a second opinion because of him not giving you enough meds to last to your next appointment  and not telling you what type of neds he was putting you on  the second time around. A lot of the other things you mention could have legitimate reasons for them. DOses always start off small and he may have had reason to put you on what he did. 

 

When it comes to side effects I think its unwise to decide ahead what you dont want as they affect us differently and you wont know how you will react till you try it - unfortunately. 

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hi!

I've had to go off Venlafaxin before because it didn't work for me. It wasn't pleasant, but you'll definitely survive. The mistake most people do is to get off of it way too quickly and that's what causes bad dreams/anxiety.

The one thing we absolutely have in common is meeting a doctor that doesn't make you feel confident about the treatment you're getting. I've had at least three of those. Being put on useless medication for a number of weeks and then switched to another (also with different doses being tried out a couple of times), is common I think.

It really sucks, I can understand your frustration. What's important is not to get discouraged. If he doesn't have any better ideas and you feel stuck, you need to find the psychiatrist/psychologist that is right for you! Some are more competent or understanding than others. Some will also listen to what you have to say a lot more.

When the explanations a psychiatrist gave me for choosing a certain medication actually made sense to me, I felt so much better.

Consider going to someone else :)

Good luck

:1cat:

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Does anyone know where I could find a good detailed list of the general characteristics/side effects of different SSRIs? I think I should do my research and try to pick which one I think will suit me best myself as my doctor clearly can not do it for me.

 

Unfortunately there are no perfect antidepressants out there and as fizzle said above, they all affect different people differently so until you try one out, you won't know what side effects it will give you, and many will have similar potential side effects listed. SSRIs can also have similar withdrawal symptoms to effexor and they generally need to be tapered off as well to minimise withdrawal while your body adjusts. It can take some trial and error to find the right one. The reason effexor can be more problematic is because it leaves the body quickly and even if you skip a single dose you can experience withdrawal symptoms so it's important not to run out or forget a dose.  I also started on 75mg effexor, it's not really considered a high dose of this drug, I was told it was a "sub-therapeutic dose" which needs to be increased to at least 150mg to work properly. Unfortunately I was never able to tolerate 150mg and every time my doc convinced me to go up to that dose I turned into a zombie. Other people seem fine on even higher doses so again no one can tell how a med will affect you individually.

 

It would be good if there was one or even just a few ADs that were consistently effective for everyone with minimal side effects but it just doesn't work that way so you may need to try several to find one that fits. I stayed on effexor because apart from some start up side effects which passed after a couple of weeks, the side effects were more tolerable than the many others I tried before.

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