Posted by JohnL on June 6, 2000, at 5:34:54
In reply to Do you ask your pill doc for certain meds?, posted by Kerry on June 6, 2000, at 0:13:29
Kerry,
Snowie and Jennifer said it perfectly. I couldn't agree with them more. Hit the nail on the head.
I don't know about you, but I sometimes find realtime examples helpful in guiding me when I try to do something new. So if asking your doctor for specific medication requests is new to you, maybe these examples might be of help? Maybe, maybe not. But I thought I would share them just in case.
About a year ago I wanted to try augmenting my antidepressant with Pindolol. So I printed up my research from Dr. Bob's Tips and from Mentalhealth.com. The stuff I printed was pretty darn convincing, and all from reputable sources. When I sat down in the office, I said something like this, "I've been doing some research on what other psychiatrists and hospitals have been having success with, and one thing that really caught my attention was Pindolol. I'm sure you know all about it, but I brought you this research to read just in case you're interested to see why I want to try Pindolol. I do want to try it. I know there are other things we could do, and I know Pindolol might not work, but I would really like to give it a try and see. If these other hospitals are having success with it, maybe it will work with me too."
His response was first a chuckle, and then, "I've tried Pindolol with a lot of patients but I just haven't seen it work. But I guess anything's possible. It's a pretty safe medication. I don't have a problem with you trying it. If you want to try it, you have to promise me you'll give it a fair trial. If we are going to go with Pindolol, we want to do everything possible to give it a fair chance. But I have to tell you, I have not seen it work."
So at that point, the decision was mine...do I go with the research?...or do I go with my own doctor's experiences? Well, I asked him, "OK, well if you haven't had much success with it, then maybe I should rethink this. Do you have any other suggestions?" And then he posed a couple choices, we discussed the pros and cons of each, and I made my choice. Unfortunately Pindolol turned out to be the dud he was familiar with. But we both knew the failure rested on my shoulders, not his. He merely guided me through the pros and cons to be sure I had all the information I needed to make my own educated choice.
On another visit I sat down and asked him, "Have you ever prescribed Naltrexone with SSRIs?" He said, "No, but it sounds interesting. Do you have some information on that?" And I proceeded to pull out my research. He took a couple minutes to read through it. Then he said something like, "I don't have a problem with this. It could be interesting. Who knows, it might work. It's a very safe medication. It's a good a choice as anything else at this moment. Usually at this point we would try another SSRI. But if you want to try Naltrexone instead, that sounds OK. If it works, I have a couple other patients I might try it with. If you don't mind being my guinnea pig, let's try it"...with a smile and a chuckle. Unfortunately, another failure for me. Naltrexone didn't work. And, it didn't work on a handful of other patients he tried it with after me. Darn.
On another visit I said, "You know, I just get the sense that this whole serotonin thing is the wrong way to go with me. I think I'd like to try a norepinephrine medication for a change. We haven't tried that yet. I know this is real old, 1980 something, but I brought this research that shows that a positive response to Ritalin predicts a positive response to Desipramine. And a negative or neutral response to Ritalin predicts a response to Nortriptyline. Since I loved Ritalin (too much), then I think I would tend to want to try Desipramine. What do think?" His response, "I used to use Desipramine a lot in the old days. It's still a very good medication. I think it's been overshadowed by the SSRIs, but I have had a lot of success with Desipramine. If you want to try it, I have no problem with that." And as with previous visits, we then proceeded to talk technically about starting doses, possible side effects, pros and cons, etc.
This Thursday I have an appointment. I'm not sure exactly how I will say it, but it will be something like this, "Last time I saw you I was taking Zyprexa and Desipramine. The combination worked better than anything in years. My anhedonia was completely wiped out. But I really couldn't tolerate the side effects of Desipramine. (he'll stop me at this point and want to know what the side effects were, what the dose was, etc) I hope you don't get upset with me, but I stopped the Desipramine and tried a different non-prescription drug instead. You know me, always tinkering to find the right combination. There are some basic international antidepressants easily available from international pharmacies. I did a lot of research and was intrigued with a French antidepressant called Adrafinil. I love it. I've never felt as good as I do right now. I brought some information about it, since it isn't FDA approved in the USA and you may or may not have heard of it. Anyway, my problem is this...I don't like having to mailorder it, and I would rather stay with an FDA drug we are familiar with. Provigil is a very close derivative of Adrafinil. Adrafinil is its ancestor. Since it's the closest thing we have, can you write me a prescription for Provigil? If it doesn't work, I can always stay with Adrafinil. But it would be very cool if Provigil works as well as Adrafinil. I know it's prescribed for narcolepsy here in the US, but my research shows that it is used more commonly as an antidepressant in Europe."
Stay tuned. I'll let you know his response. Hopefully he won't kick me out. :-) I think because my request will be for a relatively safe FDA medication, he won't have a problem with it. And who knows, maybe it will pave the road for him to try it on some of his other difficult-to-cure patients. He probably is not aware of Provigils's use as an antidepressant, and this could open up some doors for other patients.
JohnL
poster:JohnL
thread:36235
URL: http://www.dr-bob.org/babble/20000603/msgs/36265.html