Posted by Viridis on August 7, 2003, at 2:00:20
In reply to Re: Order of Diagnosis, posted by cybercafe on August 6, 2003, at 23:39:02
I saw my current pdoc when I was having severe panic attacks. They're sporadic, but they were happening then, so the diagnosis was easy: panic disorder. Solution: benzos (Klonopin daily, Xanax as needed). I also mentioned recurring, severe depression, so a diagnosis of major depressive disorder was added, with the caveat that it might be anxiety-related, so let's see what happens with the benzos.
Next visits: panic and anxiety pretty much resolved, but some depression remains. Solution: one more try with SSRIs (very low-dose Zoloft, since I've had bad experiences with SSRIs). Result: totally freaked out; called and pdoc said to stop Zoloft immediately and (in next session) to avoid SSRIs from now on.
Next session: Maybe add a mood stabilizer? Pdoc suggested low-dose Depakote; I refused and requested Neurontin. He said fine; no problems, but a pretty useless drug for me, as it turned out.
Later visits: was about to bring up the issue of ADD (with which I've been diagnosed, tentatively, by several therapists/psychologists), but my pdoc brought it up first. Tested me and agreed that this was highly likely; suggested addition of pstims. Tried Provigil first (a long shot but worth a try, in his opinion).
Next visit: Provigil OK, but not enough for concentration. Switched to Adderall -- much better.
Several visits later: added Strattera at my request -- a big help. Tried various other things along the way, but Klonopin/occasional Xanax/Adderall/Strattera seems best, so that's where I'm at now.
And it seems to work pretty well.
These "progressive' diagnoses have been quite effective for me: attack the key problem (anxiety) first, then tweak it. I think that's the best that they can do right now, given current limitations. Diagnosis should become easier in future, but for now you just have to ride it out and work with a good pdoc.
poster:Viridis
thread:248588
URL: http://www.dr-bob.org/babble/20030802/msgs/248837.html