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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by rose3700 on March 5, 2000, at 7:17:42
Hello, My father and step-mother visited yesterday. They kept saying to me that the drugs are no good ect.
I am on 300mg of zoloft, tegretol, etc.
They kept on and I had a pacic attack heart racing and broke out in a sweat...I thought zoloft was to help with panic attacksThanks
Rose
Posted by bob on March 5, 2000, at 11:29:15
In reply to help, posted by rose3700 on March 5, 2000, at 7:17:42
Rose,
Your father and step-mother don't know squat.
(and you can tell them I said so ;^)
My dad raised me to be a typical stubborn Irishman. Even though he was highly educated and he worked as a school principal, meaning he had to deal with kids with problems all the time, he had a irrational, uninformed "thing" against psychological practices of any type. Meds probably the worst -- they meant you were weak.
So, as a result, that attitude (instilled in me) was a big part of me not getting the help I needed until I was 34. And now part of the burden I need to deal with is the anger and guilt over wasting all that time.
It's all very stupid and so unnecessary.
You have a medical condition that needs medical attention. If they can't wrap their minds around that idea, then tell them to keep their noses out of your business -- if they can't be part of the solution, then stop being part of the problem.
Okay, okay ... yeah, that's a bit harsh. You should probably be a bit sensitive to the possibility that they see your treatment as a failure of theirs. Maybe you should keep that in mind first.
You know the truth of it better than us -- your condition may actually be, in part, their failure. I know my parents bear a great deal of the cause of what's wrong with me today. But -- my choice -- I've never told them so nor do I want to toss that weight onto the ones they carry for themselves. I don't want to be a part of THEIR problems, either.
As for the meds issue -- what the "etc."? Never been prescribed that one myself ;^)
300mg of zoloft? Good lord, why so much? I know that some docs will go over the cap of 200mg/d in some cases, but my own pdoc was extremely hesitant to do so.
Your mileage may vary, but in all the time I was on zoloft, it never did a thing to ease my panic attacks. No antidepressant alone has ever helped me manage my panic/anxiety. Klonopin works for me on most of my anxiety-related issues, and I'm finding that the boost Ritalin is giving my Nortriptyline is smoothing out what's left.
Keep in mind as well that while your meds may keep you on an even keel from average day to average day, there are going to be those "one of those days" that are going to push you to the limits (parental visits often being in that category!). Those days pass -- don't obsess over their ripples to the point they make you seasick all the time.
hang in there,
bob
Posted by Cam W. on March 5, 2000, at 11:37:59
In reply to help, posted by rose3700 on March 5, 2000, at 7:17:42
Rose - This is the reason that I fight the stigma of mental illness with an 'in-your-face' attitude. Giving your parents the benefit of the doubt, I would assume that they are woefully misinformed about panic disorder. They could also feel guilty, thinking that they 'caused' the disorder. I do not think that they realize the harm that they are doing. This is not an instance where tough love will work. The Zoloft can hold a panic attack so long, but when a big stress comes along, not even the Zoloft can hold off an attack.Your parents need informantion on panic disorder and also on stigma. Give them some books, articles, journal studies, diagnostic methods relating to panic disorder. This affliction is not one that I am most proficient to give advise about without my books and papers handy (they're at work). I am sure there are people who read this board that would have this information at their fingertips.
Stigma is a 'tough nut to crack'. I am really not certain how we change people's attitudes toward mental illness. Protest and pushing the issue seems to result in a rebound effect of increased stigma. Education programs do little; advertising campaigns even less. I think that the only way that we can defeat stigma is to find what truly causes them (eg turn them into medical disorders rather than mental disorder) and to find better treatment modalities to alleviate the symptoms. This would show mental illness to be no different, from a medical point of view, than diabetes. The Surgeon General's Report on Mental Illness has some good information on stigma and even better references. Stereotypes are difficult to break; they are laid down in childhood and strenghten from there.
Two Personal Experiences With Stigma Toward Mental Health
1) I was at a wake for a friend of my father-in-law's. A group of us got to talking about our jobs (they were all oilmen). When I told them what I did (essentially trying to keep people out of hospital and functioning adequately in society) a couple of these 'distinguished' gentlemen verbally 'attacked' me. They said things like, "Why are you releasing those people into my community. They are a danger to my daughters. Why can't you keep them locked-up, like we did in the 50s, we had no problems then. When I see them in my neighborhood, I call the police." My wife dragged me out of there before I caused a scene. As I was leaving I was able to fire off a last salvo. In a low voice, to the most militant of these gentlemen, I said, "I'm sorry to hear about T...'s death at such a young age (64 yr), but he had been depressed for years and refused to see the doctor. I guess he used alcohol as his medication, until it killed him." As, I turned away I saw a couple of them look down into their drinks. Later, I felt guilty, because I enjoyed feeling so smug at the time.2) Another time, I was giving a presentation on some aspect of mental health (can't remember the details) to a public group. The presentation was going great, most everyone laughing and contributing, until I mentioned that I was currently being treated for a major depression. Well, you could have heard a pin drop. I continued to present in silence, and as I slunk for the stage (to a smattering of applause) I said to myself, never again would I let that happen. Since then I have become a militant antistigmatist, using low key persuation methods backed by scientific facts.
Further to my personal experiences of stigma; I have written an op-ed piece for the Canadian pharmacy journal, Pharmacy Practice, that will appear in the March, 2000 issue (later this month). The article is 'Stigma in Mental Illness: The Community Pharmacist's Role'. I was told that they 'hacked it up' (space limitations), so I may be posting more complaints after I read it.
Thanks for letting me vent. Rose, keep in touch with us, as I believe many on this board have been through similar circumstances and can help you with this problem. You can e-mail me if you would like, and I will help as much as I can. Sincerely - Cam W.
Posted by Sigolene on March 6, 2000, at 5:19:25
In reply to Re: help, posted by bob on March 5, 2000, at 11:29:15
Dr Bob,
I lost ten years of my life, thinking that psychology and medications were only for weak people. Your have all my sympathy !
I'm now trying to catch up the time lost (do we say like that ?)by studying psychology at University.
I've got one question for you, you say you take Nortriptyline. One told me that anticholinergic meds like this one, can cause memory impairments. Did you notice something ? Do you think I could take such med. if I have to study and learn ?
Thank you. Sigolene.
Posted by Noa on March 6, 2000, at 18:16:15
In reply to Re: Dr Bob, posted by Sigolene on March 6, 2000, at 5:19:25
How maddening--your parents badger you about your meds, saying they are not effective, until they manage to badger you into a panic attack, which they then take as "proof" that they were right! Families---they never cease to amaze.
Posted by bob (NOT Dr.) on March 6, 2000, at 19:04:17
In reply to Re: Dr Bob, posted by Sigolene on March 6, 2000, at 5:19:25
> Dr Bob,
Alright Dr. B ... seems this here board ain't big enough for the two of us ... draw! ;^)
Dr. Bob always signs his posts with the "Dr." firmly attached. This here Bob almost always signs his name "bob", 85% because I'm often too lazy to hit the shift key and 45% because I have no self-esteem and 30% because I really want to be e.e. cummings.
> I'm now trying to catch up the time lost (do we say like that ?)by studying psychology at University.
You could say "I'm trying to make up for the time lost" or "I'm trying to catch up for lost time" ... in this context, I think most people would use the first.> I've got one question for you, you say you take Nortriptyline. One told me that anticholinergic meds like this one, can cause memory impairments. Did you notice something ? Do you think I could take such med. if I have to study and learn ?
The short answer is "not necessarily ... you need to try it for yourself and, even then, there may be measures you can take to compensate."
The long answer is...
"Can cause" does not equal "will cause".
Your mileage may vary, but I've had next to no side effects from nortrip ... so I'm not necessarily the best person to bounce this off of. On the other hand, all my graduate work was in the psychology of learning, so...
Memory isn't the only thing that influences whether you learn or how well you learn. Your short term or long term memory could be unaffected by a med, but a lack of focus or concentration could interfere all the same. Similarly, a med might influence your motivation -- your interest, your sense of curiousity or challenge -- and that would hamper your ability to learn.
Six months ago, I was taking 75mg/d of nortrip, 200mg/d zoloft, and 1mg/d of klonopin ... then I dropped the zoloft since it just didn't seem to be working for me. After just a week or two of tapering down from that 200mg, I started noticing my focus clearing up as if my sinuses were clearing. It helped me be much more productive in my work.
After trying wellbutrin in combination with the nortrip/klonopin and dropping that (wellbutrin makes me mean and nasty ... something no New Yorker ever needs help being ;^), my pdoc and I had the novel idea of just trying nortrip as my sole AD med, and boosted me up to 150mg/d. It fogged me in again, but nowhere near as bad as I was before dropping zoloft.
The funny thing about zoloft & me is that I had a completely different reaction to it the first time I took it. When I wasn't manic, I was still very focused, confident, and assertive -- all characteristics that help in learning.
Last anecdote -- I've been on ritalin (20mg/d) now for about a week, and my focus and energy is better than it was before I doubled my dose of nortrip. Cognitively, I'm functioning as well as I ever have, I believe. All the same, I wouldn't have described where I was two weeks ago as being impaired cognitively in any way back then ... I seemed fine to me.
I guess my advice is that lots of things can affect your ability to learn. Certainly, being depressed can have a large negative effect -- particularly when it comes to volitional or motivational aspects of learning, but also for purely cognitive aspects as well.
If you're thinking of making some change (and this is true in general, not just for monitoring your learning ability), then you need to keep a journal. Don't just keep track of how you feel, keep track of your productivity. How much are you able to read in a week? Are you keeping up with your coursework? How much are you getting from it? Whatever measures you think are appropriate. You need to do this prior to any change, so you can establish a baseline for comparison. If you want to take it one step further and be proactive about this, every Sunday set yourself some goals for the week as well, so you set yourself a target for performance based upon where you're at.
THEN, you need to make sure you (a) keep recording regularly in that journal and (b) make sure you *do* compare across several weeks. You need to keep in mind that any change in meds is probably going to create some short term problems or fluctuations in how you feel. The hardest thing will probably be keeping the same "yardstick" (or "meterstick") for measuring your progress -- I keep finding that my own ability to assess where I am and how much I can do fluctuates with my meds and how I feel.
Finally, you need to judge any change in your learning with the change in how you feel. If you do wind up with some drop in your learning performance while gaining much more in terms of an improvement in your mood, there are ways of addressing the learning problems. In my own case, ritalin is giving me a nice boost right now, but you don't have to rely on another med to fix a new problem. There are a variety of strategies you could use to address behaviorally any drop in performance -- most of which deal with taking abstract tasks and making them more concrete and multimodal (words + pictures, reading + writing, going beyond reading and highlighting text to outlining and designing self-tests).
Another way to think of it: many modern approaches to "learning disabilities" focus on learner/environment fit instead of looking to remediate some deficit inherent in the learner. The latter stance says there is something wrong with the learner and, if at all possible, this deficit needs to be "filled" or corrected. The former focuses on how to optimize the learning environment to meet the learner's needs. That's the frame of mind you need to keep -- that you may need to make changes to how you approach learning if you start having problems on a new med.
cheers,
bob
Posted by Janice on March 6, 2000, at 20:12:34
In reply to Re: Dr Bob ... not!, posted by bob (NOT Dr.) on March 6, 2000, at 19:04:17
very funny bob!
This here Bob almost always signs his name "bob", 85% because I'm often too lazy to hit the shift key and 45% because I have no self-esteem and 30% because I really want to be e.e. cummings.
I did notice dj started signing his name DJ when he started 'feeling better'.
Sigolene est Francais. And I, too, am French. Sigolene's English is is much better than my French, so please be easy on his sentence structure.
Sigolene, tu ecrit l'Anglais tres bien.
Janice (Doucette)
Posted by bob on March 6, 2000, at 20:33:14
In reply to bob, posted by Janice on March 6, 2000, at 20:12:34
> This here Bob almost always signs his name "bob", 85% because I'm often too lazy to hit the shift key and 45% because I have no self-esteem and 30% because I really want to be e.e. cummings.
>
> I did notice dj started signing his name DJ when he started 'feeling better'.[what i *didn't* mention was the 67% of me that tries to overachieve but then tries to compensate by being overly modest and self-deprecating ... i really shouldn't have mentioned it at all ....]
> Sigolene est Francais. And I, too, am French. Sigolene's English is is much better than my French, so please be easy on his sentence structure.
Hey! She asked ... or, at least, I took that as her asking how to say it... ;^)
bob
Posted by dj on June 7, 2000, at 14:31:06
In reply to bob, posted by Janice on March 6, 2000, at 20:12:34
> very funny bob!
>
> This here Bob almost always signs his name "bob", 85% because I'm often too lazy to hit the shift key and 45% because I have no self-esteem and 30% because I really want to be e.e. cummings.
>
> I did notice dj started signing his name DJ when he started 'feeling better'.
>Very astute of you Janice, though I didn't note the same myself, until i read your post...
I share the inclination with you to be e.e.cummings or bill bissett or maybe just d.j. which besides standing for my first two initials also is the short form for disc jockey which when combined with my last two intials m.d. can translate into d.j.m.d. aka SpinDoc, which is sometimes the basis for my cash flow...
Posted by bob on June 7, 2000, at 21:03:00
In reply to Re: bob, posted by dj on June 7, 2000, at 14:31:06
> Very astute of you Janice, though I didn't note the same myself, until i read your post...
goog god, the Man is back ... or have I just not noticed you around?
cheers,
bob
Posted by dj on June 11, 2000, at 17:15:56
In reply to Re: dj, posted by bob on June 7, 2000, at 21:03:00
> > Very astute of you Janice, though I didn't note the same myself, until i read your post...
>
> goog god, the Man is back ... or have I just not noticed you around?
>
> cheers,
> bobBob,
Just back for a quick vist and check in. Hope you are well and all the rest of the folks here too, both newbies and those who've been here for awhile or come, gone and come again...
Cheers to you, too!
Sante!
DJ
Posted by Janice on June 13, 2000, at 22:47:28
In reply to Re: dj, posted by dj on June 11, 2000, at 17:15:56
it is easier to just type dj. As bob said, capitals do require more effort. I think dj looks better too- from a purely aesthetic viewpoint--if your concerned about these things.
Sante!
Janice
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