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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Jeroen on September 14, 2008, at 16:08:13
shall i ask for seroquel back for psychosis
and lithium *NEW*
Posted by Racer on September 14, 2008, at 17:36:21
In reply to shall i ask for seroquel back and lithium *NEW*, posted by Jeroen on September 14, 2008, at 16:08:13
It really depends on what you're trying to treat. I don't think you've ever answered when I've asked that question, although I admit my memory is bad right now.
You said in your last post that Seroquel worked for psychosis, but not completely. If it worked, but didn't hit all your symptoms, that might be a good starting place. What are the residual symptoms which bother you? Are they mood related? Related to positive symptoms like delusions or hallucinations? Negative symptoms? If you get a good result from Seroquel, what symptoms do you believe will remain to be treated?
You probably don't want to change more than one thing at a time. If you drop three meds, and add two new ones on, you'll never really know whether what happens next is caused by withdrawing from one of those three you dropped, or by starting one of the two new ones. Change one variable at a time is a very good rule to follow.
Does your doctor ask you what to prescribe? Or does he suggest what he'd like to prescribe for you? Do you talk WITH him about this, or does he rush you out? A good relationship with your pdoc can make a world of difference in results.
Also, are you sleeping in this hospital? Or do you go home nights or weekends? (I'm just curious, since here most of us can't get hospital care for more than a few days, and never with internet access.)
Good luck, Jeroen.
Posted by Phillipa on September 14, 2008, at 18:46:38
In reply to Re: shall i ask for seroquel back and lithium *NEW* » Jeroen, posted by Racer on September 14, 2008, at 17:36:21
Jeroen that's a good question how do you get internet access at the hospital. Six hours time difference from EST? So that would make it 2am? Am I correct or wrong on that. Love Phillipa
Posted by yxibow on September 14, 2008, at 23:24:30
In reply to shall i ask for seroquel back and lithium *NEW*, posted by Jeroen on September 14, 2008, at 16:08:13
> shall i ask for seroquel back for psychosis
> and lithium *NEW*
Lithium would be for treating BP better usually, although it also addresses suicidality, and requires lithium level monitoring -- its not an easy thing to jump into.
I am still puzzled by this merrygoround of 3-6 antipsychotics in the space of a month or so. That's not the acting length in psychotropic time. The idea is to make the least changes, and that the last change is the likely culprit, in general, in medicine, although that is not an absolute.
I also concur with the other poster about just what exactly is the EXACT diagnosis -- it just doesn't seem possible that western educated doctors would jump from DSM-IV diagnoses left and right weekly.
I'm also puzzled how there is internet access in a hospital.Here in the US, if you enter a hospital, first of all there are signs not to engage or to turn off cellphones, once you enter the protected corridors.
They can interfere with hospital monitors and internal communications. Besides deep underground in some hospitals they wouldn't get a signal anyway.
Which brings me to another puzzlement, as to how there is internet access inside a psychiatric ward, unless by my personal experience there is supervised visits down to arts and crafts or exercise rooms to break the monotony and help the patient feel better.
That's the only place I would imagine a hospital possibly having an internet terminal. I can't see WiFi or plugin jacks inside a hospital bedroom. There is enough spending on just the hospital maintenance itself, if you look inside US hospitals.
Now maybe your hospital is up to a better standard, or you are in an affiliated outlying supervised clinic.
Don't take this as an ad-hominem attack but it just is puzzling to me. If so, you should give yourself credit for the will to express yourself on here and the benefit you get from socializing online since you may or may not feel comfortable with other patients, although I think real-time socialization at the time of something that can be deeply depressing is very valuable.
If you want Seroquel back, then be so. But you have to give it a 30-60 day trial, and be discharged at some point during that time to your family or some supervised care. 60 days inside a hospital would rack up something like $300,000 in this country. And once you make that decision, I plead to you to try not to quit it on day 4 and ask for one of the sulpirides again. It will have no value.That will be the "neurotransmitter guessing game X factor" just as much as discovering what is the best diagnosis.
I don't like the principle of Occam's Razor personally applied to me, but that is another story, a personal partial disagreement with my own doctor, but it means that there are not necessarily tons of diagnoses but one disorder that causes multiple symptoms and is a key part of science and medicine.
-- best wishes
-- Jay
Posted by bleauberry on September 16, 2008, at 17:39:35
In reply to shall i ask for seroquel back and lithium *NEW*, posted by Jeroen on September 14, 2008, at 16:08:13
> shall i ask for seroquel back for psychosis
> and lithium *NEW*Statistics for lithium in treating just about anything really aren't very good. But yes, anything besides an antipsychotic is, as you know, something I think is in the right direction. That being said, my gut tells me an antidepressant+antipsychotic combination would be better. I was going to post it here but it was too large, but at pubmed.com there was a lady with psychotic depression who was not responding to her antipsychotic alone so they added an antidepressant and still didn't respond and then they added Ritalin to it all. I thought how weird. Isn't ritalin going to worsen psychosis? Just the opposite. She got well enough to finally leave the hospital and was still doing well a year later. I can understand doctors giving ritalin for depression, but when psychosis is a factor? That was weird. And how about with an antipsychotic? Wouldn't the antipsychotic just block the effects of the ritalin? Wouldn't they just cancel each other out? Apparently, once again, armchair theory quarterbacking often doesn't work like we would like. I don't know what those doctors were thinking, or if it was just a lucky guess, or if they were so stupid they didn't even figure ritalin would be a strage brew for a history of psychosis, or if they had some good reason to try it, or what, but hey, it worked. That's all that matters, right?
Anyway, just one example to show you how someone else who was in the hospital a long time with psychosis and depression got well on a strange mix of meds, with only one of them being an antipsychotic. Will lithium be the one for you? I don't think statistics are in your favor with it, but anything is possible. And it makes more sense than staying in the limited world of antipsychotics by themselves.
Antidepressants of the TCA or Remeron family, Memantine, Ritalin, Glycine...these are all things that have worked in combination with an antipsychotic with people very similar to you, so you might do well to write these things down and remember them. You might do well to hunt for some of these pubmed cases yourself and show them to the doctors treating you. Give them some ideas that have worked for other resistant cases. They are probably just as confused as you are right now and would probably welcome some ideas like that, especially since these success stories in psychotic depression came from various psychiatric hospitals around the world.
Posted by desolationrower on September 16, 2008, at 19:33:19
In reply to Re: shall i ask for seroquel back and lithium *NEW*, posted by bleauberry on September 16, 2008, at 17:39:35
I wonder if the ritalin helped because it increased PFC activation, and the antipsychotic kept it from doing much in the limbic area. I think D1 are more prominent in the pfc. PFC suppression of limbic circuits is disfunctional in psychosis.
-D/R
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