What combination of psychiatric drugs has worked to improve your lifestyle? Ask me ?s

[Geaux Tigers!]

I'm an Associate Professor at a nursing college. I only teach two courses.I teach Nursing 4004 - Mental Health Nursing and Nursing 4005 - Advanced Adult Health Nursing. These are classes that every nursing graduate must complete. Basically, I train my students how to evaluate a patient's mental health and how to provide first line treatment using psychotropics (e.g. midazolam for anxiety, quietipine for a violent patient). I tell them the best way to write a proper referral to a PDOC.

I am a PDOC in a way. APRNs here are allowed to write scripts with a doctor's approval. Some have their own offices where they rely on the patient to correlate care with their own physician which is a pain the ass. I did not want to have to set up an office. So that only left me working under a psychiatrist at a clinic. I don't like the idea of working below somebody; therefore, I gave up 'professional' life in a way and be a nursing school professor. It's not a bad career, I enjoy it.

Yes, I write scripts. The hospital, in addition to the college, pays me to be there as well as a consultant at an hourly rate anytime I am there, including teaching my class. I literally treat patients in that hospital who need help. There are no psychiatric physicians at the hospital, but there is one that is also hired as a consultant that signs my legal papers so I can manage care and prescribe drugs. He operates his own clinic. Because I am hired as a consultant, the hospital requires me to 'bill' my hours to their outsourced psychiatrist. The insurance process is too wild. Trust me, I want it to be this way, it's like I'm working under him -- sure -- but only so it's legal. If a patient pays out of pocket they write a check to the "real" psychiatrist but I get 90% of the monies. If a patient's insurance pays for my fee to the psychiatrist who will pay my monies out at the end of the month.

My life is working out well. I get paid by the college, by the hospital, and then I make my own money treating patients as if I were a real psychiatrist.

The hospital is kind enough to give me an office. For me to keep my hospital consultant pay, I treat all patients who seek psychological care during treatment. Of course, these patients could go to any psychiatrist if they had a referral, but I am suggested because the hospital indirectly makes money off of my treatment. The hospital can't afford their own psychiatrist. A lot of people's insurance won't pay for a psychiatrist and I live in a rural area -- so my office visits are cheaper than in a lot of areas.

Basically, what happens is, a patient requests psychological help during their stay at the hospital-- say for trauma -- for say, PTSD. The doctors have no idea what to do in this case but they can add me to their bill and I can diagnose and prescribe. I treat around ten or so new patients every week at the hospital until they are discharged. But I have "permanent" patients. I take my repeat patients whom need counseling and do monthly visits with them. I do around 30min. sessions only, depending on volume less. It is around 12-18 people a day.

tl;dr: I am a PMH-APRN who has regular and irregular temporary patients at the hospital

------------------------------

Questions:

1. What combination of psychiatric drugs has worked to improve your lifestyle? What are you diagnosed with?
2. What drugs do you abuse and what prescription drugs help with your abuse problem?

What I'm interested in, professionally, is what drug cocktails have worked you? I like to study how each interacts with each other. This is would be beneficial for my knowledge and may help future patients.

THANK YOU FOR YOUR TIME

Also, if you have any questions for me, feel free to ask!

Any advice for me for treating patients, especially drug abusers?

 

[Geaux Tigers!]

A lot of PDOCs rely on polypharmacy, including myself— the rationale behind this is that we are medicinally trying to solve their psychological problems instead of using therapy. If the patient were to utilize therapy, mind development, etc. then our role as drug providers should lessen with time and ideally approach zero. In a perfect world, these psychiatric drugs would only be prescribed on a temporary basis; however, we know that this isn’t the case. The majority of psychiatric drugs are toxic in some way and cause addiction and withdrawal behavior. The patient must decide if the trade-off between mental alleviation with psychiatric drugs is worth the addiction and, for the most part, neurotoxicity— a PDOC will write *something*. Philosophically and scientifically, there are a lot of different and very reasonable arguments that attack the field as a whole, and I definitely understand the rationale.

As a psychiatrist (or in my case, PMH-APRN), you should strive to prescribe the fewest amount of drugs possible needed to alleviate symptoms, and there are always excess meds— yes, I prescribe excess in a lot of cases. If a patient comes back and claims they are more depressed, even with ADs prescribed, you have to decide between whether he is simply going through a bad time (everyone, no matter what drug you can conjure up, will suffer depression as a part of being a mammal, imo), or has actually suffers TRD. Clinically, I presume TRD and may write yet an unnecessary script that might be one which he may be on for years and years. It’s definitely different from traditional medical fields in a lot of ways.

Psychiatrists kill themselves, etc. (I abuse drugs) I sometimes wonder, like the critics, if the medications are really worth it versus therapy and self-discovery, and most of all-- the extent of the scientific knowledge that allows us to properly prescribe medicine. There is always research coming out saying this and that, e.g. oh the only reason this AD works is because of BDNF, etc.

Another amazing thing, you can almost look at the world as a computer, it’s amazing that we are only ourselves, one unit, doing one particular role with different schemas. I think one’s schema is the key to unlocking mental problems. As I said with the medications, it is easy to do affinities of neurotransmitters, etc. but it is difficult what processes they are inhibiting in world’s most complex computer— the human brain.

 

[Geaux Tigers!]

I've developed this chart As you can tell, I am a fan of old school TCA's. They seem to have a better response rate than SSRI/SNRI in my experience if they work well, but a lot of time the side effects are just too much.

What do you suggest I should do to improve this chart? I have a lot of ideas and want to completely re-do it.


Let me defned my use of TCA's

OK, with the Anafranil, you have a drug that is a potent enough SRI that has the same potency as the SSRIs. WHILE at the same time have strong NRI due to its desmethylclomipramine metabolite. This makes it way better than the “SNRI” venlafaxine which has negligible NRI effects except at ridiculously high doses. I think the NRI + SRI combination is important for depression; also, like venlafaxine and the other TCAs, it may interact with the opioid system in a beneficial way. It is a mild 5HT2A antagonist, which is good to reduce anxiety and improve mood and probably sleep too (and appetite). It does increase prolactin levels a lot so you have to watch out for that and its inhibiting effect there can interfere with the breakdown of melatonin so it might increase drowsiness but I’m not sure how clinically relevant that is. Great TCA.

I recently stabilized a patient on:

#60 900mg. lithium; PO, 1 tablet QAM, 1 tablet QPM for 296.5
#90 10mg. dextroamphetamine sulfate; PO, two tablets QAM, 1 tablet QPM for 314.01
#30 125mg. imipramine PO QHS for 296.3/309.81
#60 0.5mg. clonazepam PO BID PRN for 300.02/300.23
#30 80mg. lurasidone PO QD CF for 301.83/312.30
#60 100mg. modafinil PO BID QD for 327.15/296.80
#120 150mg. pregabalin PO, two tables QAM, 1 tablet PM, 1 tablet QHS for 293.83/296.80
#30 0.5mg. alprazolam PO QD PRN for 292.84//309.81

 

[Geaux Tigers!]

Do you think this is the right forum for this topic? Should it be moved to Drug Culture?

 

[Swimmingdancer]

I'm really not sure which forum would be best, I think maybe you just need to give it a little time. But I can move it to DC or OD if you want.

I mostly have lists of drugs that didn't work for me. Not sure if you're interested in that kind of feedback?

I also have some strong opinions about the American health care system and over-use of pharmaceuticals so not sure if you want to hear that, lol.

 

[Geaux Tigers!]

I would really appreciate if you would share your views with me.

 

[Jabberwocky]

I have some really strong opinions on psyciatric practice as a whole. In the most part it's a joke, legal drug pushing for people who are in need of help, instead pushed onto addictive and powerful drugs that completely ruin their head. If a person has a legitimate mental condition it's often misdiagnosed (purposefully or not) and gives them a way to charge more fees and gain more money from the companies that pay for their holidays.

I have suffered from ADHD since I was a child - and that's honest. I suffer anxiety as a result of my ADHD. I am stable on 40mg of dexamphetamine daily for the past year which has done me a wonder of good.

Before that I was doped to the teeth with anti depressants, benzos, sleeping pills and pregabalin. This is AFTER I came in to see a psychiatrist about alcohol problems at the AGE OF 16. the doses were high enough to put a rhino to sleep let alone a teenager.

All your anti depressants are crap. They don't work. Face it - they work in some cases such as after chemotherapy and a genuine chemical imbalance has occurred due to the drugs reacting in the patients. Aside from this I have seen anti-depressants ranging from SSRIs or TCAs which you think are "better" take 5 lives, all by suicide. At the same time they were given benzodiazepenes or zolpidem.

Sure it may help some who are diagnosed correctly and are actually bothered to be looked after and cared for by the shrink, suggesting CBT, therapy or other methods ASIDE from medication or in conjunction to it. Preferably a therapist not fucking related to the shrink as then there's no point. Most of the time they communicate with one anther to exasserbate problems further and hand out more addictive drugs.

It's hilarious even yourself stated they are drug cocktails. You know what the best drug cocktail is for me pal? Oxycodone, dexedrine, temazepam and maybe some valium too. Pregabalin as well actually if you can. Won't be problem anyway, if any problems occur you've made me sign a waver essentially handing over my life to you.

So you give a high potency hypnotic (midazolam) to people anxiety? I mean do you even read about what you prescribe or just look at a list and think yeah that looks good, use that. Ridiculous.

I'm almost speechless at what you've written - but then gain I'm not surprised. You're honest. You spend 30 minutes a month with people who have serious mental health issues to push scripts out as fast as you can and make as much money possible too.

Well, I hope you can sleep at night, if you can't, prescribe yourself some hypnotics - I've heard gabapentin is a great one.

 

[Geaux Tigers!]

I've heard gabapentin is a great one.

I've actually use gabapentin as a mood stabilizer, but patients with insurance get Lyrica. For BPII-NOS

BTW, I sleep well at night.

 

[Swimmingdancer]

I would really appreciate if you would share your views with me.

Certainly . I should really be getting to bed so I'll post tomorrow. Warning - it'll probably be really long, lol. (I am probably well-known for my long posts by now )

And let me or another mod know if you want this moved to OD or DC or somewhere.

. . . . . . . . . .

*You may encounter some bitterness from the many people who feel that Western medicine/psychiatry/pharmaceuticals have failed them and others. Don't take it personally but also please don't let it prevent you from hearing it and learning from the insights they have to offer. I understand many of the problems are not the fault of the practitioners but the system that they have little choice but to work within, so it seems unfair (and unproductive) to take it out on people like you, but try to have compassion for those who might. I think it's cool that you are asking people on here to share their experiences . I hope you keep an open mind.

 

[Jean-Paul]

Questions:

1. What combination of psychiatric drugs has worked to improve your lifestyle? What are you diagnosed with?

klonopin, ambien, paxil, vistaril
i am not sure the paxil and vistaril do anything, as they sure don't help on their own. i accept this full cocktail because it's the smart thing to do.
i am diagnosed with OCD and generalized anxiety. past diagnosis include major depressive disorder and cluster b. i think if i qualify for any cluster now, it's most likely c. i don't trust the diagnosis i got as a teen though.
it's panic/anxiety now, and the OCD which used to manifest itself in externalized rituals has very much internalized

2. What drugs do you abuse and what prescription drugs help with your abuse problem?

i abuse opiates and alcohol when i do not have meds. i likely need ongoing therapy to keep myself clean from other drugs once i am on my meds, as then it's a matter that therapy can help and not a need to balance my brain chemistry. (back when i was on my meds, environmental factors and emotional ones were the only triggers to want to use anything else, and were easily avoidable with the right measures)

What I'm interested in, professionally, is what drug cocktails have worked you? I like to study how each interacts with each other. This is would be beneficial for my knowledge and may help future patients.

klonopin, ambien, paxil, and vistaril was the prescription i took that changed my life. nothing else worked in 12 years of mental health issues/many, many different meds and dosages and combos
i believe an old psych i had actually gave me some drug that wasn't even a psych med but increased my dopamine directly, in hopes it would work

THANK YOU FOR YOUR TIME

yr welcome

 

[Jean-Paul]

Any advice for me for treating patients, especially drug abusers?

whoops, missed this.

please don't assume all past drug users will abuse benzos, and actually listen to your patients. place quality of life first. don't assume educated sounding peons are dangerous. please realize it isn't fair to have to dumb oneself down to get proper treatment.

 

[Morva]

My daily meds are and have been for about 3 years:

4mg Risperidone
250mg Clomipramine
2000mg Sodium Valproate
I also have Temazepam and Quetiapine prescribed to take "as needed", and completed a course of ECT approximately 3 years ago.

I don't really know what my diagnosis is anymore, Bipolar-OCD-Schizophrenia-Depression-Anxiety?

As for illegal/recreational drugs, I have experimented with a number of drugs and was a daily cannabis smoker for around 14 years (on a hiatus of about a year now), and am a sober alcoholic (again, about a year of abstinence) but the only one I use that I would classify as "abusing" at the moment is caffeine in the form of coffee and energy drinks.
Large doses help combat the tiredness that is a common side-effect of all of the above drugs, and I do shift work at odd hours.

As for what has worked for me, my current meds, along with a course of ECT seem to keep things to the point where I can just hold down a job and support my family. Having said this, I am not happy with the trade-off of the side effects and
plan on changing/reducing my meds with consultation with my psychiatrist.

Jean-Paul has some excellent advice there for treating patients.

 

[cook]

1. What combination of psychiatric drugs has worked to improve your lifestyle? What are you diagnosed with?

Mirtazapine and benzodiazepines (zolpidem, alprazolam, nitrazepam) give me sleep and benzodiazepines relieves anxiety (surprise). No SNRI/SSRI I've tried ever helped me in any way so I'm currently weaning off them. I have been diagnosed with major depression (past) and avoidant/mixed personality disorder with social anxiety. I think I've never met true professional in this area, but I don't think medicines are the solution to my problems anyway so i'm done with them, except for the symptomatic meds.

2. What drugs do you abuse and what prescription drugs help with your abuse problem?

Opiates and occasionally benzodiazepines. Low dose Naltrexone helps me not becoming dependent and avoid withdrawal, keeps my tolerance down too, but i'm still addicted mentally.

Any advice for me for treating patients, especially drug abusers?

Abusers with co-existent mental health issues (which most abuser have in my view) should be treated as whole, not separately.

 

[blight12]

OP, I have some questions. What are your thoughts.

1. I have a problem with the daily prescriptions of amphetamines for ADHD or whatever else.
My opinion is that the serious addiction amphetamines and meth can cause is related to the use of this type of drug for functional purposes.
Attempting to come of a drug like this when its being used to perform better in life and for work is incredibly difficult because you feel you need it to live.
Im sure this often leads to abuse of the more serious amps like meth.
How can doctors justify the risk of daily amp prescriptions. Can the reward truly justify the risks?

2. Daily Benzo prescriptions for Anxiety and sleep
Similar to above but with the serious dependance and physical addiction they can cause, how can medical professionals prescribe these daily since that will should pretty much ensure serious dependance on the drug

3. I have been treated very successfully with Paxil for anxiety and PTSD for 7 years so far caused by serious MDMA abuse (consecutive days, OD level dosages etc) culminating in a week of bad SS and derealization/depersonalization when i stopped this drug forever. I believe physical damage was caused by this abuse.

The anxiety and PTSD (caused by a armed robbery event) would create serious obsessive hyper vigilance behavior which was very difficult to function or to sleep since i would be forced to physically monitor and check up on sounds and my surroundings for danger.

What the paxil did for me was not remove the fear but it removed the obsessive behavior so i would not be forced to check every little sound for danger and it allowed me to eventually get to sleep or shift my focus away from the fear so as to function. This was a drastic change that made it manageable.

Questions:

1. Now 7 years later I have noticed a drastic change for the better where my anxiety and PTSD has gotten much better, almost vanished with no change to my lifestyle, environment or medication. I am wondering if my brain has healed itself and is this possible based on the cause of the damage.
I am wondering if i should try properly taper off my Paxil to see how I am without it or if I "shouldn't fix anything that aint broken"

2. I am using Seroquel for it off label use to sleep at 300mg a night. This works extremely well as it provides a natural anti histamine based sleep.
I dont get any of the side effects either. I use this as its supposedly non addictive, no dependance and no tolerance. I have not needed to increase dosage for 3 years. I am hoping to eventually move over to OTC anti histamines for sleep since I would be used to it from the Seroquel.

I was on Zolpidem before and I abused them and the tolerance was crazy that i ended up in hospital due to suspected OD from family members (I was in fact safe due to tolerance). This is why I am anti prescribed daily use of any addictive medication.

a) What are your thoughts on the above and do you think its fine and safe for short to medium term
b) Are you aware of any other drugs that provide only the strong anti histamine sleep properties of Seroquel without the anti psychotic properties. I cant see how such a large gap in the market could exist, but I cant find anything.
c) Is there anything else you could recommend over Seroquel for this that would be as effective and safer and provide a natural sleep?
d) I often use Seroquel to come off stimulant drugs. Is this safe?

Thanks OP!

 

[cook]

b) Are you aware of any other drugs that provide only the strong anti histamine sleep properties of Seroquel without the anti psychotic properties. I cant see how such a large gap in the market could exist, but I cant find anything.

Mirtazapine and trazodone at least, mirtazapine is my favourite. Some doctors refuse to prescribe trazodone for males due to risk of priaprism.

 

[LOGan1314]

Vyvanse and adderall daily has done fucking wonders for my addiction problem. I take 70 mg vyvanse in the morning and 10 mg adderall in the later afternoon and I have the longest clean time I have ever had. They don't affect my eating, sleeping, exercise, or sleep. So for people who have problems with these types of meds for ADHD or whatever, they need to realize they really are meant for some people.

However I do agree they are probably over-prescribed.

 

[blight12]

^^ Well if you are taking them daily then you are on amphetamines each day which means you are still addicted, not so?

 

[Geaux Tigers!]

Disclaimer: I am a Bluelighter and I do have problems with prescription drug abuse which, ironically, I treat people for.

I have read the responses, but I have been swamped today. I promise I will eventually get to everyone. I'm not going to disappear.

Well, when I'm sober -- I'll get to everyone. I'm on 1.5mg. alprazolam and 2mg. suboxone so I have a bit of nod going after work.

I will likely start making a lot of responses back after 5 tomorrow when I'm more sober and haven't had such a long day.

Please be patient! I won't disappear!

 

[Swimmingdancer]

We all have our problems

Maybe having personal experience makes you better at your job? At the very least in the area of having compassion/understanding I would assume. I find for me it's always easier to help others than to help myself, I think a lot of us are like that. I'm having a pretty rough week myself.

I think I will wait to write my post then, since you aren't in a rush. I want to try to think of a way to explain things that will not be like 10,000 words anyway, lol.

 

[blight12]

^^ Yeah, personally I would much prefer to be treated by somebody who had been there before themselves.