Not sure what to do

[infectedmushroom]

HI all, I took the plunge and went to see a doctor about anxiety and sleep issues i'm having. It took a fair bit of courage for me to spill the beans to a stranger about what's been going on, but he's a "professional", so I tried to be as transparent as possible.

He asked me about family history and I told him my aunty suffered from schizophrenia and my father had moderate depression issues throughout his life; as well as my mother anxiety issues.

I talked about my social phobia and avoidance (even when I HAD to attend something I would dodge it due to anxiety.)

He prescribed me something called Zyprexa which is Olanzapine. He told me it was an anti-psychotic used in the treatment of schizophrenia and bipolar mania. I told him I suffer from neither of those. He said not to pay attention to the blurbs about what it is and give it a go. Well upon further research I don't feel comfortable taking the drug. I'm not going to put something into my body (DAILY) which is prescribed for the acute stage of psychosis - and from what i've read about anti-psychs - just no, hell no. I'd rather take illegal drugs or opiates, but that's not a good outcome either.

Taking an anti-psychotic daily in my mind its extreme overkill. I want to see a different gp, I think. I don't get anxiety every day, I only get it on days when I have university, or sometimes work, and I don't get sleeplessness every night only some nights a week which makes it almost impossible to sleep before 4/5 in the morning.

What I want to do is see another doctor and be clear that I'm not comfortable taking ANY drug daily (again - overkill!) I'm nervous I'll get turned away and told to just take what I was given if I recount the story I've just told you (because I don't know what's right for my body, but a gp who doesn't know me and met me 5 minutes ago does.)

Sheesh. I feel like bailing out right now, after reading some of the stories on here and the internet and from friends about the whole prescribing world. I might try get out while i'm still alive.

Sorry for the convoluted rant friends hahaha.

 

[ayjay]

It's not uncommon for anti-psychotic medications to be prescribed for anxiety. Quetiapine (Seroquel) was the big one for this a few years ago. I tend to agree - it's a fairly blunt tool for anxiety. In some cases I think it's more about GPs being wary of prescribing benzodiazepines than any therapeutic utility.

You could try another GP and go for a mental health care plan - up to 10 sessions with a psychologist (talking therapy). You could also get in touch with Reconnexion - anxiety and sleep are their specialty.

 

[infectedmushroom]

I guess I was just curious (i've never been to a gp under my own steam before) then shocked when I discovered what he'd prescribed. It's surprising to hear seroquel was widely prescribed for anxiety as well.

I went to a different GP only to hear things I could have found out with a Google search.

I'm not going to take any (more ) drugs for these problems then usual. Of course living a healthy lifestyle and sleep hygiene techniques are incredibly useful.

I kind of exaggerated the scenario a little with the top post, I was just confused with the first doctor who made me walk out feeling like a basket case.

Thanks for your reply.

 

[Halif]

Ah, I can relate to much of what you post and especially the feeling of intense disappointment after walking out of situation which you spent a lot of courage building up to only to feel as if you've just been dismissed without having the serious issues really addressed or helped. I don't like this trend of anti-psychotics being prescribed for all kinds of shit; depression, anxiety, etc.

Also, it's not very comforting to be told to "ignore" the literature related to the medication when you're concerned it's not the right thing. It's akin to saying "Just shut up and take your meds" and further perpetuates the notion of many GPs being indifferent to the plight of patients who have very real and serious issues and concerns.

Like you say, infectedshroom, a healthy lifestyle and good hygiene are better than trying to self-medicate with stuff you get hold of yourself, but the fact is if you're anxious and depressed the whole problem is that it can be extremely hard to help yourself out of a hole by maintain good lifestyle habits. Exercise, good diet and all that are the key to good physical and mental health, but those need to be earned and without any momentum behind you it can be nearly impossible to fix yourself up.

THe most frustrating accept of my 20 year battle with clinical depression is how few people (inside or outside of the medical world) seem to understand how hard it is to maintain ANY kind of lifestyle, but sooner or later the depression cycles round and dumps you in a pit of despair where everything seems utterly futile and pointless. I've tried so many different things; meds, drugs, meditation, exercise, abstinence, fasting, living and travelling abroad, martial arts, yoga, and so on, and all these things have enriched my life but the depression hasn't gone anywhere. I'm afraid it'll be here for life, and the few doctors who have bothered to ask me about my experience instead of just throwing some prescription at me have basically admitted to having no idea what to do with me. They don't know, and I don't know.

Just try and be good to yourself and limit the damage you do if you use stuff to help cope, and feel free to PM me anytime if you want to rant or talk

 

[opi8]

Unfortunately infectedmushroom, that's pretty much par for the course.

General Practitioners are afraid of prescribing benzo's, especially if you don't have a prior relationship with them. I understand exactly why the doctor gave you what you did, and that's because you told him the truth about your aunty. It's a shame that that's how they think, but it seems to be they know best even if they don't know you at all. They usually try and treat everything under the sun with an SSRI first, then if that doesn't work (after a few months of horrible side effects) they may consider a different medicine. Some are so stubborn, I had one tell me to keep taking an SSRI that I was having serious negative side effects from because it "hadn't been a month yet", while I understand how they work, I was not going to put up with hours of agonizing headaches, dizzy spells and fainting every day, not to mention all the other minor things like the metallic taste, the "dumb and numb" feeling, I can't even remember it all but I do remember that was a horrible experience.

Once I was referred to a psychiatrist, at least he seemed to listen to me not just try and get me out the door as quickly as possible with a script for some SSRI he read about that might cure 1 out of every 100 cases in some obscure joirnal. While he noted I had mild depression and did prescribe me an SSRI for that (which I didn't fill), I didn't feel as frustrated after at least being listened to, and he did note that my body language and actions conveyed that my anxiety is real, something that cannot be easily faked.

I am sick of seeing people suffer because of how fucked the system is. Sick of seeing people barely in pain get rich selling the drugs they don't need, when I know dozens who do need something but can't get it because of stereotypes and prejudices. Even someone who is dying doesn't get given adequate pain relief because they're a junky and the "methadone should work". It's fucking sad, I really wish it would change but until it does, the majority of the world's drug users will have to put up with being seen as second rate by the medical professionals who are supposedly there to help those in need.

 

[Halif]

Agree so much with the last paragraph, opi8. There's a serious empathy deficit in the medical system. Doctors tell you how you do or don't feel, and what you do or don't need - often without hearing you out or asking any questions.

And it's clear that the majority of GPs do not have any personal experience with anti-depressants because as a patient, stopping and starting them, or switching them, and switching them around just to 'see how it goes' can create weeks of major mental upheaval. Nor do they have experience with withdrawals or dependency when it comes to benzos. It's astounding how many people have been subjected to ultra-rapid tapers, or in rare cases being completely denied anymore benzos, AFTER they've admitted to being dependent on benzos.

Sure you've made a mistake if you have got yourself dependent on benzos when they weren't prescribed to you. But does that mean it's OK for GPs to have an attitude of 'well, you shouldn't have abused that medication so now you'll just have to deal with the condequences'.

It's true that abusing prescription medication which was not required is highly irresponsible. But if a person has got themselves dependent on benzos, then it's not a time for a condescending, judgemental attitude. Nor is the time to provide inadequate taper supplies - or nothing. That's simply inhumane. Anyone who's copped it bad and experienced severe benzo WDs knows it's not a joke, it's a medical emergency and it's extremely frightening. The risk of suicide is high for some people stuck in the midst of benzo WDs which are too horrible to withstand.

If doctors knew even half of how bad it feels to have medications chopped and changed, or outright denied because of 'irresponsible' behaviour, I don't think they'd be as lackadaisical. And if they do know the extent of the suffering, and continue to practice that way, then they're heartless sadists.

 

[infectedmushroom]

It's a really big shame things have to be this way. I know how long my uncle has suffered cycling through different SSRI's. The WD's were VISIBLE when he was changing between them. He was sweating and had a headache and was generally uncomfortable and he was much grumpier and down than usual. No SSRI has ever worked for him. He went through the "just try a new one until something clicks" cycle and it burned him, badly. The GP who prescribed me Olanzapine said that there were many different options to try, and we just had to go through them. I thought of my uncle and alarm bells went off. I firmly told him I was not going to use an SSRI; an anti-psychotic was the last thing I thought he'd do.

I was told by both GP's that sleeping pills as they called them i.e. benzos are bad because they're addictive. Well duh, I thought. That was the first reason they gave for not trying them, and I understand why they didn't. Doctor shoppers, risk of abuse, Xan's recent rescheduling - etc. etc. all make a GP reluctant to write up a script.

There's a severe lack of honest, clear and helpful information for patients, who are given these medicines and told just take it because doctor says so, so don't think about it to much. I've had a glimpse today as to why people talk about pharmaceutical companies being greedy bastards. Doctors should sooner say "look, there's a very high chance this won't work and will give you nasty side-effects" than be trigger happy and write out scripts, but hey, as the song goes;

We're in the money!

 

[Halif]

He went through the "just try a new one until something clicks" cycle and it burned him, badly.

I'm sick to death of hearing that "just try 'em till one works" shit, and it's another example of someone saying something without any care or understanding of what that actually entails when you're the one taking the meds.

It's not like trying on different t-shirts to find one that fits. It's week and months of having your whole body and brain radically changed over and over.

There is nothing at all to be gained from challenging a doctor, but it's infuriating and disempowering to have no voice when what we're talking about is our very ability to function and live any kind of normal, productive life. For every time I've heard that "it's addictive" line when it comes to benzos, or opiates, I have to fight to hold in the hypocrisy and demonstration of gross ignorance on their behalf - because they prescribe SSRIs, SNRIs and other AD meds which for all intents and purposes create a dependence.

Has anyone tried to get off of venlafaxine (Effexor) abruptly? Or slowly for that matter? It has shocking withdrawal symptoms, amongst which include a dramatic worsening of the depression it was supposed to treat. I had to take it daily, and unlike other AD meds (ie. sertraline) where skipping a day is no big deal, with Effexor skipping a day was dire. So it was very much a dependence with extreme withdrawals possible which were bad enough to push someone over the edge if you get me.

So the whole "It's addictive, and therefore bad" is stupidly simplistic and shows the disturbing level to which doctors wear their blinkers and are hardwired into thinking about substance classes in a black and white way and telling you about their view and theories like it's scripture - without them ever having even a jot of first hand experience with any of it.

Sorry for going off ranting again, infectedshroom... this is obviously a topic which stirs up a lot of emotion for me. Being shuffled around between centres and meds and not having my first hand accounts listened to or acknowledged has left me very frustrated and angry. You know, sometimes when I'm really angry about it all I imagine a scenario whereby the doctors who have prescribed this and that, and refused to prescribe things I know work, were forced to undertake the EXACT same regimen of shit that I've been prescribed and taken out of a desperate desire to get better and have a life, and then check back a decade later and see how they were doing and if they'd changed their perspective much.

Truth is, however, I wouldn't wish that experience on anyone at all.

 

[infectedmushroom]

For every time I've heard that "it's addictive" line when it comes to benzos, or opiates, I have to fight to hold in the hypocrisy and demonstration of gross ignorance on their behalf - because they prescribe SSRIs, SNRIs and other AD meds which for all intents and purposes create a dependence.

The whole "It's addictive, and therefore bad" is stupidly simplistic and shows the disturbing level to which doctors wear their blinkers and are hardwired into thinking about substance classes in a black and white way and telling you about their view and theories like it's scripture - without them ever having even a jot of first hand experience with any of it.

...this is obviously a topic which stirs up a lot of emotion for me. Being shuffled around between centres and meds and not having my first hand accounts listened to or acknowledged has left me very frustrated and angry.

The narrow minded, simplistic attitude "take this, i'm a doctor, you are not" must become incredibly frustrating very quickly.There must be doctors out there who are understanding and even have first hand experience themselves. If I were in your shoes i'd be fuming as well - I've just had a glimpse into such such a world and I don't like at all what I see.

 

[lovepsychadelics]

Hahaha yes doctors do have a fair degree of god syndrome going on. Most don't know the full details of what they are prescribing. The most amusing thing is they worry about benzo's because they are addictive. Thing is any drug can be addictive, hell food can be addictive. Most of the SSRI's end up addicting people. Indeed the time period required (2 weeks) to produce desired effects often is enough to addict an individual. Effexor is one of the WORST drugs on the face of the planet yet it's regularly prescribed often to people with 0 depression who suffer a borderline personality disorder. Indeed some psychiatrists resist the BPD diagnosis because it's almost untreatable and it's much more socially acceptable and profitable to diagnose depression.

I'd probably get one to prescribe avanza (mirtazapine) and ONLY take it when your feeling anxious or having trouble sleeping and then only 1/4 of a tablet MAX. In my experience it's one of the better medications out there. It does increase appetite and make you drowsy. However if taking 7.5 mg's or even 3.75 mg's it works for anxiety and/or anxiety related sleep issues, at least for me at any rate.

 

[spacejunk]

^ top post, lovepsy - and from what I know of mirtazapine, pretty sound advice too.

 

[Halif]

Effexor is one of the WORST drugs on the face of the planet

QFT.

About two years back (I think) I got a prescription for an anti-depressant that my doctor seemed pretty horny about. I mean he was pushing it pretty hard like he sure it was going to work. What I found odd was that he kept using the brand name, but when asked couldn't actually tell me the active chemical. He wasn't hiding it from me, he just didn't know and didn't seem to have it anywhere. Strange for something that he was sure would help my depression, when four different AD meds had only partially worked for me in the last fifteen years.

I took the script but didn't fill it. I went home and found out it was desvenlafaxine (brand name 'Pristiq'). I knew immediately that remove the 'DESmethyl' and what you have left is venlafaxine, AKA EFFEXOR. That disturbed me more than a bit. Effexor has a shocking reputation, and seems to work for only a very very small number of people.

Anyway I searched to find out how different Prixtiq and Effexor were. It was nigh on impossible to find information on it which didn't trace back to studies funded by a division of Pfizer. So I looked for anecdotal accounts and had a hard time finding anything good about it. Not many people make it past two weeks, citing all manner of side effects.

Long story short, I decided to try it anyway. I have tried a bunch of anti-depressants and have always responded best to run of the mill SSRIs. I hadn't tried a SNRI before. While they were claims from the makers that desvenlafaxine was a more streamlined, effective, and less disruptive version of Effexor, the anecdotal eveidence suggested that they two are extremely similar. The Pristiq 50mg tablets I had were a time-release version so the risk of getting hideous WDs from skipping even one dose where minimised. I gave it a month which was very hard because it made me feel strange and unstable, but if I'm going to disrupt my brain function I want to give it a real go and be sure that it really does/doesn't work.

After a month I went back to the doc and told him it was no good at all for me. In fact, it was the single worst AD med I've tried. He said I could go back to the old one at a higher dose which I agreed with, but when I asked about how to taper from the Pristiq he said there was no need. I found that odd, and I didn't like the idea of stacking a double dose of my old SSRI on top of an SNRI which I'd been taking up to the prior day. I mentioned some concern, and he then gave me some of the worst possible advice imaginable:

He told me to break the tablets in half, and then into quarters for a three or four day rapid taper. I said nothing because I didn't see the point much in arguing (by which I mean pointing out the obvious fact that you're not supposed to do that - it's actually dangerous).

Point of this is: It says in HUGE bold lettera on the info sheet inside the box (and on the box itself) that you MUST NOT BREAK THE TABLETS because doing so destroys the time release mechanism and instead you got a big old dose of SNRI coming in to your body, setting you up for the legendary Effexor and Friends (like Pristiq) crash and burn complete with suicidal tendencies increasing dramatically, brain zaps, fever and all the other good shit.

So sadly, unless you have a good GP and are able to fully trust them, you really must take responsibility for everything you take. What drives doctors to prescribe a certain drug is, I have to assume, sponsorship of some sort from big pharma. I think it's fairly well documented that big pharmaceutical companies hold information seminars in top notch resorts where GPs are invited to attend this 'seminar' and then enjoy the next few days doing whatever they want - all expenses paid.

No wonder they get excited about certain meds ... which they don't know the name or function of.

 

[berocca]

Agree so much with the last paragraph, opi8. There's a serious empathy deficit in the medical system. Doctors tell you how you do or don't feel, and what you do or don't need - often without hearing you out or asking any questions.
...
If doctors knew even half of how bad it feels to have medications chopped and changed, or outright denied because of 'irresponsible' behaviour, I don't think they'd be as lackadaisical. And if they do know the extent of the suffering, and continue to practice that way, then they're heartless sadists.

There is no (working) feedback mechanism in psych. medicine. How do they find out when they're wrong? As far as I can tell, no-one goes looking to find out why patient such and such stopped showing up anymore (which I assume will continue to be the case until enough patients stop showing up to keep the money engine turning over, unlikely in the current supply/demand situation).

Because the patients aren't "experts" their testimony is questionable, even if they're the ones undergoing the experience. The lack of empathy further distorts both realities.

Like you say, it's almost courtroom-like: "Overruled! I declare the patient feels like this" as if their anecdotal evidence trumps your empirical/experiential evidence.

It also applies on the counselling side where you can see keywords lighting up the eyes of the practitioner grossly disproportionate to how you actually feel and you waste a lot of expensive minutes trying to clarify the situation...

Amplify this with administrative errors, which are then further amplified by adding computers to the mix...

As for the original poster - yes, get another doctor. Your one may be trying to assuage guilt through prescription to justify a paid-for cruise. But also beware those trying to diagnose via internet forum, like me. Broken system is broken, and they like to keep it that way.