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Mental Health drug prescribing

markosheehan

Bluelighter
Joined
Sep 17, 2016
Messages
238
hi

recently I had a meeting with my psychiatrist. I explained all the psychological problems I am going through anxiety,OCD etc. I specifically said I dont think ssris work and they would not work for my anxiety. I also suggested I think a anticonvulsant drug would work best(e.g pregabalin) i think. he seem to ignore me when I said this. he prescribed prozac and he would like to see me in a month. should I bother with the doc anymore? if i go back to him and say the prozac did not work whats the most likely next thing he will prescribe could anyone guess. I just dont want to waste my time and money so if hes not going to prescribe something useful i might as well not go to him.

I would love to hear peoples thoughts and what psychiatrists usually do in this situation ?

thanks
 
Why are you against SSRIs? Prozac is a great drug for anxiety & OCD. I took it for years for OCD myself (though I recommend you do CBT while medicated so you might not need to permanently be on meds). Why do you specifically want pregalabin? It's not typically used to treat anxiety or OCD.

It is standard to try SSRIs first for anxiety & OCD. Dr knows his shit. Drs also generally don't let patients tell them what to prescribe.
 
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I have talked to many people who say they are not very effective. Benzos and pregabalin seem to be more effective for anxiety subjectively for people. I do not think targeting serotonin is a good way for reducing anxiety. In fact some studies have linked increased serotonin levels with increased anxiety.

Pregabalin reduces glutamate levels which is much more effective at reducing anxiety.
I will still try prozac though. If I go back to him in a couple months and say it did not work is it likely he will change me to something else ?

I am going to try CBT but he said its back logged and I wont be able to start for a while.
 
Yes, if the Prozac doesn't help he'll try you on something else. I really don't agree with your assessments though, & I've looked at a LOT of psychiatric research, done research in the field, & taken most meds available for anxiety & depression myself. Keep an open mind & give it a try. IMO Prozac is the best med you could have been started on - generally superior for your Dxes over other similar meds.

It's never a good idea to go straight to meds that are known to cause dependence & are often abused, & withdrawal from benzos can be FATAL due to their lowering of the seizure threshold. SSRIs actually work by reducing serotonin, as they down regulate 5HT receptors. That's why they take 4-8wks to kick in. If you do CBT while on them, you can be permanently cured eventually. GABAergics are more like band aids - temporary fixes that don't treat the underlying cause. I have tried all the common benzos & pregabalin & I didn't find any of them remotely useful for my OCD. Lorazepam helps with very rare panic attacks or hyper stressful situations - I've taken it 10x in 13yrs - but I think that is an appropriate use of benzos. Daily is not such a good idea - though for some benzos ARE necessary, even daily. But it almost always makes sense to try other things first.

You can do CBT on your own. I did, with great success. Can you elaborate on your anxiety & OCD- what causes it, how it presents? Obsessions & compulsions?

Btw, asking for the meds you did may have negatively affected your relationship with your dr. It comes across as drug seeking, like you just want to get sedated.
 
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Very good points. Also taking benzos daily produces dependence and benzo withdrawal can take a very long time, sometimes a year or longer when properly tapered after being used for long enough. Takes a long time to return to normal and all that time you wiull have higher anxiety than you had before, and if you can't take it daily you run the risk of seizures. It's a very good idea to try safer drugs first. Also, usually they begin to stop working nearly as well while you're still on them. Which is why a lot of people end up on high dosages and it doesn't even work well and they want to get off and it's hell.
 
Fairnymph and shadowmiester both make very very good points. Listen to them.
I had a horrible case of ocd with panick disorder, and prozac completely fixed it. i mean completely. I washed my hands til they bled, i couldnt eat anything that wasnt sealed air tight from the factory or else id have a total freak out, i'd have panic attacks 8-15 times a day where id have to hit the ground wherever i was and curl into a ball with my heart racing, tunnel vision, ringing in my ears, thinking i was going to die each and every time. but with prozac it resolved in months, but i needed to take it for about 2 years before i had no trouble getting off it. but it resolved the problem completely and gave me my life back.

if you really suffer from these disorders, then the cost they tender on your life is huge. you would want a real solution. benzos have tons of negative issues in the long term, like shadowmiester said, and your gonna be hard pressed to find a doc who will give you an ongoing script of them, and thats also because youd be masking your issues instead of solving them, like fairnymph pointed out. benzos are good to stop a freakout, but they are not a good prophylactic treatment. you need to work on your issue with therapy and prozac will help, likely in a complete and priceless manner. give it a try. and if your one of those that gets sexual side effects, they have meds to fix that too. i understand your desire for pregabalin, shit, i want a script too, but thats not gonna fix the issues you speak of. if your dedicated to getting better, than you might want to give prozac a try
 
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and to answer your question, he'll most likely prescribe another ssri next, so its not going to help if you just show up and say it didnt work. also, its going to take a good 2 months to find out if it works.

If you have these issues, but thier not acute and not seriously effecting your life, and essentially you just want the drugs you want, then thats a totally different situation and a different conversation in a different thread.
 
I used to think anti deppressants where bullshit. Then I got on wellbutrin and it completely cured my anxiety. Finding the right meds can be stressful but it's so worth it in the long run
 
and to answer your question, he'll most likely prescribe another ssri next, so its not going to help if you just show up and say it didnt work. also, its going to take a good 2 months to find out if it works.

If you have these issues, but thier not acute and not seriously effecting your life, and essentially you just want the drugs you want, then thats a totally different situation and a different conversation in a different thread.

Ehh, I really think it depends on how he responds to Prozac & the individual dr. Some will skip over other SSRIs/SSNRIs, especially after a very bad reaction, to more atypical meds. But yes, some drs will have you try multiple SSRIs no matter what. I get the feeling this dr isn't one such, but that's pure speculation.
 
Wellbutrin has done amazing things for my anxiety. Give the doctor a chance to do his job. If your not happy after 4-6 months fire him and find a different one
 
The cytochrome P450 genetic test (determines how your body metabolizes a drug) can be a useful aid to a doctor in determining how you will respond to a particular antidepressant. Several people in my intensive outpatient program who have failed at multiple antidepressants have had this done and it can take a lot of the trial and error out of the picture.

But honestly, you telling your doctor you "need" Lyrica (or a benzo) and nothing else will do, sounds like drug seeking behavior to me. You very well may have shot yourself in the foot for ever getting a script for a scheduled medication with this doctor.
 
Everyone made a good point. While I can understand where you are coming from with the SSRI's, it doesn't sound like you've been on one, so you can't know if any of them will work for you. It's common practice to try them first, as they are much more researched for these disorders than the anti-convulsants. Another thing you'd have to worry about with things like benzo's and pregabalin is the risk of seizure after stopping them or running out. That was one thing that was concerned me a bit when I was taking gabapentin, along with benzo's, and I was also abusing alcohol at times--the risk of seizure if I didn't take it or when I stopped. Since I took the gabapentin three times a day (a pain, but I think you can take pregabalin less), I would run out quickly, then be concerned if I couldn't fill it right away. In the end, I got off the gabapentin because it did not help my anxiety at all, and I quit the drinking, which helped my anxiety A TON... I am still on the benzo's, but a low dose, and I do have a legitimate anxiety disorder(s). I have also tried many SSRI's, SNRI, and an MAOI. I am currently trying a new AD.

Express your concerns with your doc, he/she is supposed to help you, but trust that they have more knowledge on this subject than you.
 
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