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Dr.G- Need advice
unperfectlyhappy posted:
I was wondering if it is normal for your pdoc to ask you what you need in regards to medication? I seen him again today and he just asked what I needed and gave it to me without giving it a second thought. I have been seeing him for 6 years and have had over 30 med changes but nothing seems to work and now he just asks me what meds I want. He doesn't really talk to me about how I'm feeling or anything like that, it just seems more like hes just trying to pass the time until he can see the next patient. He ignores my symptoms when I on a manic high and when im depressed. He only had me on Effexor until today. I requested that I be put on Topamax and Diazepam for my anxiety. He gave me both of those on top of the Effexor and sent me home. I'm so frustrated but I really dont think i can handle the stress of finding another pdoc right now. I feel as if I have failed myself because I can't even get my pdoc to care enough to help me. Any suggestions?
Joseph F Goldberg, MD responded:
Dear Unperfectlyhappy,

The usual standard of care would be for a doctor to review relevant symptoms (eg, sleep, energy, appetite, concentration,, mood, anxiety, etc.), side effects, and life issues/stresses and then if it seemd like a change in medicines was appropriate, to present the options that are scientifically appropriate, review their risks and benefits, indicate which options may be best in the doctor's opinion, and then decide together on what the best course of action would be. Doctors would not usually rely on a patient to tell them what medicines they should take any more than surgeons wouldn't ask their patients where they should be cutting, or car mechanics shouldn't ask their customers how to fix their engines.

Topamax unfortunately had 5 negative published placebo-controlled studies for the treatment of mania and a number of case reports showing that it can cause or worsen depression so, although it once held promise as a possible remedy for symptoms of bipolar disorder (based on its mechanism of action), it's no longer considered a treatment for mood disorders (although it can be very helpful for weight loss, binge eating, migraines, and alcoholism). It also unfortunately can cause significant problems with memory and attention for about a third or more of people who take it.

There are some videos under the "Resources" section of this website that discuss treatments for bipolar depression which have research evidence behind them.

I believe that the doctor-patient relationship is a collaboration and both parties need to feel a sense of trust in the other in order to be able to work together. The doctor, for his or her part, should be bringing their expertise to the table. If those ingredients aren't there, the concerns should be discussed openly; if open discusssion doesn't improve the situation, then it is certainly reasonable to look elsewhere.

Good luck -

- Dr. G.
doxielover10 responded:
[TRIGGER] Hey girl, calm down. I have no idea what the percentage is, but I believe that most (is a pdoc a Psychiatrist ?) are only doing medication. They suggest you work with a therapist on your problems.

When I died from renal failure because of that poison lithium, which also killed my thyroid. My Psychiatrist and my Internist worked together to get me through.

My therapist helps me with moods etc. Of course if I believe I'm having a drug problem I can call Dr. K anytime, we've been together 19 years. Because I have a medical background he trusts me and gives me much latitude. Somewhere on this board tells what happened to me.

Why don't you ask your pdoc ? It's a perfectly good question.

ddnos replied to doxielover10's response:
Doxielover, this has nothing to do with the thread, but when you said, "....because of that poison, lithium" I just wanted to say that obviously, lithium was " poison" to you, but know that it's been a life saver for many. I have been taking it for 20 years successfully, and so have many others. Just because lithium was bad for you doesn't mean it's "poison" and doesn't mean its bad for everyone. I'm pointing this out not because you don't realize that (assuming you do) but because there may be some who read that and are turned away from a medication that could do wonders for them.

Forgiveness is letting go of the hope that the past could have been any different --Unknown

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