Doctors Lounge - Psychiatry Answers
"The information provided on www.doctorslounge.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician."
Forum Name: Psychiatric Topics
|ModestGoddess - Sun May 13, 2007 7:44 pm||
I'm a 23 y/o female with history of childhood sexual abuse from a family member, 5 yr domestic violence relationship, and 1 adult rape. I've been in and out of some kind of counseling or medication treatment since I was 15. I've been diagnosed with a lot of different things: posttraumatic stress disorder, depression, generalized anxiety, bipolar disorder (by only one psyciatrist that I later found out had a poor reputation), and even borderline personality disorder (as a teenager, which I disagree that its appropriate to diagnose a 16 y/o with a personality disorder). I think bipolar and borderline are pretty off-kilter, and I don't even feel that depression really describes how I feel. For the most part, I feel content and optimistic, I enjoy activities, my energy level is good, I feel hopeful about the future, etc. I think PTSD probably most closely describes it now. I'm in the process of switching therapists (my last one was counterproductive to me), I go to a weekly sexual assault support group, and I'm prescribed Cymbalta and Klonopin.
I have a few questions about my medicationsl:
1.) First off, I have some difficulty trusting the psychiatry profession. It seems that every new person I see has their own opinion about what medications I should be on (but they all seem to think I should be on SOMETHING), and they are differ from one another. I've been prescribed a variety of different things since HS, predominantly the SSRI class but also other things. I hated taking things back then because I felt forced, but about a year ago, I decided I might benefit from a medication and so was open-minded. I've taken a few different things this time around, but I don't notice any real changes. In fact, sometimes I find that I feel worse on medications or feel basically the same. I know medication is not supposed to be a cure-all-- that's why I am involved in therapy, I go to a group, I exercise, I journal my feelings constantly, do a lot of different things to help manage it etc etc. However, some professionals I've seen seem to think that I should be feeling 100% better with the "right" medication, but I tend to disagree-- I think of course I'm going to be feeling somewhat bad, anxious, depressed, whatever because I'm dealing with difficult issues. I'm sick of switching meds all the time-- Part of me feels like I should just stick with the cymbalta because it seems "good enough," and part of me feels I should discontinue (i've only been on a lil over a month anyway) because it doesn't really seem that different than anything else I've done, including no medication. What should I do? I know you may say to talk to the Dr prescribing it for advice, but as I said before, I'm cynical about psychiatry in general-- it just doesn't seem like there's one right answer, and I don't necessarily trust their opinion just because they have the power to prescribe meds.
2.) Secondly, I had been taking Benadryl or Tylenol PM for sleep almost every night for the past 3 years. The sleep problems are completely related to anxiety/PTSD, and my Dr just started prescribing me Klonopin a week ago, which I've been taking just at night. It works really well, no groggy feelings the next morning like with the OTC (or other prescription sleep meds I've been prescribed here and there). In fact, it also has lingering affects the next day, which helps me to feel less anxious durign the day too. The problem is, I am terrified about becoming addicted to them. I think this fear is because I work as a social worker with clients with substance abuse issues, and a lot of them have abused benzos, so there is all this anti-benzo rhetoric at my agency and a zero tolerance benzo policy for clients. I have no history of substance abuse, but I'm still afraid of it. The Dr wrote teh prescription for 2 pills a day (so my insurance would pay for 60 rather than 30) and told me to take one at night, two if needed. However, I wanted to avoid taking it unless I really "needed" it...but the problem is, I've been taking it every day since I got it for anxiety/sleep (and have gotten positive benefits from it). The Dr doesn't seem to think there's any problem with taking them all the time, but again, I don't necessarily trust Dr's opinions and think a lot of things are irresponsibly prescribed. Should I continue taking it the way I'm doing it now (one a day at night), take it only when I absolutely have to (and alternate it with something else for sleep....my work schedule is odd and requires me to go to bed wicked early, much earlier than my biological clock wants to, so I'm afraid I "need" sleep meds for the time being), or try to stop taking it altogether?
|Dr. K. Eisele - Mon May 14, 2007 11:08 pm||
You've only been on the Cymbalta for about a month. As long as it isn't causing adverse effects, I'd have you continue it because you could still get some benefit from it within the next 2 - 4 weeks. It takes awhile to work.
Benzodiazepines! What a sticky wicket that one is. My personal philosophy is benzos are good medicines that serve a very useful purpose. Most of the time, the folks who end up abusing benzos are the ones who lie about the reason they need it. For example, Suzie Q. comes in complaining about anxiety, but what she really wants is a benzo because it gives her a buzz (and she doesn't really have anxiety). The patients who do well with benzos are those who truly do have anxiety or other real reasons why a benzo makes sense, have no history of drug addiction, and who are afraid, like you, that they will become addicted.
I have some patients who I would never prescribe benzos to, and others who have been taking them for years with no problems. I also have a really firm rule--if you lose the benzos or the prescription, don't call me. I think if your doctor has this kind of rule, probably he or she is prescribing them responsibly.
Klonopin is less addictive than some of the other benzos, like Ativan and Xanax, because it isn't as potent and it is longer-acting. The drug-seekers tend to know this also, so a red flag is someone requesting either Ativan or Xanax specifically.
I tell my patients with true anxiety disorders to take the benzo as prescribed, because the studies show that it is more effective that way, and less likely for patients to become addicted and/or develop a maladaptive way of handling anxiety. If you have a real anxiety problem and take the benzo scheduled (not when you feel like it), then you are treating the anxiety, versus popping a pill just because you're stressed, having a bad day, etc.
Hope this helps!
|| Check a doctor's response to similar questions|
Are you a Doctor, Pharmacist, PA or a Nurse?
Join the Doctors Lounge online medical community
Editorial activities: Publish, peer review, edit online articles.
Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members.