Cat Whisperer, I think seratonin syndrome is a very valid concern, but I’m 99% certain the doc is aware of it; it’s fairly common and something that even non-psychiatrists must constantly be on the lookout for. I’m confident a psychiatrist knows what it is and knows what he’s doing when prescribing it.
Here’s the thing–not every set of symptoms results in a clear diagnosis. Doctors don’t like to admit this, partially because the system is based around diagnoses and partially because patients don’t want to hear “I don’t know what’s wrong with you, and more tests and referrals aren’t going to give a clearer answer”. But we’d be better off if more doctors would admit that, and indeed I teach my residents to say exactly that.
A lot of people have this attitude that “my doctor could figure out what’s wrong if he would just LISTEN TO ME”, as if life were the last ten minutes of a House episode. But most of the time he’s listening just fine; there just isn’t a neat diagnosis or treatment that goes with your set of symptoms. Unfortunately we have a fairly limited set of tools at our disposal.
Accordingly, speculative treatments need to be presented as such. “I don’t know what is going on with you, and more tests aren’t going to tell me. But your symptoms are clearly bothering you, and I want to give you some options. We have classes of medications that treat broad ranges of conditions. I’m not saying you have one of those conditions, but some of your symptoms are similar and the meds may help. They may not help, and the side effects may be intolerable. But you may be better off on them, so if you’d like to give it a try, we can.”
Medicine is not an exact science all of the time. Sometimes it’s still an art. Both doctors and patients need to learn to acknowledge the difference.
From my linked article -
I would truly love to believe that all doctors prescribing SRRIs have it in mind when someone like monstro shows up with four medications already, but I don’t have confidence in that any longer. I think Doctor J is describing it very well; I don’t think there’s any bad intentions on the part of the doctors, but you don’t always get the results you hope for.
monstro, I had a thought this morning - you can talk to your pharmacist about prescriptions and drug interactions. They seem to be an overlooked resource, but they’re the experts on drugs.
Wow, well, I retract what I said then. I feel like we’ve already talked about it 1000x (only in second year of med school) so I assumed it was very well known.
Always good for patients to be vigilant, though.
I’ve decided to take the Luvox (I know. Will I make up my mind already?!) The thoughts are gearing up for some reason and my hands are all dystonic, reminding me why I went to see this guy in the first place. So if Luvox is the magical fix, then I’m going to let it do its mojo on me. And if it’s not, I can stop taking it (hopefully without a bunch of hassle).
The doc prescribed a low dose of it anyway (25 mg). Combined with the low dose of Anafranil, I don’t think it will kill me.
I just need to have trust that that this guy knows what he’s doing. Maye that’s why it’s taking so long to fix me. I just don’t trust people enough.
Who knows if this is the case for this guy, and it is no excuse for his absolute crappy communication skills, but some psychiatrists are sort of like some expert surgeons who do well despite being poor communicators and, well, assholes … but instead of having skill with their hands that get people coming even though they hate them they have their ability to be medication gurus and concoct the potion that works.
monstro, through the years I have admired your posts - I am very sorry to hear that you are having such a hard time right now. I have no advice or knowledge to offer (I’m a pediatrician, not a shrink, I hear your symptoms and think Tourettes, which is of no help whatsoever, just another label of no utility); only best wishes for a speedy response to an effective treatment plan.
Btw, the problem with the rope skipping is that it is a bit more difficult to keep up for any extended period of time - it really is an high intensity interval training kind of exercise - the mini-trampoline is more of something you can keep up for as long as you need to emotionally. And bouncing on a trampoline is kind of like Steve Martin’s old joke about playing a banjo: you can’t play a sad song on a banjo, and its hard to not crack a smile bouncing a trampoline. Oh okay fine, you can play the Blues on a banjo … but a bouncing on trampoline is still fun. 
Thanks, DSeid. Your compliment actually means a lot because I’ve always thought you had a low opinion of me. Don’t know why. I just did.
I thought Tourette’s too, but my symptoms didn’t appear until I was 21. I’ve searched the medical literature about adult-onset TD and have found studies about people who had tics as children that grew worse with adulthood, but nothing about it just springing out nowhere.
It’s also just been within the past two years that I’ve had vocalizations (mostly a kind of echocalia…repeating my thoughts out loud).
The main problem with it is that I’m just too much of a klutz! I’d be falling all over the place. I’m evidence that not all black girls can jump rope. Or do those complicated hand-clapping games. Or do the stereotypical neck-swirl that generally accompanies the exclamatory “Oh, no he DI’INT!!!”
But I can swim. A little.
Again it is of no utility whatsoever, but childhood tics are often not labeled as such - sometimes just eyeblinking that occurs for weeks at a time, blamed on allergies or thinking that maybe the kid needs an eye exam - or vocal tics that are restricted to what sounds like just habit throat clearing, that mainly show up when the kid is tired. So they could have been missed. But so what? Even if the label was accurate it does not change the treatment plan at all or advance understanding much. The bottom line is still finding the right combination of medication and other interventions that provide adequate relief and for now that has meant some trial and unfortunately some error.
I am sorry that somehow I gave off the impression that I thought poorly of you. Really.
And on preview I see that this is three posts with smilies in a row. Bleh. But it stays anyway!
It’s not every day in the Pit that we get three smilies in a row. We should get a prize or something.
And I hope I didn’t make you feel bad, either. Sometimes I guess I read more into people’s posts than what’s warranted.
I have a question, trying to understand this “dissociation” concept.
Sometimes I’m in a situation which other people would find stressful but, because I know how to solve it, I don’t find it stressful at all. That’s fine. That is serenity.
Other times I’m in a situation where if I could I’d be screaming and running in circles, but I don’t do it because there’s people who need Someone Strong and I got that lottery ticket. So instead of screaming and crying and running and saying “why me?”, I pat backs, keep the house clean, wipe noses, feed everybody… And then people will congratulate me on my serenity and I’ll think “if you only knew”.
Would “dissociation” be when you do the second thing so often and so deeply that you don’t notice you’re doing it any more?
Pretty much. More importantly, it’s doing the second thing without conscious choice.
*Knowing *that you have an emotion or negative thought and *choosing *not to feel/think it right now is called “suppression” or “thought suppression”. It can be very useful when dealing with stress, especially stress like the behavior of your coworkers. It’s when you chose to push those negative thoughts or emotions down so you can deal with them at a more appropriate, comfortable or safe (physically or emotionally) time. It’s healthy defense mechanism.
When it happens to you *without *you choosing to do it, generally without you being aware of it, it’s dissociation, and it’s considered not a healthy thing, especially if it’s the primary way you deal with stress. You can get away with it occasionally, especially in acute trauma situations, but long term it tends to lead to dysfunction in life and relationships.
I don’t think it’s actually a good idea to trust a doctor who has not earned your trust. It’s one of those things that doctors like to make you feel guilty about.
One doctor I had would love to tell me that you must learn to trust some people. Thing is, if he had actually paid any attention, he would know that, up until him, I had trusted every doctor I’d ever had–because they gave me a reason to do so. He was the first doctor I’d had who pulled the stupid 10 minutes thing and refusing to talk about the issues so I could know he understood them. And he’s the one who put me on a benzo for longer than he was supposed to.
I know doctors want to be able to treat as many patients as possible, but that’s not so effective when you can’t have time to treat them. Treating every patient like they need the same amount of time is foolish.
My suggestion is to actually tell the doctor about these things. If he can explain why it’s safe to take three serotonergic drugs to your satisfaction, then try it and see if he can gain your trust. But don’t just hand out your trust: I learned the hard way that that’s how you wind up worse.
Thank you, one of the reasons I love this place is because it increases my vocabulary.