[invisibleboy]

So today I met with my pdoc to see if the new med (imipramine) was helping. I posted earlier about how terrible this med was making me feel. The insomnia and intense anxiety is really wearing me down. Since it was a very low dose, my pdoc didn’t believe me. She thought the depression was just getting worse. I had already told her I don’t feel depressed. This is not the first time she has insisted I’m depressed when I’m not.

She kept pushing and pushing to convince me to stay on the imipramine, that my symptoms were depression and we should increase the med. She tried to talk me into one more week and I finally broke down and said I couldn’t take this for another week. She ended up letting me discontinue the imipramine and instead she raised my seroquel, but I feel bad because I could tell she was frustrated.

I am generally compliant when it comes to doctors but more and more I’m finding doctors discounting how I feel and basing treatment on their own (wrong) perceptions. I respect her education and experience but wish doctors would respect my experience in return.

I just hope I sleep tonight.

[Rajjing]

Just thought I would show the other side of the picture, having worked in a pdoc setting. They see one set of things that sometimes don't get brought up or are ignored. Specifically, whether this applies or not I don't know, reacting to internal stimuli. Many folks will deny hearing voices or seeing things despite obviously reacting to them. Want to say it stinks that you feel not heard and I wish the best for you but the pdoc may not be doing it to be mean, just interpreting what they see with what they hear too.

[invisibleboy]

Thanks, but I understand her interpretation, and she was basing it on the assumption I was depressed. Yeah, some patients will deny being depressed but they are constantly telling me I have good insight. I am not depressed but I am exhausted and totally worn down from these side effects.

I just feel like it’s not a two way street. I know she has the degree but I have the body.

[Rajjing]

Originally Posted by invisibleboy

Thanks, but I understand her interpretation, and she was basing it on the assumption I was depressed. Yeah, some patients will deny being depressed but they are constantly telling me I have good insight. I am not depressed but I am exhausted and totally worn down from these side effects.

I just feel like it’s not a two way street. I know she has the degree but I have the body.

Definitely and don't forget that. There are ways of both listening and observing without invalidating how you feel

[wiretwister]

we fight like cats and dogs ... but I know he only wants the best for me .. and I do trust him ... I just do not always agree with him .. when I am "well" he listens to me mostly and gives into my requests where he can ... when I am "not well" he can be pretty stern ...
I find myself calling him for help between our scheduled sessions and for that I will not give him up .. his "bedside" manner sucks . but I feel I am very lucky to have him ... I hope things work out for you ... a good pdoc can be hard to find ... I have had this one since the hospital ... he has seen me at my worst and doing better ... it's a hard pill to swallow but sometimes he is right ... best wishes ... Tigger ..

[~Christina]

I guess I have been very lucky when it comes to Pdocs . Any medications we agree to together

[Aurelius710]

I don't think I've ever had to fight any of my docs overly so on medications, but I've also bluntly told them I will walk away from you as practitioners and not look back if you try to push me into a treatment/to take a medication that I am 100% against.

That said, it's not all blustery defiance. When an issue like that (side effects, new symptoms) arises, I can speak their language. I've dealt with enough medical issues (both physical and psychological) that I can do a differential diagnosis in my sleep.

I get an odd symptom and I'm thinking to myself: What is it? When am I getting it? Does it occur when I take my medicine? Immediately? How long after? Does it occur after I eat? Etc. etc. I then try to present the docs with the most likely possibilities that I see.

They generally work with me after that and if I agree to "one more week" I make it clear that I will unilaterally stop the medication if the side effects become intolerable. It's my happy medium we're trying to find, when it boils down to it. Luckily, I've only had to do that once, when seroquel gave me heart palpitations that woke me up from a dead sleep at 2am. I'm not risking that for "one more week".

I'm wondering if incorporating a kind of differential into your future interactions might help? It would allow you to put your experiences into a framework that your doctor could work with and would allow you put your doctor's suggestions within that same framework. Gives you both a chance to make your case.

[Guiness187055]

Yes we make all decisions together. I guess I am lucky

[WildcatVet]

My old pdoc was an absolute gem...couldn't have been any better. I'll let you know about the new one if I ever get to see him...he just rescheduled my first appt for the third time...

[UpDownAround]

Pdoc, t, and GP - I am straight up with them and they are with me. They will hear me out and if they don't agree I will hear why and what the want to do and why that is. I would not have it any other way. If they won't play my rules, I will switch to someone who will.

[CaminoDeOro]

OP, if that were my pdoc they would be on a very short path to getting fired and me finding another one. If they do not at least listen to you and explain why they see things differently and allow you to respond ...... it is not good.

I'm very lucky to have a near-ideal pdoc now who collaborates with me and does not push things I don't want other than to explain her opinion on it. We're working together on a very long, slow, and arduous evaluation of one med after another because after 20 years of flailing around, it is time to stop and really try to be systematic about it.

I've seen god-awful pdocs do similar things, I knew a girl once who was on paxil and started getting side effects consistent with the very beginning appearance of serotonin syndrome. She complained. They raised her dose. Within a couple days she was constantly agitated. A couple days after that she smoked some weed to try to calm down and had a psychotic break.

Pdocs are like any other profession. Half of them are gonna be less competent than the other half, and a few of them are going to be absolutely terrible.

I've had to dump a couple crappy pdocs who wouldn't listen to me. There was one who was convinced I was full of crap because most of my meds are at such low doses, and I still have side effects or rough withdrawal when changing. Well, guess what. I asked my current excellent pdoc to give me the genetic test for metabolic function, and just as I've known for years, I'm a CYP2D6 poor metabolizer. The result of that? Many medications will affect me at much lower doses, and have greater incidences of side effects.

Imipramine is metabolized in part by CYP2D6, BTW.... you might want to check that out.