dr's and meds

I am finding out just how little my General practitioner knows about psych meds - and really, it is quite frightening. I found a bunch of research saying that the 2 meds i am taking can potentially be a MAJOR drug reaction and result in seritonin coma in some people.

I'd really like to see how many people this is true for - where either your main dr, p-doc, or psych nurse didn't know what you needed them to know for YOUR safety.

I find it very alarming. Actually my GP also found it alarming and was appalled how little info her sources gave her and was going to get more info.

Anyone?

Pretty much any GP i've seen over the past few years has said they will prescribe, but only as long as i'm reguarly seeing a psychiatrist and if they've sent a letter to the gp about what I'm on and dose. If I want anymore info about the meds they say they can't really give me any and tell me to speak to my psychiatrist about it. I normally just do my own research seeing as I'm in a medical profession and have the means to do it.

i'm on an antidepressant that is rarely prescribed. i need GPs who are knowledgeable about it, or who are willing to find out about it, because the interactions from almost every drug under the sun are potentially lethal .

i expect my pdoc to be knowledgeable about what he is prescribing me, but i dont hold my GPs to the same standard (in terms of crazy meds). like anna, i do my own research and think it's my responsibility to be more educated than my GPs - i deal with my drug on a daily basis, whereas none of my GPs (i go to 3 depending on who is more convenient at the time) have ever had another patient on the same drug as i am.

i would never trust a GP to make decisions regarding my crazy meds, simply because they do not have the 7+ years of training that pdocs do in that area. that said, even pdoc had to do a major refresher when we considered using the drug that i'm on.

i dont think ignorance is a problem in itself (afterall - just think of how many meds there are out there!) but willingness to be more educated should you come across a combination you are not familiar with is vital.

now whenever i go on a new med (e.g., something as simple as cold/flu) i get my GP to check, my pharmacist to check, and i run a check myself. that said, i wasn't so vigilant before i started using this particular antidepressant, and most interactions when they are listed as possibilities are more towards the "rare" than "probable" end of the scale. unfortunately the drug i'm on is more like a "guaranteed trip to ER" .

wow - reading both your comments is really fascinating! thanks for sharing those. omg deli, "guarenteed trip to the ER" @_@ that is where i was at with the Tylenol severe cold pills i was about to take - and doing my own research was how i found out that not only was that a MAJOR reaction with the AD and a moderate with the Anxiety, but a MAJOR between the AD and anxiety too! That's the info i sent my GP and she was apalled.
Now i am in a position where the GP wants me to see the PNP and the PNP thinks i have too many practitioners and will only do a consultation with me. I am very confused and irritated about the whole thing because these can be so dangerous and i have a very sensitive body that doesn't like foreign substances in it.
*shakes head*
Wish me luck - anpt is wed.

Thanks to all who are taking the poll - i think this is a very important matter to know about and to get the word out for people to be aware of what they are taking and not assuming that the GP knows what is happening.

Kiya, I didn't vote because none of the choices fit for me. Also, lumping GPs in with Drs would mean GPs and pdocs would be together, and I would expect them to have very different knowledge and expertise in this area. Pdocs will know more.

I was not on any meds (for depression I had at the time) partly because my former T told me she would terminate me if I took meds. But after I quit with her and my anxiety got really high, I broached the topic with my GP. I had researched what drug I wanted for anxiety, if she thought it was appropriate (buspar). She had heard of it but never prescribed it before. She wanted to put me on an anti-depressant for anxiety, even though I wasn't depressed anymore. She said some ADs are good for anxiety. That is true, but I didn't want to take an AD. So she prescribed buspar after first looking up a standard dose to try, using a handheld PDA that she took out of her pocket. Buspar didn't help with my anxiety so later she gave me xanax (but first trying to get me to take an AD for anxiety again). I really had the impression that she just liked to prescribe ADs for anxiety rather than anti-anxiety drugs. Much much later I went to a PNP for ADHD symptoms. She has been great! She is very knowledgable about psychotropic meds. She has the training for this, whereas my GP did not. I do not find anything wrong with that. I don't expect my GP to be an expert as that is not her area.

Kiya, are your PNP and a GP both prescribing psych meds for you? If so, it might be better just to stick with one, and of those two, the PNP might be best, as she has training in this area. A PNP should be knowledgable about drug interactions. Also, if a mistake is made by the prescriber, the pharmacist is another person who might catch it.

Kiya, do you have an existing relationship with the PNP? Or would this be your first time seeing her? If you have seen her before, is she prescribing meds for you also? If you do go to see her regularly, what does she do for you if she doesn't prescribe meds? Does she do therapy with you?

If both your GP and PNP are prescribing meds for you, maybe that is why the PNP will only consult now--multiple prescribers is not a good thing. I would suggest that you request your GP to call up your PNP for a phone consultation and get it straightened out who is going to do what. That shouldn't be your job to get the two of them straightened out. Also, often when I see a specialist, such as my cardiologist, he will send a report of his meeting with me to my GP, for my files, so that GP knows what is going on with my health. If you decide to have your PNP do all your psych med prescribing, you could also request that she send reports of any med changes to your GP, so that GP stays in the loop.

Sunrise, thanks for all that. I've not even met with the PNP yet. There's a lot of warning flags in my head about this:
A. she didn't hear what I said and translated it totally different on the phone and to my T.
B. she isn't understanding that I only have one perscriber (GP) and there are not "too many cooks in the kitchen" and no one knows what they are doing.
C. she is only in the clinic one day a week and feels i am too complicated, and if something came up, she'd not be there to help.

Something needs to happen here. I am on the generic of Buspar and it is causing more side effects than help. There are a lot of issues; no ins, no money for out of pocket, my "pharmacy" is Target whose ppl (not a blanket statement here, but just the target I go to and the ppl i have dealt with) really don't care if i live or die - customer service is terrible and i doubt they'd catch anything unless it was in bold on the bottle. I found the interaction by chance.

Whew... lots of ranting from me *breathe, kiya*. Yeah i was originally on lexapro for both ad and anxiety. i still need a better option than what i am on, but i feel like that isn't what is going to happen here. =(

OK - first off I believe that when it comes to medications, up to us it's research research research our meds as much as possible, to be sure we're comfortable with what our Dr.'s are prescribing us - especially when it comes to psych meds. I wouldn't trust anyone but my pdoc to prescribe my psych meds and even she doesn't know everything - although she's pretty darn good. She frequently looks stuff or consults with the hospital pharmacist when I have questions she can't answer.

There are a few really good sites for finding out about drugs on-line that I like:

mayoclinic.com (not as comprehensive as some, but plain language)

medline (geared at practitioners as opposed to general public - but more info on drug interactions and precautions - I think they also have a drug interaction checker)

crazymeds.us - there a little original shall we say, it's a site run by consumers / survivors. but there stuff is really researched and written in an followable format and always gibes with what I get off of medline/

I have a lot of dr.s in my life and occassionally one wants to try something new - usually my addictions Dr., if it's anything more complicated than a simple antibiotic I run it by my pdoc first.

Also make friends with your pharmacist - they're trained in drugs and can be really helpful in explaining things and checking for interactions. I admit I get annoyed when I pick up my prescriptions every month, he reminds me that at the dosages of two drugs I'm on that do interact I'm at greater risk of heart arrythmia's. We've been having the same conversation monthly for 3 years. But I'd rather know.

I also believe it's important to only have one prescibing Dr. - ok sure sometimes, if I'm out of one of my addictions meds and don't have an appointment scheduled with my pdoc, I'll let my addictions dr. write the script, but I immediately let my pdoc know.

And since it's not my family GP who is doing the prescribing when I go for my annual physical, I take a written list to give her of what I'm on at what doses so that my chart is up to date.

Because one of my drugs has serious interaction potential - I also wear a medic alert bracelet, and carry a wallet card showing everything I'm taking, in case I wind up in an accident.

Sorry if I've come on a bit strong - but i believe in being an informed consumer.

--splitimage

I saw a pdoc a LONG time ago, I don't remember what she was considered but she wrote perscriptions and did therapy.

Anyways, of course she wasn't the only doc I saw but I saw her for 3 sessions total. On the first session she perscribed me a very strong tranquelizer. I was having trouble sleeping but I thought that was a bit too much. None the less I took it because she gave it to me and knew what I needed.

After taking the first pill, I was the sickest I had ever been in my life. I thought I was going to die. Every inch of my body and every strand of hair was hurting. My pain lasted for a week before it finally went away. I was still sick in her session the following week so my mom had to go in with me to talk for me about my reaction to the meds.

My mom also looked at the side effects once I got sick and one of the side effects, though extremely rare, was death. This freaked my mom out. She didn't tell me about it until I was feeling better but it really did scare her.

In my appointment the following week when my mom was explaining how sick I was, the doc STILL insisted on me taking the medicine again! I of course refused.

So yeah docs can really stink sometimes, if they don't take the time to get to know the medication they are giving their patients. I'm really sorry that you are going through this! Take care

SplitImage - no, not too stong at all- this is all great, important info to know and learn from. I appreciate your indept explanations and experiences/advice as well as the links. The link i had found was Drugs.com and it has an interaction site.

http://www.drugs.com/drug_interactions.php

Kris, also thanks for sharing your experience - likewise very important. Like mine, the rare side effect when mixed together (as mine are) looked very very serious:

"...may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea."

Of all those, I had 7 of the side effects including the mental state changes. Beyond the two prescriptions, the GP also has me on 5HTP, Serene, Kavinace, Tyrosine, Theanine, and Taurine. Sadly, I keep wondering when I am going to drop into a coma...

Kiya, can you tell us what two drugs you are taking that have the bad interaction? Maybe that information could help others....

Why don't you meet with the PNP one time and see what you think? It seems you are getting a negative impression of her before you have met, and maybe that would change once you see her. Is there an alternative to this one-day-a-week PNP? I think the PNP's concern is a valid one--could you see someone for prescriptions who works 5 days a week?

I was on Buspar for a number of months and had quite a few side effects, some of which were good. But it did not help with anxiety at all. Have you found the Buspar to help with anxiety? If not, did you try anything else? I took Xanax occasionally (it is very potent for me), usually when I was too anxious to sleep. It is really too strong a drug for me to take on a daily basis or during daylight hours, but some people really do well on the benzos, and this is a very common choice for anxiety. I also have a prescription for Propranolol, which is good for especially anxious situations (take right before) and it is not a benzo so doesn't put me to sleep. (It is also used to treat high blood pressure, so if you have low blood pressure, you would not want to take it.) By the way, when I quit Buspar, I did it cold turkey, as my doctor instructed, and was that ever a mistake. My
GP reasoned that since the drug was not helping me at all with anxiety, that it was having no effect on me, so if I quit I would not notice it. Was that ever wrong! I was extremely volatile for a couple of weeks after quitting. If I did it again, I would taper. However, I didn't have the health concern (negative side effects) you do.

sure: citalopram and buspirone
but i also take supplements; 5HTP, theanine, taurine, tyrosine, excitaplus, adrecor, ...i can't remember what else. all dr directed.



yeah... heart palpitations, changes in brain.... all that fun stuff. just now i thought i was gonna black out - maybe because i only took 1/3 of it yesterday so i could write my paper.... grrrrrrr.

thanks sunny

Well, how about the propranolol I mentioned above? That is not a benzo and is not addictive.

Quote:

she won't prescribe for me

Kiya, what is your purpose in seeing her? Is it for prescriptions? If so, it seems like you can save yourself some trouble and stop seeing her since she won't prescribe for you. Or does she provide some other service that will be helpful to you?

Who advises you on what supplements to take? Is it your GP? Do you find the supplements helpful? How is life when you are not taking citalopram or buspar?

How did your meeting with the PNP go?

Sunrise, it went really well and i am so relieved.
After learning more of my history and how little meds i have taken, the PNP has decided to double check her theory on why i am still reactive to the meds as well as what the GP thinks about the supplements, take me off of both of those prescriptions SLOWLY and put me on lamaticil generic at a very low dose. She wants to get me to baseline so that the triggers are lessened and so i am not swapping alters all the time. So that is the current plan. at least there is a plan - i was feeling lost in outer space.

Oh i forgot about that...
"Well, how about the propranolol I mentioned above? That is not a benzo and is not addictive."
but i will keep it in mind if the lamaticil doesn't pan out. I've read it is usually for BP. which is interesting to me on another related note, but not concerning this thread. and as the buspar is in effect, i'll not even be able to write about it. this is why i can't take it when i know i will be studying. @_@

i hope the PNP briefed you on the risks of lamictal, yeah? i am sure she would have, but just double checking given that you've been on quite a cocktail already .

GP's, as their same suggests, are general. They're not specialists like psychiatrists are, so they may know the basic effects of the medications or if it's a more uncommon one, they may not know it at all because they're not expected to. That's the job of the psychiatrist or psych. nurse.

For myself, I have a very detailed, 1200+ page book on medical pharmacology published by Elsevier journals. So if need be for me, I just look it up myself and from there, I'll either use my student access to get scientific database access and find very detailed info. or I'll just browse the web to get more info.

For myself, my family doctor (whom I don't often see as there's no need) is quite knowledgable because he's been in the business of medicine for quite some time. But if he doesn't know specifics about a medication, then I'm not too concerned especially if it's a medication prescribed for only certain disorders or rarely prescribed at all. They're not researchers so at most, they'll know the labelled use of the medications, possible side-effects and drug-drug interactions. Other than that, they're probably not going to know much else and they may not even know all drug-drug interactions nor side-effects. They'll likely to know common side-effects and common drug-drug interactions.

If I go and take a part from the medical pharmacology book and bring it to my doctor, they're probably going to understand the physiology that's going on due to the medication, but they're not going to know something such as the percentage of plasma protein binding and they may not even know how it gets biotransformed. But that's expected, they're there to simply apply the basics of the meds.

I vote for the last option because I'm on a very common med and if my family doctor didn't know what Seroquel was, then I'd be worried.

ummmm... no.... but i've not started on it yet and won't for at least a month. she wants me to stop my other two first. She said that usual does for the generig lamictal was 200-400mg and she was going to put me on 25mg because i am such a lightweight.

Kiya, I'm so glad it went well. I'm glad you will be getting off the Buspar. If it wasn't really helping with your anxiety, then no point in taking it.

Why are you going to stop the citalopram?

The propranolol, like many drugs, has multiple effects on the body. It can help with anxiety, but also lowers blood pressure. So if you are anxious and have very low blood pressure, you probably wouldn't want to try this.

What does your GP think about the supplements? Was it your GP who recommended you take all the supplements?

Does lamictal help with anxiety? I have heard about it more in the context of being a mood stabilizer for bipolar. It will be interesting if that drug can help control alters switching. That would be great! Hope you find it helpful,have no side effects, etc. My PNP also likes to start people on a very low dose of psych meds and work up slowly. I think there is no harm in being cautious, unless you need immediate relief.

Good luck with the new plan! I am glad you like the PNP and that she was able to listen to you. I feels great to not be lost in outer space anymore, doesn't it?

Yep - she talked about it in terms of being a mood stablizer because each alter does bring in their stuff... and each is triggered in by anxiety of some kind. So she is hoping that at a low dose it will just help me find neutral and not keep spiraling off into triggerland/ alters. Hard to imagine... but it would be nice. Because I know we can get really super irritable!!! that is when kristin is in and usually gets her favorite coffee. the coffee helps us stabilitize. PNP was thinking that all these seritonin things aren't helping me - thus the talk with GP who put me on them all. Confusing sorta, but it really does just feel good to know SOMEONE is guiding this. Oh PNP said that the lamaticil would help with both the depression and the anxiety, that's why she is taking me off the citalopram as well. i can't tell that it is doing any good, either. the buspar does take away some of the anxiety, but at such a cost. heart palpitations, excitability, hyperness.... oy.
I do hope this next thing works. I'm almost afraid to read the side effects. but PNP said only something really super mild and not a big deal at all.... i hope that is accurate for *me*, knowing my body responds to things in a pretty volatile manner.