Should I tell the Pdoc or keep it to myself?

When I was first dx'd I did a lot of research on the internet and reading through forums on different available medicines. He put me on Geodon and tried me on Lamictal. The geodon worked ok but the lamictal gave me a rash so it was stopped. Anyway, one of the things I read up on was Topamax. A side effect of this med is weight loss. (which I could greatly use!) So I thought, Great! So on my 2nd or 3rd appointment I asked him about it and very sternly he said no that it isn't for bipolar. I think this pdoc is anti-med. He doesn't want me on xanax (I only take the .5mg and he wants to give me only 15 a month. That will not work, currently get 30 a month and could use more.) He won't even prescribe a sleep aid. Tells me to take 2 benadryl. I take benadryl all day for allergies. It doesn't make me sleepy.

Well, I suffer from migraines and take Zomig. I marked them on the calendar and had 14 in March. I went to my regular dr and asked for a preventative. She gave me Topamax.

There is an interaction between Topamax and Geodon but I guess my Geodon dose is low enough that it won't be affected.

I was taking 120mg of Goedon and lowered it myself to 30mg. The pdoc went along with it and prescribed 40mg. Says anything under 40mg is like not taking it at all. ---And...If I'm not taking it at all I have no reason to see him for a $110 10 minute visit just for refills. ...But that's another gripe, I won't go there on this thread...

He accused me three times in one sitting, practically without taking a breath, of abusing the xanax because I requested a refill before it was time to be filled again. He even called the store and asked when it was filled last. (it had been a month and a half). The drug store had lost my script. He screwed me on the last refill appointment. Instead of putting 2 refills on it he didn't put any. There must have been an angel on my side because the pharmacy found the old script. I got my xanax anyway. I take it prn and sometimes when I can't sleep. But .5mg doesn't do much for me...

God I'm rambling...sorry...

My question is- What do you think he will do when I tell him I'm on the Topamax? Or should I even tell him at all?

It seems pretty important to let pdoc know ALL of the meds you are on. Really, med interactions/side effects can be a matter of life and death...and a pdoc is going to have a lot more knowledge than a general practitioner about the interactions between psych meds.

I wonder if the overarching issue is a lack of trust between Pdoc and yourself? He seems suspicious about your xanax use, and it sounds like you don't totally trust his opinion on meds. Do you feel like you need to find a different Pdoc??

I agree with Tree. YOu definitely need to let him know. IT's a medication that messes with your neurotransmitters just like psych meds do and he needs to know. If you're not happy with him, maybe you should take some time and start looking around for a new one. You can do that without leaving the one you're seeing.

Topamax isn't really ever a first line medication for bipolar disorder but it's definitely been used before. It's also really important to focus on sleep to avoid cycling (I'm sure you know that... im sure he knows that too). That being said, there are more effective meds for sleep out there than Xanax. Even some that aren't controlled substances. Benadryl isn't going to do anything for the kind of insomnia that comes from having bipolar disorder. Maybe you could do research on some other options (Vistaril, Trazodone, even Restoril). For me Restoril works even better than Klonopin or Xanax to be honest. It's a C IV controlled substance as it's in the benzodiazepine family but doesn't have the addicting property that others do. Maybe if you go in and explain exactly what you're thinking he would be more willing to listen to you and explain why he is or is not doing things. I like my new pdoc because he totally works collaboratively with me to come up with the winning combo of meds. I wish you luck with this guy. But if he's really not listening and you're having that much trouble it's definitely not worth your money. You'd be better off somewhere else. Take care!!!

You absolutely MUST let pdoc know everything you are taking. His concern with xanax is that it is addictive. He may feel you need to cut back on it's regular use, which may be a very good idea. You say you need more than 30 a month; that is pretty high quantity use for a med that should only be used as needed.

I think it is very important to tell him. All of your doctors need to know all of the meds you are taking.

I use Xanax as needed. I am prescribed .5mg but I take less. I have found that most times half or a quarter helped enough. I now use and eighth most of the time. (Sometimes just knowing I have it on hand can be all the calming I need). I have learned if I take that smidgen 1/8th as soon as I notice a feeling of anxiety possibly becoming out of control, it is the pefect amount it to prevent the anxiety/panic from getting worse. It also helped prove to the doc that I would not abuse it. He prescribes it now with refills. At first he prescribed one month at a time. When the one month Rx lasted several months the first few times, he was reassured that I was truly taking it PRN. I also had to watch taking it often at full strength because I found I was feeling more depressed then.
So, I share this to encourage you to consider trying a lesser doses to see how that goes for you.

I think your he sounds very professional.

I think you should always tell your pdoc what another doctor is prescribing. They all should be on the same page as far as treatment goes. My pdoc does not do benzos and feels they are dangerous. So when my regular doctor prescribed a benzo combo drug for another medical condition, I told my pdoc right away and she was okay with it. It seems counterproductive to your treatment not to disclose this.

It is absolutely critical that your pdoc know all meds you are taking, including over the counter and herbal stuff. Interactions are not something to be messed around with. I have 3 Dr's in my life, and aside from things like antibiotics, the only person I let prescribe meds is my pdoc, even though I don't like him much - he does know his meds.

As for the Xanax - a lot of Dr.'s won't prescribe benzo's at all or only will for a short period of time. I'm lucky my pdoc does and I'm on a fairly high daily dose that puts my addictions Dr over the edge, but she doesn't interfere because she recognizes that I have a legit anxiety disorder that requires treatment.

And really there are better sleep aids that are non addicting than the benzos.

But if you feel that your pdoc, is not a good fit for you, and isn't willing to discuss meds options with you, then by all means look around for a new one.

--splitimage

It sounds like you are interested in making all of the decisions about your meds yourself. That you know what you want and need based off of your own research on the computer...which is not always accurate, and you are using him for obtaining your prescriptions only. When he doesn't, you Doctor shop and get stuff your P-Doc has advised against for good reason.

So yes, indeed, if you are not going to comply with your treatment and communicate with your P-Doc, why are you paying him $110.00 for a 10 minute refill appointment?

If you feel this isn't the right P-Doc for you, you have the responsibility to yourself to find the right one, not just make your own half-*** decisions, but that's a choice. If you chose not to do this for yourself then you really have nothing to complain about.

I think he will be irritated when you tell him. The patient/provider relationship is based on trust, and when you behave this way it tells him he can't trust you.

Yes, I think you should tell him.