Psychiatrist for second opinion only?

[mermaidcafe.livejournal.com]

A couple weeks ago, I had a really strange reaction to a dosage change in an antidepressant, and I'm still suffering the effects of it. My doctor doesn't know why this happened or how to fix it. I don't know if this is something that a good doctor *should* know how to deal with or if I really am in a peculiar situation and my doctor's doing the right thing.

I'd like to find a psychiatrist/psychopharmacologist that will just listen to this particular situation and give a second opinion. I don't want to change doctors unless it turns out that another doctor is better equipped to deal with this situation, so, understandably, I'd rather avoid the intake process with another physician. I don't know if this conflicts with medical ethics or not, but I figured it was worth a try. Does anybody have ideas on how I can run what's happening by another pdoc? Even if somebody here happens to be one or be friends with one, that would be a huge help and for legal purposes, I would realize it's not actually medical advice.

Thanks for any ideas.

(btw--any chance of a mental health tag getting added?)

Comments

[ron_newman]

re the tag: that's probably worth subdividing out. I'll try to work on it later this week.

[mermaidcafe.livejournal.com]

awesome. thanks!

[ron_newman]

And I actually did it, though I forgot to note it here.

[anyee.livejournal.com]

Side effects on antidepressants are hard to predict and even harder to explain. A "good" doctor may be cognizant of this and may admit not knowing what to do rather than making something up off the top of his head. Why do you want legal help? Do you think the doctor did something maliciously r negligently? Not knowing something that is occasionally unknowable isn't going to make a great legal offense.

If you're still suffering the side effects, you need to drop down to the lower dose, slowly, or taper yourself completely off of the medication. Is that what you're doing now with your doctor's supervision? That's the only solution right now unless you have some sort of neurotoxicity, in which case you need specialized evaluation that the average psychiatrist won't have.

Your explanation of "really strange reaction" and "dosage change" doesn't help me much, but I am trained in this sort of thing as a neuroscientist.

[mermaidcafe.livejournal.com]

Thanks for the response. Hopefully you'll have some ideas on this.

To clarify, I don't think I need legal help; I just thought a doctor who wasn't my doctor might feel weird legally giving me an opinion. I just didn't want to put a second-opinion doctor in a weird position where s/he felt like s/he was giving medical advice to a nonpatient--hope that makes more sense.

I did drop down back to my original dosage, but it didn't help. My doctor is supervising all of this/recommending the changes. I was on 80 mg Cymbalta and 200 mg Wellbutrin SR. We upped my dose of Wellbutrin and changed the release form to xl (so I was then on 80 cymbalta and 300 Wellbutrin XL). I got incredibly depressed the day I took my first dosage. There was a short period of feeling really good, kind of hyper, but then I crashed back again. My doctor and I talked. We decided I'd give it another day and then, if I didn't feel better, go back to 200 mg Wellbutrin SR and up the Cymbalta to 100 mg. I was still depressed the second day, so I went back to the original Wellbutrin and upped the Cymbalta. I still felt crappy so my doctor told me to go back to my original plan (80 mg Cymbalta; 200 mg Wellbutrin SR).

Eventually it stabilized and I felt good for a few days and thought it was all better. But yesterday I crashed again. I've been back on the original dosage for 10 days now. I know this stuff all works slowly so it's hard to sort out what's doing what, but hopefully something will explain the ups and downs.

Can you think of any explanations for this?

[anyee.livejournal.com]

First question: why did you up your Wellbutrin dosage? If you were having problems controlling your depression, you could be "crashing" because your disease is being poorly managed at the moment.

I can think of a few:
SR and XL have different release patterns. XL has a much slower release that is supposed to occur at a steady amount over the day. It's possible that your metabolism causes this release to "speed up". This isn't crap; liver enzymes do magic things. How were you taking the SR before this day? 2x100mg or 1x200mg?

Also, you went up 100mg in a single day, which is going to cause some side effects, especially the hyper-ness. This goes away after a few days for most people. Two days is not a good amount of time to determine the new effects of an antidepressant. Unless you had a serious reaction, ie suicidality, delusions, you may have wanted to tough it out for those few days to see if it resolved. As I said, for most people, it does. For me, it does, and I'm up to 400 a day as needed.

Changing both doses of medication near each other, plus changing formulations, will in my quasi-professional opinion explain most of the ups and downs you're dealing with. I think you really do need to wait this one out a little more. And again, if you're taking more medication because you're feeling more depressed, and you're still feeling more depressed, it could very likely be your brain and not the meds.

[mermaidcafe.livejournal.com]

Thanks!

I upped the Wellbutrin because I was having some mild to moderate depressive symptoms--but they've definitely been severe now.

Meds do need time to level out. I asked my doctor about seeing if the WB XL would smooth out and she said she'd never heard of anyone experiencing severe depression as a side effect and that's why she told me to change. The hyperness lasted just that one day, very briefly, but there was huge depression before and after. I don't know if the upped WB would've gotten better eventually or not.

[adrian-turtle.livejournal.com]

I consulted Dr. Popp a few years ago, and I also think well of her. I hope she has time to give you a second opinion about this problem. I know you're trying to avoid "the intake process," but a responsible doctor will need to know a lot of your medical history to investigate this kind of problem (drug reaction, or drug interaction, or new symptoms of a chronic problem, or some different issue.) So it might look a lot like an intake process from your side.

Referral

[oceanandmtns.livejournal.com]

Sierra Wong - 781-424-7121

She stays up on the latest pharmaceuticals and is very knowledgeable about them, what works together, what doesn't...

She's in Lexington on Muzzy St about 15-20 minutes from Alewife Station. Definitely worth talking to.

Re: Referral

[mermaidcafe.livejournal.com]

Thanks! :)

[icecreamempress.livejournal.com]

Getting a second opinion doesn't conflict with medical ethics at all. If you phrase the request along the lines of "Something weird happened, and I wonder if you could offer a second opinion, just in the hope of getting another doctor's perspective" that will go a long way toward reassuring the second doctor that you're not trying to enlist him or her for a Big Malpractice Case.

Sadly, my brilliant psychopharm isn't taking new clients, but I don't know if that extends to second opinions or not. Her name is Dr. Sabrina Popp, and you can find her on Yelp.

[mermaidcafe.livejournal.com]

Yes, you recommended her before and I called and heard that on her recording. But I should leave her a message and see if she can offer an opinion about this. Thanks!

Of course he does not how to "fix" it....

[nvidia99999.livejournal.com]

Virtually all these cocktails are based on trial and error, and each person has different reactions. There is very little systematic science. In part because it's a combinatorial problem. Say there are 10 or 15 drugs one could take, it's easier to calculate the number of possibilities (2 at a time, 3 at a time...).

Re: Of course he does not how to "fix" it....

[mermaidcafe.livejournal.com]

*She* might if it's a common problem of mixing certain meds or certain doses. You're right; most of it is just pharma roulette, but there might be doctors who've seen this enough times before to make suggestions based on anecdotal evidence.

It's a combinatorial problem in part, but there are so many other contributing factors that have to be taken into consideration. Not just the dosages and release forms of the meds, but other things. If you change the dose of a drug that works on a certain neurotransmitter, then sometimes you can wipe norepinephrine out of your body for a while. That's a problem that's not fixed by changing the combinations. And there are still more problems--the difference between generics and name-brand can be big enough to have an effect, and even different generic manufacturers of the same drug can vary wildly (some can release too slow or too fast, for example). Some drugs interact with other supplements.

So there's the big picture, which a knowledgeable doctor will be able to see and consider. Thankfully, since any knowledgeable patient would head for the exit if any doctor said "let's combine these 2! ok, now try these 7!" and tried divorcing them from context.

[purpless77.livejournal.com]

These meds can be scary. I can't offer any advice as to who to go to. But wanted to say, check Yelp. The reviews there can be very helpful.
And you can easily tell if someone is reviewing themselves. Don't worry about ethics, most good doctors will tell you openly to get a second opinion. In a situation like this you should definitely get a second maybe even third opinion. Kudos to you for staying on top of this. I hope you feel better really soon and that everything works out for you.