When PDOC Says NO

I saw my pdoc yesterday. She's generally excellent and I've been her patient for 2-plus years.

Since 10mg Abilify (which is recently added) is helping to keep me stable, I told her that I want to drop my Lamictal dose from 300 to 150. I am doing a lot of work in therapy and feel its important not to be so medicated that the underlying issues aren't presenting themselves in therapy.

When I told my pdoc of my desire to decrease the Lamictal to 150 she said NO! That will destabilize you - if you want to decrease it, 275, 250 at most! Case closed, make an appt. for 2 weeks.

Okay, but...if I'm so stable on meds that I'm not working out the more serious issues in therapy, that means I spend my life on a lot of medication. Not something I want to do.

Last night I took 200mg., with the intention of staying with that amount for now. I feel like this is my body and my life and I have the right to decide what to put into my body. Dr. W., however, will be so annoyed at our next appointment in 2 weeks when I tell her I've dropped the Lamictal down so much.

I'm wondering what others do in this type of situation? Please chime in with your own experiences.

It's dangerous to drop med dosages by yourself, especially with anticonvulsants like Lamictal. It's better to do a slow taper with your pdoc's guidance and see how things go. Suddenly stopping or making changes in meds can definitely destabilize a person. I understand not wanting to be on too much medication, that's completely understandable but I think your doctor is just wanting to take things slow and make sure you'll be okay

I used to be on 400mg of lamictal and I was able to safely drop to 200mg overnight (as per my pdoc’s instructions). However, looking back on things, I could have given myself a nasty seizure by cutting my dose in half (based on what I read after the fact).

I personally don’t think it’s safe to do large cuts with anti epileptics like lamictal. It’s the seizures that you have to worry about. People have gotten seizures from large drops or sudden cessation, even when they never had a seizure in their entire life.

I mean, I’m not a dr, but if you’re adamant about reducing your dose, do consider the potential for seizures. It’s very serious and I only want the best for you.

Thank you both, very much. I had not thought of the practicality of decreasing the Lamictal. I'm just so afraid of blowing the chance I have with learning coping skills in therapy, rather than relying on meds like I have for so many years.

Geez...I'd forgotten about the seizure issue. I barely slept all night and feel nauseated today. *sigh* I'll go up to her suggested 250 tonight and work on it from there. Stay with the 250, and when I see her in 2 weeks bring it up again.

Yeah I think the fact that the PDOC is putting their foot down speaks to how much they actually care about how you are doing. If they didnt care theyd just agree with whatever you wanted, whether it would be helpful to you or not.

Id say maybe when your next appointment comes, just try to see if your doctor is willing to talk it out abit more. They should consider your wishes too- but at the end of the day- if what is best for you is NOT cutting the dose- it might be worth listening to even if its not exactly what you want

Quote:

Originally Posted by Under*Over Yeah I think the fact that the PDOC is putting their foot down speaks to how much they actually care about how you are doing. If they didnt care theyd just agree with whatever you wanted, whether it would be helpful to you or not. Id say maybe when your next appointment comes, just try to see if your doctor is willing to talk it out abit more. They should consider your wishes too- but at the end of the day- if what is best for you is NOT cutting the dose- it might be worth listening to even if its not exactly what you want

Thank you so much, Under*Over. I believe that you are correct. My pdoc and T have made it clear that Dr. W. does very much care about me...maybe sometimes more than I do about myself.

I will take the 250mg. tonight and if I'm still really itching to drop it down, I'll call her next week. But for now i will follow her advice.

Being on medication does not negate therapy. You will find as you get better that your understanding of issues will deepen over the time you take. You may be itching to get off a medication but your body is used to the medications. Please dont jeopardize your wellness.

... and so did your doc that should have reminded you.

This thread has been incredibly helpful. I did what my pdoc very reluctantly agreed to, which was cutting the Lamictal down by 50mg. (so 300 to 250). Then I got busy and forgot about the dose I was taking...just swallowed the pills at bedtime and that's it.

So the 4th day rolled around and I had a therapy appt. By the time I got to my T's office I was feeling flattened. Depressed, and it was an effort for me to be engaged with the session (very unusual). Got home afterwards and started feeling downright depressed. I thought, "Oh, no. Here we go again...."

Then *bang* it hit me: Lamictal dose! Whew. That's most likely what the problem is. I raised the dose back to 300mg. and feel much better today.

So much for dropping med dose It's always the same old, same old...

Possum and jimi - yes, you are both spot on. possum, I still deny my own mental illness on some level. I get annoyed with myself!

jimi, normally she parses every detail of the possible awfuls, but this time she didn't. I think I caught her off guard. She just almost yelled NO

Hi.

I do understand where you are coming from. One still wants to be able to think through things while one meds and not have their thoughts be hazy. I get that.

I also understand what you mean regarding your doctor, and believe that some people are missing the point. Yes, a doctor does not want their patient to become unstable, but I think that a doc having some degree of flexibility is very important. Yes, they are the professional and the doctor knows what to prescribe, but they should (in my opinion) also listen to how the patients feel- if the patient is not totally comfortable with a medication/dosage for reasons like the one you mentioned, then they should take it into account.

There is actually a point at which the doctor can be both the professional and actually listen to concerns the patient has (and take them into consideration).

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Originally Posted by TicTacGo Hi. I do understand where you are coming from. One still wants to be able to think through things while one meds and not have their thoughts be hazy. I get that. I also understand what you mean regarding your doctor, and believe that some people are missing the point. Yes, a doctor does not want their patient to become unstable, but I think that a doc having some degree of flexibility is very important. Yes, they are the professional and the doctor knows what to prescribe, but they should (in my opinion) also listen to how the patients feel- if the patient is not totally comfortable with a medication/dosage for reasons like the one you mentioned, then they should take it into account. There is actually a point at which the doctor can be both the professional and actually listen to concerns the patient has (and take them into consideration).

Interestingly, I have noticed that pdocs tend to respect men's decisions not to take meds, or to take minimum dosages more than they do women's.

My pdoc is immensely caring and I trust her. I only wish that she would lessen her medication agenda just enough to consider how I feel. I do believe that she cares about me...maybe almost to excess, sometimes.

yeah...i have female friends/acquaintances who go to psychiatrists, and I agree with you on that. ive also noticed that -male psychiatrists- aren't as big on giving male patients benzodiazepines as they are the ladies, but stimulants it seems an even playing field. i don't get it.

as a male...I prefer female psychiatrists. they're not as egotistical, they'll talk to me more about what they think is going on and how to approach it, and they don't take quite as an authoritarian approach to the whole process.

a female acquaintance told me that she repeatedly had to put her foot down with her male psychiatrist, otherwise she'd have been loaded to the gills. she now has a female psychiatrist she's wary of, i think its because they really just don't care for each other, but..her 2 drug combination is stable, and she just needs the prescriptions, so there you go.

I do actually see what both you and @still_crazy are saying.
I am a male and do prefer seeing a female doctor (whether it be my GP or pdoc) because she seems to be easier to talk to and open up to about issues, as well as being more considerate. If I have a serious issue with meds, she will agree that if I am having side effects that are intolerable, an alternative must be found.

I am glad that you are feeling better BethRags. I found out that dropping my medications was to my detriment. Seroquel was one of those. I really didnt manage without that. Klonolpin is another one that I would like to get off all together but the reality off this medication means my tics are full blown.

There was one time I was an voluntary inpatient and I refused to take my medication due to some type on mind flip. I found myself walking along the corridors needing the walls to hold me up. It was a rude shock of how much the medications were helping me to be functional.

Sometimes our minds really want to be free of the mental illnesses emotions and the medications that go with it. I hope you can find balance in all the that will help you to be well whether it's medications or therapy or physical activity.

I'm super lucky with my pdoc. He's great at listening to me, and taking my feelings into consideration re meds.


The only time I really ran into a glitch with him, when I wanted to use the Ashton method to taper of clonazepam. He was skeptical, but agreed, but then was hesitant to prescribe the full doses of diazepam that the schedule calls for. So we're kind of half following the schedule.

splitimage

@BethRags
Are you bipolar? I am assuming you are. It is my belief that all people with bipolar experience the desire to stop meds, reduce them or change them especially when we feel well. I do not know why this is. I was non med compliant for a few years with my antipsycs because I was afraid of weight gain and I worked so hard to lose the 127lbs. I ended up on a good dose of geodon and it seems to only have me battling a 10lbs up and down weight issue. My meds work perfect now but I am 44 ans started the journey in my 20's so you are not alone.

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Originally Posted by possum220 I am glad that you are feeling better BethRags. I found out that dropping my medications was to my detriment. Seroquel was one of those. I really didnt manage without that. Klonolpin is another one that I would like to get off all together but the reality off this medication means my tics are full blown. There was one time I was an voluntary inpatient and I refused to take my medication due to some type on mind flip. I found myself walking along the corridors needing the walls to hold me up. It was a rude shock of how much the medications were helping me to be functional. Sometimes our minds really want to be free of the mental illnesses emotions and the medications that go with it. I hope you can find balance in all the that will help you to be well whether it's medications or therapy or physical activity.

Ugh, I hear you on the Klonopin. I've been taking it for 20 years and been twice unsuccessful at going off of it (even though I did so very slowly).

My doc says exactly what you've pointed out - that we don't realize how much meds are helping us to be functional.

Thank you so much for your support, and for sharing your valuable experiences.

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Originally Posted by splitimage I'm super lucky with my pdoc. He's great at listening to me, and taking my feelings into consideration re meds. The only time I really ran into a glitch with him, when I wanted to use the Ashton method to taper of clonazepam. He was skeptical, but agreed, but then was hesitant to prescribe the full doses of diazepam that the schedule calls for. So we're kind of half following the schedule. splitimage

I have heard great reports on the Ashton method, and it sure makes sense to me. I hope it works out for you - even if you're following it in part.

Quote:

Originally Posted by TicTacGo Hi. I do understand where you are coming from. One still wants to be able to think through things while one meds and not have their thoughts be hazy. I get that. I also understand what you mean regarding your doctor, and believe that some people are missing the point. Yes, a doctor does not want their patient to become unstable, but I think that a doc having some degree of flexibility is very important. Yes, they are the professional and the doctor knows what to prescribe, but they should (in my opinion) also listen to how the patients feel- if the patient is not totally comfortable with a medication/dosage for reasons like the one you mentioned, then they should take it into account. There is actually a point at which the doctor can be both the professional and actually listen to concerns the patient has (and take them into consideration).

Hi TicTac, I'm so sorry...I didn't see your reply until just now.

I've seen around 35 pdocs over the years and I honestly can't recall any one of them who struck a happy medium with meds. Most are insistent about prescribing medication and a handful were basically anti-med (go figure). The anti-med pdocs were their own special kind of annoying.

I only wish that my pdoc would validate my desire to be off meds. That I'm genuinely concerned about developing secondaty health problems. She doesn't have to stop prescribing them or change her methods, but please...just honor the fact that taking these damn*d medications all the time makes me feel such despair. I resent the, "Oooohhhh...but you need those medsss...we know that, don't we??"

I'm def not looking to change pdocs, I'm just trying to figure out how to be assertive and clear with her. I agree...be a professional - but be a human being, too.

I agree with the sentiment that a doctor should be empathetic. But there's a point where excess listening to a patient becomes disregard for what's best for the patient.

For example, I know my former pdoc cared a lot about my well-being (I only stopped seeing him because I moved, otherwise I would have stuck with him because he's a great, caring doctor).

However, in some of my earlier days with mental health issues, he had to put his foot down and say, hey, I actually think you'll be better off on these meds and here's why.

Sometimes I took his advice, and sometimes I didn't, and I'm not saying this will be the case for you with your pdoc, but when I took his advice, I generally felt better, and when I disregarded his advice, I felt worse, on average.

It was a long learning process that I'm still not totally okay with, though I know that I need to be on meds to feel good. That's just the way it is. I questioned meds for years and years and I questioned them so much. I learned to not follow that path anymore. Questioning things that don't need to be questioned is not good for me.

Now, I don't know if your struggle with meds is in any way similar to mine. You may have different concerns than I did about meds. Perhaps you could just keep talking to your pdoc about your concerns. Don't give up in advocating for yourself.

I still have thoughts that I should go off my meds, but I really just have to examine what the consequences would be if I did go off of them. I would end up hospitalized--a $10,000 affair or whatever an ER visit would cost these days. I am not saying this applies to you, but I am just sharing my own experience with these things.

I hope you can find some peace around this subject. Just keep telling your pdoc how you feel and have open conversations about the meds. Try to get your pdoc to justify why she wants you to be on the meds. I know it's probably challenging to have her explain that, but maybe that will give you some more comfort about the subject.