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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Peter on August 5, 2003, at 9:55:41
Hello all:
It's been quite a while since I've posted here.
Quick background: I was diagnosed in 1996, after a few years of drug abuse (pot then cocaine & heroin), with a comorbid disorder of bipolar (mild, but I fall somewhere along the bp spectrum), adult ADHD, social anxiety, depressive anxiety. I've been seeing the same pdoc since '96, when he literally had me start up depakote right after I quit heroin. Since then, he has had me on every combination of just about every med I can think of - anticonvulsant mood-stabilizers (depakote, neurontin, lamictal), SSRI's (all of 'em), benzos (klonopin, restoril), other AD's (effexor, wellbutrin, moclocbemide, trazadone), beta blockers (inderal, tenorman, etc.) dopamine agonists (permax, mirapex, etc.), stimulants (adderal xr + IR, dex spansules, concerta), strattera, ambien, and the list goes on.
I went through periods over the years of becoming rather upset at my pdoc for constantly changing my med regime, even at times when I thought I was settled and doing well. BTW, my pdoc has stated to me numerous times that my disorder is not severe at all, but just 'difficult to pinpoint and treat." I've gone to numerous other pdocs for consultations, and each one has told me something different; one said I don't have BP but I do have ADD, another said the complete opposite, and a 3rd said I have none of the above, and only some depressive anxiety.
My most recent combo, which I had been taking since late winter/early spring, was adderall 35mg, prozac 5-10mg, lamictal 50-100mg, strattera 25mg, klonopin 2-3mg, temazepam 15mg, trazadone 25mg. Of course, I had to titrate the lamictal over months, and the doses of all the other meds were constantly in flux over the months).
In mid-June, my doc decided to begin the shuffle again; this time I think it was because I was experiencing some agitation. He first had me stop the prozac; seeing that my agitation was still there, he had me stop the lamictal (which never really did anyything for me anyway). As both of these meds have long half-lives, he had me stop them 'cold,' stating they would 'wean themselves out of my bloodstream.' And they did - no severe withdrawal (nothing like zoloft!).
I went on a trip to Europe late June, and I'm still there now. During my stay, I again became a bit more agitated than usual, and my pdoc took that as an opportunity to taper (5mg - a -day) off the 35mg adderall. I reluctantly followed his instructions; out of all the meds I've taken, I've found the adderall to most accurately target and treat whatever comorbid disorder I actually have. I was markedly less symptomatic on adderall (more focused, productive, calmer, social, etc.). But, at moderate-high doses, it did sometimes cause me to isolate and avoid people more, and it gave me 'dips' in my mood when it wore off. But still, the anticonvulsants did nothing but put a 'heavy blanket' damper on my mood; the SSRI's would help only temporarily (a few months) and didn't seem to target whatever my 'core' disorder is; the klonopin is ok, and now I just use it at night for sleep 'cause it makes me too drowsy during the day. Everything else was obviously ultimately unsuccesful, as I'm not on any of it anymore.
Anyway, I tapered and stopped the adderall; the first few days I experienced intense fatigue, but then I began to experience complete restlesness, fidgetiness, irritability, impulsiveness, racing thoughts, etc. Now, this is after I'd been off of the lamictal and any other 'mood stabilizer' for months. But right after stopping the adderall, this began. It got worse the more time elapsed since having stopped the adderall. I've even begun drinking at night to ease the restlesness - when I took adderall, I was calm and had no desire to drink alcohol or take street drugs.
I told my pdoc that this is the first time since I was 11 or 12 that I'm on such a small amount of 'substances' (prescribed or not). I've always taken combinations of meds and this has really just made it more difficult to pinpoint my diagnosis; that's why he had to eliminate each med this last time one-by-one so he could see more clearly what was going on with me; each cocktail produces more synergistic effects which further confuse the whole situation.
So finally, I'm on only 25mg strattera during the day and 2mg klonopin + 15mg temazepam at night. But I'm still experiencing these typical ADHD symptoms. Isn't it logical to assume that ADHD is in fact the core of my disorder and that the adderall ALONE, not combined in yet another cocktail, would be a wise choice at this point?
The anticonvulsants might very well have 'calmed' me to a certain extent in the past, but in an indirect way, dampening my mood as I mentioned, thereby 'masking' but not treating my seemingly evident ADHD.
BUT, my pdoc said starting up the stim now isn't a prudent move, and instead he's taking me off strattera! I agree with coming off strattera - any acute side-effects would have abated by now, but I still get so restless and agitated even on such a low dose.
But why wouldn't he allow me, for the sake of simple relief, to resume the adderall?
It seems like it's just one huge guessing game for him and I'm the gineau pig. He loads me down with tons of meds and then, when I eact badly, he has no idea which out of all of them works and which causes the problems, so he takes me off each one. But it's obvious from taking adderall on and off for years, that it is the most effective med, as it renders me least symptomatic out of the billions my doc has put me on.
He claims that my restlesness/irritability/mood lability, etc. is not signs are ADHD because ADHD 'sufferers don't experience such intensity of discomfort.' Is that true? Why do ADD'ers seak treatment then? Also, he's not the one feeling these symptoms, I am. He's even admitted to not really understanding my condition and how to treat it. That's very comforting!
I'm so sorry for being so long-winded. Thanks to anyone bore with me up to this point,
My basic questions are:
1) As, he's having me now stop Strattera, he said I should skip a day of my 25mg, and then resume with 10mg caps (I have 15 of the 10mg's with me). Does Strattera taper produce withdrawal symptoms? If so, what? How long does it take to get off it?
2) I'd appreciate any advice and opinions about what I'm experiencing and the resulting frustration of my pdoc not agreeing to place me back on adderall, though I've experienced that it is on-the-whole more effective for me than any other med I've taken. I'd appreciate it; I've been bottling this all up inside for months, even years.
thank you so much,
Peter
Posted by Susan J on August 5, 2003, at 10:07:16
In reply to advice, please-pdoc trouble, posted by Peter on August 5, 2003, at 9:55:41
Hi,
I'm afraid I'm not familiar with most of the meds you are taking, but I "do" know that you know your body and your mind the best, better than any doctor. Medicine, unfortunately, involves a lot of trial and error. If you felt the best, most stable, most productive on Adderall, then I think you should get back on it.
It's "your" body, your mind, your life. The doc is probably trying the best he can, I'm not faulting him at all. But only "you" know what's truly going on inside. It's your health, you can take charge of it. Plus, if you find yourself wanting to drink, I would take that as an indicator that a particular med, or lack of it, isn't working for you.
Taking Paxil was the worst thing I've ever done....it saved my life getting off of it. I may not have my depression totally under control, but I'm not in the hell caused by a drug that wasn't right for me.
Good luck. You're in my thoughts. :-)
Susan
Posted by fallsfall on August 5, 2003, at 12:00:11
In reply to advice, please-pdoc trouble, posted by Peter on August 5, 2003, at 9:55:41
You should be able to have a conversation with your pdoc about the adderall. As Susan points out, you know your body best. However, your pdoc knows the meds best. You need to merge your information and hopefully come to an agreement. If your pdoc won't talk about it with you and try to explain his point of view, then you need a different pdoc. You, by the same token, need to be willing to listen to him and be educated by him enough to participate in an informed decision.
Good luck!
Posted by maryhelen on August 5, 2003, at 22:25:16
In reply to advice, please-pdoc trouble, posted by Peter on August 5, 2003, at 9:55:41
I do not know what type of drug adderall is, but I certainly have been on more meds and combinations than I will ever remember.
If your pdoc admitted that he really doesn't understand your condition or how to treat it, what is his objection to you being on adderall? When my pdoc is stumped as to how else to treat my depression, he will make an appointment for me to see a mood disorder specialist for a second opinion. I believe that is what your pdoc should do, or as another poster suggested, get a new one.
maryhelen
Posted by lesliekay on August 6, 2003, at 3:27:48
In reply to advice, please-pdoc trouble, posted by Peter on August 5, 2003, at 9:55:41
i have been sick for 18 years...i have had a lot of p-docs...the one thing i have learned...if they don't listen, then don't talk! I now have the most wonderful doc in the world, he lets me formulate my own game plan and as long as it is not toxic, he lets me go for it. My disorder is now under control for the first time, and it is because of him and the respect he shows me. I hope you can say the same very soon.
Leslie
Posted by Peter on August 6, 2003, at 6:30:13
In reply to Re: advice, please-pdoc trouble, posted by lesliekay on August 6, 2003, at 3:27:48
Thank you all for your feedback. It's really helped me a lot. And I really admire your patience for reading through that 'essay' I wrote! Thank you.
I don't mean to be bashing my pdoc. I'm more frustrated at the situation and the feeling of having no idea if I'm even treatable, what my diagnosis is, and how sick I am.
I can say that my mood lability and anxieties have hugely interfered with my daily functioning for years, resulting in lost jobs, relationships, etc. It just sucks to go through so many meds, but to always feel that you're in a 'transition period'and you still have not reached a state of equilibrium.
So I finally decided to email my pdoc and just outright say: 'I'd really appreciate if you write me a sentence or 2 describing your reasoning for my not resuming the adderall."
And he was very nice about it. Finally something makes sense! He said that I am still in an 'acute' state, meaning not in a state of equilibrium, and that ADD'ers are, while symptomatic, are still in a state of equilibrium, albeit a relatively dysfunctional one. He said that my 'mood lability, desperation, and intensity' are not ADHD, but more like a mixed mood state with anxiety (perhaps superimposed on some ADHD symptomatology). So, he said, until I reach more of a state of this 'equilibrium,' we should banish the idea of resuming a stimulant.
It makes sense. He's the doctor, not me. But, again, this is the continuation of the lifelong 'transitional phase.'. It's this phase that makes me feel like I haven't reached an 'even' state, or one in which I can function socially, occupationaly, etc. It thereby hinders me in a lot of ways and I let it destroy my confindence. I just got to be more patient and accepting of myself.
Anyway, at least I got a rational reason for not resuming the adderall and a sense that I will, at some time, reach this state of 'equilibrium.' We'll see. Thanks again for all your help, guys,
Peter
Posted by lesliekay on August 7, 2003, at 5:15:12
In reply to Re: advice, please-pdoc trouble, posted by Peter on August 6, 2003, at 6:30:13
Hey, he actually does make sense! I know it is frustrating, I am one of the lucky ones who has a doctor that pulls out his scripts and lets me dictate. (within reason of course) It just happened today. I hope the relationship you have with your doctor improves, or, you find one that makes you an active participant in your treatment. I never improved until I got to say what I wanted to say and someone listened...remember that...good luck leslie
Posted by Peter on August 10, 2003, at 7:12:04
In reply to Re: advice, please-pdoc trouble, posted by lesliekay on August 7, 2003, at 5:15:12
Hi everyone:
Well, it looks like it might be med startup time again.
After a few weeks of tapering everything, I've been down to 10mg strattera during the day, and 2mg klonopin,15mg temazepam, and 25mg trazadone at bedtime.
My opinions of the adderall have changed; As my body/mind have been reaching more of a state of equilibrium, I've been finding that I feel much less socially withdrawn and numb to my surroundings than when I was taking adderall.
My agitation has gotten much lower, and everything seemed to be going ok - until last night. I had a long period of feeling 'overly-charged-up' and excessively energetic. I'm a musican, and I found that I was going nuts playing the piano, joking, and singing for hours. That sounds fun, but it got to a point where I felt out-of control and overwhelmed by all the energy. Within a few hours, my mood seemed to switch to one of irritability and lowness.
Obviously this sounds like a classic 'hypomanic' or even 'manic' episode. My pdoc of 7 years has always told me that though I have a comorbid disoI'm tapered down to almost nothing and I had this 'episode,' I'm beginning to think that he's right, as now I do see signs of manic-like behaviour.
I was getting pretty psyched that finally I'm on so few meds, but, if my bipolar disorder is progressive and dangerous, I by all means am willing to start up a mood stabilizer again (though I've tried every anticonvulsant mood stabilizer AND Lithium in the past, and they all had wierd effects on me.
Since my pdoc now claims I have a mixed-mood combined with some ADHD symptomology, I'm wondering if a med like Wellbutrin would be better for me than another 'mood stabilizer.' I've tried Wellbutrin in the past, but only for a few eeks, and it agitated me so we did away with it. I was also on a load of other meds. Perhaps now it would be different.
I'm also thinking of trying lithium again, in spite of my fears of losing track of my hydration and salt intake and experiencing lithium toxicity. But when I tried it, again I was on a load of other meds and I started getting a bit of a tremor within the first week, so the doc said I might as well stop taking it. Might be different now.
Anyway, sorry - just felt like venting. Thanks,
Peter
This is the end of the thread.
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