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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by deloris on November 6, 2003, at 3:09:15
I cannot think straigt anymore, started 6 yrs ago, since then various rx's, currently on Lithium-Elavil-Ritalin-Aricept-Klonipin-Estrongen I am 51 and once had a brain, any others experienceing this? Ritalin helps best but get irritable when it wears off, this is a living hell, in the past took provigil, lamitcal, adderall etc, At worse when I awake have to take ritalin to function like to do anything!!!I live in hell, I was never ADHD in past, whats wrong? HELP HELP DR BOB someone........
Posted by KimberlyDi on November 6, 2003, at 11:33:17
In reply to Thinking - Attention Deficet Problems-Cognitive, posted by deloris on November 6, 2003, at 3:09:15
Posted by Clayton on November 7, 2003, at 11:47:21
In reply to Try Strattera, helped me (nm) » deloris, posted by KimberlyDi on November 6, 2003, at 11:33:17
I will post this to several Stratera threads and so will try to keep it generic.
My pdoc and I are considering putting me on Stratera. I need to know the symptoms it was prescribed for in your vase, it's effficacy at addressing those symptoms and its sie-effects, especially withdrawl that I see so many scary posts about in this forum.
I have mild ADD. My real peoblems are Social Anxiety (SAD), very dysfunctional mood depression and insomnia, amd a lack of drive and motivation. (I'm physically fit, so my physical health is not likely the cause of that). I was on Przac - it did nothing. Then I was put on Paxil. It was only about 20% efficacious at controlling SAD and improving mood. Then I found a very good new pdoc who immediately added Remaron as an adjunct to the Paxil. The amotivational component was reduced by only about 25%. It remains a career threatening problem.
THIS (Remaron plus Paxil) was the keys to the kingdom! It worked in only 3 or 4 days. Not one single SAD attack in the time I've been on it (5 months) and a good 80% improvement in mood with a corresponding reduction in dysfynction. The lack of motivation, unfortunatekly, didnot improve. Still, it was a life saving improvement that ended horrible psychological pain.
Remaron is unique. It increases the production of both seratonin and norepinephrine and therefore, increases supply by supplimenting, not blocking reuptake. This made it synergistic re: seratonin as supply was up and reuptake was doen.
But darn! The result was TOO MUCH seratonin. Two months ago, I became truly bipolar with rapid onset for the first time in my life. Crying and Wailing alternateig with ranting and compulsive spending. (VERY atypical for me). It was triggered by extreme stress but the underlying cause was an overload of seratonin.
So...the doc has dialed back the Remaron dose and given me the mood stabalizer Zyprexa (which wipes out all your emotions) to stop the manic symptoms until the seratonin dose is dialed in. I hate the loss of emotion but it'sa temorary necessary expedient. Unfortunately, this cut also reduces my only Norepinephrine support.
My doc and I are considering swapping out the Paxil for Straterra while keeping the Remaron. This shifts the synergy to the norepinephrine side of the equation while maintaining some seratonin support from the Remaron.
So I need to do as much research as I can about Straterra as the final decisom is mine and, in this day and age, all mental health prescriptions are best guesses based on intuition and informd judgement.
What were your sysptoms. Why was it prescribed for you? Did it work and how well? How long did it take to work? How does your doc explain it's intended action and why did he/she choose it? I'm reading some scary stories about side effects and withdrawl. What side effects, if any, did you run
into? Did it improve your mood (especially if you transitioned from an SSRI)? Did it help, exacerbate or not effect your anxiety levels? Any effect on drive and motivation? Did it help your ADD (if that's one of your issues)? Is there ANY other advice, information or experiences you'd like to share on this?That's a big pile of questions and I'm asking a lot. I know your time is limited and valuable. But ANY information you are willing and have time to share is appreciated most gratefully! I do need help and I have to make decisions about what therapy/meds to pursue. The more kmowlede I have, the better.
Thanks for taking time to read this.
Kindest Regards.
Posted by KimberlyDi on November 7, 2003, at 16:50:26
In reply to Re: Try Strattera, helped me » KimberlyDi, posted by Clayton on November 7, 2003, at 11:47:21
Clayton,
> I will post this to several Stratera threads and so will try to keep it generic. <
First thing, the multiple posts of the same thing aren't necessary. One thread with a good summary in the subject will do the trick.
> What were your sysptoms. Why was it prescribed for you? Did it work and how well? How long did it take to work? How does your doc explain it's intended action and why did he/she choose it? I'm reading some scary stories about side effects and withdrawl. What side effects, if any, did you run
into? Did it improve your mood (especially if you transitioned from an SSRI)? Did it help, exacerbate or not effect your anxiety levels? Any effect on drive and motivation? Did it help your ADD (if that's one of your issues)? Is there ANY other advice, information or experiences you'd like to share on this? <Strattera was an entirely positive experience for me with exception to the cost (it's not on the preferred drug list and has a co-pay of $50). Worst side effects (SE's) were insomnia and dry mouth. Previously, I was on Effexor alone. Effexor made all ADD-symptoms worse. I couldn't concentrate, or recall words, or focus, or read, anything. I went wandering from room to room, forgetting my original intent to go into the room, to be distracted yet again, and again. Strattera was WONDERFUL in correcting those problems. I was sharp as a tack again at work. Decreased my appetite also.
I'm not currently taking it since I'm slowly withdrawing from Effexor but I might resume it in the future when I find what I think of as my *base* drug. The one that will handle my depression and anxiety problems. Effexor failed because it raised my blood pressure too high.
No problem about taking up my time... Psycho-bab wouldn't exist if it weren't for people with questions... and others with possible answers.
p.s. missed a few questions. my pdoc didn't suggest it, i did, after much research... i presented my case, and she decided it was worth a try. It had affect almost immediately (placebo effect?) and my mood was different, good and bad. Good because I was happy I could live up to my potential and it upped my energy level. Bad because I was more aggressive and stood up for myself more... previously being very passive. Bad for my already established relationship patterns... ha! Anxiety did not increase, actually decreased because of a higher confidence in my ability to handle life's curveballs. I was only on it a few months before I discontinued, no withdrawal from it. I was at 40mg X 2 daily at the end. PDoc did try to up me after only 4 day at 40mg x 1 daily in the beginning. It was too soon. I was jittery and decided to stay at 40mg x 1 daily for 2 weeks, then increased.
:)
KDi in Texas
Posted by Clayton on November 8, 2003, at 5:48:15
In reply to Thinking - Attention Deficet Problems-Cognitive, posted by deloris on November 6, 2003, at 3:09:15
I cannot think straigt anymore, started 6 yrs ago, since then various rx's, currently on Lithium-Elavil-Ritalin-Aricept-Klonipin-Estrongen I am 51 and once had a brain, any others experienceing this? Ritalin helps best but get irritable when it wears off, this is a living hell, in the past took provigil, lamitcal, adderall etc, At worse when I awake have to take ritalin to function like to do anything!!!I live in hell, I was never ADHD in past, whats wrong? HELP HELP DR BOB someone........
__________________________________________________
Hi Deloris,You were very concise and yet have given me so much to respound to. I am fifty-two and just got back to work after three months of enforced medical leave brought about by cognitive impairment. No memory. No intuition, highly compromised analytical ability. I am a software engineer whose main HOBBIES were Physics, Math and Philosophy. I am NOT gifted but I used to have a brain and I know how it feels to loose it.
And I have lived in hell, unrelenting misery and suffering, just as you have, with the worst time coming every morning when I tried to get out of bed.
I self-diagnose myself as borderline AD but not HD. I am have an overwhelming amotivatioal syndrome. My main problems are Social Phobia in the extreme (though I love people and need their company), mood depression and insomnia.
How did I get this way? Best GUESSES: 1. genes, 2. extremeley violent dysfunctioal childhood home with 6' 3" mean alcoholic father and a mom who was verbally demeaning to her children and took my father's abuse, setting an example of weakness, 3. Illegal Drugs - about two years of swallowing meth tabs on and off in my twenties causing permanent damage to my dopamine and norephinephrine systems and therefore, my "reward system". I can't set goals, plan or follow through. Maybe it's ADHD but I tend to think that I can't conceptualize the reward at he end of the rainbow. Anyway, this history rules Ritalin out for me. So does 30 years of marijuana use that I have finally stoped. I KNOW pot makes you lazy in the short run and compromises short term memory. Maybe these effects are permanent And so I make no plans and take no actions to influence my future for the beter, 4. Habitual laziness (a little old fahioned thinking there) and, 5. Psycotropic drugs.
Your ADHD is, I think, probably the result of your psychotropics. I think you are taking too many drugs. And the wrong ones. Remember this FACT. NOBODY understands the mechanism of action of a single psychotropic, especially antidepressants - that is, how they achieve their intended result. And that's when one drug is used in isolation. Mix a bunch together and you have a Synergistic Psychotropic Soup that no one can hope to begin to understand. Not a prayer. Maybe in two hundred years but not now. Here's some guesses. 1. I've taken Elavil (to help my insomnia - but NEVER AGAIN). It impairs my mind for days. It's well known a a "dumb drug". It clouds my mind and destroys my ability to reason. I can't sustain a rational train of thought. Why aren't you using a more modern antidepressant? 2. Klonapin: My pdoc put me on Klonapin. For me it is extremely sedating. I can't think. It gives me total amnesia for the entire six hour period it lasts. It is well known that benzos impair memory. This one, Klonapin, I find extremely brutal. It also makes me feel depressed (unlike Xanax). If you are taking Klonapin to help sleep, it is disrupting your brain's normal sleep cycles and impairing the quality of you sleep. Poor sleep equals poor memory and poor reasoning plus bad judgement, 3. Why does yur doc prescribe Aricept? I hope it's not to "compensate" for the memory loss caused by Klonapin and Elavil. That would be CLASSIC BAD PSYCHIATRY. 4. Ritalin: You are blessed not to have an addictive personality but the stuff will still eventually make anyone dependant. Maybe you can't get going without it because you are habituated to it (it may has depleted your dopamine and you need it to squeeze out whatever dopamine is left). 5. I was misdiagnosed with ADHD a couple years back and was given lithium. It did nothing for me except remove my emotions (and that's DEPRESSING) and SEDATE me. More sedation means more impaired cognitive function. 5. Estrogen: No comment. I'm a man and can't understand menopause. If your best judgement is that the benefits of HRT outweigh the risks, I guess you should go for it. You ARE using your Best Judgement, aren't you?
You should be on a modern antidepressant (if any at all). They all have their flaws but Elavil is "dirty" as hell. It affects you brain in literally hundreds of unknown ways.
Are you SURE you have ADHD? You are taking drugs fully capable of explaining the AD symptoms they are prescribed to treat. The ritalin, in theory, could explain manic phases. Here's a suggestion - take it or leave it. Ask you pdoc to explain the purpose of every single drug you take. You should get a clear answer in plain English - no psycho-babble. Ask him/her how they selected the specific drugs that comprise the mixture you take. Again, you should get a clear answer in plain English. The answer should at least demonstate that the doctor was concerned with and mindful of the interaction of every single drug with all the others. Ask the doctor what the synergistic effect is of taking all these drugs in combination. If he/she admit that they are not sure and are going partly on past experience and largely on intuition, that's a GOOD thing! If they pretend, obfuscate or actually believe they know, in my amateur opinion, it is time to find a new doctor.
I am not a healthcare professional. I'm just a guy who has done some reading and thinking. I am bound to be wrong about some things. Use GREAT caution if you decide to heed my advice. But remember to use great caution and your best judgement when heeding a professional's advice, too. They too rely on intuition and educated guesses. It is your responsibility to use your best judgement about whether to accept their best judgement!
Here's one scenario. It's hypothetical and heuristic because I am definetely NOT qualified to plan such a coarse of action: Use every resource at your disposal to find the best pdoc you can. Learn everything you possinly can about your problems and the effect of psychotropics on them. Then go to that doctor. Here's where your self-education comes in. Ask questions. Ask ones you know the answers to from your research. I'm not advising you to ask trick quesstions or be really devious. Just be in a position to assess their knowledge. If they don't know, do they bluff or obfuscate? Does this doctor have a state-of-the-art comprehension of your conditions, the drugs you take and psychotropics in general? Does the doctor admit that in this era in history, there is much we do not know, that their tools are limited, all have negative side-effects and that any treatment they suggest will be based in large measure on past experience and gut level intuition?
THEN use YOUR best judgement and intuition on whether you are willing to give this doctor a try. If so, ask them to skillfully wean you off that soup you are swallowing. I think the Elavil should go first and, at least initially, be replaced by a modern antidepressant. You want to quit or drastically reduce the Klonapin next. This should eventually get you to a state where the doctor can begin to assess whether the ADHD is real or was induced or exacerbated by the medicine. Start to wean off the lithium. If bipolar symptoms don't manifest themselves, try to quit the lithium entirely. If you ARE bipolar, ask about the modern antipsychotic mood stabalizers seeking those that impair your cognition and normal emotions the least.(By this time you WILL feel your cognitive skills returning, either way. Be patient...it will take time). And if your improved skills start allowing you to stay on task, start to get rid of the Ritalin. Use Provigil if it helps (it helps me - what did it do for you when you tried it??? - I'm really curious). I'm not sure of the purpose of the Aricept, but if it was to offset memory loss, you won't need it after you recover from the Klonipin and Elavil.
So where does that leave you? Well, on a single moden antidepressant. It will likely be Stratera (an SNRI) because that is approved for ADHD and will help you stay on task, vigilant and focused. Your Pdoc may want to use bupropion because it has a small dopaminergic effect and weakly blocks reuptake of Seratonin and Norepineohrine, too. It's real mechanism of action is completely unknown and, personally (don't forget...I'm just a guy, NOT a doctor), I think Stratera is your best option. And here's one more suggestion, based only on a personal bias. Add Remaron as a second antidepressant. I'm very enthusiastic about it because it worked for me. It gave me my life back. I CREDIT REMARON WITH RESTORING MY MEMORY AND COGNITIVE FACALTIES. Remaron is unique. It enhances both seratonin and norepinephrine levels by increasing the supply produced in you brain, not by blockung reuptake. It has no sexual side-effects. And it starts working in about three days.(Effexor would also support the same two neurotranmitters but it would do so by reuptake blocking. Read about it in this forum. There are a lot of scary stories about side effects and terrible withdrawl symptoms).
With this combo, you would have synergistic support for norepinephrine levels based on the dual action: increased supply and diminished reuptake. Good for mood, concentration, focus, drive and staying on task. The Remaron will also suport your seratonin levels. Some reputable research studies show that Remaron improves memory (I can send the links if you want them) I won't bore you with the details but Remaron plus an SSRI (Paxil) saved my life. I was amazed! I had given up hope on drugs. In my case, we're talking about putting the synergistic emphasis on the seratonin side. In your case,with Stratera, the norepinephrine side. (Because of my amotivational syndrome, my doc and I are considering swapping out the Paxil for Stratera. The decision is yet to be made. He says it may improve my mood substantially as well as help with motivation and completing tasks. I broached the idea and he said he had already been considering it. Although Paxil had little efficacy until Remaron was added, it is still the "Social Anxiety" drug and I'm a little afraid to abandon it or mess with success.
Please forgive such detailed advice from an amateur. My honest guess is that you are on too many meds and probably some that are wrong for you.
If you find the right doctor and work together with him/her you WILL FREE YOURSELF FROM HELL and get your MIND BACK!
This happened for me and I know it can happen for you. I have not had a single SAD attack since I got with the right doc on the right TWO meds - I can't take credit; it was partly good luck. (Maybe some day, I'll manage with fewer. That's certainly what Solo seems to have done). My mood depression has lifted. Most mornings I awaken happy and get up early. I still have my bad days, but not nearly as bleak and black and conflicted and rending as before. There has been one recent setback, really a major tragedy in my life, that I've discussed in other posts. It actually was precipitated by too high a dose of Remaron acting in concert with Paxil resulting in seratonin levels that were way to high.
Just like your ADHD seemed to appear out of nowhere, I woke up one day and began to discover that something entirely new was happening to me - I was manic depressive. I walked around crying and wailing, then seitched to excited, animated ceaseless talking and ranting. Both behaviors are entirely out of character and without precedent for me. One of the classic behaviors of bipolar disorder is spending money you don't have. I sat here at the computer all night one fine evening buying things and overdrawing my checking account by $1000.00. It sure was fun! So the Remaron dose has been dialed down and I am taking a modern antipsychotic mood stabalizer, zyprexa, temporarily until we are comfortable that the seratonin levels are proper. This is one reason why my doc and I are thinking of substituting Strattera for Paxil.
If I'm way off target with my suggestions here, I apologize.
If you ever want to discuss these issues privately, email to TheoryQuery@aol.com.
Take Good Care of Yourself!
OTHER: Provigil is very helpful to me as an occassional adjunct to the SSRI and Remaron. You mentioned that you've tried it. I'm very interested in what you experience with it was like and why you discontinued use. It improves my memory, reduces anxiety, sharpens my mental focus and allows me to quickly direct focus to a variety of disparate tasks that may all be hitting me at once. That sound like hyperbole so perhaps I should just say my brain seems to function like when I was in college again.
Posted by deloris on November 16, 2003, at 19:09:05
In reply to Try Strattera, helped me (nm) » deloris, posted by KimberlyDi on November 6, 2003, at 11:33:17
Thanks to all who replied. I was not given Ritalin until 4 yrs after having the cognitive problems. That was the only thint that helped, I was off of it for 1 month and only took lithium and zoloft. The zolfot didn't do nothing for me, so I went back to elavil cause at least I can sleep when I take it, before that it was klonopin and ambien to fall asleep, I hate taking the lithium (constant urination) but it does keep me more calm. What drives me crazy is that ya I am depressed because I can't use my mind anymore not because of anything else, I'm tired of doc's telling me I'm depressed, any person would be depressed if they couldn't use there mind anymore, is it early Alzeimers? I think alot of peole are getting this and getting diagnoised as depressed or bi polar, how in the hell do you get Bipolar overnight? Or AD? I used to take Depoprover birth control shots and it seemed when I quit taking them all this started but when I tell the doctors that they don't hear me, one said oh that would be hard to prove and got snooty.
This is the end of the thread.
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