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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by spoc on March 21, 2004, at 23:28:50
Hi,
I was put on Ritalin alone in January, and can't figure out if it's actually making my problems worse; is just insufficient alone; or if some other independent problem(s) have just kicked in or worsened. I’ve added some background in case it will help any "similar someones" out there to see any of his/her own history in it. Any responses will be much appreciated – I’m pretty new to the meds game and I have so many factors that could be mimicking other things, that I fear I’ll never figure things out. Ask your pdoc, you say? My (soon to be ex) pdoc isn’t into actually discussing the meds he picks for a patient; or exploring complications -- or solutions -- off the beaten path.
I had sought help for what have always felt like chemical issues (mainly mild to moderate depression/lethargy and OCD-like rigidity/time wasting/overthinking); but that could partly be a "developmental" issue (complete lack of structure & direction) that turned monstrous as I managed to continue floundering all my life. Never had to learn wind-up OR follow through, or even fake it for long. Have had an insufficient, unmonitored, 100% flexible work-at-home job for years now, and no other real responsibilities or commitments (e.g. spouse, kids, pets, family nearby, scheduled obligations). Know lots of people but keep a tight valve on it -- constructed total privacy and show only what I want, when I want. I detest all of the above and it makes me miserable, by the way. So as you can see, with a set up like this I'm not sure where anything originates. Does the OCD and depression/lethargy come to get me; or do I give in to an OCD grip because I can, and then get depressed/lethargic from the time wasting, going nowhere fast and inertia? Historically I have had some anxiety problems but as I can hide to my heart’s content now the untriggered, remaining extent is blurred and unknown. And I have some very bizarre, not inconsequential little tendencies but not actual “rituals” as I understand them.
A sub-type of ADD was surmised. When first on 5 mg. Ritalin 3x/day, I felt a huge improvement in making small decisions as I went through my daily routine and errands. Which previous to that I had begun to let slide to the extent possible, often due to getting hung up on the 10,000 related factors my brain conceives of in relation to anything I try to do, no matter how simple. But I noticed not much if any improvement in the things I tend to hyperfocus and lock onto (e.g. anything that can be done on a computer. I think this is a true addiction but that's another topic). Anyway I did feel the classic calming effect from the Ritalin rather than any kick or whatever.
Then, I started becoming very depressed and at first assumed it was all due to the negative, mismatched type of therapy I had simultaneously started, which was and still is a real factor especially because it wasn’t what I signed on for and was a shock to be getting. Pdoc said to raise Ritalin dose to 10 mg. but still I got more depressed, and couldn't shake it even briefly after forcing myself to get out and mobilize for awhile, which is rare. Have ended up in my most paralyzed, withdrawn state ever. Am locking onto computer almost 24/7 and don't know if that is cause or effect, but prior to Ritalin and this “therapy” I had some control over yanking myself away for awhile (before this it was a lock on exercise but I didn’t truly “enjoy” that as I do computers). Pdoc said go up to 15 mg. and then 20. I got to 15 then stopped, because the depression and lethargy weren't lifting as he predicted and I was sure I was hyperfocusing more. And generally feeling horrible physically. I admit that my nutrition and health habits are a mess, BUT they were for years before this too and I didn’t feel anywhere near this bad.
Apparently depression isn't typically caused by Ritalin, so if my nosedive was independent, I'm wondering if maybe Ritalin only helps me when I am up and out and moving, and need to make those small decisions that are unconscious for most? Is it possible that it could either not help -- or make worse -- a focused, concentrated activity like computer work/writing; but help at other times? Or does the way I've reacted just mean this is not the drug for me (i.e. even just working behind my computer I should feel better, or even be able to extricate from the damn thing)? Believe me when I tell you I didn't sabotage it. I wanted and expected it to work, and was highly encouraged at first. It seemed the least of the psy med evils in many ways.
Had told the pdoc that SSRIs haven't worked for me (mostly apathy) and sadly as it’d be “perfect,” neither did Wellbutrin (agitates me and exacerbates the hyperfocus). I asked him whether, if the increased Ritalin dosing wasn't the trick, I could next try combining it or maybe Wellbutrin with something to address the downsides of how those affect me. Or, trazodone in low dose (25 to 50 mgs) for sleep has actually had a big AD effect on me in the past when combined with a stimulant, but I don't know if that would last since supposedly 25 to 50 mgs is too low to dent depression. Also asked if, independently or with something else, I should try Klonopin. I have had Valium around for sleep forever but rarely touch it despite raging insomnia, due to bittersweet “why bother” benzo nature. Thought maybe I should try to get over that and take a chance. I know that I often feel very good the day *after* I do take a Valium for sleep. I’m not ready to jump to trying TCAs or MAOIs yet. (Yes, in all of this you’re hearing the weight gain fear. My metabolism and history justifies it, but for years I’ve kept it in check with huge effort and I won’t give in without trying all else first. FYI, I did gain weight on Zoloft previously. I know, ultimately it’s a matter of how much more a person can stand before they bite the bullet.) I shouldn't bring this controversy up so never mind but I was also open to trying Tramadol, at least to get over the worst hump and “paralysis.”
Bottom line is I could “risk” trying whatever now, since under the “developmental” problem theory I think if I can stay mobilized for just long enough to accomplish something and increase faith in myself, maybe I’ll be able to take it from there on my own. For what (if anything) it’s worth, I’m by nature conservative and cautious with drugs so no preexisting “tendencies” are there to stir up through usage of any given thing. If it sounds like it really isn’t prudent to use something regularly (say a few times a week at least), I won’t bother using it all at. Like how I’ve been with the Valium so far. But I need to reevaluate everything. I haven't seen pdoc since I gave up on the Ritalin, but he already balked at all of the above and told me his next Instruction will be Effexor. He thinks that is the next "cleanest" and least complication-loaded choice, but isn't that kind of.....LUDICROUS to say???? I think everything I mentioned above would be a shorter and less messy trial...
Sorry for any unnecessary word count here, I just have little experience with this stuff and so many of you seem to know so much. I hunger for your eyes and minds! Hoping my saga rings some bells with someone!!! Thank you! ;- )
Posted by zeugma on March 21, 2004, at 23:57:38
In reply to Ritalin = hyperfocus, lethargy?? Other med ideas?, posted by spoc on March 21, 2004, at 23:28:50
Effexor is what Dr.Amen recommends for Overfocused ADD (which is basically ADD plus OCD). Clomipramine (a TCA) might be even better for this sub-type, but would probably cause some weight gain. Effexor by itself would be a toss-up as to weight gain, but the meds you might have to take to deal with the s/e would probably cause you to gain weight :)
Or you could try Strattera. It would help with the depression but I doubt it would do much for the addictions- unless your obsessions are anxiety-driven, in which cause it might have an anxiolytic effect. It definitely would, if you combine it with Klonopin.
Strattera seems to cause modest weight loss. It is the best alternative from that point of view.
Posted by spoc on March 22, 2004, at 1:01:17
In reply to Re: Ritalin = hyperfocus, lethargy?? Other med ideas?, posted by zeugma on March 21, 2004, at 23:57:38
Thanks, that's good to hear because based on some things I've read I was recently wondering about the Strattera possibility!! (FYI, earlier I posted some unique dosing info I found to another thread). As you mentioned I did see it can exacerbate overfocus in some, but zeroed in on the potential for the AD effect, in a drug that's still within the class of those which treat what I may have (this pdoc diagnosed ADD based only on a conversation). Maybe my "obsessions" WILL turn out to be anxiety-driven. Either way I think Strattera is way worth a shot. Just curious for future reference -- is it being commonly combined with various other things yet (to adjust for any "deficits" in its action on a given person), as are so many other meds?
So disappointing that my pdoc didn't think of or bother mentioning such an obvious thing, especially given the minefield that is Effexor, HIS next idea. And I don't think it would be outrageous to prescribe both Strattera and Klonopin-as-needed at my next visit, but his only song seems to be if not Ritalin, an SSRI, and by itself. I'm sure I could get that kind of revolutionary and probing analysis from any GP....or dentist. (Sorry, I'm not usually as much of a 'tude person but it's just been such a massive and expensive wipe out with this guy.)
> Or you could try Strattera. It would help with the depression but I doubt it would do much for the addictions- unless your obsessions are anxiety-driven, in which cause it might have an anxiolytic effect. It definitely would, if you combine it with Klonopin.
>
> Strattera seems to cause modest weight loss. It is the best alternative from that point of view.
Posted by Keith Talent on March 22, 2004, at 7:12:18
In reply to Re: Ritalin = hyperfocus, lethargy?? Other med ideas? » zeugma, posted by spoc on March 22, 2004, at 1:01:17
Lots of people here have complained that Ritalin makes them too on edge. Perhaps you should go for Dexedrine (some say it calms them) and clomipramine (OCD and depression).
Posted by Hattree on March 22, 2004, at 7:42:16
In reply to Re: Ritalin = hyperfocus, lethargy?? Other med ideas?, posted by Keith Talent on March 22, 2004, at 7:12:18
I find Ritalin a poor excuse for a stimulant. For me its almost absurdly short-acting (kind of like a carnival ride you wait in line for and then its over in 30 seconds). Not sure that's why but its also the worst for me on my moods. Give Dexedrine or Adderall a shot, or even Concerta (long-acting Ritalin--not my fave either, but better than the regular). My son does fine on Ritalin, though, ymmv.
Posted by Bill LL on March 22, 2004, at 8:45:23
In reply to Ritalin = hyperfocus, lethargy?? Other med ideas?, posted by spoc on March 21, 2004, at 23:28:50
Although SSRI's by themselves did not work, they might work for you in combination with Ritalin. The study was done on geriatric patients, but should apply to younger ages also. The results were very good for this combination.
Posted by spoc on April 3, 2004, at 13:49:43
In reply to Re: Ritalin = hyperfocus, lethargy?? Other med ideas?, posted by Bill LL on March 22, 2004, at 8:45:23
Hi, a belated thanks to everyone! Just wanted to post this update so that anyone surfing Ritalin s/e won't be unnecessarily discouraged. I am starting to have some medical testing done and for one thing, just found out I have had a chronic, untreated sinus infection for years, that has contributed to making my head an un-fun place to be no matter what. The GP I saw before the specialist said he believes that sometimes "speed" related drugs are used as part of sinusitis treatment (which may be a different thing), so he didn't suspect a connection between my feeling awful and the Ritalin. But *I* theorize that after years of having this infection -- untreated with antibiotics and flaring up in full intermittently -- my head feels so crummy that I blamed the Ritalin when this recent flare-up coincided with it. My sinus infection symptoms involve a lot more fatigue, headache, general head congestion and dizziness than they do runny nose, sneezing, etc. I am still having other things looked at too but just wanted to state for the record that the problem may not have been the Ritalin at all...
This is the end of the thread.
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