![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by MrTook on May 24, 2010, at 12:01:27
My therapist mentioned to me once that he has seen good results from people who take a drug holiday for a couple of weeks to try to regain some efficacy from a drug that has worked for them before. Have any of you had any success with something like this?
Posted by bleauberry on May 24, 2010, at 16:09:23
In reply to Drug Holiday?, posted by MrTook on May 24, 2010, at 12:01:27
Well, if you like a horrific withdrawal syndrome that kicks in within a couple days and then the real risk of the drug not working like it did before, go for it.
I don't know who the therapist is and I can't comment on that, only to say it doesn't sound to me like they are trained on the workings of drugs.
With some meds, such as stimulants (adderall, ritalin), and benzos (xanax, klonopin), and opioids (pain killers, tramadol), then yes drug effectiveness can be restored via a drug holiday. That is, if you can weather a potentially severe withdrawal syndrome. They are characterized by intense anxiety, flu-like symptoms, dark depression.
I can't think of a single antidepressant or antipsychotic or mood stabilizer drug that you can just stop for a holiday and not experience the worst nightmare of your life.
It depends though on how long you've been on it. The longer, the harder to stop. Once in a while someone can just stop a med cold turkey and have no problem at all. That is rare.
As many have noted here over the years, too many to count, returning to a drug that previously worked is often a disappointment. It is not unusual for it to not work like it did before. This is mostly seen with any of the reuptake inhibitors. Granted, some people can start and restart their zoloft or prozac over the years and have it work every time, but that is rare.
If a drug you are taking is not working like it used to, then the best first step is to add another one to it that has a different mechanism. For example if the drug is zoloft, a serotonin med, then you would consider adding a norepinephrine med to it, such as nortriptyline. After a few add-on trials that don't work out, then the next step is to switch completely to a new med.
Bottom line though is that a therapist is not a doctor. If you have a trusting relationship with your doctor and you are confident of their expertise, then ask them if the therapist idea is a good one or not and ask if you can just stop the med cold turkey without any problems. I think most doctors would be very uncomfortable with that idea.
Posted by MrTook on May 24, 2010, at 18:04:49
In reply to Re: Drug Holiday?, posted by bleauberry on May 24, 2010, at 16:09:23
Thank bleauberry. This poop-out just has me really anxious.
I had a great 4 years on lexapro 10 mg, and then I just went through the rabbit hole about a year ago. Went up to 20 mg lex and that worked pretty well, but had a few lapses. I added deplin, but I am in the middle of another lapse right now.
I know I really haven't even begun to scratch the surface of medication, but as my problems seem to mainly manifest as GAD/OCD you can probably see why I might be upset.
I wouldn't disparage my counselor too much. He seems like a really good guy and he made sure to tell me that I should ultimately follow the plan my pdoc laid out for me. I was just curious if others had had success with a holiday strategy.
Posted by morganator on May 24, 2010, at 20:09:29
In reply to Re: Drug Holiday?, posted by MrTook on May 24, 2010, at 18:04:49
You may just be having a period of more depression/anxiety that may just need some time to pass. I say stay on Lexapro, start taking fish oil if you do not already, and start exercising religiously and stretching if you have the energy. Stay away from alcohol.
Posted by StillHopefull on May 24, 2010, at 20:52:05
In reply to Re: Drug Holiday?, posted by morganator on May 24, 2010, at 20:09:29
I had plenty of meds poop out over the years. I either increased the dose, added on another med, or changed meds completely. NEVER heard of a drug holiday for ADs.
Maybe you should increase the dose of Lexapro... Over a period of about 5 years I increased my dose of Lexapro up to 60mg. That dose worked for about 2 years before it pooped out.
Good luck!
Posted by detroitpistons on May 26, 2010, at 15:19:39
In reply to Drug Holiday?, posted by MrTook on May 24, 2010, at 12:01:27
My doctor basically implied to me that I will be on meds for the rest of my life. She said that if I've had several episodes of depression, that there's a ninety something percent chance that I'll get another one. I was not aware of that the probability was so high, but it does make sense. However, I think a tiny percentage of depressives who can become like a super meditative, Nirvana-reaching Zenmaster could stave off depression forever. :)
> My therapist mentioned to me once that he has seen good results from people who take a drug holiday for a couple of weeks to try to regain some efficacy from a drug that has worked for them before. Have any of you had any success with something like this?
Posted by bleauberry on May 26, 2010, at 16:40:19
In reply to Drug Holiday?, posted by MrTook on May 24, 2010, at 12:01:27
Ask to add Nortriptyline to your ongoing Lex.
I have no scientific proof, but I am convinced that when a treatment targets both norepinephrine and serotonin simultaneously in fairly equal potencies, the likelihood of a more complete response is enhanced and the likelihood of avoiding poopout is enhanced. While SSRIs are so popular because of their supposed lighter side effects (not true) and because of the political atmosphere of the medical community, I am convinced that focusing treatment predominantly on serotonin at the expense of the other neurotransmitters is destined for disappointment down the road. I say that based on hundreds of posts I've seen here over the years from longtime SSRI users. The longest I ever saw someone go on prozac was 10 years, zoloft 8 years, lexapro 4 years, and all of those were very rare happenings in the big picture. Nearly everyone following longterm pure SSRI treatment develops some kind of weird problems they never had before, in addition to their original symptoms.
But that is just what my eyes have seen. Take it or leave it at your discretion.
Dr Gillman at www.psychotropical.com has some great stuff you should read on dual-function antidepressants. There are none on the market. Effexor and Cymbalta do not qualify, as their potencies for serotonin vs norepinephrine are predominantly serotonin with very little norepinephrine. You have to create your own with a combo such as Lex + Nortriptyline.
Posted by MrTook on May 27, 2010, at 20:29:09
In reply to Re: Drug Holiday?, posted by detroitpistons on May 26, 2010, at 15:19:39
yeah I am pretty okay with the fact that I will be on meds of some sort. I was thinking of just going off to try to boost efficacy. I think there is a consensus that that is a bad idea and I will agree with that.
Posted by MrTook on May 27, 2010, at 20:39:19
In reply to Re: Drug Holiday?, posted by bleauberry on May 26, 2010, at 16:40:19
Bleauberry thank you for the follow up. I will certainly talk to him about that. Just one question in your mind are Amitriptyline and Nortriptyline equivalent or is Nortriptyline superior?
I have been a little wary of norepinephrine reuptake inhibition is the simplistic view is that norepinephrine can be the anxious neurotransmitter.
Posted by jedi on May 28, 2010, at 0:12:22
In reply to Re: Drug Holiday?, posted by MrTook on May 27, 2010, at 20:39:19
> Bleauberry thank you for the follow up. I will certainly talk to him about that. Just one question in your mind are Amitriptyline and Nortriptyline equivalent or is Nortriptyline superior?
>
> I have been a little wary of norepinephrine reuptake inhibition is the simplistic view is that norepinephrine can be the anxious neurotransmitter.Well I'm not Bleuberry but I'll put in my two cents anyway. Nortriptyline is the major metabolite of Amitriptyline. IMHO it is a cleaner medication.
Jedi
Posted by Dr. Bob on May 28, 2010, at 14:17:00
In reply to Re: Drug Holiday? » MrTook, posted by jedi on May 28, 2010, at 0:12:22
> Nortriptyline is the major metabolite of Amitriptyline. IMHO it is a cleaner medication.
Could you explain what you mean by "cleaner"? Some people might get the wrong idea. Thanks,
Bob
Posted by jedi on May 28, 2010, at 15:16:15
In reply to Re: cleaner medications, posted by Dr. Bob on May 28, 2010, at 14:17:00
> > Nortriptyline is the major metabolite of Amitriptyline. IMHO it is a cleaner medication.
>
> Could you explain what you mean by "cleaner"? Some people might get the wrong idea. Thanks,
>
> BobSure, sorry for not being more clear in my statement. By "cleaner" I just meant that nortriptyline would probably have less side effects than amitriptyline.
The other definition of "cleaner", in regards to psychotropic medications, is that a medication can be more specific in its affect on neurotransmitters. The "cleaner" medications, such as SSRIs affect mostly serotonin. Where a "dirty" medication, like my friend Nardil; affects serotonin, norepinephrine, dopamine, GABA and who knows what else.
Oh He**, I give up,
Jedi
Posted by Dr. Bob on May 28, 2010, at 16:17:41
In reply to Re: cleaner medications » Dr. Bob, posted by jedi on May 28, 2010, at 15:16:15
Posted by morganator on June 1, 2010, at 1:51:37
In reply to Re: Drug Holiday?, posted by bleauberry on May 26, 2010, at 16:40:19
> Ask to add Nortriptyline to your ongoing Lex.
>
> I have no scientific proof, but I am convinced that when a treatment targets both norepinephrine and serotonin simultaneously in fairly equal potencies, the likelihood of a more complete response is enhanced and the likelihood of avoiding poopout is enhanced. While SSRIs are so popular because of their supposed lighter side effects (not true) and because of the political atmosphere of the medical community, I am convinced that focusing treatment predominantly on serotonin at the expense of the other neurotransmitters is destined for disappointment down the road. I say that based on hundreds of posts I've seen here over the years from longtime SSRI users. The longest I ever saw someone go on prozac was 10 years, zoloft 8 years, lexapro 4 years, and all of those were very rare happenings in the big picture. Nearly everyone following longterm pure SSRI treatment develops some kind of weird problems they never had before, in addition to their original symptoms.
>
> But that is just what my eyes have seen. Take it or leave it at your discretion.
>
Are you sure cases of being successfully treated with SSRIs for a long time is all that rare? Don't you think this may just what you have seen, as you already mentioned? I know several people that have had success on one SSRI for a very long time. I think we just hear about the cases of "poop out" and other bad experiences on the internet. I was on Zoloft for 8 years and the only reason it stopped working was because I stopped taking it. I crashed 5 months later after the perfect storm sent me into a horrible mixed state. After this I tried Zoloft and it just didn't work for me the same way. I had a lot more going on then also. If I had not stopped taking Zoloft and had avoided physical and emotional trauma, there is a very good chance I would still be successfully treated by it today. I just think we hear more about the bad experiences people have on the net and the people having good experiences are simply out there living their lives and not bothering to come on the internet to tell everyone how great their medication has been working for them for so many years.
Posted by humanPDR on June 9, 2010, at 9:15:42
In reply to Re: Drug Holiday?, posted by morganator on June 1, 2010, at 1:51:37
> > Ask to add Nortriptyline to your ongoing Lex.
> >
> > I have no scientific proof, but I am convinced that when a treatment targets both norepinephrine and serotonin simultaneously in fairly equal potencies, the likelihood of a more complete response is enhanced and the likelihood of avoiding poopout is enhanced. While SSRIs are so popular because of their supposed lighter side effects (not true) and because of the political atmosphere of the medical community, I am convinced that focusing treatment predominantly on serotonin at the expense of the other neurotransmitters is destined for disappointment down the road. I say that based on hundreds of posts I've seen here over the years from longtime SSRI users. The longest I ever saw someone go on prozac was 10 years, zoloft 8 years, lexapro 4 years, and all of those were very rare happenings in the big picture. Nearly everyone following longterm pure SSRI treatment develops some kind of weird problems they never had before, in addition to their original symptoms.
> >
> > But that is just what my eyes have seen. Take it or leave it at your discretion.
> >
> Are you sure cases of being successfully treated with SSRIs for a long time is all that rare? Don't you think this may just what you have seen, as you already mentioned? I know several people that have had success on one SSRI for a very long time. I think we just hear about the cases of "poop out" and other bad experiences on the internet. I was on Zoloft for 8 years and the only reason it stopped working was because I stopped taking it. I crashed 5 months later after the perfect storm sent me into a horrible mixed state. After this I tried Zoloft and it just didn't work for me the same way. I had a lot more going on then also. If I had not stopped taking Zoloft and had avoided physical and emotional trauma, there is a very good chance I would still be successfully treated by it today. I just think we hear more about the bad experiences people have on the net and the people having good experiences are simply out there living their lives and not bothering to come on the internet to tell everyone how great their medication has been working for them for so many years.
>
>As a student of neuroscience and biochem, I totally agree with you. Having taken a couple of SSRIs with absolutely no reduction in depression/anxiety, IMO serotonin isn't the whole picture. All the SSRIs did was turn me into a lobotomized individual with ZERO motivation, flat affect etc...terrible. The only thing that has ever worked is that MAO Selegiline in the EMSAM patch (at min dose of 6mg to maintain MAO-B selectivity). In my case, my depression was dopaminergic, not serotonergic.
That being said, many people do respond well to them, although statistically they aren't much better than placebos. Placebos in treatment of depression are surprisingly effective however, which may lead to a statistical "under-estimation" of SSRI efficacy.
The truth is, the scientific community still doesn't know **** about the complex pathophysiology of depression. Theories range from NT/receptor ratios/lvls to endogenous endorphin abnormalities to abnormal HPA-axis (hypothalmic-pituitary-adrenal axis) which has alot to do with elevated stress hormones exerting negative feedback and various brain regions. This theory is supported by the observed atrophy (monitored by CREB mRNA via in situ hybridizations) of brain regions such as the hippocampus in chronic depressives.
IMHO, I think depression has its roots in all three of those theories, but in different "ratios" from patient to patient, which is why some respond to SSRI, and some only to MAOIs. But I still feel that to focus solely on the 5-HT system is a vastly oversimplified pharmacological target.
Posted by detroitpistons on June 9, 2010, at 11:33:52
In reply to Re: Drug Holiday?, posted by humanPDR on June 9, 2010, at 9:15:42
> > > Ask to add Nortriptyline to your ongoing Lex.
> > >
> > > I have no scientific proof, but I am convinced that when a treatment targets both norepinephrine and serotonin simultaneously in fairly equal potencies, the likelihood of a more complete response is enhanced and the likelihood of avoiding poopout is enhanced. While SSRIs are so popular because of their supposed lighter side effects (not true) and because of the political atmosphere of the medical community, I am convinced that focusing treatment predominantly on serotonin at the expense of the other neurotransmitters is destined for disappointment down the road. I say that based on hundreds of posts I've seen here over the years from longtime SSRI users. The longest I ever saw someone go on prozac was 10 years, zoloft 8 years, lexapro 4 years, and all of those were very rare happenings in the big picture. Nearly everyone following longterm pure SSRI treatment develops some kind of weird problems they never had before, in addition to their original symptoms.
> > >
> > > But that is just what my eyes have seen. Take it or leave it at your discretion.
> > >
> > Are you sure cases of being successfully treated with SSRIs for a long time is all that rare? Don't you think this may just what you have seen, as you already mentioned? I know several people that have had success on one SSRI for a very long time. I think we just hear about the cases of "poop out" and other bad experiences on the internet. I was on Zoloft for 8 years and the only reason it stopped working was because I stopped taking it. I crashed 5 months later after the perfect storm sent me into a horrible mixed state. After this I tried Zoloft and it just didn't work for me the same way. I had a lot more going on then also. If I had not stopped taking Zoloft and had avoided physical and emotional trauma, there is a very good chance I would still be successfully treated by it today. I just think we hear more about the bad experiences people have on the net and the people having good experiences are simply out there living their lives and not bothering to come on the internet to tell everyone how great their medication has been working for them for so many years.
> >
> >
>
>
>
> As a student of neuroscience and biochem, I totally agree with you. Having taken a couple of SSRIs with absolutely no reduction in depression/anxiety, IMO serotonin isn't the whole picture. All the SSRIs did was turn me into a lobotomized individual with ZERO motivation, flat affect etc...terrible. The only thing that has ever worked is that MAO Selegiline in the EMSAM patch (at min dose of 6mg to maintain MAO-B selectivity). In my case, my depression was dopaminergic, not serotonergic.
>
> That being said, many people do respond well to them, although statistically they aren't much better than placebos. Placebos in treatment of depression are surprisingly effective however, which may lead to a statistical "under-estimation" of SSRI efficacy.
>
> The truth is, the scientific community still doesn't know **** about the complex pathophysiology of depression. Theories range from NT/receptor ratios/lvls to endogenous endorphin abnormalities to abnormal HPA-axis (hypothalmic-pituitary-adrenal axis) which has alot to do with elevated stress hormones exerting negative feedback and various brain regions. This theory is supported by the observed atrophy (monitored by CREB mRNA via in situ hybridizations) of brain regions such as the hippocampus in chronic depressives.
>
> IMHO, I think depression has its roots in all three of those theories, but in different "ratios" from patient to patient, which is why some respond to SSRI, and some only to MAOIs. But I still feel that to focus solely on the 5-HT system is a vastly oversimplified pharmacological target.Amen! The SSRI's that I've tried didn't do much for me either. Apparently, norepinephrine plays a significant role in my particular depression because I've only responded well to Effexor.
Posted by Humanpdr on June 11, 2010, at 8:08:11
In reply to Re: Drug Holiday? » humanPDR, posted by detroitpistons on June 9, 2010, at 11:33:52
That's good effexor works for u!!
Posted by Tony P on June 13, 2010, at 14:46:19
In reply to Re: Drug Holiday? » detroitpistons, posted by Humanpdr on June 11, 2010, at 8:08:11
Having been pretty sure for years that I have "atypical depression", I did some more reading on it recently, and discovered (1) Yes, I fit the description in even more ways than I realized; (2) it's not really "atypical" at all -- when the whole spectrum of depressions is looked at, "atypical" is the commonest single form! So pure SSRI's not only don't work for me, they probably don't work well for 40% of the depressed population.
I've had a strong belief for years that all 3 of the usual transmitters are important in relieving depression, and that dopamine was largely ignored because of its bad associations with cocaine & other addictive substances. Now dopamine seems to be getting more attention again. My own present regime hits all three receptors (+GABA) with a cocktail of 6 meds, and works well most of the time.
Moreover, it makes it easier to take a drug holiday from one med without major withdrawal nasties. I've found that just a 2 or 3 day holiday can give me a rebound surge of energy. Longer term ones take more planning, and probably require some replacement meds.
I do think a holiday can be helpful, but there are risks: I switched from Serzone to Wellbutrin some years ago when the Serzone seemed to be pooping out, and I am convinced that the Wellbutrin permanently affected my response to Serzone (at least for a year or two). When I went back on Serzone, I got much worse SRI side-effects, and it no longer had the beneficial effect on sleep.
Posted by stewie on June 14, 2010, at 17:18:44
In reply to Re: Drug Holiday?, posted by humanPDR on June 9, 2010, at 9:15:42
Just to complicate matters, I will put in my two-cents.
I returned to celexa and lamictal several years after they pooped-out. I was skeptical, because returning to ssris that had once worked but then stopped had just been a waste.For some reason, though, going back to this combo helped once.
I'm not going to say that it did not poop out again, because it did, but I got a bit of mileage out of it even on round 2.Having said all of that, the notion of hitting other receptors certainly makes a lot of sense to me, and maybe you will find yourself doing that no matter what.
I am really starting to think that so many doctors develop such a "willy-nilly" approach because they are stuck with tools that promise much more than they deliver and because we humans are so idiosyncratic in our responses. Small wonder that so few graduating doctors go into psychiatry.
Posted by detroitpistons on June 15, 2010, at 10:44:16
In reply to Re: Drug Holiday?, posted by stewie on June 14, 2010, at 17:18:44
I respect psychiatrists in that they more or less have zero tools to work with...It's like trying to flip a pancake with a fork! What they do is all about having knowledge gained by working with hundreds or thousands of patients. The same goes for all doctors, but especially psychiatrists because they are stuck in the stone age as far as having diagnostic and prescribing tools.
That said, I think it would be good if psychiatrists had extra training in neuropharmacology.
> Just to complicate matters, I will put in my two-cents.
> I returned to celexa and lamictal several years after they pooped-out. I was skeptical, because returning to ssris that had once worked but then stopped had just been a waste.
>
> For some reason, though, going back to this combo helped once.
> I'm not going to say that it did not poop out again, because it did, but I got a bit of mileage out of it even on round 2.
>
> Having said all of that, the notion of hitting other receptors certainly makes a lot of sense to me, and maybe you will find yourself doing that no matter what.
>
> I am really starting to think that so many doctors develop such a "willy-nilly" approach because they are stuck with tools that promise much more than they deliver and because we humans are so idiosyncratic in our responses. Small wonder that so few graduating doctors go into psychiatry.
Posted by Humanpdr on June 15, 2010, at 16:04:12
In reply to Re: Drug Holiday? » stewie, posted by detroitpistons on June 15, 2010, at 10:44:16
I absolutely think psychiatrists should have more extensive psychopharmacology/neurology training. The problem is that in medical school, 99 percent of the material is basic physiology/anatomy etc. Little time is spent exclusively on psychopharmacology, and psychiatry is definately a neglected field, both by big pharma and medical training.
That being said, my psychiatrist is awesome. He and I discuss complex pharmacology and approach my anxiety/depression from a very analytical/empirical POV, which I love bc I'm a neuroscience and Chem dual major at my university. But there are SO MANY ignorant MDs who know literally only undegrad intro psychology level material when it comes to psychopharmacology.
Posted by detroitpistons on June 15, 2010, at 17:21:34
In reply to Re: Drug Holiday?, posted by Humanpdr on June 15, 2010, at 16:04:12
Totally agree...I had a doctor who wouldn't prescribe me Dexedrine instead of Adderall, but he didn't really give a good explanation of why. I think it had to do with Dexedrine having a bad stigma a long time ago because it was probably abused a lot (maybe even by med students in the 70's!). However, I think that more and more doctors are going back to it for people who don't prefer the peripheral nervous system stimulation from the L-amphetamine.
I only know basic chemistry and basic biochemistry, but even with that level of knowledge, I can still figure out that out of the 4 salts in Adderall, the D-amphetamine is still the majority component (roughly 75 percent?). I tried to nicely explain that to him, using more of a questioning tone so that he didn't feel like I was lecturing him. I said something to the effect of, "But doesn't Adderall have largely the same active ingredient as Dexedrine?" He still wouldn't prescribe it to me. If anything, I would think that Adderall has more abuse potential than plain old D-amphetamine because of the stimulating effects of the levo enantiomer...I don't know.
Psychiatrists need to be intimately familiar with the chemistry of the brain, but a lot of this just comes down to a doctor's interest in the field, work ethic, time constraints, etc. If you're a psychiatrist, you need to keep up with the research, read papers, read journals, etc, perhaps even more than other specialists.
Regarding psychotropic drug discontinuation, I don't think most psychiatrists have any clue as to what's going on in the brain. Some doctors still don't take withdrawal very seriously. I've seen studies that indicated physiological changes such as reduced cerebral blood volume...Bottom line, they have to have a pretty good knowledge of organic chemistry, neurology and pharmacology, and many of them don't.
I hate to keep using ADHD stimulants as examples (the same ideas apply across the board), but some doctors now prefer to prescribe Vyvanse for ADHD patients who previously took Adderall (or Dex) successfully. Why? Is there actually a therapeutic benefit or are they just "going with the flow" and listening to the drug reps too much? I just don't think that a lot of people, including doctors, are putting 2 and 2 together. My doctor wanted to get me on Vyvanse, which is hilarious to me because he wouldn't prescribe me Dexedrine, which is essentially the exact same drug!!! Unbelievable.
If you have a patient who has been compliant with Adderall or Dex for a long time and isn't an abuser, then why spend the extra money and switch to Vyvanse? Cost is a big issue to me because I don't have insurance. Unless I'm missing something here, Vyvanse is simply D-amphetamine/Dexedrine attached to an L-lysine molecule so that it has to be metabolized by the liver. Is there really any therapeutic benefit to that other than the fact that you can't crush it up and snort it? What you have left after Vyvanse is metabolized is still pure D-amphetamine, right?!! I mean, this drug has been around since 1887 and it's still being patented!! First it was with Adderall and now it's Vyvanse. This is a perfect example of the "patent extender" drugs that are reformulations of an old drug.
Anyways, I got off on a tangent there, but my main point is just that my doctor really made me question the depth of his knowledge because he didn't seem to understand some pretty basic concepts.
> I absolutely think psychiatrists should have more extensive psychopharmacology/neurology training. The problem is that in medical school, 99 percent of the material is basic physiology/anatomy etc. Little time is spent exclusively on psychopharmacology, and psychiatry is definately a neglected field, both by big pharma and medical training.
>
> That being said, my psychiatrist is awesome. He and I discuss complex pharmacology and approach my anxiety/depression from a very analytical/empirical POV, which I love bc I'm a neuroscience and Chem dual major at my university. But there are SO MANY ignorant MDs who know literally only undegrad intro psychology level material when it comes to psychopharmacology.
Posted by violette on June 15, 2010, at 18:32:44
In reply to Re: Drug Holiday? » Humanpdr, posted by detroitpistons on June 15, 2010, at 17:21:34
I think some of the doctors are just paranoid about being monitoring for the schedule IIs they prescribe.
One of my former PDocs of 5 yrs prescribed me Ritalin for ADD. I didn't like it too much, so he prescribed me Adderall, which gave me anxiety. I then asked for Dex, giving him the same reasoning (what you described is printed in the Merck manual). He said-this one time, I'll write you the prescription...but I can't treat you anymore. So he referred me to one of his colleagues. This was after 5 years.
It was one of the best things that happened to me, since I never went to the doc I was referred to and later found my new PDoc who is also a therapist. He had no problem prescribing the Dex on the 1st visit...either did the other one who I visited when shopping for a psychiatrist- therapist. Then again, they were over the age of 60 (experienced) and don't mind using those substances to augment for depression symptoms if they are reasonable and helpful. (In my experience, psychoanalytic doctors view ADD a bit differently.)
My situation really had nothing to do with research or psychopharmacology knowledge. Decision making ability is an important, but underrated quality, of an adept physician.
Posted by Humanpdr on June 16, 2010, at 6:48:48
In reply to Re: Drug Holiday? » Humanpdr, posted by detroitpistons on June 15, 2010, at 17:21:34
Yes, Dexedrine has a terrible stigma and many pdocs don't rx it for that reason. The barbaric heavy handed atitude of the DEA and their "war on drugs" unfortunately impacts Pdychiatry and other specialties such as pain management.
While it's true that Dexedrine is more abusable, but that stems from it's more selective cns stimulation, and lacks the pns anxiety/sweating/fight-or-flight adrenergic effects of the L-isomer in adderall.
But for that reason, it SHOULD be rxed for an ADHD patient who experiences anxiety from mixed isomeric salts etc...
Also as someone mentioned, having a pdoc who is also a therapist is great, cause they don't just want to hand u a prescription and kick you out the door. My pdoc also does therapy which is awesome and helps alot.
This is the end of the thread.
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