![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by snarley on February 12, 2004, at 16:52:25
Hi all, first time poster here, but i've read pretty thorougly most of the last month's threads. So here's my situation:
I've been seeing a psychiatrist for depression for years, been on effexor for the past year @ 150mg a day. My psychologist did some tests on me (memory test, iq, symptom questionairres, etc) for ADD and found that I am adult ADD. He sort of laughed about it, saying that he should have noticed it sooner (jeez that made me feel great). I have been terrible in school for my entire life (but due to high iq it didnt become REALLY noticeable until high school-- at which point it was attributed to chronic depression). My grades never really improved, and have always had focus issues, i just got less depressed. So anyhow, now i'm finally diagnosed as ADD (overfocused type or something), so everything should be fine once he relayed the info to my psychiatrist and we could get the medication thing going...right?
Wrong. My psychiatrist doesnt like to prescribe normal ADD meds. he instead said he wanted to raise my Effexor over a several week period (to above the fda approved max dosage of 225) to see how i react to that (is Effexor even for ADD??). I've been fine on the effexor 150/day for my depression and am worried increasing it might screw up something that already works for that.
I also have been reading about the effexor withdrawal posts other folks have made on this board. So if it doesnt work i'm going to have to go through hell withdrawals from the extra 150/day i'll be taking? which will make me worse??? and then trial-and-error with strattera when it seems from stuff i've read (including books by Dr. Amen, renowned ADD doctor guy) that neurostimulants are the only things that work reliably?? not to mention that from friends whove been on it, straterra has really rotten/raunchy side effects?? (the psychiatrist said he would try strattera next because he doesnt believe in stimulants or something)
I have tried talking to the pdoc about it but he is adamant that this is the route he wants to take even if it costs me another quarter at school (i'm a 23 year old 3rd or 4th year freshman in college, on and off academic probation all the time, no financial aid because of bad grades/low courseload, with my grade records having been wiped a grillion times due to medically excused poor performance from my "depression", parents flipping out about the money they dump into therapy just to maintain my gross underachievement).
I'm seriously at the end of my rope here. not to mention that the extra effexor (been on the first dose increase for a few days so far) is tying my stomach in knots and i'm a lil sweaty and dizzy.
What should i do? Should i try to find another psychiatrist? call him and talk to him about it some more (he already hates me this week i think)? what the heck am i supposed to be doing about my midterm exams in the meantime? no matter what, if i try to find another doctor it's gonna take like a month to get to the point he'd prescribe something?? i'm a worse mess than i was before the ADD diagnosis and the effexor getting ramped up (which is pretty freaking bad). Also given my tendency to overfocus on certain things, all i want to do is punch a wall, i've just been fuming about this whole thing since it happened and thus its even harder to get my school stuff done.
Thanks,
Marley (snarley when i'm cranky, or so my friends have affectionately nicknamed me when i'm in a rotten mood)
Posted by zeugma on February 12, 2004, at 17:25:14
In reply to EFFEXOR for ADD? frustrated w/ my psychiatrist, posted by snarley on February 12, 2004, at 16:52:25
Dr. Amen recommends Effexor for overfocused ADD.
High dosages (up to 300 mg/day and even higher) are not uncommon.
I would think that Effexor plus a stimulant would be the best option, unless there is a specific reason for NOT trying stimulants. For example, I'm extremely underweight, and stimulants reliably worsen this to medically dangerous levels. So I take strattera to manage my severe inattentive ADD (a different subtype than yours). Strattera is a good antidepressant as well as an ADD med (so you see opinions vary).
One last thing:Your doctor is not an ADD specialist. You might want to find one, if effexor doesn't work for your symptoms at the higher dosage.
Posted by snarley on February 12, 2004, at 18:48:12
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatrist, posted by zeugma on February 12, 2004, at 17:25:14
>zeugma writes:
>
> Dr. Amen recommends Effexor for overfocused ADD.
>
i must have skipped over that part in the book my therapist gave me to read, choked the whole "change your brain, change your life" thing down in about 3 hours last nite, guess didnt catch everything hehe.
> High dosages (up to 300 mg/day and even higher) are not uncommon.
>
my major concern with that is that i've been grossly overmedicated by other psychiatrists in the past (which i guess is why i settled on this guy, he's fairly conservative medwise). It just sets off warning bells in my head when i see that the ultra high doses arent fda approved. I've been jerked around and put on lots of really wierd drug regimes in the past, one of which landed me with a dependency on ativan (was totally going with doc's prescription, not popping extra, he over time just upped the dosage a TON) that took me about 6 or 8 months to get over (was having panic attacks for months as i was getting off of it). So that's why i'm worried.
> I would think that Effexor plus a stimulant would be the best option, unless there is a specific reason for NOT trying stimulants. For example, I'm extremely underweight, and stimulants reliably worsen this to medically dangerous levels. So I take strattera to manage my severe inattentive ADD (a different subtype than yours). Strattera is a good antidepressant as well as an ADD med (so you see opinions vary).
>
It had never been a doubt in my mind that i wanted to stay on my 150mg/day of effexor, its working well for the depression, what i had thought going into this whole mess was that he'd leave the effexor as it was and put a stimulant or strattera on with it or something. But he wont budge on the upping the effexor thing (*sigh*)
> One last thing:Your doctor is not an ADD specialist. You might want to find one, if effexor doesn't work for your symptoms at the higher dosage.
>
>
I have a call in to my therapists (not the psychiatrists) voicemail (hopefully he will call back after he is done with his appts today by 5 or 6) to ask him what he thinks of the whole deal, and if maybe he could talk to the psychiatrist or what he thinks about maybe finding someone else who is more experienced with ADD.
zeugma: Thanks for the help/input, if anything it gave me a more structured and systematic way to think about and address the overwhelming problems of the day and i've calmed down a little bit (though still feeling that effexor increase, ick)Any other input from anyone on this stuff? ie how to cope with school in the meantime? i was actually having a semi-decent quarter for the first time in over a year, it will annoy me to no end if i manage to screw it up when (miraculously) i have been doing ok so far. I talked to the prof i was supposed to have a midterm with and got him to postpone it until tuesday next week. hopefully i will have some things straightened out by then. ugh.
Snarley
Posted by jerrympls on February 12, 2004, at 19:30:20
In reply to EFFEXOR for ADD? frustrated w/ my psychiatrist, posted by snarley on February 12, 2004, at 16:52:25
Marley-
In my opinion - get a second opinion. I don't trust doctors who don't use meds that were designed for a specific purpose FOR that specific purpose - make sense? Meaning, Adderall/Ritalin/Dexedrine are FDA approved for ADD. Yada yada - you know this I'm sure.
Anyway, I had a doc who was completely against benzos - like Ativan, etc - he said "Everyone gets addicted to them - everyone." However, then he turned around and wrote me a script for 3 refills of Adderall - an AMPHETAMINE!?
I'm on Effexor 150 now as well and have added Concerta (long acting Ritalin). It works well. See a doc who knows what he/she is doing and isn't afraid of meds. That's what I did.
Hope this helps
Jerry
Posted by scott-d-o on February 12, 2004, at 23:11:47
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatrist » snarley, posted by jerrympls on February 12, 2004, at 19:30:20
some pdocs get various drug propaganda in their heads about certain meds and that's when their prescribing practices start to make little sense. I have been told "benzo's are addictive as heroin" by one pdoc, and another one whom didn't think twice to prescribe klonopin and adderall within the first two weeks of treatment. it turns out that he, and i for that matter, were right; those were the meds that I needed.
benzo's get the worst rap of all, i think because companies that hold patents on SSRI's attempt to smear the reputation of these great medications, so doctors will prescribe a SSRI as first line treatment for anxiety every time; regardless of the fact they are useless for anxiety disorders. just know that there are other factors at work such as these..
some doctors will not prescribe any meds that are immediately effective, meaning they will only prescribe meds that take a certain period of time to "take effect." think about it, just about any med that immediately alters your psyche has at least some hysteria surrounding it regarding abuse. if a doctor refuses to prescribe a med it also may mean that he knows nothing about it, and doesn't feel you are even worth the effort to learn despite the big dollars you fork over every month. the pdoc suspects you will never have the audacity to disagree with him, and that the patient, particularly one in a depressed state, would never dare to think they know what's better for themselves than someone with a pretentious "m.d." at the end of their title. besides, what incentive does he have to care for your welfare? keeping your mental problems intact is what keeps you coming back every month and is what pays the bills. i speak from experience, i have confronted doctors such as this and most will be able to provide no justification for their choice in medication or therapy; instead they just tell you to get out of their office.
please note I speak only of some pdocs, not all. in your case, i don't think it's a matter of under or over medicating. the fact is, your current pdoc isn't carefully choosing your meds, rather he is avoiding certain meds on purpose, perhaps the ones that could help you the most. effexor's manufacturer must have a good marketing dept because I haven't encountered a pdoc yet who hasn't tried to prescribe it for me, however, when I come onto this forum all I hear are disasterous results with this med.
my current pdoc is primarily a forensic psychiatrist, so perhaps he isn't exposed to all this b/s as much as the others.
of course, my advice is to find another doctor, but in the mean time, try not to obsess about it and try not to let it distract you from what is most important (college/work/etc.)
scott
Posted by PsychoSage on February 12, 2004, at 23:29:53
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatrist, posted by snarley on February 12, 2004, at 18:48:12
I am really pissed because I wrote 4 paragraphs, and they were erased when I hit back because I wanted to edit.
ANyhow, Effexor is a reasonable treatment option. I have been given that option as well as Wellbutrin which I am on. I have ADD symptoms from substance abuse and bipolar disorder. I was wondering what your whole psychiatric history is like. I mean what are your various issues and diagnoses because stimulants are not good for everyone. I also think introducing them to an adult can be problematic because there are no parents to dose for the children.
Well, stimulants can propel you into depression because of tolerance and the daily swings.
I also have a horrific college record at a top 5 nationally ranked renown institution. I am on leave every other year. It's really frustrating.
I just started Provigil {day 2 just ended}, and I am optimistic. I am not going to ever be permitted to take stimulants any time soon, since I had a relationship with meth which ended 3 years ago.
I was also told by my person that Aricept is something we'll consider. It's an anticholinerase reuptake inhibitor or something like that. It is an Alzheimer's drug that improves executive functions, organization and time management which are totally overlooked by stimulants. I will also be looking into anti-Parkinsonians.
Provigil was my idea, and the other drugs were my prescriber's ideas. I am looking forward to exploring them.
There are definitely options besides stimulants. Personally, I have to be very careful with anything that affects dopamine because I am prone to psychotic symptoms now because of my last run with meth.
Look for an ADD clinic in your area. There may be a long waiting list, but it is worth a shot. I wouldn't get excited about strattera since it affects norepinephrine, and that is already being affected if you are on a high dose of Effexor. You are not missing out.
Additionally, you have to be careful of adding stimulants to effexor because I was in the hospital twice when taking a tiny bit of methamphetamine while on Effexor {medium to low dose} four years ago. The diagnosis was amphetamine poisoning which just means overdose.
Good luck!!!
You need a shrink that treats children probably. Does your school have counseling and psychiatric services?
Posted by snarley on February 13, 2004, at 16:12:06
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatrist, posted by PsychoSage on February 12, 2004, at 23:29:53
Psychosage--
You wanted to know about my psych history, and that seems pretty valid considering that it probably does affect what kinda advice i get. So here goes (be warned, it's exhaustive):
was dx'd with depression in highschool as my performance in school was becoming particularly dismal (as opposed to gradeschool where i just barely slid by). I was seeing some child/adolescent psychiatrist and was given paxil. After a few years of that i started abusing coffee (yes, abusing coffee-- I was told a speed addiction would have been cheaper, heh). Was drinking about five 5-shot mochas from starbucks a day, heh. that's 25 shots of espresso. Became anorexic my senior year of highschool and started skipping a lot of classes, which i had to take over during the summer because i failed them of course. But i did graduate. The whole anorexic thing had come to a head when i passed out several times during evening extracurriculars-- i was active in the drama program and passed out a few times during evening practices. This caused a lot of concern and after a huge conference with all my teachers, parents, and some school admins (i went to a private school, so they were pretty attentive to my situation), I was forced to go into a treatment program for my eating disorder. I went from about 100 lbs at 5'9" tall up to about 140 in a few months (my original weight was about 125 or 130), and i have the freaking stretch marks to remind me of that for the rest of my life. ugh.
at some point as i was getting over the anorexic thing I started itching uncontrollably, they said it was the paxil and took me off of it. By this time i had switched pdocs again and now this one said i was bipolar and put me on depakote. I went off to my first year of college at a small private university.
Stopped taking the depakote because it was making me fat (about 145 or 150 lbs, heh), got in with a bad crowd and started smoking weed for the first time in my life. also did mushrooms once. did really poorly in school and my dad intervened and took me to see yet another psychiatrist, who put me on lithium or something based on the previous psych's dx. The school wiped my grades from my record and gave me a 6 month leave of absence.
During the meantime i went to live with my mom and started seeing another psychiatrist. this guy was a total nut, and piled on a ton of meds (i was a little off though, i had been raped recently and was in a pretty rotten state). Dx started out as depression for which i was given prozac-- which i found out later was giving me a bad reaction--hallucinations and such. But the pdoc thought i was just getting worse and instead started piling on all sorts of stuff like antipsychotics and benzos and stuff. I was hospitalized 2x in a 2 month period for flipping out totally, which now i think was understandable given the huge med load i was on (about 7 to 10 drugs at any given time). One of the pdocs at the hospital the second time around said i was addicted to ativan and i was detoxed. I was just taking the med according to the prescription the psychiatrist gave me, which was like 2mg a few times a day, which i later found out was totally insane and overmedicating. Should have probably sued the guy for malpractice and screwing up about 2 years of my life during which i was a ZOMBIE/crazy person but i was too busy dealing with withdrawal symptoms to deal with much else.
So i went off EVERYTHING and quit that doc and after 6 months of panic attacks went back to school at a community college. No crazyness, no depression, but was just doing poorly in school. I went through a couple years there taking classes every few quarters, always dropping half of them and then either getting A's or F's in the remainder depending on how the classes were structures (i did great in classes with labs or in some classes based solely test grades). But i wasnt the psych basket case the previous docs would have had me believe i was, just had trouble focusing/getting work done/sitting in class (i would get up and walk around in the hall for a min or two every half hour or so otherwise i just couldnt stay on task, which would piss profs off to no end since i had no "real" explanation for why i needed to do it).
last year i got depressed again and went to see my current psychiatrist and a started seeing a separate therapist as well (the guy is really cool, a forensic psychologist who specializes in NPD (narcissistic personality disorder) which my dad has, and caused some problems for me when i was growing up). The psychiatrist put me on effexor for the depression which has helped but the focus issues remain. I transfered to another 4year university and have continued my dismal level of performance in classes despite my 148 IQ and finally a few weeks ago after getting the tests done, i was diagnosed ADD. and now we're caught up to the current issues. tada.
so basically i've had a lot of other problems along the way that i've had to work through, but the ADD has always been an underlying problem.
Also, over the past few years as far as recreational drugs go, i've done coke 2x (once a year, stupid i know, i wont do it again), mushrooms one more time, and extacy once (which gave me the worst month of my life after taking it, i was so depressed, will never do it again). I've cut off all drug use now though since i have learned (albeit slowly) that it was just a really stupid thing to do. I still drink occasionally in social situations but that's it. If people are smoking weed around me, i'll just frown and leave.
As far as parents go, my dad has narcissistic personality disorder and is currently dealing with a bout of depression. My mom has some OCD-like symptoms or overfocused stuff but has never been to see a doctor about any of it and refuses to believe she has any sort of problem. She is also a high-functioning closet alcoholic, and has been for about the past 15 years (i.e. she still is very productive and organized and holds a high-paying job with no problem)
---
so given all that info / me spilling my psych history guts all over this thread... any other input psychosage? =D
Marley
Posted by snarley on February 13, 2004, at 16:31:51
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatrist, posted by PsychoSage on February 12, 2004, at 23:29:53
So i've been on the warpath w/ regard to my doc yesterday and today. Been on and off the phone with my mom and my therapist a lot expressing my distaste about being put on some huge dose of effexor. Finally put a call in to my psychiatrist a few hours ago on his voicemail and have since been waiting for a call back.
So I just got off the phone with him after he finally called me back. I'm sure he's been getting guff from my psychologist (who works in the same office with him) about the phone call he got from me and my worries, etc. So the psychiatrist now says that he wont take my effexor dose above 225, because in his experience if it isnt helping at 225, it wont help at higher doses or something. So i'm sort of relieved that i'm not going to get overdrugged on that before he abandons it as a treatment option (i think this is maybe his compromise because i so adamantly expressed my worry about being put on a really high dose of effexor ie 300+). A big load off my mind. Still dealing with the stupid dosage increase side effects of dizziness and sweaty palms and twitches though, ick. But in the past those go away within a few days of the dose increase.
In the meantime, I've also checked out my school's student mental health services building, and they have psychiatrists there who apparently deal with ADD on a regular basis. But I couldnt get in for am initial appt until the 27th. My current pdoc's timeline is 2 weeks from this past tuesday to see if the effexor starts working at all and then try something else, so for the moment i'm sticking with that, but i did make the appointment for the 27th so if i decide i want to switch docs i can. I'm still a little worried about what the current doc would try next if the effexor doesnt work, I dont want to waste months on "alternative" non-stimulant regimes if the stimulants are going to be the thing that'll work best in the end, which is what most people seem to be thinking is the best option.
Marley
Posted by PsychoSage on February 15, 2004, at 4:06:51
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatrist » PsychoSage, posted by snarley on February 13, 2004, at 16:12:06
Okay, this is really long. Thanks for divulging so much. It is early/late, so I will read it all when I am totally able to digest it all because of the sheer volume.
Posted by francesco on February 15, 2004, at 18:45:07
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatrist, posted by snarley on February 12, 2004, at 18:48:12
Hi Snarley, I have had ADD too and my problems are under certain respects similar to yours, since I can't get stimulants where I live (in Italy). What I can say is that your psychiatrist's suggestion, to increase Effexor, seems to make sense, since at the higher dosages it's supposed to affect also dopamine. Moreover, as someone else on this board said, Amen says that Effexor is his first choice for Overfocused ADD and that this kind of ADD makes worse on stimulants alone. This is the theory, now something personal ...
I managed to try Ritalin for some days and for my add was completely unuseless. I could concentrate far better on Anafranil, which is supposed to be similar to Effexor. Moreover Ritalin made me feel 'drugged', and the ups and downs, the major change of personality, the necessity to taking it every three our and an half convinced me that stimulants were not for me. I don't know about you anyway, just sharing. Best Wishes
Posted by PsychoSage on February 15, 2004, at 21:50:36
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatrist » PsychoSage, posted by snarley on February 13, 2004, at 16:12:06
> Psychosage--
>
> You wanted to know about my psych history, and that seems pretty valid considering that it probably does affect what kinda advice i get. So here goes (be warned, it's exhaustive):
>
> was dx'd with depression in highschool as my performance in school was becoming particularly dismal (as opposed to gradeschool where i just barely slid by). I was seeing some child/adolescent psychiatrist and was given paxil. After a few years of that i started abusing coffee (yes, abusing coffee-- I was told a speed addiction would have been cheaper, heh). Was drinking about five 5-shot mochas from starbucks a day, heh. that's 25 shots of espresso. Became anorexic my senior year of highschool and started skipping a lot of classes, which i had to take over during the summer because i failed them of course. But i did graduate. The whole anorexic thing had come to a head when i passed out several times during evening extracurriculars-- i was active in the drama program and passed out a few times during evening practices. This caused a lot of concern and after a huge conference with all my teachers, parents, and some school admins (i went to a private school, so they were pretty attentive to my situation), I was forced to go into a treatment program for my eating disorder. I went from about 100 lbs at 5'9" tall up to about 140 in a few months (my original weight was about 125 or 130), and i have the freaking stretch marks to remind me of that for the rest of my life. ugh.
>
> at some point as i was getting over the anorexic thing I started itching uncontrollably, they said it was the paxil and took me off of it. By this time i had switched pdocs again and now this one said i was bipolar and put me on depakote. I went off to my first year of college at a small private university.
>
> Stopped taking the depakote because it was making me fat (about 145 or 150 lbs, heh), got in with a bad crowd and started smoking weed for the first time in my life. also did mushrooms once. did really poorly in school and my dad intervened and took me to see yet another psychiatrist, who put me on lithium or something based on the previous psych's dx. The school wiped my grades from my record and gave me a 6 month leave of absence.
>
> During the meantime i went to live with my mom and started seeing another psychiatrist. this guy was a total nut, and piled on a ton of meds (i was a little off though, i had been raped recently and was in a pretty rotten state). Dx started out as depression for which i was given prozac-- which i found out later was giving me a bad reaction--hallucinations and such. But the pdoc thought i was just getting worse and instead started piling on all sorts of stuff like antipsychotics and benzos and stuff. I was hospitalized 2x in a 2 month period for flipping out totally, which now i think was understandable given the huge med load i was on (about 7 to 10 drugs at any given time). One of the pdocs at the hospital the second time around said i was addicted to ativan and i was detoxed. I was just taking the med according to the prescription the psychiatrist gave me, which was like 2mg a few times a day, which i later found out was totally insane and overmedicating. Should have probably sued the guy for malpractice and screwing up about 2 years of my life during which i was a ZOMBIE/crazy person but i was too busy dealing with withdrawal symptoms to deal with much else.
>
> So i went off EVERYTHING and quit that doc and after 6 months of panic attacks went back to school at a community college. No crazyness, no depression, but was just doing poorly in school. I went through a couple years there taking classes every few quarters, always dropping half of them and then either getting A's or F's in the remainder depending on how the classes were structures (i did great in classes with labs or in some classes based solely test grades). But i wasnt the psych basket case the previous docs would have had me believe i was, just had trouble focusing/getting work done/sitting in class (i would get up and walk around in the hall for a min or two every half hour or so otherwise i just couldnt stay on task, which would piss profs off to no end since i had no "real" explanation for why i needed to do it).
>
> last year i got depressed again and went to see my current psychiatrist and a started seeing a separate therapist as well (the guy is really cool, a forensic psychologist who specializes in NPD (narcissistic personality disorder) which my dad has, and caused some problems for me when i was growing up). The psychiatrist put me on effexor for the depression which has helped but the focus issues remain. I transfered to another 4year university and have continued my dismal level of performance in classes despite my 148 IQ and finally a few weeks ago after getting the tests done, i was diagnosed ADD. and now we're caught up to the current issues. tada.
>
> so basically i've had a lot of other problems along the way that i've had to work through, but the ADD has always been an underlying problem.
>
> Also, over the past few years as far as recreational drugs go, i've done coke 2x (once a year, stupid i know, i wont do it again), mushrooms one more time, and extacy once (which gave me the worst month of my life after taking it, i was so depressed, will never do it again). I've cut off all drug use now though since i have learned (albeit slowly) that it was just a really stupid thing to do. I still drink occasionally in social situations but that's it. If people are smoking weed around me, i'll just frown and leave.
>
> As far as parents go, my dad has narcissistic personality disorder and is currently dealing with a bout of depression. My mom has some OCD-like symptoms or overfocused stuff but has never been to see a doctor about any of it and refuses to believe she has any sort of problem. She is also a high-functioning closet alcoholic, and has been for about the past 15 years (i.e. she still is very productive and organized and holds a high-paying job with no problem)
>
> ---
>
> so given all that info / me spilling my psych history guts all over this thread... any other input psychosage? =D
>
> MarleyI think you are not on stimulants because of your history with hallucinations or because you may have evidence of an abuse pattern with substances. I am not sure, but look around. Generally, just focus on symptoms and not disorders. That's how doctors look at things I think when they give you drugs. I am not totally sure.
Stimulants are dangerous for a person who has had a lot of adverse effects with meds. It wasn't your fault, and you were overloaded with scripts. However, if there is something manic as opposed to purely ADD about you then maybe your doctor would be conservative about stimulants which can make you psychotic and angry if you are on my side of the spectrum.
Anyways, I am totally speculating. You clearly have an emotional history that is multi faceted. It's awesome you stay away from illict substances. It seems as if you have some family dynamics and maybe some regret. What those dynamics are I am not sure, but do you think ruminating about past school performance and not being well when you "were supposed to" is something that you cycle in your head? Well, I do it daily, so that is why I put it out there.
I think you should be extra cautious about stimulants if you get your hands on them. You must be mistrusting and apathetic about shrinks by now, so keep pushing because I am still looking for that right combo like everyone else. Just remember that using stimulants will be something to manage. It's not just pop them and get better. You have to watch out for symptoms and crashes. You need to realize that they bring you down too or you build tolerance. You may reach a point when you are kind of worn by them. Just realize that you are going to have to be looking at more drug options and other drugs like ALzheimer's and anti parkinsonians and doapmine agonists as stimulant alternatives.
With your history of depression they are guaranteed to leave you depressed in some way if you stop cold turkey.
I am sorry about your trauma. Obviously, that weighs into your depression and emotional style. Don't confuse the stimulants for making you love-worthy and the panacea for your ills.
They may be totally necessary for you but take your ADD-ness with a grain of salt. You have many dimensions to yourself.
Use them wisely, and tell me how you do!
Posted by PsychoSage on February 15, 2004, at 22:03:41
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatrist, posted by snarley on February 13, 2004, at 16:31:51
> So i've been on the warpath w/ regard to my doc yesterday and today. Been on and off the phone with my mom and my therapist a lot expressing my distaste about being put on some huge dose of effexor. Finally put a call in to my psychiatrist a few hours ago on his voicemail and have since been waiting for a call back.
>
> So I just got off the phone with him after he finally called me back. I'm sure he's been getting guff from my psychologist (who works in the same office with him) about the phone call he got from me and my worries, etc. So the psychiatrist now says that he wont take my effexor dose above 225, because in his experience if it isnt helping at 225, it wont help at higher doses or something. So i'm sort of relieved that i'm not going to get overdrugged on that before he abandons it as a treatment option (i think this is maybe his compromise because i so adamantly expressed my worry about being put on a really high dose of effexor ie 300+). A big load off my mind. Still dealing with the stupid dosage increase side effects of dizziness and sweaty palms and twitches though, ick. But in the past those go away within a few days of the dose increase.
>
> In the meantime, I've also checked out my school's student mental health services building, and they have psychiatrists there who apparently deal with ADD on a regular basis. But I couldnt get in for am initial appt until the 27th. My current pdoc's timeline is 2 weeks from this past tuesday to see if the effexor starts working at all and then try something else, so for the moment i'm sticking with that, but i did make the appointment for the 27th so if i decide i want to switch docs i can. I'm still a little worried about what the current doc would try next if the effexor doesnt work, I dont want to waste months on "alternative" non-stimulant regimes if the stimulants are going to be the thing that'll work best in the end, which is what most people seem to be thinking is the best option.
>
> MarleyGood luck, Marley. Well, the alternatives are not so bad if they are augmenters and adjuncts. I am more skeptical of the norepinephrine drugs like effexor, wellbutrin, and strattera. Other alternatives like dopamine agonists, anticholinerase inhibitors and provigil are worth it. I am leaving my options open. The stimulants are basically the cocaine without the euphoria.
Posted by Kacy on February 16, 2004, at 14:11:59
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatrist, posted by snarley on February 12, 2004, at 18:48:12
Marley:
I have add/inattentive. The first drug that seemed to work for me was Wellbutrin. Unfortunately, I broke out in hives just as it reached therapeutic levels. That was about three and a half weeks after starting. I was taking 150 mg. first thing in the morning and, again, at noon. For a day, I felt hope and excitement because it was helping me concentrate. I was working at the computer and about two hours had passed without me realizing it. I was teaching myself html, something I had meant to do for a while. I couldn't believe I had been working at it with full concentration. (I'm older than you and have needed this a long time. It's been so long since I have been able to do something like that. As I have gotten older, my problems with inattentiveness have worsened.) Wellbutrin is a drug I recommend that you try. It increases both seratonin and dopamine.
With Wellbutrin, take the Strattera. It's a norepinephrine reuptake inhibitor. You will get more norepinephrine since it clogs up the intake valves in some of the pumps that are constantly vacuuming up some of those transmitters. That leaves you with a larger supply. It's a great help to me. I still needed the stimulants, though. I had to go through a long time of trying the others before they were added on. (Thank the feds for that.) By itself, Strattera helped. It certainly wasn't enough for me. I have wondered, though, if I would have been able to get and maintain a response to Adderall if I hadn't started with Strattera. Is the clogging of those pumps leaving more of the Adderall in play, or is it just leaving more of my own paltry supply of natural norepinephrine in play, giving me just enough to be helped? I don't really know, but I know that the most Adderall my doctor can bring himself to write a script for is the minimum amount I need to get a fairly good effect, and I'm grateful for the combination.
I don't know enough about all the names for the different facets of Add, but if yours is the same, then talk to your doctor about Wellbutrin and Strattera as a combination. I wish I could use it.
Effexor, on the other hand, I'm not crazy about. My first doctor (who avoided writing a script for a stimulant like it was the plague) insisted that I go up to at least 300 mg. of Effexor before he would consider adding anything on. At 225 mg., I didn't get any additional benefit; because of the side affects, I refused to continue taking that much. I don't think Effexor's supply of serotonin with its much smaller supply of norepinephrine is a good idea for Add. My biggest deficiency is norepinephrine, and it seems to me that seratonin is always going to win the competition for the transport into the cells. As for Effexor and dopamine, I believe that presenting the 10:1 seratonin to dopamine ratio of Effexor as a benefit for Add is ludicrous, and my first doctor said (after I pushed for the answer) that the dopamine affect at high doses of Effexor is more theory than fact. I take the drug because I need some seratonin supplementation. I plan to switch to another brand someday. I take only 75 mg. I used to take 150, but after starting Strattera, I got as good a response with just the 75 as I had gotten with 150. I still don't like Effexor's side affects, but I keep using it because after taking it two and a half years, I know the drug well. I can recognize seratonin depletion within a day because of those famous side affects as well as because of its benefits, and I am using that to learn to manage Adderall and supplements and food choices to enhance the whole system. It's been a long road to here, and I'm still getting used to the whole package.
I hope you can make your classes a number one priority and just get through that while you work toward getting the right combination of prescriptions for you. Sadly, it takes time. As an example, it took me eight months to start Strattera, get over the side affects of 80 mg., go through an increase to 100 mg., and then get over the side affects of that. The 100 mg. dose took the most time. It took five months and I almost gave up. Two days before my appointment with my doctor, it miraculously changed. I've been fine with it since. (There were other tiresome missteps along the way.)
I'm sorry it's been so frustrating for you. Hang in there.
Posted by snarley on February 17, 2004, at 0:03:38
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatris » snarley, posted by Kacy on February 16, 2004, at 14:11:59
thanks for the input kacy, that actually helped a lot. My doctor hasnt really brought up Wellbutrin as an option, will bring that up when i talk to him tomorrow.
I was wondering what your side effects were when you were being upped on the Effexor? I'm up to 187.5/day at the moment (doc plans to take me to 225--maybe more) and i've been experiencing the standard dizzyness/twitches after the increase, which have since gone away. the sweaty hands/feet however have not really gone away (i have been on 150/day for moderate depression for the past year). I made the increase to 187.5 about a week ago and the sweaty hand thing has really been getting on my nerves as i sweat all over my homework papers for no apparent reason (i'm not nervous or anything). I've had to start placing an extra paper between my hand and my homework while i'm writing to soak up all the sweat. It's pretty disgusting--If i hold a hand up within about 20 seconds the sweat will accumulate and drip right off my hand. I also cant really operate the touchpad on my laptop now as the hand-sweat pools on the pad and makes the mouse jump around. ICK!! I tend to have vivid dreams as well but those dont bother me really. Should i tell my pdoc about this when we go over my meds tomorrow or will this go away? I've had the sweat thing happen before but it has gone away within a few days in the past, it has been a week this time and it's annoying the heck out of me.
Schoolwork is going ok, though i've found i've been more distracted since upping the effexor (it's probably the sweating thing). I have a take home midterm due tomorrow and i'm almost done with it. Still have some back homework to do but i think my profs understand what i'm going through and are willing to work with me.
Marley
Posted by PoohBear on February 17, 2004, at 18:44:31
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatris » Kacy, posted by snarley on February 17, 2004, at 0:03:38
Marley:
I've read this whole thread... You've been through a lot and my hat's off to you that you're still looking for answers and haven't given up; some people would have...
I'm 47 an was Dx with ADHD 7 years ago. Nothing at the time worked. Strangley though, Effexor HAS worked. Though not specifically an ADD medication, for me it seems to work by eliminating some of the mental clutter and streams of unwanted thoughts that would continually compete with my ability to do other things. I also take a small amount of Wellbutrin to offset the sexual side effects of Effexor as well as Topamax for sleep and mood stabilization. (I also have clinical depression and atypical bipolar...)
As for the side effects of Effexor, they tend to diminish after serveral days/weeks at a given dosage plateau, depending on the person.
I personally went up to 225mg, had some adverse side effects, went back down to 75mg for several months and then noticed this past week that it seemed to be losing it's effectiveness, so increased the dosage to 150mg. This time no nightmares, very little in the way of side effects, which tells me my body needed the higher dose.
You hang in there, keep your chin up and be encouraged; I'll be praying for ya,
Tony
Posted by Kacy on February 18, 2004, at 9:30:20
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatris » Kacy, posted by snarley on February 17, 2004, at 0:03:38
Marley:
I spent three months getting over side affects with Effexor. I never had sweating on it, though. What warming I had was a benefit as I run cool, not hot. (Strattera has also caused that for some people who posted here, but they seemed to get over it.)
I just waited out the side affects. I had different side affects each month. Each resolved within a month.
The sweating sounds terrible. I would be explaining that to the doctor if I suffered it. It's certainly not a side affect you are going to be able to stand permanently. I would tell the doctor about the dreams, too. Those are common. I'm glad they don't bother you. (On occasion, I have them too.)
After increasing to 225 mg., the only side affect I had was when I missed a dose. That was scary. The only description that comes close is an interruption of the visual feed. Think of the old black and white movies; when you see the sudden jerk from one part of a scene to another because some damaged pieces of the reel were cut out, then you see what happened. It was so fast that I only knew it after it happened. The shift in scene was small. No sound was missing. It happened about eight times before I took the missing dose and it had time to work. That was too much interference with my brain.
By now, you've seen your doctor. I hope he was open to trying Wellbutrin.
Posted by francesco on February 18, 2004, at 13:52:38
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatris, posted by Kacy on February 18, 2004, at 9:30:20
Hi Kacy, which side-effects did you have from Effexor ? I think it could be next AD but I'm quite hesitant about it. Thanks
Posted by micro on February 19, 2004, at 0:38:19
In reply to EFFEXOR for ADD? frustrated w/ my psychiatrist, posted by snarley on February 12, 2004, at 16:52:25
> Hi all, first time poster here, but i've read pretty thorougly most of the last month's threads. So here's my situation:
>
> I've been seeing a psychiatrist for depression for years, been on effexor for the past year @ 150mg a day. My psychologist did some tests on me (memory test, iq, symptom questionairres, etc) for ADD and found that I am adult ADD. He sort of laughed about it, saying that he should have noticed it sooner (jeez that made me feel great). I have been terrible in school for my entire life (but due to high iq it didnt become REALLY noticeable until high school-- at which point it was attributed to chronic depression). My grades never really improved, and have always had focus issues, i just got less depressed. So anyhow, now i'm finally diagnosed as ADD (overfocused type or something), so everything should be fine once he relayed the info to my psychiatrist and we could get the medication thing going...right?
>
> Wrong. My psychiatrist doesnt like to prescribe normal ADD meds. he instead said he wanted to raise my Effexor over a several week period (to above the fda approved max dosage of 225) to see how i react to that (is Effexor even for ADD??). I've been fine on the effexor 150/day for my depression and am worried increasing it might screw up something that already works for that.
>
> I also have been reading about the effexor withdrawal posts other folks have made on this board. So if it doesnt work i'm going to have to go through hell withdrawals from the extra 150/day i'll be taking? which will make me worse??? and then trial-and-error with strattera when it seems from stuff i've read (including books by Dr. Amen, renowned ADD doctor guy) that neurostimulants are the only things that work reliably?? not to mention that from friends whove been on it, straterra has really rotten/raunchy side effects?? (the psychiatrist said he would try strattera next because he doesnt believe in stimulants or something)
>
> I have tried talking to the pdoc about it but he is adamant that this is the route he wants to take even if it costs me another quarter at school (i'm a 23 year old 3rd or 4th year freshman in college, on and off academic probation all the time, no financial aid because of bad grades/low courseload, with my grade records having been wiped a grillion times due to medically excused poor performance from my "depression", parents flipping out about the money they dump into therapy just to maintain my gross underachievement).
>
> I'm seriously at the end of my rope here. not to mention that the extra effexor (been on the first dose increase for a few days so far) is tying my stomach in knots and i'm a lil sweaty and dizzy.
>
> What should i do? Should i try to find another psychiatrist? call him and talk to him about it some more (he already hates me this week i think)? what the heck am i supposed to be doing about my midterm exams in the meantime? no matter what, if i try to find another doctor it's gonna take like a month to get to the point he'd prescribe something?? i'm a worse mess than i was before the ADD diagnosis and the effexor getting ramped up (which is pretty freaking bad). Also given my tendency to overfocus on certain things, all i want to do is punch a wall, i've just been fuming about this whole thing since it happened and thus its even harder to get my school stuff done.
>
> Thanks,
> Marley (snarley when i'm cranky, or so my friends have affectionately nicknamed me when i'm in a rotten mood)Hello, Marley your Pdoc sounds as if he is out of his league. If you truly have ADD, and it appears likely that you do based on the info. which is posted here. Please note that stimulants are not euphoric when ADD is present. I think that is safe to say that a calming affect to a stimulant is somewhat diagnostic because stimulants are just that to the general population [which is why college students etc. take them to stay awake]!
It is healthier to avoid taking medication of any kind, however, it is unethical to withhold a medication from a patient who clearly may benefit from it{safety taken into consideration}.The bottom line is... the experience and the diagnostic abilities of your caregiver.
You appear to have lost confidence in your Pdoc. Therefore, I humbly suggest that you find a more experienced one as well as a Pdoc that has an extensive understanding of Psychopharmacology.
Docs in general tend to treat what they are most comfortable with [if they do not continue to educate themselves and keep up with their readings]- Their treatment modalities and skills plateau. Top docs are top Docs for a reason- IT is your Pdocs narrowed thinking that may slow the progression of many patients therapy.Also,please keep in mind that any Physician who side steps answers to logical questioning or becomes defensive is revealing their inadequacies or lack of confidence in their own skills. There is a bottom half to every class regardless of the profession! There is never a day that goes by that I don't try to learn something new for the benefit of others. That my friend is the true calling to medicine. Some have it/Some don't/ Some can't/ some won't/some could, but never will! Its personal motivation. IT can't be taught!!!!
You will have you day in the sun. You have my best wishes in your search and may it be short lived. Regards, MicroP.S. Please seek out a Pdoc at Teaching Institution who specializes in the treatment of ADD and its comorbid disorders.
Posted by Kacy on February 19, 2004, at 7:58:33
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatris, posted by francesco on February 18, 2004, at 13:52:38
Francesco:
I was afraid of Effexor and put off starting it for several weeks. I had small bouts with dizziness and nausea the first few days. I had some sleeping problems for a while and dry mouth for the first couple of weeks, mostly at night. The third month, I had embarrassing bouts with flatulence, something I'd never had problems with before. I learned not to eat overprocessed pasta like Lean Cusine, and have given up beans and molasses-based licorice.
One side affect I can't get over is blurred, close-up vision. It's hard for my eyes to adjust and I had to start carrying reading glasses and leaving them all over the house. I couldn't read the phone book at all. When I went off Effexor to see how Strattera would be without it, I could immediately read the phone book again. I went back on Effexor and ten days later–I could no longer read it. Since then, a great eye doctor has helped me read and see up close again, but I still have trouble switching from up close to across the room and vice-versa.
The sexual side affects seem to be permanent for me. Since I couldn't take Wellbutrin to counter it and no other stimulants have helped bring back my libido for very long, I'll quit Effexor and try another SSRI as soon as I'm comfortable with my other medication. I've had relief from that when I lowered the amount of Effexor I was taking and when I started Strattera and Adderall. But after a brief change, the problem comes back.
The side affect of missing a dose is nausea. It's like having the flu. I had to lie down until the pill took affect. That took an hour and a half to four hours depending on how long I went without taking it. Once, I didn't really feel okay until the next morning. Withdrawal usually started at about eight hours after I missed the dose. Since going down to 75 mg. (as it works so much better with Strattera) I skipped one dose to see what would happen. The withdrawal symptoms didn't start until the next morning. I got these 'head hits' that were like the ones you can get with a bad head cold or with the flu when you move your head too much or too quickly. It wasn't really very painful–just a little strange.
I never had terrible trouble quitting it like others have reported. I was at 112.5 mg. when I quit once. I just went down to 75 mg. for a couple of days, then to 37.5 mg. for a couple of days and then went off. I had mild nausea late afternoons for about a week and some tiredness. That was it.
If I could afford SamE, I'd try that with tryptophan. I'm not trying to discourage you from trying Effexor. I do think it's a good drug and it helps me by stopping excessive ruminating, as my doctor calls it.
I hope this helps.
Posted by snarley on February 19, 2004, at 14:39:44
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatrist, posted by micro on February 19, 2004, at 0:38:19
Well, I talked to my pdoc on tuesday and told him about the sweating, and he reduced me back down to the 150mg/day of effexor that had worked for me before and abandoned it as an ADD treatment option in my case. We'll just stick with it to use for my depression.
Now he is putting me on strattera (starting at 40mg a day, how high do doc's usually take that up to for an average adult dose?). frankly i'm a little afraid of how this will go... i've read a lot of stuff about how strattera has lots of really rotten side effects in a lot of people. I have one close friend with ADD who's doc tried him on strattera when it came out last year (he had been on dexedrine for a long time) and apparently it made him groggy/tired all the time and he couldnt keep food down. So his doc took him off. The other day he was like "whatever you do, dont let him put you on strattera next", and now here i am.
I took my first dose a little while ago and from a pointer my friend gave me i made sure to take it with food, apparently otherwise you get nauseous? there was no warning on the bottle about that, so i'm glad my buddy told me. Anyhow, I took the dose a little late-- at noon because i slept in today; had to break off my relationship with my boyfriend of about a year because there was too much drama, but regardless it's making me sad to not have him around even though i know it's for the best. Too much stuff to deal with lately.
I'm hoping that the strattera works out but why on earth do docs always prescribe the new "designer" drug with all the side effects as opposed to the old drug you can get generics for that are proven safe and well-tested??!? ugh.
Lastly, i've read that strattera has some antidepressant properties to it too-- if it works out for me and i stay on the strattera will my doc likely be able to lower my effexor dose below 150, or should he?
Marley
Posted by alohashirt on February 19, 2004, at 19:59:21
In reply to still sorta frustrated, now pdoc trying strattera, posted by snarley on February 19, 2004, at 14:39:44
I am taking Strattera wih Concerta. The Strattera on its own made me drowsy but reduced distraction. With Concerta my focus is even better.
No side effects.Good luck!
Posted by micro on February 19, 2004, at 21:56:44
In reply to still sorta frustrated, now pdoc trying strattera, posted by snarley on February 19, 2004, at 14:39:44
> Well, I talked to my pdoc on tuesday and told him about the sweating, and he reduced me back down to the 150mg/day of effexor that had worked for me before and abandoned it as an ADD treatment option in my case. We'll just stick with it to use for my depression.
>
> Now he is putting me on strattera (starting at 40mg a day, how high do doc's usually take that up to for an average adult dose?). frankly i'm a little afraid of how this will go... i've read a lot of stuff about how strattera has lots of really rotten side effects in a lot of people. I have one close friend with ADD who's doc tried him on strattera when it came out last year (he had been on dexedrine for a long time) and apparently it made him groggy/tired all the time and he couldnt keep food down. So his doc took him off. The other day he was like "whatever you do, dont let him put you on strattera next", and now here i am.
>
> I took my first dose a little while ago and from a pointer my friend gave me i made sure to take it with food, apparently otherwise you get nauseous? there was no warning on the bottle about that, so i'm glad my buddy told me. Anyhow, I took the dose a little late-- at noon because i slept in today; had to break off my relationship with my boyfriend of about a year because there was too much drama, but regardless it's making me sad to not have him around even though i know it's for the best. Too much stuff to deal with lately.
>
> I'm hoping that the strattera works out but why on earth do docs always prescribe the new "designer" drug with all the side effects as opposed to the old drug you can get generics for that are proven safe and well-tested??!? ugh.
>
> Lastly, i've read that strattera has some antidepressant properties to it too-- if it works out for me and i stay on the strattera will my doc likely be able to lower my effexor dose below 150, or should he?
>
> MarleyMarley, You may request Straterra in capsules as low as 10mg and titrate it slowly so that you can discern its side effects more readily. It does work at lower doses when used in combination with other cns meds. The sedating effect it has on many people may be reduced by taking it directly before bedtime as well as help dampen any untoward se's.
It may be that a good response could lower your effexor requirement, but please don't until you have a good working knowledge of how it effects you.
As for the new drugs, there is a great need for new meds in the mental health industry. Hopefully, Your doc has evaluated the drug regarding your particular needs and understands its current pharmacology, but the truth is each medicine a patient swallows is an experiment until the drug has had the test of time whether it be for ADD, hypertension, cardio etc...
Please do not let your friends experiences keep you from what may be your swan song of meds. Everyone is different in response although the most common se's are the most common for a reason.
I wish you peace and go with "your" instincts always. Regards, Micro
Posted by confetti on February 27, 2004, at 13:24:40
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatrist » snarley, posted by jerrympls on February 12, 2004, at 19:30:20
> I'm on Effexor 150 now as well and have added Concerta (long acting Ritalin). It works well. See a doc who knows what he/she is doing and isn't afraid of meds. That's what I did.
Jerry, I wondered if you could tell me your dosage of Ritalin?
I took a friend's Ritalin 20mg SR and it worked very well, except a return of symptoms in the evening. I went to the doctor and asked for Ritalin 3 a day doses, and Effexor for overfocus. He gave me the Effexor and Ritalin, but only 5mg twice a day.
The days I've taken it I don't feel like it's enough Ritalin. I don't get the same benefits as when I took the 20mg SR. I feel tired and not as motivated.
Posted by AntiTrust on February 28, 2004, at 15:33:32
In reply to Re: EFFEXOR for ADD? frustrated w/ my psychiatrist » jerrympls, posted by confetti on February 27, 2004, at 13:24:40
my step daughter is on Effexor for ADD, I believe the same dose. I do believe that alone helps her in school etc. but she is in another state and not up on what is happening w/ her now.
This is the end of the thread.
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