Posted by JohnL on June 7, 2000, at 5:15:29
In reply to someone please please help!!!!!!!, posted by ryan_s on June 6, 2000, at 16:01:38
That is a frustrating situation. Though there are lots of ways to approach this problem, and everyone would probably do it differently, here's what I would do in your shoes. Actually, I have done this and it worked. The basic message is that sometimes we need to do some wheeling and dealing with doctor, some verbal contracting, some comprise agreements. That will often open a door that is otherwise slammed shut.
In your shoes, I would get back into that doctor's office as soon as possible. When seated in the office, I would (and have) proceed to say something like this...
"I don't think I made myself clear on our last meeting. That's my fault. But I need to emphasize to you that all antidepressants make me more depressed. That includes Effexor. I don't know what chemistry is responsible for my symptoms, but whatever it is antidepressants only aggravate it. On the other hand, I know for a fact that Adderall completely normalizes me. There's no need to experiment with other medications when we already know what works with me. It will save me and you a lot of time and frustration.
I understand your concerns of abuse. I agree that is a legitimate concern. But abuse can only occur if there is no control. So I would like to make a deal with you that will provide control. (for the sake of example, let's assume your dose is 5mg in a.m. and 5mg in p.m.) Give me a prescription for 60 5mg tablets. That's 2 a day for a month. If I call you for a refill before a month is over, then you will know I have abused the drug and have run out prematurely. And since a hardcopy prescription versus a phone call or a label on the bottle is legally required for refilling an Adderall prescription, you are in complete control of how much medication I have. If I run out before a month is over, I've abused the drug, broken our verbal contract, and we'll have to re-evaluate what to do at that time. But until that occurs--I don't think it will--you should trust me and at least give me a chance to prove my credibility. I'm not asking for anything special, just to be normal. Adderall can do that for me.
Now let's assume that over time I develop tolerance and need higher doses. That's a possibility, right? Well, then we have to make a decision of whether having a normal productive life is a fair trade-off for needing a higher dose. The risk-benefit factor. But we aren't at that point yet. We can cross that bridge if and when it occurs. For now I think the best thing to do is get me started on a medication that we know works, and create a way to control dosing to avoid abuse. We can do that. OK? Is that alright with you?"
In addition to taking this diplomatic type approach, I would definitely bring into the office printed copies of some information for the doctor to see. Lay it right out in the open on the desk, facing the doctor, before you sit down. The information to print is found in Dr. Bob's tips section. Go to the section where it discusses stimulants for depression. You will find doctors from around the country verifying the credibility of stimulants for depression, their reasons why, their personal preferences, and their views on the risk-benefit factor. I think it will be most impressive for your doctor to see that you have done some serious homework, that you are aware of all the pros and cons of stimulants, and that you know for a fact how other doctors are using stimulants. And it provides credibility for your doctor to see in print actual physicians at major institutions who rely on stimulants for certain cases of depression. It's very difficult for a doctor to argue against what reputable phsycians at major institutions are doing, and have been doing for decades.
If you do all this and there is still no cooperation, then you need to do some more digging for another doctor. Hospitals and family physician offices can provide names that you might not find in the phone book. Call doctors' offices for names. And don't rule out regular general practitioners. If you briefly present your case on the phone to enough regular doctors, you will stumble onto one who is comfortable and willing to treat you with Adderall.
And one final note--this is optional, and maybe not good advice--but if you do all the above and get no cooperation, tell the pdoc before you leave that you are not happy with his/her service and you will not be paying for it. I did that with a disappointing pdoc. He was stunned silent. A few weeks later I got a notice in the mail of late payment. I called the office and reminded them I was not happy with the service and would not be paying. They said they would have to turn it over to a collection agency. I said fine, do what you have to do, but I'm not paying for inferior service. I never heard from them again. No phone calls, no letters, no notices, no collection agency. It was in their best interest--and cheaper--for them to just forget it.
But hopefully with some diplomatic deal-making and some printed reputable support for your case, it won't go that far. :-)
JohnL
poster:JohnL
thread:36332
URL: http://www.dr-bob.org/babble/20000603/msgs/36396.html