Posted by adamie on November 7, 2001, at 15:29:07
In reply to Re: Stimulants, how do you get them? » adamie, posted by Rick on November 7, 2001, at 0:47:34
hi. regarding my situation, I have a lot of it written out in the thread above named "Give up on Zyprexa"? So far all AD's I've tried have made me worse. What I am suffering from is severe depression caused by Accutane. Severe inability to think, concentrate, and remember. my memory is beyond horrible. I cant even remember anything about my ex-fiance. Also I sleep too much and am pretty tired.> > hi. There seem to be a lot of messages on this forum regarding stimulants. I myself am desperate for relief and I'm just wondering, how do you get these stimulants? Do your pdoc's prescribe them after several AD failures or do you get them by some other means? I am sick of feeling this way. If something can help after just one dose then I want it. I'm the type of guy who wouldn't even drink coffee but now my life is on the line. please reply.
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> My own pdoc suggested Ritalin augmentation after I asked for something to help offset Celexa+Klonopin induced fatigue and apathy. But I already had my mind set on Provigil, and talked him into it. If you're conversant with the various meds and strategies, *some* pdocs will really respond to the credibility this builds. But it's certainly not the only way to end up with a stimulant prescription. An aside, since you mentioned coffee: Coffee wakes me up but makes me jittery. Provigil wakes me up but doesn't make me jittery.
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> JohnX2's strategy sounds like it might work. I have some additional thoughts, but it's hard to make really informed suggestions since you didn't say anything about your condition and med history, or even what specific "relief" you seek. I assume you're more specific than this in discussions with your pdoc -- otherwise you're not real likely to get what you need very soon.
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> That said, the best approach depends a lot on whether you have an open-minded and informed pdoc, or a diehard member of the "SSRI's R Us" mega-network. If she's open-minded and informed, just talk about why you think a stimulant could help, and talk about what you've read/heard from credible sources to support this.
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> Incidentally, before he would prescribe the then-unfamiliar-to-him Provigil (modafinil) for me, my pdoc wanted to know the "real" story behind it, i.e., what people are saying on the internet boards as opposed to the drug company spin and company-funded studies. That's smart. I don't think all pdocs think this way, unfortunately, so it could help to be armed with evidence from studies, etc., e.g. passages from the following review which cites stimulants as a proven augmentation alternative:
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> http://www.psychiatrist.com/supplenet/v62s18/v62s1802.pdf
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> If he's not too open-minded, find another pdoc if you're not locked in by an HMO or restrictive insurance plan. Call around and see what their specialties are, whether they believe in using agents to potentiate AD's (you can get casually throw in stimulants as an "example" with thyroid hormone, pindolol, lithium, multiple AD's, etc.) Ask how they feel about polypharmacy. Ask what they think about MAOI's (pdocs who will consider them today seem to be better-informed and more open-minded). If you're in a fairly large city, find pdoc names in the phone book and search Medline and Google to see if they have any writings that suggest they might be receptive to stimulants. If you're in a university town, note that university-affiliated pdocs are often more research-minded and tend to be more open-minded as a result.
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> If you're stuck with Ms. SSRI-of-the-month, you need to be a little more persistent. Start subtly, and then get pushier in later visits if necessary. Tell her, for instance, that the latest AD may be helping some, but that it's continuing to cause so much fatigue or apathy that you can't appreciate the benefits. Keep it up as necessary. If you end up with Wellbutrin or Wellbutrin augmentation (and find it doesn't actually help!), just continue to act hopelessly fatigued and apathetic. (Again, this may mean just play up how you really feel, for all I can tell.)
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> If you're interested in Provigil (vs. a traditional stim) and prone to anxiety, act as if Wellbutrin added too much anxiety (it DID for me), and point out how you've read that Provigil doesn't increase anxiety very often. If you're interested in Provigil as an AD augmentor per the recent studies, cite those studies as well as the safety factor vs. amphetamine-based stims (lower incidence of anxiety or crashing or blood pressure increases or addiction potential; Class IV substance vs. Ritalin's much more stringent prescription control/monitoring as a Class II, etc.)
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> As long as you avoid coming off as someone looking for a fix -- and I highly doubt THAT would happen -- there's a good chance you'll get your stim prescription before long. Especially if you get a good pdoc.
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> Good Luck,
> Rick
poster:adamie
thread:83396
URL: http://www.dr-bob.org/babble/20011104/msgs/83453.html