Posted by Viridis on June 5, 2003, at 16:24:22
In reply to Re: rules/regs of prescribing stims, posted by Snoozy on June 5, 2003, at 11:03:11
I don't think a specific test is required for a diagnosis of ADD, but various tests exist and there are standard symptoms/guidelines. In my case, the first time ADD came up was when I was seeing a therapist during a period of terrible depression. After a few sessions (which were mildly helpful), she said she really thought I had ADD, would probably need appropriate meds, and referred me a cognitive therapist who works mainly with children. He ran through some standard questionnaires, took a detailed history, and said I almost certainly had ADD. He also told me he had ADD himself, and it had taken him a long time to come to terms with it.
He also experimented with several forms of biofeedback, including an EEG scan that measures brainwave activity. He said mine was "quite unusual" (I can't remember the specifics), much like that of kids he treats with ADD. He wasn't licensed to prescribe, but urged me to ask my doctor for Ritalin or Adderall, and offered to write a letter supporting this.
I wasn't comfortable with the idea, so let it go. Then, a couple of years ago, when I was experiencing recurring anxiety and depression (largely based on disorganization and feeling overwhelmed), I went to see a psychiatrist after a very negative experience with my GP and very poor reactions to several ADs. My pdoc immediately put me on benzos, which helped greatly but still didn't solve the concentration issues. He tried a few other things which weren't so great, and I decided I would bring up the ADD/stimulant issue. When I next saw him, he actually brought it up first, and said he thought I showed classic ADD symptoms. He read off a standard set of questions (I answered yes to nearly all of them) and then said he could definitely justify prescribing Ritalin or Adderall, with Adderall his preferred choice. He gave me some Provigil to try first (he said it's pretty hit-or miss for ADD); I liked its energizing effects, but it didn't really help much with focus.
So, I started Adderall. It's worked very well in conjunction with Klonopin, and I've stayed at a very low dose (10 mg/day). I also skip the Adderall for a day or two here and there (to reduce the chances of tolerance) and this causes me no distress.
Re: depression: I told my pdoc that the Adderall was helping a lot with the "residual" depression I experienced after starting Klonopin (K reduced my anxiety and depression a lot, but some depression still came and went). He said that amphetamines can be excellent ADs, but that he had to be very cautious in prescribing them, and use for depression alone is "frowned upon". However, he did mention that for severely depressed patients, he will occasionally prescribe short courses of stimulants to "jump-start" things while he gets the ADs sorted out and the patient is adjusting. He said that he really had to be prepared to justify this, so reserves it for very severe cases.
So, apparently off-label use is allowed, but doctors are watched quite closely and so are generally uncomfortable with this.
poster:Viridis
thread:231443
URL: http://www.dr-bob.org/babble/20030604/msgs/231710.html