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Re: Medications, need Opinions geno

Posted by psychosage on April 21, 2004, at 16:37:34

In reply to Medications, need Opinions, posted by geno on April 20, 2004, at 8:36:11

> Hello all. Im posting this becase i do believe im taking the proper medications, but they may be too many, or conflicting. I myself have been doing research. I have 2 doctors perscribing these meds. One is a family practice doctor, the other doc is more of an addiction doctor, and internal medicine.

Okay, if you want to be truly honest to yourself you have to keep all psychotropics to one doc {specialist preferably}. If that doctor doesn't address all your needs move to another doc.

You have to speak up for yourself if you want to take care of yourself because primary docs are clueless about addiction and polypharmacy with psych meds.

> To start, i suffer from Opiate addiction, primarily oxycontin or heroin. Intranasally only.
> I tried every way to stop, but keep relapsing. Even aa/na, didnt help. Rehab didnt. So i figure there is somthing wrong upstairs.
> I may have hit the nail on the head, but im taking 5-6 different medication.
> I also suffer from refractory depression, Social anxiety, social phobia, ( i cannot be around people unless im high). Sleep disorder, and lack motivation or energy and just lay around.

I have similiar issues. Isolating is actually an ego problem, so I'm quite familiar. Whether you are inferior or superior neither one is accurate and thinking of yourself as inferior is not doing the world a favor. You'll learn that both ways of thinking come from the same parents. Both put your mind out of reality and lead to chasing a high or indulging in a low {yes, there is a such thing}.

> So, to be brief, 2 months ago, i went to my specialist doctor who is authorized to perscribe a newer drug called suboxone.(the main ingredient is buprenorphine, a partial opiate, but on this drug, you cannot use or it wont work. This drug totally elimnated all withdrawls. Also in the pdoc book, it tooted for depression in some people. It does NOT give me a high such as methadone. He persribed me suboxone 8mg 2x daily.
> He also diagnosed me for ADD. He said i could have suffered from this before my addiction, but coming off drugs, alot of addicts have add symptoms and such. So he perscribed me Adderall, 20mg 2x daily.

sketchy move. regardless of the fact opiates and stimulants are different subjective experiences and have different effects on the brain, they both are associated with pleasure, and amphetamines are very powerful and impressive to the addict mind whether you admit it or not.

I use provigil, and I frequently question how I am doing with it in relation to my recovery. It's not the samelevel of stimulant, but it still is one.

I couldn't tell you to leave it now, since stims can really give the lift and boost people need to function that can not be found in any other drug and antidepressant, but keep close tabs on it because they definitely lead to tolerance, dysphoria and mood swings. You can be stimulated and be depressed at the same time too, so don't rely on adderall to balance yourself.

> The third drug, he perscribed was Clonodin 0.2 which really counteracts any anxiety from adderall, and makes me drowsy.
is this another ADD solution? Strattera may be better. do you have hypertension?

> The fourth med, for sleep, is Ambien10mg.

this will contribute to a little sluggishness and grogginess regardless of what they tell you about it being more selective for GABA than benzos like ativan etc. {i took ativan for sleep too}.

I would split the pill in two. 5mg is also a theraputic dosage. I take 5mg myself. Now you shouldn't use 10mg to knock you out. If 5mg can make you drowsy enough to fall asleep then that is good. I don't think 5 or 10 makes your sleep any more healthier. I almost prefer benzos for sleep because you have muscle relanxant qualities ambien doesn't have.

> Now my family doctor, who knows basically nada for addiction, perscribes me Lexapro 10mg and klonopin 3mg. I want him to up the lexapro to 20mg.

okay, well, I get the sense drugs are added on and piled according to their class: stimulant+sedative+X+X=balance.

That's not good math.

A good doc would have you on strattera or wellbutrin and not adderall for ADD. Even though the subjective effects are very different, the non-stims can be effective.

> Again(med combo)
> Suboxone 8mg 2x daily
> Adderall 20mg 2x daily
> Klonopin 1mg 2-3 x daily

perhaps you can move to Effexor XR which works on depression and social anxiety. i don't have a high opinion of the SSRIs for GAD or social anxiety, but effexor is slightly different. It also is given for ADD.

> Lexapro 10mg

will make you apathetic, so watch out.

> Ambien 10mg sleep
> Clonodine 0.2 as needed. klonipin si your as needed drug apparently.

> Now that seems like alot, but this combo makes me feel more motivated, social, less prone to use, less cravings, not high, but feel pretty good. If i feel anxious, ill take an extra klonopin, 3mg max, if i feel too sedated, ill take another or 10mg adderall. The side effects i get are GI upset, constipation, occational headache, and insominia.
> Any opinons would be appritiated.
> geno

You want to try to get a combo that is working and you have to think as little as possible about it because thinking about speeding up or slowing down is really leading to pill dependence. Even though you are prescribed them for real conditions, your dose escalation and "as needed" basis are also causes for concern and monitoring because you are an addict.

I am not saying you are addicted to adderall or klonipin, but in a subtle way, your "as needed" dosing fulfills your addict mind. Trust me, it's a reality for many even after they stop drugs and booze.

Now some of that may be unavoidable, and you are going to end up with trying to fight your addiction and script drugs may be the right thing at the right time, but when you are on this combo for a while and then all of a sudden your emotional situation detiorates anyways which is normal for recovery people and psych med people, then you will be very very very let down.

I would try to cover as much as possible with antidepressants and Strattera because they are not reinforcing. You could probably keep some adderall, and it may be your primary ADHD drug lifeline, but you should build around that with non controlled substances.

There are other sleep drugs like trazadone which is not reinforcing.


some ideas are:

Depression: Wellbutrin {stimulating and given for ADHD}, Effexor {works on ADHD but behind wellbutrin and works on anxiety}, Remeron {good for sleep and a multi action antidepressant}

ADHD: Strattera {often used in combo or alone with another stim including provigil for ADHD} and moderate Adderall {CONTROLLED}, maybe Provigil {CONTROLLED} which will be less thrilling than adderall, but may be excellent with strattera.

Anxiety: Effexor XR or SSRI- otherwise benzos DEFINITELY compromise the effect of Adderall big time. You are just bouncing back and forth and really wasting more pills. Benzos cancel out stimulants.

Sleep: Think Trazadone or Remeron {knocks you out I hear} or lower Ambien to 5mg {CONTROLLED}

Ask your doctor to monitor all your meds at once. Some meds have interactions or require dosage tinkering if used in combo with others because of how they are metabolized by the liver.

Effexor and adderall may not be good for some people because it can cause serotonin syndrome. Some combos act synergistically.

All controlled drugs are reinforcing period. you can be in recovery and use them, but they require careful monitoring and honesty in all ways.

Good luck!

Check out - It is run by an ADHD person who has other conditions and who I think may or may not be in recovery, but he writes as if he is familiar with recovery issues and meds.




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