Posted by zeugma on October 10, 2004, at 8:45:23
In reply to Re: rip van winkle syndrome » zeugma, posted by karaS on October 10, 2004, at 4:03:10
> > > Hi z,
> > >
> > Yes. Tomorrow will be my day off (sort of). And the day after. But there's so much I have to do. It is almost more exhausting for me to be in my chaos of an apt. than to be in my workplace. I think I'm going to listen to music, and let my mind drift. My ADD really feels like a REM state: directionless, random processes that follow their own course. I think Strattera had such an effect on my ADD because it is such a powerful norepinephrine reuptake inhibitor, and suppressor of REM sleep. But I can't take it (see below).
>
> Music has always been my salvation - until recently that is. My stereo system and most of my tapes and CDs are all boxed up. I haven't opened them from my last move. I never wanted to stay in this apartment so I haven't unpacked a lot of things. Hopefully I will move soon and get more music back in my life (literally and figuratively).
>Hi kara, I hope so too! Btw I read your comment in Social but was too shy to respond ;)
> It's hard for me to focus sometimes but I don't feel like my thoughts are "directionless random processes". That must be a strange feeling.
>It's why I have described my waking life as 'dream-like' to all my therapists since my early 20's. They displayed no understanding of what I meant. My current doctor says my symptoms are not typical of any disorder she knows of, although she concurs that I definitely have ADD in addition to other problems (learning disabilities, severe anxiety, vulnerability to depression). the research doctor at the university study I interviewed for said much the same. This doctor, who I admired for her candor (not something I have found typical of therapists or doctors) told me I needed to see a specialist in whatever disorder I thought most imperative to treat, rather than participate in a general study on depression. She did tell me I qualified for it, as I did exhibit symptoms of depression consistent with DSM criteria. I now see, however, that while her candor was appreciated, it is the fashion now for drug companies sponsoring studies to do their best to weed out the difficult cases so the product they are sponsoring can demonstrate significant separation from placebo. This is one reason the new meds are simply not as effective as those from the first generation. Imipramine was tried on everyone in the hospital, and its clinical profile slowly emerged from its being tested on a vast range of individuals with numerous disorders.
> > I am sure that TCA's have a more direct action on panic. Don't have the energy to speculate further, but what you have said corroborates my own experience.
> >
> > > I haven't started the Cymbalta yet because I didn't want to have unexpected side effects while working. I'll start it this weekend. I hate starting new drugs. Can you tell?
> > >
> >
> > No I couldn't :)
> >
> >
> > > How are you doing balancing the Strattera and Ritalin?
> >
> > The Strattera is gone. it tore my stomach apart, and it seemed that I got a response only from doses that came close to 40 mg. Plus it would wear off around 1 or 2 pm necessitating bid dosing, and of course, more side effects. It did its job for a little but it is not a medicine that I can tolerate. I am now taking 30 mg ritalin LA am plus 10 mg at noon. It is not doing wonders for me, but I tolerate it better than Strattera, and I need something I can take that does not feel worse than the original condition. If I needed Strattera to work full-time, I would opt for part-time and try to scrape by. I would have no choice.
>
> I don't understand. I thought that in the past you had taken Strattera for at least a year and had done well on it. Why is it irritating your stomach now? Is is possible for compounding pharmacies to put the medication into a patch?I did not explain myself well enough (following my dr.s injunction to cut down the caffeine is making it harder to write!). I did take Strattera for almost a year. It had a powerful effect on my ADHD; powerful enough to allow me to actually follow through on an unexpected opportunity I was offered in my field (not my academic field, unfortunately). I had received similar opportunities previously but the ADHD was so pronounced that the opportunities were lost. The Strattera always hurt my stomach. But since it worked, I put up with it, tried different strategies (changing diet, taking FiberCon and other supplements, etc.) which worked somewhat but were hardly curative. The stomach problems were not the reason I discontinued. I stopped it because it made me more and more fatigued, and I cannot tolerate a med that elevates my fatigue above baseline. The fatigue was not evident in the beginning, but gradually became more and more severe. It was not due to insomnia or anything treatable. it simply drained me, and I am being slowly drained, energywise, anyway, by the narcolepsy (ie I am more tired now than I was 2 years ago, and the fatigue has a progressive character that makes it rather frightening. Being fairly sure that I do have narcolepsy (pdoc concurred) is comforting, as the forum boards of narcolepsy are full of stories of worsening fatigue through the 20's, increasing through the early and mid 30's till almost complete anergia results. Stims reverse this partially but not completely, and experts on narcolepsy are more candid about the limitations of stims in narcolepsy than Pfizer, Lilly, et al. are in plugging the dramatic effects of their newest AD's: stims only partially reverse the terrible fatigue. That does console me a little. I would rather get an honest picture of what to expect than an inflated one. Do you know I appreciate candor?)
Back to Strat, 2nd trial. Immediate AD effects, immediate 'clearing' of my thought process. But it does intensify the fatigue. And a med that does this is off my list, period. (I mean fatigue that does not subside with time. I can discriminate between the antihistaminic effect of nortriptyline, which is 'sedating', and the peculiar, recalcitrant fatigue of Strattera. Sedation I can deal with, since it passes in 2 weeks and what is left is the propensity to sleep, which is why the TCA's are so great for insomnia. Nortriptyline does not increase my fatigue. if it did, I would chuck it too, and was prepared to do so last year when I systematically lowered my meds one by one to see which one was draining me beyond my usual, awful draining.)
> Is there a reason that you never consider or try Adderall or Dexedrine?
>
I would try them. I don't know my pdoc's rationale for preferring Ritalin. But I think what he is doing is making sure I give Ritalin an adequate trial by increasing the dosage to what is therapeutic *for me*. I am a rapid metabolizer of drugs and I know that I need to take Ritalin LA every six hours despite the fact that it's marketed as an eight-hour formulation. If the higher dose of Ritalin simply does nothing, then I will bring up the other stims. But as he said, "We shouldn't give up on it yet," and I agree. It may work at this dose, or a higher one. I'm skeptical, but I think he is being conscientious. Also, the little I have been able to find on this topic suggests that Ritalin is safer than amphetamines when combined with a TCA. That may be his rationale.
> > I explained to my pdoc that Ritalin simply is not as effective for my symptoms as Provigil or Strattera, but that the latter two are not tolerable. I told him that Ritalin's inefficacy in itself causes anxiety, so he let me increase my clonazepam. There is nothing more anxiogenic, for me, than to know that my focus is slipping away, and that others can see it (I have a job that calls for constant interaction, and trust me: they can). My pdoc told me also to decrease caffeine as much as possible, as they compete for the same receptors. I had much the same thought. But if Ritalin at the higher dose doesn't help, it will be caffeine all the way. I am not having serious s/e from Ritalin, so I suppose the dose could go higher. We'll see.
>
> Doesn't coffee rip you insides out as well? Or do you take caffeine pills?
>
Coffee rips up my insides, and my therapist suggested I take caffeine pills. If Ritalin doesn't work, and then Adderall etc. doesn't either, I am going to make the stockholders of the company that makes NoDoz very happy.Of course, coffee rips up my insides less than Strattera...>
> > By the way, to answer your question in your last post: I think I have both. A fun combination :) I am also restarting buspirone, 15 mg hs, as I told him it blocked hypnagogic hallucinations when I knew I would be vulnerable to them (ie, when I am stressed or have gotten inadequate sleep previously). I took it last night without problems. I tolerate buspirone well at low dosages.
>
> That made me nauseous. But I'm glad it's helpful to you. Maybe you won't need to keep the clonazepam at the higher rate once you've taken this a while.Buspirone does not work as an anxiolytic for me. It does work as an AD. But it is useless for social phobia, and it's the (very realistic) fear of being perceived as being 'half-asleep' that drives the anxiety to the point of near panic. Clonazepam actually helps the ADD symptoms since the anxiety worsens them. Buspirone doesn't, and I have pushed its dose to its limit of tolerability (for me, 30 mg) with no effect on this kind of anxiety. My pdoc wants me to take 15 mg at night because of its effects on my strange sleep disturbances, and as he said, "it may help in some crazy way with the cycles underlying these disturbances." Again, I think his reasoning is sound here. But it is simply not a viable anxiolytic.
>
> > So you are starting Cymbalta today? I am getting impatient!
>
> You mean you're getting tired of hearing about it. :-) I was planning on taking it today but i've been having allergy and sinus problems with headache and pressure and swollen membranes for several days now. I couldn't bear the thought of adding on a drug to give me worse symptoms. I wish I could figure out what I'm having this reaction to. It might be the Armour thyroid medication. I'll be going back to the synthetic T4 tomorrow so we'll see if that changes anything.OK then, tell me if the T4 helps! That's not as interesting as Cymbalta, but I have to be grateful for small things :)
>
> Hopefully I'll be in the mood to start the Cymbalta soon. I probably shouldn't have said anything about it until I had actually started on it.
>
It would be too shocking, at this point, for me to deal with your taking Cymbalta without advance notice. if you value my cardiac health, please let me know in advance!-z
> K
>
poster:zeugma
thread:397388
URL: http://www.dr-bob.org/babble/20041007/msgs/401112.html