Posted by karaS on October 10, 2004, at 18:15:34
In reply to effects and side effects » karaS, posted by zeugma on October 10, 2004, at 8:45:23
Hi z,
> Hi kara, I hope so too! Btw I read your comment in Social but was too shy to respond ;)
You're too cute!
> > 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.On the otherhand, if there are several other conditions that a person has, it might make it dificult to judge how effective the medication has been. Too many other factors invovled - how do you separate things out?
> > > > How are you doing balancing the Strattera and Ritalin?
> > 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?)Yes, I can see why you would prefer the truth. There are too many decisions you need to make and it's hard to plan when you have false promises or
expectations. I didn't realize that narcolepsy was a progressive condition. I thought it was more treatable than that. Of course there's always hope for better future treatments.Do either of your parents have any of your conditions? If so, how have they managed to deal wtih them?
You didn't respond earlier to my idea of Strattera in a patch. Is that at all possible? I don't know why they don't make more medications in patch form. There are so many people I've read about on the boards here who can't take medications orally because of stomach, IBS or other problems.
> 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.)I don't remember if I've ever asked you if you've tried desipramine. If you tolerate the TCAs well but need more stimulation, would that or even propityline be a possibility?
> > 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.Now that I read your response, I think I remember asking you that question before. Sorry. It's good to know that there are other options to try though if increasing the Ritalin isn't enough.
> 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.
>
> Buspirone does not work as an anxiolytic for me. It does work as an AD.... "it may help in some crazy way with the cycles underlying these disturbances."
That's a different usage for it. I hadn't heard of that.
> > > So you are starting Cymbalta today? I am getting impatient!> 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!
My pdoc will be sorry to hear that I haven't started it yet. He's eager to hear how his first patient is doing on it. Fortunately I'll get his voicemail and let him know that way. (Cluck, cluck)
Well, one of these days that shock does have to come. So be prepared! Aside from working and my allergy/sinus problems and my fear of meds in general, I don't want to face the possibility of it not working for me. (I think it's fairly safe to assume that I also have Avoidant Personality Disorder.)
Well, I'd better go attend to my long list of chores now. I can hardly wait.
Talk to you later,
Kara
poster:karaS
thread:397388
URL: http://www.dr-bob.org/babble/20041007/msgs/401260.html