Posted by Ritch on January 20, 2005, at 0:05:14
In reply to do many drs prescribe stims for depression?, posted by CareBear04 on January 19, 2005, at 19:27:45
> i've heard of this being done, but i've certainly never met a pdoc who would do this for me. then again, i tend not to have atypical depression nor purely melacholic depression, but rather, jittery and agitated depressions.
>
> 10mg of adderall doesn't seem like too much to me. i take 30mg of xr and 10mg of immediate release. but then again, when i started at about 20-30mg a day, i was on lithium for my mmood stabilizer, which is as strong as they come for me.
>
> i have the tendency to self-medicate or adjust my doses myself, too. it doesn't help that my pdoc gives me scripts for a handful of prns that i can take at my discretion. at least she's pretty cool about taking more or less meds depending on how i feel, which is more than what it sounds like your pdoc is like.
>
> i think if my pdoc put stringent restrictions on what i can and can't do, i'd be more apt to disobey. my last pdoc kinda joked that if i were any younger, he would diagnose me with oppositional defiant disorder. maybe knowing this, the drs would rather help me do things safely than take the chance that i could hurt myself by disobeying their orders.
>
> i don't remember much anymore about what the last couple of posts were about, but i hope this relates at least minimally.
The real theme that Ron is talking about is self-discontinuation of a *new* medication (add or change) that is prescribed at one visit and then soon after the add or change, the patient experiences what they sincerely believe (with good evidence) of *worsening* of their condition (an immediate manic reaction). It is generally understood that it takes a classic unipolar depressive at least a two week trial (i.e) with an antidepressant to experience much positive benefit. So one might expect a doctor to poohpooh adverse effects of the AD and push the patient to comply and wait it out. With bipolar things get a lot more complicated... there are a lot of substances that can worsen the condition immediately (and potentially very dangerously) and not just fail to work and give "side effects". I just think Ron's pdoc was a little asleep at the wheel and didn't pay proper attention. I took a 4-day course of high dose prednisone once (for hives) and nearly flipped out so bad that I almost lost my job. It was kind of like putting salt on a slug. This is where pdocs have to watch things closely... When the communication loop isn't the best sometimes the patient needs to make the call.
poster:Ritch
thread:441138
URL: http://www.dr-bob.org/babble/20050119/msgs/444521.html