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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by ryan_s on June 6, 2000, at 16:01:38
can someone please help me out here. i am a college student in dayton, oh that has been diagnosed with depression and anxiety. after being diagnosed with these psych disorders i was put on a variety of antidepressants and antianxiety medications (i will save you the time of listing them all because i have tried over 12). yes, ssri's, nari's, antipsychotics, and anticonvulsants have been tried with no help whatsoever, which makes me think that i am not depressed. the frustration from switching and from one medication from another was one of the most frustrating processes in my life. the fact that most antidepressants take two weeks to kick in did not help my impatient urge to feel good about myself.
about two weeks ago i found a 20 mg pill of adderral in my room (my roomate left this behind by accident upon moving out of our house for the summer). when i found this pill,i had been off of any kind of psych drug for three months. at first i was hesitant to try a drug that had not been perscribed to me, but then i thought "i have been on over 12 psychiatric drugs;what is one more pill going to do to me". that night i decided to give adderall a go. to my surprise this drug was the best thing that ever happened to me. i actually wanted to talk to people, i wanted to get up off of my couch and do something, i no longer had an urge to look away when talking to others, and did not feel the need to fidget. adderall blew all of the other antidepressants and antianxiety drugs out of the water. adderall actually made me feel like myself.
here is where things get tricky. since i had such a good experience with adderall, i wanted to see if a psychiatrist would perscribe it to me. i looked in the phone book under the yellow pages for psychiatrist. do not do that, because there is no section. finally i found a section labeled mental health. upon calling the listed numbers, most of the practices either were for outpatient only or did not have a psychiatrist, period. to make a long story short, i found a number to a psychiatrist that i visited a year and a half ago. i visted dr. fitz today confident that she would perscribe me adderall. i told her straightforward, "i do not want to take anymore antidepressants (they only made my depression worse) and that i shadily tested adderall myself." after one hour of trying to convince dr. fitz that i might be ADD, she gave me a sample of effexor. she said that adderall is to easily abused. i do not care if it is easily abused because i am not an addictive type person. all i know is that the one night of being on adderall made life worth getting excited for again.
i do not know what to do at this time. i am sick of getting the run around by calling random numbers under mental health in the yellow pages. all that i want is a pdoc that will listen to my needs, and one that is also in the dayton, oh area. if anyone can help me please reply. thank you so much.
frustrated,
ryan
Posted by tina on June 6, 2000, at 16:37:41
In reply to someone please please help!!!!!!!, posted by ryan_s on June 6, 2000, at 16:01:38
Do you have a family doctor who knows you well and would help you out?
> can someone please help me out here. i am a college student in dayton, oh that has been diagnosed with depression and anxiety. after being diagnosed with these psych disorders i was put on a variety of antidepressants and antianxiety medications (i will save you the time of listing them all because i have tried over 12). yes, ssri's, nari's, antipsychotics, and anticonvulsants have been tried with no help whatsoever, which makes me think that i am not depressed. the frustration from switching and from one medication from another was one of the most frustrating processes in my life. the fact that most antidepressants take two weeks to kick in did not help my impatient urge to feel good about myself.
>
> about two weeks ago i found a 20 mg pill of adderral in my room (my roomate left this behind by accident upon moving out of our house for the summer). when i found this pill,i had been off of any kind of psych drug for three months. at first i was hesitant to try a drug that had not been perscribed to me, but then i thought "i have been on over 12 psychiatric drugs;what is one more pill going to do to me". that night i decided to give adderall a go. to my surprise this drug was the best thing that ever happened to me. i actually wanted to talk to people, i wanted to get up off of my couch and do something, i no longer had an urge to look away when talking to others, and did not feel the need to fidget. adderall blew all of the other antidepressants and antianxiety drugs out of the water. adderall actually made me feel like myself.
>
> here is where things get tricky. since i had such a good experience with adderall, i wanted to see if a psychiatrist would perscribe it to me. i looked in the phone book under the yellow pages for psychiatrist. do not do that, because there is no section. finally i found a section labeled mental health. upon calling the listed numbers, most of the practices either were for outpatient only or did not have a psychiatrist, period. to make a long story short, i found a number to a psychiatrist that i visited a year and a half ago. i visted dr. fitz today confident that she would perscribe me adderall. i told her straightforward, "i do not want to take anymore antidepressants (they only made my depression worse) and that i shadily tested adderall myself." after one hour of trying to convince dr. fitz that i might be ADD, she gave me a sample of effexor. she said that adderall is to easily abused. i do not care if it is easily abused because i am not an addictive type person. all i know is that the one night of being on adderall made life worth getting excited for again.
>
> i do not know what to do at this time. i am sick of getting the run around by calling random numbers under mental health in the yellow pages. all that i want is a pdoc that will listen to my needs, and one that is also in the dayton, oh area. if anyone can help me please reply. thank you so much.
>
> frustrated,
> ryan
Posted by KAP on June 6, 2000, at 19:32:38
In reply to someone please please help!!!!!!!, posted by ryan_s on June 6, 2000, at 16:01:38
> can someone please help me out here. i am a college student in dayton, oh that has been diagnosed with depression and anxiety. after being diagnosed with these psych disorders i was put on a variety of antidepressants and antianxiety medications (i will save you the time of listing them all because i have tried over 12). yes, ssri's, nari's, antipsychotics, and anticonvulsants have been tried with no help whatsoever, which makes me think that i am not depressed. the frustration from switching and from one medication from another was one of the most frustrating processes in my life. the fact that most antidepressants take two weeks to kick in did not help my impatient urge to feel good about myself.
>
> about two weeks ago i found a 20 mg pill of adderral in my room (my roomate left this behind by accident upon moving out of our house for the summer). when i found this pill,i had been off of any kind of psych drug for three months. at first i was hesitant to try a drug that had not been perscribed to me, but then i thought "i have been on over 12 psychiatric drugs;what is one more pill going to do to me". that night i decided to give adderall a go. to my surprise this drug was the best thing that ever happened to me. i actually wanted to talk to people, i wanted to get up off of my couch and do something, i no longer had an urge to look away when talking to others, and did not feel the need to fidget. adderall blew all of the other antidepressants and antianxiety drugs out of the water. adderall actually made me feel like myself.
>
> here is where things get tricky. since i had such a good experience with adderall, i wanted to see if a psychiatrist would perscribe it to me. i looked in the phone book under the yellow pages for psychiatrist. do not do that, because there is no section. finally i found a section labeled mental health. upon calling the listed numbers, most of the practices either were for outpatient only or did not have a psychiatrist, period. to make a long story short, i found a number to a psychiatrist that i visited a year and a half ago. i visted dr. fitz today confident that she would perscribe me adderall. i told her straightforward, "i do not want to take anymore antidepressants (they only made my depression worse) and that i shadily tested adderall myself." after one hour of trying to convince dr. fitz that i might be ADD, she gave me a sample of effexor. she said that adderall is to easily abused. i do not care if it is easily abused because i am not an addictive type person. all i know is that the one night of being on adderall made life worth getting excited for again.
>
> i do not know what to do at this time. i am sick of getting the run around by calling random numbers under mental health in the yellow pages. all that i want is a pdoc that will listen to my needs, and one that is also in the dayton, oh area. if anyone can help me please reply. thank you so much.
>
> frustrated,
> ryan
Dear Ryan,Near Dayton (Cincinnati OH) Northgate area there is a clinic Called New Life 1-800 New Life I suggest you call them. I highly recommend. Dr. Marg Rinck. Phd
I know another Dr may not seem like the best response but I do know something About ADD my 2 brothers have it and now one is Bi Polar also my teenage son has it and may be bi polar.Thanks for being honest. KAP
Posted by Andre Allard on June 6, 2000, at 21:07:16
In reply to someone please please help!!!!!!!, posted by ryan_s on June 6, 2000, at 16:01:38
The reason why the doc did not give you adderall is because it is not used to treat depression. On it's own, Adderal does not have any antidepressant effects at all if any. When combined with another AD, it can be useful. Adderall works right away while ADs take weeks to become effective. The fact that it affected your mood is probably due to Adderall's stimulating effects. You see, Adderall works on a a neurotransmitter called dopamine. Depression is related to alterations in serotonin and norepiniphrine. This is why adderall is not given as an antidepressant because it does little for the neurotransmitters that are affected by depression. Also, adderall is generally not for long term treatment either.
You mentioned that you have tried many ADs. It is very, very rare that twelve medications have had no positive effects on you. Did you give the ADs a full six weeks at a maximum dosage? You should only dismiss an AD after no response has been seen after six weeks/maximum dosage.
I have been on effexor xr off and on over the last year. I am currently on 300 mg/day + trazadon 100mg/night to help me sleep. I have been on many AD as well and effexor has been the best by far. Good luck!
Posted by shar on June 6, 2000, at 22:23:22
In reply to Re: someone please please help!!!!!!!, posted by Andre Allard on June 6, 2000, at 21:07:16
L - I haven't used Adderall before, but I've gone through a number of AD's. My experience has been that it really is important to give the meds a chance (4-6 weeks at a more than introductory level). That is, unless you have really severe reactions to it (like I did with serzone).
Another important point, IMHO, is that the better you know your doc, the more willing they may be to have you participate in what you take. I do a lot of research, and make a lot of decisions with my doc; things to add, subtract, etc. Right now I'm on a combination that has been successful for a while (over a year), so we haven't done much changing.
So, your experience with the doc on your first visit may not be repeated once you hook up with someone. My dentist is always talking about " drug-seeking" behavior and I think docs in general just initially assume we want to abuse drugs.
I actually see an RN who is specially trained and able to prescribe, except for controlled substances (like Klonopin!!).
If you don't think you're depressed, you can do a lot of research into that and ADD or whatever you might think is going on, and talk with your doc about it. Once the doc understands that you know what you're talking about, you'll probably have good luck with collaborating more.
Best,
s
Posted by JohnL on June 7, 2000, at 5:15:29
In reply to someone please please help!!!!!!!, posted by ryan_s on June 6, 2000, at 16:01:38
That is a frustrating situation. Though there are lots of ways to approach this problem, and everyone would probably do it differently, here's what I would do in your shoes. Actually, I have done this and it worked. The basic message is that sometimes we need to do some wheeling and dealing with doctor, some verbal contracting, some comprise agreements. That will often open a door that is otherwise slammed shut.
In your shoes, I would get back into that doctor's office as soon as possible. When seated in the office, I would (and have) proceed to say something like this...
"I don't think I made myself clear on our last meeting. That's my fault. But I need to emphasize to you that all antidepressants make me more depressed. That includes Effexor. I don't know what chemistry is responsible for my symptoms, but whatever it is antidepressants only aggravate it. On the other hand, I know for a fact that Adderall completely normalizes me. There's no need to experiment with other medications when we already know what works with me. It will save me and you a lot of time and frustration.
I understand your concerns of abuse. I agree that is a legitimate concern. But abuse can only occur if there is no control. So I would like to make a deal with you that will provide control. (for the sake of example, let's assume your dose is 5mg in a.m. and 5mg in p.m.) Give me a prescription for 60 5mg tablets. That's 2 a day for a month. If I call you for a refill before a month is over, then you will know I have abused the drug and have run out prematurely. And since a hardcopy prescription versus a phone call or a label on the bottle is legally required for refilling an Adderall prescription, you are in complete control of how much medication I have. If I run out before a month is over, I've abused the drug, broken our verbal contract, and we'll have to re-evaluate what to do at that time. But until that occurs--I don't think it will--you should trust me and at least give me a chance to prove my credibility. I'm not asking for anything special, just to be normal. Adderall can do that for me.
Now let's assume that over time I develop tolerance and need higher doses. That's a possibility, right? Well, then we have to make a decision of whether having a normal productive life is a fair trade-off for needing a higher dose. The risk-benefit factor. But we aren't at that point yet. We can cross that bridge if and when it occurs. For now I think the best thing to do is get me started on a medication that we know works, and create a way to control dosing to avoid abuse. We can do that. OK? Is that alright with you?"
In addition to taking this diplomatic type approach, I would definitely bring into the office printed copies of some information for the doctor to see. Lay it right out in the open on the desk, facing the doctor, before you sit down. The information to print is found in Dr. Bob's tips section. Go to the section where it discusses stimulants for depression. You will find doctors from around the country verifying the credibility of stimulants for depression, their reasons why, their personal preferences, and their views on the risk-benefit factor. I think it will be most impressive for your doctor to see that you have done some serious homework, that you are aware of all the pros and cons of stimulants, and that you know for a fact how other doctors are using stimulants. And it provides credibility for your doctor to see in print actual physicians at major institutions who rely on stimulants for certain cases of depression. It's very difficult for a doctor to argue against what reputable phsycians at major institutions are doing, and have been doing for decades.
If you do all this and there is still no cooperation, then you need to do some more digging for another doctor. Hospitals and family physician offices can provide names that you might not find in the phone book. Call doctors' offices for names. And don't rule out regular general practitioners. If you briefly present your case on the phone to enough regular doctors, you will stumble onto one who is comfortable and willing to treat you with Adderall.
And one final note--this is optional, and maybe not good advice--but if you do all the above and get no cooperation, tell the pdoc before you leave that you are not happy with his/her service and you will not be paying for it. I did that with a disappointing pdoc. He was stunned silent. A few weeks later I got a notice in the mail of late payment. I called the office and reminded them I was not happy with the service and would not be paying. They said they would have to turn it over to a collection agency. I said fine, do what you have to do, but I'm not paying for inferior service. I never heard from them again. No phone calls, no letters, no notices, no collection agency. It was in their best interest--and cheaper--for them to just forget it.
But hopefully with some diplomatic deal-making and some printed reputable support for your case, it won't go that far. :-)
JohnL
Posted by michael on June 7, 2000, at 8:33:57
In reply to Re: someone please please help!!!!!!!, posted by JohnL on June 7, 2000, at 5:15:29
I think JohnL has probably given you the best advice for a situation like yours.
One other idea I had, that you might mention, is modafinil (provigil) - it's a non-amphetamine psychostimulant, and therefore much less prone to problems with abuse. And I believe AndrewB has indicated that it is often used as an antidepressant in europe (hope I got that part right) - you might want to mention that also.
The only down-side is that it's really expensive, so it's probably not an option if one doesn't have insurance (don't know if that's an issue for you, or not).
And one last resort/idea - you can get adrafinil - the drug "ancestor" of modafinil - via mail-order from overseas. I know there are a number of people here who've had some success with it - myself and JohnL included. The downside, once again, is the insurance aspect (it's not FDA approved). However, it is a LOT cheaper than modafinil. Good Luck!
> That is a frustrating situation. Though there are lots of ways to approach this problem, and everyone would probably do it differently, here's what I would do in your shoes. Actually, I have done this and it worked. The basic message is that sometimes we need to do some wheeling and dealing with doctor, some verbal contracting, some comprise agreements. That will often open a door that is otherwise slammed shut.
>
> In your shoes, I would get back into that doctor's office as soon as possible. When seated in the office, I would (and have) proceed to say something like this...
>
> "I don't think I made myself clear on our last meeting. That's my fault. But I need to emphasize to you that all antidepressants make me more depressed. That includes Effexor. I don't know what chemistry is responsible for my symptoms, but whatever it is antidepressants only aggravate it. On the other hand, I know for a fact that Adderall completely normalizes me. There's no need to experiment with other medications when we already know what works with me. It will save me and you a lot of time and frustration.
>
> I understand your concerns of abuse. I agree that is a legitimate concern. But abuse can only occur if there is no control. So I would like to make a deal with you that will provide control. (for the sake of example, let's assume your dose is 5mg in a.m. and 5mg in p.m.) Give me a prescription for 60 5mg tablets. That's 2 a day for a month. If I call you for a refill before a month is over, then you will know I have abused the drug and have run out prematurely. And since a hardcopy prescription versus a phone call or a label on the bottle is legally required for refilling an Adderall prescription, you are in complete control of how much medication I have. If I run out before a month is over, I've abused the drug, broken our verbal contract, and we'll have to re-evaluate what to do at that time. But until that occurs--I don't think it will--you should trust me and at least give me a chance to prove my credibility. I'm not asking for anything special, just to be normal. Adderall can do that for me.
>
> Now let's assume that over time I develop tolerance and need higher doses. That's a possibility, right? Well, then we have to make a decision of whether having a normal productive life is a fair trade-off for needing a higher dose. The risk-benefit factor. But we aren't at that point yet. We can cross that bridge if and when it occurs. For now I think the best thing to do is get me started on a medication that we know works, and create a way to control dosing to avoid abuse. We can do that. OK? Is that alright with you?"
>
> In addition to taking this diplomatic type approach, I would definitely bring into the office printed copies of some information for the doctor to see. Lay it right out in the open on the desk, facing the doctor, before you sit down. The information to print is found in Dr. Bob's tips section. Go to the section where it discusses stimulants for depression. You will find doctors from around the country verifying the credibility of stimulants for depression, their reasons why, their personal preferences, and their views on the risk-benefit factor. I think it will be most impressive for your doctor to see that you have done some serious homework, that you are aware of all the pros and cons of stimulants, and that you know for a fact how other doctors are using stimulants. And it provides credibility for your doctor to see in print actual physicians at major institutions who rely on stimulants for certain cases of depression. It's very difficult for a doctor to argue against what reputable phsycians at major institutions are doing, and have been doing for decades.
>
> If you do all this and there is still no cooperation, then you need to do some more digging for another doctor. Hospitals and family physician offices can provide names that you might not find in the phone book. Call doctors' offices for names. And don't rule out regular general practitioners. If you briefly present your case on the phone to enough regular doctors, you will stumble onto one who is comfortable and willing to treat you with Adderall.
>
> And one final note--this is optional, and maybe not good advice--but if you do all the above and get no cooperation, tell the pdoc before you leave that you are not happy with his/her service and you will not be paying for it. I did that with a disappointing pdoc. He was stunned silent. A few weeks later I got a notice in the mail of late payment. I called the office and reminded them I was not happy with the service and would not be paying. They said they would have to turn it over to a collection agency. I said fine, do what you have to do, but I'm not paying for inferior service. I never heard from them again. No phone calls, no letters, no notices, no collection agency. It was in their best interest--and cheaper--for them to just forget it.
>
> But hopefully with some diplomatic deal-making and some printed reputable support for your case, it won't go that far. :-)
> JohnL
Posted by leslye on June 7, 2000, at 11:49:01
In reply to someone please please help!!!!!!!, posted by ryan_s on June 6, 2000, at 16:01:38
ryan, have you found your local chapter of CHADD (children and adults with ADD)? If not, go the their national web site (www.chadd.org) and find your closest chapter - you can call them, and usually they will have a list of local docs who are experienced in the diagnosis and treatment of ADD in adults- your story is extremely common - often we see parents who have tried their kids' ritalin or adderal, or college students who have taken their roommate's meds- I think it is human nature!!!Docs who treat ADD aren't as shy about using stimulants - and, my belief ( and I beleive the consensus of the current treatment community) is that even in adults, stimulants are still first choice. you may end up needing a supplement of another agent if your anxiety doesn't respond to the stims, but alot of folks do well just on stims. Good luck hunting down someone who really knows what to do with adult ADD. leslye
Posted by Sara T on June 8, 2000, at 12:03:10
In reply to Re: someone please please help!!!!!!! » ryan_s, posted by leslye on June 7, 2000, at 11:49:01
> ryan, have you found your local chapter of CHADD (children and adults with ADD)? If not, go the their national web site (www.chadd.org) and find your closest chapter - you can call them, and usually they will have a list of local docs who are experienced in the diagnosis and treatment of ADD in adults- your story is extremely common - often we see parents who have tried their kids' ritalin or adderal, or college students who have taken their roommate's meds- I think it is human nature!!!Docs who treat ADD aren't as shy about using stimulants - and, my belief ( and I beleive the consensus of the current treatment community) is that even in adults, stimulants are still first choice. you may end up needing a supplement of another agent if your anxiety doesn't respond to the stims, but alot of folks do well just on stims. Good luck hunting down someone who really knows what to do with adult ADD. leslye
Ryan,
I second what Leslye said. I am an adult with ADD and only realized it through my child's condition. I also tried some of his ritalin before seeing a doc and concluded it worked for me. It is very important that you find a pdoc who know adult ADD. Also, bring your school records with you so that you can validate your belief by comments from teachers as well as family. Diagnosis of ADD in adults requires a careful history taking.
Also, depression and anxiety are commonly comorbid conditions with ADD, and as my pdoc said, it is hard to tease them apart. Effexor is an antodepressant used in ADD treatment because it has an activating effect similar to stimulants. I agree with others also, that you need to give your meds a fair trial.
Finally, pick up the book, DRIVEN TO DISTRACTION, authors Ratey and Hallowell.
Sara T.
Posted by ryan_s on June 8, 2000, at 19:22:43
In reply to Re: someone please please help!!!!!!!, posted by Sara T on June 8, 2000, at 12:03:10
i just wanted to thank all of you for your response. it was greatly appreciated. the info on CHADD was a great help.
thanks much,
ryan_s
Posted by KarenB on June 9, 2000, at 0:57:04
In reply to Re: someone please please help!!!!!!!, posted by ryan_s on June 8, 2000, at 19:22:43
Dear ryan_s,
I was previously (mis)diagnosed as Bipolar and recently, after research, found that I was ADD. It made sense of my entire life. I am on Adderall now, along with Buspar and the combo is working better than anything has in a very long time. I agree with the suggestion of Modafinil (Provigil), however, as it is not considered addictive, as Adderall is. It is a drug used for Narcolepsy but I have read (here) that it is classified and used as an antidepressant in Europe AND as one here in the States by some knowledgeable docs. (BTW, whoever wrote that, I would like the source, so I can bring it to my pdoc, who is not familiar with Provigil).
I, like you, have tried numerous SSRIs and mood stabilizers to no avail. Psychostimulants are the only meds that work for me. Period.
Seratonin and Norepinephrine imbalance are not the only reasons for depression. My problem is most assuredly depression and is caused by Dopamine imbalance. Drugs that increase Dopamine work for me, others, like SSRIs, make me feel sleepy or crazy. And, yes, I have given a fair trial to many of these meds.
Call your local CHADD chapter for a good doctor reference, then go ahead and get tested for ADD. Once you have been diagnosed, if this indeed is your condition, you'll have no problem getting your meds. Also, go to www.addclinic.org (.com?) for more info. Read the article entitled "314 vs 296," which covers how to differentiate between Bipolar and ADD. You probably have "innattentive type," which does not include hyperactivity in it's symptomology. This is why it is so commonly misdiagnosed or not diagnosed at all in children, because those suffering are not disruptive in the classroom. I was always accused of not applying myself. How many times have you heard THAT one?
Best to you, Ryan.
Karen
Posted by KarenB on June 9, 2000, at 11:19:13
In reply to Re: someone please please help!!!!!!!, posted by KarenB on June 9, 2000, at 0:57:04
Ryan,
Interesting info on Provigil at: www.docguide.com Just do a search on Provigil and/or Modafinil. Apparently, the company is pushing for the drug's acceptance as an ADHD alternative and for different types of fatigue. www.neuroinv.com has an article on the manufacturer, Cephalon, which covers additional research for those wishing to invest in the company. This was very informative as well.
Now I am armed for my next appointment with my doctor.
Why do you figure I need to do the research when he is the one getting $200 per hour? Hmmmmm...
Karen
Posted by S.D. on June 9, 2000, at 13:36:58
In reply to Re: someone please please help!!!!!!!, posted by KarenB on June 9, 2000, at 0:57:04
Props to you Karen, you are awesome. It's fantastic how much caring and well-informed information and support is available here.
(Especially appreciated after a Usenet newsgroup I used to frequent largely degenerated into flames and feuds).peace and health,
S.D.
Posted by KarenB on June 10, 2000, at 1:42:52
In reply to you go, girl! » KarenB, posted by S.D. on June 9, 2000, at 13:36:58
> Props to you Karen, you are awesome. It's fantastic how much caring and well-informed information and support is available here.
> (Especially appreciated after a Usenet newsgroup I used to frequent largely degenerated into flames and feuds).
>
> peace and health,
>
> S.D.Thanks, S.D, I needed that one:)
Don't be unaware, though - there are a few smouldering flames burning here too but they are just best avoided. With all the good info and great people here, I think it's worth it to hang around.
Peace and health back atcha...
Karen
This is the end of the thread.
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