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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by CareBear04 on August 29, 2007, at 23:55:19
I'm seeing a new psychiatrist next week, and I need some advice on getting the meds I need.
I was never diagnosed with ADHD as a child, but in college, on the basis of what I described, the psychiatrist started to treat my ADHD symptoms. I started on high-dose Wellbutrin, then Strattera, then Provigil, then Adderall. Since then, I've also tried Dexedrine and Concerta, but Adderall XR works best for me. I have records that include "History of ADHD" and note that I'm currently taking Adderall. I'm just worried that the new pdoc is going to dig deeper into the ADHD diagnosis, especially if he learns that I never actually had the neuropsych testing for ADHD.
My other problem is that I'm also treated for Bipolar I, which I guess affects the way ADHD is treated. I'm on a high dose of Adderall XR-- 30mg twice a day, when most Bipolar people with ADHD get much lower doses.
I also have a few other conditions that might make a pdoc think twice about Adderall. First, I've having involuntary eye-twitching, which I don't think is connected to the Adderall, but stimulants are known to exacerbate the problem. Second, recently, I've had blood clots. They have a clear nonmedication-related cause, but given that Adderall can mess with the heart and the brain and cause clots that lead to strokes, he may think it's a bad idea to keep Adderall in the mix with the blood clots. Should I keep the information on the blood clots to myself?
I'm worried about whether I'll get Adderall. I'm starting school again next month, and when I got on Adderall in college, it was a life-changing difference in my performance. What can I do to best persuade this new pdoc to prescribe it for me?
Any thoughts or input would be great!
Thanks,
CB
Posted by Racer on August 30, 2007, at 0:13:47
In reply to Getting prescribed Adderall, posted by CareBear04 on August 29, 2007, at 23:55:19
My advice? Don't over think it.
Do certainly tell the doctor about the blood clots -- that is important information, and there's a clear non medication cause, so it shouldn't be a problem. On the other hand, not telling him could be hazardous to your health, if he prescribes something which would exacerbate the problem.
Here's the conclusion I've come to: be honest, be straightforward, don't try to use subtle methods of influencing him, and stick to the argument which I think trumps all others: the stuff works for you. That being the case, it just makes sense to continue it.
The only thing I wouldn't necessarily include in your history with him is that you haven't had neuropsych testing. That's less relevant, since most ADHD is still dx'd based on clinical signs.
Good luck.
Posted by CareBear04 on August 30, 2007, at 0:50:38
In reply to Re: Getting prescribed Adderall, posted by Racer on August 30, 2007, at 0:13:47
Thanks Racer! You sound very wise, or at least very well-versed in the art of obtaining psych meds. It's the absolute truth that Adderall works for me, and you're right that my telling the new pdoc so is the strongest case I can make, rather than try to outmaneuver him more subtly. Thanks so much for your insight!
CB
Posted by Girlnterrupted78 on August 30, 2007, at 0:58:47
In reply to Getting prescribed Adderall, posted by CareBear04 on August 29, 2007, at 23:55:19
"..especially if he learns that I never actually had the neuropsych testing for ADHD."
If he doesn't bring it up, don't bring it up either, and don't even get slightly close to the topic. It is a GREAT advantage to you that your previous pdoc already had you on Adderall. That should be the only ADHD history to be discussed.
BTW, did you actually have concentration problems as a kid, or did they begin later as a teen? Were you maybe not treated for them? Or you definitely didn't have ADHD as a kid?
"..started on high-dose Wellbutrin, then Strattera, then Provigil, then Adderall. Since then, I've also tried Dexedrine and Concerta, but Adderall XR works best for me."
How did the other medications work for your ADHD? How was Wellbutrin? Did Straterra work (It did NOTHING for me, except make me sleep and make me feel sick..)
Did you ever try Ritalin? How about Provigil? How different is Provigil from Adderall?"..I'm on a high dose of Adderall XR-- 30mg twice a day, when most Bipolar people with ADHD get much lower doses."
I was also on that dose when I was on Adderall. I took Ritalin for a while, but it gave me anxiety. Adderall worked WONDERS for me.
However, I have to tell you something: Based on MY experience with Adderall, I would NOT take it everyday or in such a high dose, EVER.
Why? You build tolerance. And sooner or later, it won't work. It won't work AT ALL. This is based on my experience and on that of other people I've known who've also been on Adderall and have taken it on a daily basis.
Personally, I think the best way to take Adderall is in extreme situations where you need it, or only when you really need to study.
My doctor also prescribed 30mgs of the time released Adderall, EVERYDAY. And geez, I've regretted it forever.The first two weeks it was a miracle drug. It made me social, sharp, super motivated, and able to dig into work fast and easily. I could go through chapters and chapters nonstop, take a break, clean the house, go back to studying. No procrastination, no guilty feelings, no brain fog or disturbing thoughts. One time I studied from 6pm to 6am nonstop for a final. Impressive stuff.
However, after 2 weeks, the effects GREATLY diminished. After a month, it barely worked. Now it does nothing for me. I waited 6 months, and tried it again.. nothing. I waited a year.. nothing. Ahhhh! I built tolerance to Adderall for good!!
So I just wanted to tell you my experience. You might be different (or you might not) but I also read of someone who had the exact same experience long before I even tried Adderall.. and I was dumb because I didn't believe it. But it happened to me too. I hope it doesn't happen to you. How long you've been on it so far?
While you have it, you want to enjoy it at the most. But when you least expect it, it's gone, and sadly, it can be gone for good.
Best of luck
GI78
Posted by rina on August 30, 2007, at 3:02:49
In reply to Re: Getting prescribed Adderall » CareBear04, posted by Girlnterrupted78 on August 30, 2007, at 0:58:47
WOW!!I thought I was imaging things...mine only lasted exactly 2weeks as well.That's a record for me. All the others lasted at least a month, maybe three, give or take but Adderall. Two lousy weeks!! Now my pdoc is going to prescribe Dexedrine to add to the Adderall and see if it will do something positive but if not, were back to the drawing board. I don't know what's left. So far I've tried. Ritalin,Straterra,Concerta,Methyphenidate,Focalin,Provigil and now Adderall. I'm running out of things to try!!
Posted by sam123 on August 30, 2007, at 8:27:10
In reply to Re: Getting prescribed Adderall » CareBear04, posted by Girlnterrupted78 on August 30, 2007, at 0:58:47
> "..especially if he learns that I never actually had the neuropsych testing for ADHD."
>
I have been treated for ADD for over a decade and never had ADD testing.
Posted by Phillipa on August 30, 2007, at 10:36:05
In reply to Re: Getting prescribed Adderall, posted by sam123 on August 30, 2007, at 8:27:10
Definitely tell him of the blood clots as there is meds you can take for them to prevent. Are you not not something like coumadin now? Phillipa
Posted by med_empowered on August 30, 2007, at 10:58:26
In reply to Re: Getting prescribed Adderall, posted by Phillipa on August 30, 2007, at 10:36:05
Id vote against talking about the clots. I mean, *do* get that treated, *do* let whatever doc handles that know about the adderall but...you don't want the shrink to wuss out on giving you something that helps b/c they're afraid of liability issues. Shrinks deal with mental stuff; real docs deal with the rest...thats my philosophy, at least.
In some moody people, stimulants can have mood elevating and stabilizing properties. Some docs occasionally use amphetamines for acute mania; its odd, but apparently it sometimes works. So the BP I thing shouldn't be a problem, unless a) you're (hypo)manic and/or prone to psychosis or b) your doc takes a strict line on rx'ing in bipolar disorder..in that case, you should probably get a new one anyway, since you'll need a doc who responds to you, not official APA guidelines and treatment algorithms.Good luck.
Posted by CareBear04 on August 30, 2007, at 11:07:38
In reply to Re: Getting prescribed Adderall » CareBear04, posted by Girlnterrupted78 on August 30, 2007, at 0:58:47
Hi!
Thanks for the advice about the testing. Yeah, in the past five or so years, about four different psychiatrists have kept me on Adderall or Dexedrine with no questions asked.
As a kid, I was pretty inattentive, but I was also a high achiever, so I got by. By middle and high school, though, my concentration was so bad that I skipped more classes than I attended. Same in college until I got put on Adderall.
Strattera did nothing for me at all! Wellbutrin may have worked a little, but I was taking 450mg of the regular release because the XL didn't work for me and the SR had a really nasty sulfur smell. So... that meant 6 of those pretty big Wellbutrin tabs a day, which was too much. Provigil actually helped quite a bit. It made me very attentive and focused on my work. I only switched to Adderall because I went back to a different doctor who liked the outcomes she'd had on Adderall. I took Ritalin in the form of Concerta. I thought it was pretty good-- very smooth, didn't make me as jumpy. You're right about the effects of high-dose Adderall wearing off, unfortunately. My last prescriber, and for the past two or so years, I've been on 60mg a day, but I haven't seen a psychiatrist since the end of June, so I haven't gotten a new prescription. I've been making do with the pills I had left over, so I cut down to 30mg XR a day, then 20, then 15mg Dexedrine spansule. When I tried to go cold turkey, I could definitely feel myself dragging, like I was still half asleep. And the thing is, like you say, I've gotten to the point where I don't even really feel the effect of Adderall like before. It doesn't boost my concentration or energy or decrease my appetite like at first, but when I don't take it, I can really tell.I also think my Adderall tolerance is messing with my response to caffeine. Caffeine now also doesn't do anything for me, yet I keep drinking coffee. Maybe they work on the same neurotransmitters, and tolerance to one increases tolerance for the other?
I'd love to go back to having the same Adderall effect that I had years ago when I first started it, even though I don't know of a period when I can go off it for an extended time. I'd love to hear more of your experience!
CB
Posted by CareBear04 on August 30, 2007, at 13:14:19
In reply to Re: Getting prescribed Adderall, posted by Phillipa on August 30, 2007, at 10:36:05
Hi Phillipa,
Yes, I've been on Coumadin for four months now and will be on it for at least a few more months. My PCP is monitoring the clotting, so do you think it's necessary to tell the new pdoc?
CB
Posted by CareBear04 on August 30, 2007, at 13:18:14
In reply to well..., posted by med_empowered on August 30, 2007, at 10:58:26
Thanks for the advice! My PCP is handling the blood clot problem, so maybe I won't bring it up to the new pdoc.
Yeah, I think I need a dr who is willing to be flexible and who isn't overconcerned with liability. My last pdoc prescribed me Adderall for four months and then suddenly wouldn't prescribe it anymore, citing cases of sudden death. He didn't care that I'd been on it for years; he opposed the stimulant treatment for Bipolar/ADHD. I hope it works out better with the new person.
Thanks!
CB
Posted by Phillipa on August 30, 2007, at 20:08:15
In reply to Re: Getting prescribed Adderall » Phillipa, posted by CareBear04 on August 30, 2007, at 13:14:19
Yes in my opinion I do as the more info a doc has the more open he may be to other meds as well. And your physical health is at stake. Clots are nothing to fool with. Do you know what caused them? Phillipa
Posted by CareBear04 on August 30, 2007, at 22:35:44
In reply to Re: Getting prescribed Adderall » CareBear04, posted by Phillipa on August 30, 2007, at 20:08:15
The funny thing is that I've previously been diagnosed with Von Willebrand's, a bleeding disorder. I was originally put on oral contraceptives not only to control bleeding but because OCPs increase clotting. In three years on birth control and Adderall, I had no clotting problems. Then, in April, I was in the hospital for a few days. I had an IV in one arm and a blood pressure cuff on the same arm, which I've since learned from a nurse friend is one of the first lessons in nursing school on what not to do. When I told my PCP at my next visit and showed him my swollen arm, he said it wasn't uncommon for people to get clots after having IVs. The thing is, I've had a lot of IVs and blood draws in the years I've been on these meds, and I've never developed blood clots. Of course, I never had an ultrasound to confirm until this time. I was put on Coumadin for three months, but it wasn't thought to be that big of a deal because the clot had a clear preceding cause. Then, at my follow-up ultrasound a month ago, my arm was fine now, but the tech found clots in my neck, in both the IJ and the subclavian veins. I guess they could be IV-related, too, because I had a subclavian central line that hospitalization. But, for whatever reason, the first ultrasound didn't find any clots in the neck. In any case, I'm on the Coumadin for another three months, and in October, I have to get a full-body ultrasound including my legs since blood clots there can be dangerous.
Anyway, I guess I'm reluctant to tell all this to a new pdoc because it's being monitored by my PCP and because I'm afraid the pdoc will overreact and think only of worst-case scenarios like stroke or sudden death. What do you recommend?
Thanks!
CB
Posted by Phillipa on August 30, 2007, at 22:59:43
In reply to Re: Getting prescribed Adderall » Phillipa, posted by CareBear04 on August 30, 2007, at 22:35:44
Carebear I've been a nurse for many years not pracaticing now but never heard of blood clots with Iv's and blood draws. And I worked even in ICU. Something doesn't sound right you don't have thrombocytopenia do you? Thick blood. Phillipa better google to make sure right name.Tell your doc
Posted by Phillipa on August 30, 2007, at 23:05:50
In reply to Re: Getting prescribed Adderall » CareBear04, posted by Phillipa on August 30, 2007, at 22:59:43
Carebear no it's not thrombocytopenia that is a bleeding disorder. There are many causes of blood clots please google them. See what fits sorry for the wrong term. Phillipa
Posted by Phillipa on August 31, 2007, at 0:01:02
In reply to Re: Carebear No I'm wrong, posted by Phillipa on August 30, 2007, at 23:05:50
Right term I hope Phillipa so sorry
Thick Blood: Common Causes Print Page Send a Link
Certain ethnic races (particularly Caucasian) may have a genetic predisposition towards thick blood. Defects in the coagulation genes adversely affect the capability of the body to turn off the switch that activates the clotting process. These defects may also affect the body’s ability to clean up the fibrin deposits formed as a result of the clotting process.1
Thick blood may also be caused by the presence of harmful pathogens such as fungi, viruses, bacteria, and parasites. These pathogens can actually activate a coagulation response in the body as a way to avoid being attacked by the body’s immune system.1 Soluble fibrin monomer (SFM), a clotting agent, lines the capillaries with fibrin making it impossible to transfer oxygen and nutrients to body tissues. A lack of oxygen and nutrients then creates an ideal environment for these pathogens to survive and cause illness. The blood must first be thinned to expose the pathogens before they can be
Posted by seldomseen on August 31, 2007, at 3:38:38
In reply to Re: Getting prescribed Adderall » Phillipa, posted by CareBear04 on August 30, 2007, at 22:35:44
I want to strongly encourage you to tell your new pdoc about your vWF, your clots and your coumadin.
Are you on vWF replacement?
Posted by KayeBaby on August 31, 2007, at 13:19:36
In reply to Re: Getting prescribed Adderall » Phillipa, posted by CareBear04 on August 30, 2007, at 22:35:44
This is my way of thinking about it.
Make sure you are well informed. Weigh risk/benefits.If you decide not to reveal the clotting problem you are effectively taking personal responsibilty for any possible adverse effects. If you are willing to take that responsibility that is your choice.
You have removed control by not to giving that Dr. possibly relevant info. You are now, to a large degree, your own Dr. It would be unethical now to hold him responsible for any harm.
I'm not against that approach, have done it myself.
I think a person has a right to make these decisions about their life but we cannot have it both ways.
Kaye
Posted by CareBear04 on August 31, 2007, at 17:36:55
In reply to Re: Getting prescribed Adderall » CareBear04, posted by KayeBaby on August 31, 2007, at 13:19:36
Thanks for the thoughts. You're right-- if I choose not to tell this new dr, I can't hold him responsible for any adverse outcomes. I think my problem is, though, that I've had so many doctors who had full information make bad decisions with bad results, so I've kind of lost faith in the medical profession. In many cases, I've been left to deal with the results without any responsibility on the part of the dr. I guess I'll have to see how things go with this new guy.
CB
Posted by KayeBaby on August 31, 2007, at 21:56:36
In reply to Re: Getting prescribed Adderall » KayeBaby, posted by CareBear04 on August 31, 2007, at 17:36:55
I hear you loud and clear on that.
You seem very capable of making the choice for yourself.
I'm hoping for you to a get a gem!!
Best,
Kaye
This is the end of the thread.
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