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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Xevious on July 5, 2002, at 3:56:37
I'm looking for some advice from folks here before I go back to my doc to try new meds...I have ADHD, inattentive subtype, with minimal hyperactive and impulsive symptoms. Although I have every imaginable inattentive symptom, my symptom "hit list" of critical ones to stamp out includes:
Dreaminess, fogginess, spaciness, internally-drifting attention when reading or attending lectures. (All aspects of wakeful focus) In a typical lecture setting, I will only be able to pay attention for a couple of minutes before drifting into an eyes-open, half-sleep of internal daydreams and tangental thoughts until, many minutes later, I snap out of it, wonder what the heck I missed, and re-focus for another minute or two before the cycle repeats. I get about 10% of the content of most lectures, but have some great dreams and ideas this way!
I've tried Ritalin and Adderall thus far. Two weeks on Ritalin at various doses gave me very little CNS benefits while treating me to a host of perepheral nervous system side-effects. I really didn't like this drug at all.
Adderall has been a godsend in many ways. After more than ten years of chasing the solutions to incorrect diagnoses of depression, anxiety, etc., this one drug, at low doses (10-20mg/day) dramatically improved or eliminated ALL of my various symptoms except the ones on the "hit list" above. I feel more relaxed, stable, capable, and just generally good on Adderall... until it leaves my system in the evening, that is.
Higher doses (40-50mg/day) of Adderall improved the "hit list," improving my lecture focus to perhaps 50% (a dramatic improvement) but also dramatically increases my pulse and already hypertensive blood pressure to dangerous levels. (Beta blockers get me "drunk," so I've just started Aceon for the BP; we'll see how that goes...) I also don't like the way Adderall feels in the first two hours - I'm guessing that this is because of my sensitivity to methylphenidate.
My doc is willing to try dex or Focalin, but baulked at my suggestion of Provigil, saying that it was "untested for ADD." I'm sure I could talk him into it, however, if I felt that it would really be worth a try. (I'm assuming that since my "hit list" are similar to sleepy symptoms, a stim like this might work well.)
Any suggestions, especially from other dreamy inattentive types out there? Where do I go next???
Thanks,
-Xevious
Posted by Hattree on July 5, 2002, at 10:25:01
In reply to Med question for ADD'ers, posted by Xevious on July 5, 2002, at 3:56:37
All-day Dex (the spansule) might help with that first 2 hours and the end-of-day doldrums. I find it comes on and goes off more smoothly than the others. Sometimes I do a late day boost of caffeine or a tiny bit of ritalin or adderall.
I'm inattentive ADD, too...don't see too many of us on the board. No drug has helped me as much as I would like, and its always a trade-off (sure do like sleep better without them) but I do pay attention in meetings now.
Posted by Seamus2 on July 5, 2002, at 12:50:17
In reply to Med question for ADD'ers, posted by Xevious on July 5, 2002, at 3:56:37
I'd try Dexedrine as it has less peripheral adrenergic activity, meaning your BP isn't as likely to climb.
I think the jury has come to the conclusion Provigil doesn't work that well for ADD, though ymmv.
Can you describe how beta-blockers make you "drunk" and what you were taking and at what strength? I've never heard of this type of reaction. Perhaps it only occurs in conjunction w/ the Adderall? (beta receptors blocked but alpha unopposed?)
Seamus
Posted by Zo on July 5, 2002, at 17:19:28
In reply to Med question for ADD'ers, posted by Xevious on July 5, 2002, at 3:56:37
Provigil is such an easy med to try, to get on and off of. He has no basis to balk except a problem in responding intelligently to his patients.
Dex is the cornerstone of my life and brain. Then I added Lamictal and felt way better (BPII, ADD etc etc,) But when I added Provigil to that! Well! I have this abiding sense of well-being,and feel happy a good deal of the time. . .and this is after searching for twenty years.
Oh--there's a rule against using Provigil AND Dex? Give me a break. Why not compare these things as AGENTS. They are entirely different, Provigil does not work on the same area of the brain. It wouldn't be enough, alone, for the ADD symptoms, for me. . but oh my, this is good.
Zo
Posted by Xevious on July 5, 2002, at 18:28:22
In reply to Re: Med question for ADD'ers, posted by Seamus2 on July 5, 2002, at 12:50:17
Thanks, I think I will try dex next as the methylphenidate really didn't agree with me. d-Methylphenidate could be the right drug for me, but on this board, dex seems to be the magic drug for adult ADD-affected folks.
I'm on 4mg of Aceon a day (an ACE inhibitor for BP that reverses damage to the endothelial lining of capillaries) and was given a handful of 25mg pills of Atenolol (beta-blocker) to use as-needed for when the Adderall puts me over the edge. I've only tried the Atenolol once as a test so I could become familiar with the side effects before using it in a situation that I need to concentrate, but I think that I'd only use it in an emergency, as I became giddy, floaty, a bit dissociated and just cool, man. The effects were somewhere between that of alcohol and marijuana. I know that beta-blockers reduce anxiety, but I was a little too loopy for my own comfort!
> I'd try Dexedrine as it has less peripheral adrenergic activity, meaning your BP isn't as likely to climb.
>
> I think the jury has come to the conclusion Provigil doesn't work that well for ADD, though ymmv.
>
> Can you describe how beta-blockers make you "drunk" and what you were taking and at what strength? I've never heard of this type of reaction. Perhaps it only occurs in conjunction w/ the Adderall? (beta receptors blocked but alpha unopposed?)
>
> Seamus
Posted by Xevious on July 5, 2002, at 18:37:34
In reply to Re: Balked shmalked » Xevious, posted by Zo on July 5, 2002, at 17:19:28
Thanks, Zo. Did the Provigil specifically help your wakeful focus? That's what I'm looking to target.
Actually, I really trust the doc that I'm seeing - he is empathic, intelligent, very knowledgeable of ADHD (it is one of his specialties) and open to trying new things. He knows that I'm well-informed and respects my insights and suggestions, but isn't afraid to argue with me or offer his own contradictory experience or knowledge! Like I mentioned, I don't think he'll object to me trying Provigil (or anything else, for that matter) if I let him know that I *really* want to try it, and why, instead of merely asking if he had had any success with it.
And if he doesn't, I'll find another doctor, because I'm shooting for the "oh, my, this is good!" :)
Thanks!!!
> Provigil is such an easy med to try, to get on and off of. He has no basis to balk except a problem in responding intelligently to his patients.
>
> Dex is the cornerstone of my life and brain. Then I added Lamictal and felt way better (BPII, ADD etc etc,) But when I added Provigil to that! Well! I have this abiding sense of well-being,and feel happy a good deal of the time. . .and this is after searching for twenty years.
>
> Oh--there's a rule against using Provigil AND Dex? Give me a break. Why not compare these things as AGENTS. They are entirely different, Provigil does not work on the same area of the brain. It wouldn't be enough, alone, for the ADD symptoms, for me. . but oh my, this is good.
>
> Zo
Posted by Zo on July 6, 2002, at 3:31:09
In reply to Re: Balked shmalked » Zo, posted by Xevious on July 5, 2002, at 18:37:34
It depends on what you mean by focus. I'm a writer. Yes, if I look at the work done. Subjectively, however, I feel more spacey, in the sense that I go into the flow at the drop of a hat. . .and stay there. But somehow this kind of spaciness is very different.
So, no, it's not like the edge of coffee or Adderall--and that was the only focus I knew. This experience of being productive and creative with no edge is so new, it's hard to describe. . this drug acts on a different part of the brain than anything previous. I don't know how or why. . but I agree!Let me know if I've just confused things. It's "wakeful". . .but different! I'm very pleased with it.
People often overshoot their best dose, tho, unaware that too much just worsen things--find your dose window and stay in it! (BTW,the first few days were eurphoric.)
Zo
Posted by Xevious on July 6, 2002, at 5:47:11
In reply to Re: Balked shmalked » Xevious, posted by Zo on July 6, 2002, at 3:31:09
Thanks again, Zo. Your description really does help. As a graduate student having to write a dissertation *and* as a musician who hasn't been able to write or play in quite some time, it would be good to find some of that kind of focus... It would be quite nice to be able to wakefully loose myself in my art again, and even better if this kind of wakefulness also worked on boring lectures! :)
Next week, I have 10-hour classes all week, and I'll be titrating my dose of Adderall to see where I get the most effectiveness without crossing that overdosage boundary. Then, I'm going to switch to dex to see the difference. Depending on how dex alone feels, I might add Provigil.
Wish me luck!
Posted by BLPBart on July 6, 2002, at 15:51:15
In reply to Re: Balked shmalked » Zo, posted by Xevious on July 6, 2002, at 5:47:11
I'm an ADDer who first started on all these psychomeds when diagnosed with depression. i currently take 40 mg/day of dexedrine (the spansules). I've been taking this with 300 mg/day wellbutrin SR but I'm thinking about quitting the wb. I used to take wellbutrin with prozac but had horrible SEs from the prozac after I added the wellbutrin. I'm now having some strange side effects just showing up and I'm afraid it's the wellbutrin. I've been reading a lot lately about wb having interactions with other medications, including amphetamines. I'm thinking about just staying on the dex and see if it helps with the depression as well as the ADD. These posts have me very interested, however, in trying a combination of dex and provigil. Zo, what dose of provigil do you take?
Posted by BekkaH on July 6, 2002, at 20:20:12
In reply to Re: Balked shmalked, posted by BLPBart on July 6, 2002, at 15:51:15
I'm now having some strange side effects just showing up and I'm afraid it's the wellbutrin. I've been reading a lot lately about wb having interactions with other medications, including amphetamines. I'm thinking about just staying on the dex and see if it helps with the depression as well as the ADD.
**************************************************
Hi. May I ask what strange side effects you are having on the Wellbutrin plus dexedrine combo? Wellbutrin and/or at least one of its metabolites suppresses the liver enzyme known as cytochrome P450 IID6. Dexedrine is a substrate for that enzyme (i.e., it needs the enzyme in order to be metabolized). If the enzyme is suppressed too much, then dexedrine won't be properly metabolized and could build up to dangerous levels in some people.
Some people (5-10% of Caucasians, as well as some others) have genetic polymorphisms for this enzyme, and it may not function as well as it does in those who don't have the genetic polymorphism. I know some people who do very well on that Wellbutrin + Dexedrine combination. I know others who do well on Wellbutrin + Ritalin; unfortunately, I am not one of them. I am quite certain I lack the IID6 enzyme, or else I have a "deficient" version of it. When I tried the Wellbutrin + stimulant combinations, I got quite sick, but you may not have the same problems I have. Perhaps something else is causing those strange side effects. Did you change your dosage recently?
Bekka
Posted by Zo on July 7, 2002, at 0:54:20
In reply to Re: Balked shmalked » Zo, posted by Xevious on July 6, 2002, at 5:47:11
Good luck. . and you can't imagine how good it feels to see someone using the damn meds as the agents they are. Thank you.Crank that Adderall [2.5 mg too much for me, you lucky dog] and ace those tests!
Zo
Posted by Zo on July 7, 2002, at 1:02:07
In reply to Re: Balked shmalked, posted by BLPBart on July 6, 2002, at 15:51:15
Like you, I would suspect Wellbutrin when it comes to any weirdness. I loved it at the time, but had the most amazing awful skin reaction, after two years, and can never take it again.Which is fine, because it's only weak Dex. . and Dex is a much cleaner, easier med.
I take only 10mg Dex and 150mg Provigil. My pdoc suggested taking another 50 in the afternoon, if it helped me remember to go to bed at night. . which it does, but then I don't feel like it.
If I take 200mg at once, however, I feel awful. I exceed my dose window---did I say this?--Provigil only has like about 100mg. of dose window. More is not better.
I have also been on Effexor for many years. Only learned of my BPII last year.. but the addition of Lamictal to all this proved to be The Holy Grail. I simply am not depressed. . no matter how I try!
And Provigil added the sweetest sense of well-being. . .
So, I don't know if this is helpful to you, but I'm not sure I need a plain AD anymore, and eventually will test that out.
40mg! Wow!
Zo
Posted by BekkaH on July 7, 2002, at 1:05:20
In reply to Re: Balked shmalked » Xevious, posted by Zo on July 5, 2002, at 17:19:28
Hi Zo,
Do you take anything at bedtime? I see you take several activating medicines, and I wonder whether you have any trouble sleeping? May I ask how much Dex you take now? Have you ever tried Adrafinil? Do you have trouble with med interactions? I have so much trouble with that.
Thanks.
Bekka
Posted by BLPBart on July 7, 2002, at 15:04:52
In reply to Re: Balked shmalked -BLPBart, posted by BekkaH on July 6, 2002, at 20:20:12
> I'm now having some strange side effects just showing up and I'm afraid it's the wellbutrin. I've been reading a lot lately about wb having interactions with other medications, including amphetamines. I'm thinking about just staying on the dex and see if it helps with the depression as well as the ADD.
>
> **************************************************
>
> Hi. May I ask what strange side effects you are having on the Wellbutrin plus dexedrine combo? Wellbutrin and/or at least one of its metabolites suppresses the liver enzyme known as cytochrome P450 IID6. Dexedrine is a substrate for that enzyme (i.e., it needs the enzyme in order to be metabolized). If the enzyme is suppressed too much, then dexedrine won't be properly metabolized and could build up to dangerous levels in some people.
>
> Some people (5-10% of Caucasians, as well as some others) have genetic polymorphisms for this enzyme, and it may not function as well as it does in those who don't have the genetic polymorphism. I know some people who do very well on that Wellbutrin + Dexedrine combination. I know others who do well on Wellbutrin + Ritalin; unfortunately, I am not one of them. I am quite certain I lack the IID6 enzyme, or else I have a "deficient" version of it. When I tried the Wellbutrin + stimulant combinations, I got quite sick, but you may not have the same problems I have. Perhaps something else is causing those strange side effects. Did you change your dosage recently?
>
> BekkaHi Bekka,
I'm about 99% convinced that the interaction with drug metabolism is what caused me to have the problems when I combined prozac with wellbutrin.The problems I'm having now are completely different. About a month ago I started having extreme post-nasal drip which makes me feel like I constantly have to swallow. Then to make matters worse, I sometimes feel like I can't swallow (very hard to describe). It's like I have to concentrate really hard on the muscles that I need to swallow. I tried adding antihistamines and decongestants. These do nothing for the post-nasal drip, just add to the problem with dry mouth that I already have from the dex/wellbutrin combo. I've been doing some research and found out that rhinitis is a fairly common side effect from wb although I don't know why it would suddenly start now. I'm wondering if I'm already having some problems because it's allergy season and the wb is just making it worse. I'm afraid this might sound trivial to my pdoc but it's really driving me nuts. My throat hurts, I feel like I'm drowning in my own snot (sorry, I know that's gross) and I'm always sick to my stomach because of it.
Posted by BLPBart on July 7, 2002, at 15:07:51
In reply to Re: Balked shmalked, posted by Zo on July 7, 2002, at 1:02:07
>
> Like you, I would suspect Wellbutrin when it comes to any weirdness. I loved it at the time, but had the most amazing awful skin reaction, after two years, and can never take it again.
>
> Which is fine, because it's only weak Dex. . and Dex is a much cleaner, easier med.
>
> I take only 10mg Dex and 150mg Provigil. My pdoc suggested taking another 50 in the afternoon, if it helped me remember to go to bed at night. . which it does, but then I don't feel like it.
>
> If I take 200mg at once, however, I feel awful. I exceed my dose window---did I say this?--Provigil only has like about 100mg. of dose window. More is not better.
>
> I have also been on Effexor for many years. Only learned of my BPII last year.. but the addition of Lamictal to all this proved to be The Holy Grail. I simply am not depressed. . no matter how I try!
>
> And Provigil added the sweetest sense of well-being. . .
>
> So, I don't know if this is helpful to you, but I'm not sure I need a plain AD anymore, and eventually will test that out.
>
> 40mg! Wow!
>
> ZoHow did you convince your doc to prescribe provigil? Is this one of the meds that you can order on-line only with a prescription or can you order it on your own?
Posted by BekkaH on July 8, 2002, at 5:18:55
In reply to Re: Balked shmalked, posted by BLPBart on July 7, 2002, at 15:07:51
How did you convince your doc to prescribe provigil? Is this one of the meds that you can order on-line only with a prescription or can you order it on your own?
************************************************
Are you in the U.S.? I'm pretty sure it's available in the U.S. Isn't Provigil the same as Modafinil? The one that's not available in the U.S. is Adrafinil. Correct me if I'm wrong.Bekka
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