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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by zarathustra on September 20, 2003, at 18:22:49
Thank you very much to everyone who took the time to respond to my little 'bio'. It helped, espescially to see that some people can relate.
Goodby Nietzsche.... Hello Plato :-)Anyways, I feel Great! Not perfect, or even high; just good. I havent felt this way for about ten years now. Since my last positive response to an antideppressant (zoloft), which pooped out big time and never worked again. It is curious to note that I appear to be getting more of an antidepressant boost than any type of ADD benefit.
However, I am a little more organized and 'together' but I think that is a result of my depression being lifted. I have been on Dexedrine for 1 week now (5mg B.I.D.) I remember the first dose, It 'knocked me off my feet', WOW, I felt good! Enthusiastic, goal oriented, optimistic, and sociable. More importantly beyond that there is this undescribable alteration of 'my' world, similar to what zoloft did.two Questions.
1.
What does this tell me? Does it suggest a positive depression diagnoses? (I cant see that, because it is an amphetamine and it works on everyone) or, does it rule out ADD because my negative symptoms dont appear to be subsiding? Do I need a higher dose?2. How do I take this drug? I dont quite understand the intricaces of it, despite the readings. As far as I am aware, most psychoactives require a 'steady state' or level in your blood to be effective such as the ssri or epival; they correct an imbalance. Am I to take dexedrine as a sort of p.r.n.? If I dont need it (not doing anything important that require much focus) should I not take it? (so as to prevent dependance) OR would that be interfereing with some therapeutic effect I dont know about. I guess my question really is, is 'Does dexedrine treat add + depression symptomatically?' or is there some "rewiring" that occurs too? Should I stay on this drug forever?
AND finally, How do I prevent dependance? I recall a post years ago which suggested not taking it on weekends or something but I could not find it.
Also, if I dont have ADD then is it justifiable to take dexedrine as an antidepressant?
Also, I just started a new job doing night shift. So does my B.I.D. dosing start at midnight when I start work?
SORRY.....My two question blossomed into thirty
:-) (thats typical of me)thank you.
Andrew
Posted by fachad on September 20, 2003, at 23:00:05
In reply to Dexedrine is AMAZING! (but I am skeptical), posted by zarathustra on September 20, 2003, at 18:22:49
>...It is curious to note that I appear to be getting more of an antidepressant boost than any type of ADD benefit.
IMHO, response to a particular med does not really have diagnostic significance...here's a statement of my thoughts on this topic from an earlier post:
I'm somewhat skeptical about the validity of DSM-IV diagnosis. I think they are a convenient way to group symptoms and present something “scientific” sounding to third party payers, but I don't think they are as valid as medical diagnosis like streptococcus caused strep throat.
The one thing I absolutely don't buy into at all is medication treatment specificity in psych disorders. By that I mean I don't think one class of meds is always indicated in one class of disorders.
Benzo's probably help some depression patients. Mood stabilizers help some anxiety patients. ADs help some OCD sufferers. Stimulants help some depression patients, and that does not necessarily mean those patients "really had" undiagnosed ADD all along.
The diagnosis are somewhat questionable, but the specificity of treatment concept is a carryover from the germ / antibiotic medical model and it just does not hold water in psych disorders.
It's a real shame in that it limits the possible treatments that are tried and also results in a diagnosis in the event of response. "Oh, I guess you really had (whatever) disorder, because you responed to (whatever class) of meds. Now expect these symptoms too, because they go along with your disorder."
>Anxiety patients go through life thinking that that's just the best meds have to offer without having been given the freedom of choice to try bzd's on equal footing with ssri's and similiar drugs.
Yes, and they have to PAY more for those less effective SSRIs, too. And depression patients go on from one ineffective, side effect laden AD to another, without trying stimulants, unless there is some indication of ADHD, or without trying benzos, unless there is evidence of GAD, or whatever...
Posted by Kacy on September 21, 2003, at 17:14:19
In reply to Dexedrine is AMAZING! (but I am skeptical), posted by zarathustra on September 20, 2003, at 18:22:49
Zarathrusta, I think you still have to fight to change long-standing habits when you get chemical help for add. Do you read any of the books, try any of the advice, go to any of the add websites? I can recommend some. What are the "things you do and the things you don't do" that cause you the most regret and frustration? Are you add/inattentive or hyperactive?
I would start the doses as you leave for work if you are waking up right before you go. In other words, I would take it at the beginning of your waking day. I don't think the dose level you are taking is addicting.
This sounds great: "Enthusiastic, goal oriented, optimistic, and sociable." If the drug did those things for me, I'd stay on it forever. I got some of that once on Ritalin, but it was at 4 x a day of the highest dose and three times a day is the maximum my doctor he can prescribe. I don't get much or any response at lower level. I want to try dexadrine. Initially, I turned it down because of its name. I've used Ritalin and Adderal and, now, Strattera.
Reading other people on the sites helps me. Below is a post I got somewhere—might even have been here. I saved it because it was so funny and inspiring.
"First, YOU ARE NOT WHAT YOU DO. We are more than how we pay the bills. We are more than arbitrary designations that categorize us- degrees, awards, whatever. We are more than what they say we are."You're talking to the woman who owes my library almost $500 in overdue fines, crashed my new car into a LARGE street sign shortly after I bought it, because I "forgot" to use the emergency brake. I leave my purse on top my car, and drive off, and then have to order all new credit cards. Recently, not only did I forget to lock my front door before leaving to go to the store I ACTUALLY FORGOT TO CLOSE THE DOOR in subzero weather. When I apply for a loan, they actually laugh. I've manage to P*** off nearly everyone who comes in close contact with me on a regular basis, and, well, I yell. In the ten years since I graduated HS, and have been in school I STILL don't have a degree (actually, I hope I get to go back to school, because last semester I just didn't turn in two 40 page term papers- I just couldn't do 'em) I guess if it came down to it, I could say that I'm incompetent, too.
"BUT, I know that despite my vagaries, I still can do stuff no one else can- I can figure stuff out, entertain my friends, make my daughter laugh so hard milk comes out of her nose, and make my husband know that he's LOVED. I take care of my mama. I'm nice to old people, animals, and little kids. I read lots, and know more than they could ever possibly quantify."
Posted by Dr. Bob on September 21, 2003, at 19:50:27
In reply to Re: Dexedrine is AMAZING! (but I am skeptical), posted by Kacy on September 21, 2003, at 17:14:19
> Zarathrusta, I think you still have to fight to change long-standing habits when you get chemical help for add...
Sorry to interrupt, but I'd like follow-ups not about medication to be redirected to Psycho-Social-Babble. Here's a link:
http://www.dr-bob.org/babble/social/20030913/msgs/262262.html
Thanks,
Bob
Posted by Viridis on September 21, 2003, at 23:15:11
In reply to Dexedrine is AMAZING! (but I am skeptical), posted by zarathustra on September 20, 2003, at 18:22:49
Stimulants can be good antidepressants, and used to be prescribed this way. However, now that most are Schedule II and there are so many concerns about abuse etc., very few doctors will use them except in the case of a diagnosis of ADD. My pdoc told me that very occasionally he will prescribe stimulants for severely depressed patients in the short term, while other ADs (hopefully) kick in, but says that he really has to be prepared to explain this, so is very cautious.
I'm not sure what your response means; there are so many overlapping conditions, and the diagnoses of most are pretty sketchy. Are you depressed because you have ADD, or does depression have ADD-like symptoms? It's hard to say -- I'm in a similar situation. I've been diagnosed with ADD and certainly fit the profile in many ways, yet a lot of it does seem to be related to anxiety and depression. When I treat the anxiety with benzos, I do much better, but still have some depression and problems with organization. Adderall helps this, but is it really working against ADD, depression, or both? Now I've added Strattera and it helps too, but although it's marketed for ADD, it's supposed to have antidepressant effects as well. So, this doesn't help much to answer the question.
One sign of ADD is supposed to be a "paradoxical" response to stimulants -- calmness etc. instead of activation. However, this seems to be rather controversial. Adderall does have a calming effect for me, but then, an effective AD should do that too.
Ultimately, I don't think the diagnosis matters nearly as much as your response. If you're doing well, I'd stick with the dexedrine, and maybe try adding Strattera for additional focus.
Re: tolerance/dependency etc.: I've been taking Adderall (very similar to dexedrine) for a couple of years now and just skip it for a day or two once in a while to avoid developing tolerance. This hasn't caused me any problems, and my pdoc encourages this. However, some people seem more prone to becoming dependent on stims than others. As far as I know, stimulants can be taken on an as-needed basis, since their effect is immediate and doesn't require a "break in" period like most standard ADs. However, I'm not sure how consistent the AD effect would be if you just took them occasionally. This is something to experiment with (under your doctor's supervision).
Posted by Kacy on September 22, 2003, at 9:43:11
In reply to Re: Dexedrine is AMAZING! (but I am skeptical) » zarathustra, posted by Viridis on September 21, 2003, at 23:15:11
> …One sign of ADD is supposed to be a "paradoxical" response to stimulants -- calmness etc. instead of activation.…
An exception: the inattentive/listless form of Add reaction isn't the paradoxical response. The drugs are supposed to be activating, but that activation doesn't include euphoria or hyperactivity.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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