![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by iforgotmypassword on September 1, 2005, at 19:32:09
in relation to the symptoms and what drugs help when probs with it are the case. i'm sorry i already did this basically. :(
Posted by linkadge on September 2, 2005, at 7:23:36
In reply to describe executive functioning for me again, posted by iforgotmypassword on September 1, 2005, at 19:32:09
Lack of executive function can happen in a lot of mental illnesses, from depression to schitsophrenia.
It is the result of prefrontal hypofunction, from dammage or perhaps biochemical hypometabolism.
Some symtpoms include distractability, inability to concentrate on a given task for long, hampered long term goal setting and planning, lack of ability to controll thoughts and actions, impulsivity, reward deficiancy, problems with verbal comprehention.
Treatment involves agents that are known to affect frontal cortex function. Stimulants, Noradrenergic TCA, strattera, bupropion have all been used.
Other agents that are not first line but may help include remeron, deprenly, aricept.
SSRI's tend to make executive function worse.Depression and ADD should probably be treated wtih a TCA, or SSRI + stimulant.
Linkadge
Posted by Meri-Tuuli on September 2, 2005, at 12:04:26
In reply to Re: describe executive functioning for me again, posted by linkadge on September 2, 2005, at 7:23:36
I don't think this is working properly.
Posted by Meri-Tuuli on September 2, 2005, at 12:06:21
In reply to Re: Why is magnesium used?, posted by Meri-Tuuli on September 2, 2005, at 12:04:26
Sorry, BP went weird on me, I was tring to post a message in reply to Linkage's answer about executive functioning, but instead the title jumped to the title of a previous post. Oh dear!
Posted by Meri-Tuuli on September 2, 2005, at 12:12:23
In reply to Re: describe executive functioning for me again, posted by linkadge on September 2, 2005, at 7:23:36
Hey!
What I am trying to say is that that list sounds exactly like me!!!!!!!!!!!!! It was almost scary.
I am begining to suspect that I might be ADD - probably the reason why I am finding reboxetine incrediably calming, although its not helping with depressive thinking. And it seems to have pooped out on me.
Any advice? I have a faint feeling that I have as much chance of being prescribed a stimulant here in the UK as landing on the moon. Sigh.
Any one know what the feeling is with British GPs and stimulants? I already know that they won't touch the MAOIs.
Meri
Posted by Nickengland on September 2, 2005, at 14:04:47
In reply to executive functioning etc....., posted by Meri-Tuuli on September 2, 2005, at 12:12:23
Hello Meri!
>Any one know what the feeling is with British GPs and stimulants? I already know that they won't touch the MAOIs.
From what I've read on the boards and my persoanl experience with GP's and psychiatric medications, I am afriad to say I very much doubt one would prescribe a stimulant. In the past my GP said he wasn't even in a position to prescribe lithium even though i'm bipolar and lithium is the most well known drug to treat it. Basically if you want to be prescribed anything other than prozac, effexor or ciprimil, really you need to see a psychiatrist (be refered to one by your GP) This goes for getting a diagnosis behond that of the standard clinical depression too and to be treated with the best medication for your individual needs.
Are you currently under a psychiatrist?
Most NHS psychiatrists are pretty crap I've found, I quite literally had to educate my one to get on the current medications i'm on today. Basically he is a consultant psychiatrist but hadn't even heard of most of the current treatment options for bipolar disorder. Long story, I won't bore you with the details lol :-O
Good news is, you will be able to get a stimulant prescribed by a psychiatrist and investigate whether you have ADD. To do this, forget your GP, and forget an NHS referal for a psychiatrist ~ unless you know before hand he is one, a consultant and two, has some experience in adult ADD. If you pay privitely to see a psychiatrist (hopefully one that has knowledge in ADD, which you could check out before seeing him) then thats your best chances for getting a stimulant....as far as I know.
I think Tom Twilight has been prescibed a stimulant before through a privite psychiatrist, hopefully if he see this post he'll be able to add more. I do believe you will have to pay privite prescription costs unfortunately, i'm not sure how much this would be depending on the stimulant and dosage prescibed ~ Ed will be your best bet for that, but you can also check the BNF online which gives prices of medcations there, which are pretty accurate from what I understand ~ again hopefully Ed can expand on that!
If a stimulant is what you need, because at the end of the day that is what will relieve your symptoms, then I think you will definately be able to get one ~ you just have to push for it and look in the right places, but you will get one.
Hope this helps.Kind regards
Nick
Posted by linkadge on September 2, 2005, at 14:06:30
In reply to executive functioning etc....., posted by Meri-Tuuli on September 2, 2005, at 12:12:23
I would personnaly try a TCA, if you have not already.
Linkadge
Posted by Phillipa on September 2, 2005, at 18:33:26
In reply to Re: executive functioning etc....., posted by linkadge on September 2, 2005, at 14:06:30
So Link you think the nortriptaline would help with this. And a confession I haven't started it yet. I'm afraid of the darn side effects. Fondly, Phillipa
Posted by crazy teresa on September 2, 2005, at 18:45:09
In reply to Re: describe executive functioning for me again, posted by linkadge on September 2, 2005, at 7:23:36
Hi linkadge!
What is reward deficiancy? I've not heard of it.
Thanks, crazy t
Posted by linkadge on September 3, 2005, at 7:03:33
In reply to Re: executive functioning etc....., posted by Phillipa on September 2, 2005, at 18:33:26
Many of the TCA's including nortryptaline have been used in the treatment of ADD.
Primarily because the noradrenergic effects engage the frontal corex. Many of the TCA's also block certain serotonin receptors and lead to increased catecholamine output in the frontal cortex.
If an SSRI is working but making you apathetic, I think your best bet is lower it slightly and add some nortryptaline. Failing this, add some remeron, or wellbutrin.
Linkadge
Posted by linkadge on September 3, 2005, at 7:08:48
In reply to Re: describe executive functioning for me again » linkadge, posted by crazy teresa on September 2, 2005, at 18:45:09
People with executive function (ADD ADHD etc) often experience reward deficiancy. Basically even if they finish a task, it is hard for them to take pleasure in what they have accomplished.
Sometimes stimulant treatment can reverse this effect, whereby a patent treated succesfully can take more pleasure in completing tasks.
Linkadge
Posted by Tom Twilight on September 3, 2005, at 8:23:08
In reply to Re: executive functioning etc..... » Meri-Tuuli, posted by Nickengland on September 2, 2005, at 14:04:47
Hey Meri
Sorry about the delay, I'm really tired!
I'll do my best to respond to your questions, and Nick's Excellent post!>I have a faint feeling that I have as much chance of being prescribed a stimulant here in the UK as landing on the moon. Sigh
> From what I've read on the boards and my persoanl experience with GP's and psychiatric medications, I am afriad to say I very much doubt one would prescribe a stimulant.I'm afraid your both absolutely right!
Unfortunatly the vast majority of British Psychiatrists both NHS and private will not prescribe Stimulants for love nor money.
A few British psychiatrists will prescribe stims, but probably only if your classic ADHD, and your lucky, and possibly prepared to lie (you must say that you find stims sedating/calming)
As for GPs forget it, unless you've got a diagnosis from a psychiatrist> Most NHS psychiatrists are pretty crap
Also, I'm afraid very true!
> I think Tom Twilight has been prescibed a stimulant before through a privite psychiatrist, hopefully if he see this post he'll be able to add more.
I'll do my best!
Nick's right, I did get a prescription for Dexedrine and an ADD diagnosis from a private UK psych.He was a nice guy, although rather eccentric.
Unfortunatly he was forced to retire, partly because he prescribe stimulants and he also disagreed with most UK psychiatric practice and wasn't shy of saying so! (I miss him)
I went to see an NHS psychiatrist after him, who was absolutely terrible and deeply unpleasant,I'm still angry, but thats another story.> If a stimulant is what you need, because at the end of the day that is what will relieve your symptoms, then I think you will definately be able to get one ~ you just have to push for it and look in the right places, but you will get one.
Amen Nick, that is an excellent sentiment! and true
Meri, I hope I haven't been to negative in this post, I'm trying to be realistic without crushing you
As Nick says if your determined you will get a stimulent prescribed, either in the UK or abroad.Personally I would consider going to America, I know this sounds like a big step, but you could waste a lot of money on Private UK psychiatrists without getting what you want (I have done this).
I have heard of people who have traveld to the US to get stims, so it can be done.
Alternativly you could have luck with a UK doc, I just wouldn't count on itHere is a short list of alternative medications for ADD/Executive functioning which aren't as tightly controlled as classic stims
1) Parnate-has been shown in a few clincical trials to help ADD, its occasionally prescribed in the UK
Parnate can be combined with Reboxetine, despite what some people think2) Provigil-Can be bought easily if not cheaply over the internet, I didn't like it, but other people have success
3) Sellegiline-MAO B inhibitor, somewhat helpful for ADD
4) Donzepil-Acetylcholine Cholinesterase Inhibitor (phew), shown in clinical trials to help Executive function in ADD.
Not usually used alone to help ADD thoughTake care Meri
If you have any questions don't hesitate to ask(PS) Sorry if this post is a bit ropey
I've been suffering from nasty insomnia lately, which is effecting me
Posted by Tom Twilight on September 3, 2005, at 8:28:43
In reply to Executive functioning.....For Meri-Tuuli and Nick!, posted by Tom Twilight on September 3, 2005, at 8:23:08
I don't know if you've tried an Cholinesterase inhibitor (I haven't).
To me it seems like their worth a try for Exectutive Function.
If they start to make you feel depressed stop straight away!Heres a studyAACAP: Donepezil (Aricept) May Improve Executive Functioning in ADHD
By Paula Moyer
Special to DG NewsSAN FRANCISCO, CA -- October 28 -- The cholinesterase inhibitor donepezil (Aricept), a first-line treatment for certain types of dementia, may also have a role in the treatment of attention deficit/hyperactivity disorder (ADHD).
In a study presented here October 26 at the 49th annual meeting of the American Academy of Child and Adolescent Psychiatry, Dr. James Waxmonsky, a research fellow in psychiatry at Massachusetts General Hospital, in Boston, Massachusetts, United States, reported on an initial trial of donepezil in children and adolescents with ADHD.
According to Dr. Waxmonsky, problems with executive function -- such as organisation, time management, and hierarchical thinking -- are seen in approximately 25 to 50 percent of children with ADHD. "After stimulant therapy is begun, we see a lot of children who have a response to treatment but continue to have problems with executive function."
Donepezil has been shown promise in this area among patients with Alzheimer's disease, and earlier research showed clinically significant improvement in ADHD symptoms after donepezil therapy, with the largest gains made in area of executive function.
Dr. Waxmonsky’s team enrolled seven children, age 6 to 17 years, in a 12-week, open-label, clinical trial of donepezil in combination with existing stimulant treatment. The subjects all had ADHD and executive function deficits. The researchers assessed executive function, adverse events, classic ADHD symptoms, and overall functioning.
The starting dose of donepezil was 2.5 mg daily, with a maximum daily dose of 10 mg. The stimulant dose was fixed at the subject's pre-trial dose.
Results show a 25 percent improvement in attention and a 25 percent improvement in executive function tasks. There were no serious adverse effects. In ongoing research, the researchers plan to study the effects of donepezil in a larger patient base.
"This is the first study to specifically evaluate a pharmacological treatment for executive function deficits in ADHD," he said. "It is also one of the first prospective studies of donepezil’s tolerability and efficacy in ADHD children." The results are encouraging and warrant further study, he said.
Posted by linkadge on September 3, 2005, at 8:44:42
In reply to Executive functioning...For iforgotmypassword, posted by Tom Twilight on September 3, 2005, at 8:28:43
Oh wow, a acetylcholinesterase inhibitor in conjunction with a a stimulant. Both alone can cause depression, I'd be mindfull of this side effect.
Linkadge
Posted by Nickengland on September 3, 2005, at 12:11:44
In reply to Executive functioning.....For Meri-Tuuli and Nick!, posted by Tom Twilight on September 3, 2005, at 8:23:08
Hi Tom,
Thank you for the compliment of my post and thanks once again for being able to respond!
>(PS) Sorry if this post is a bit ropey
Not at all, is was brilliant, very informative indeed. :-)
I'm actually considering trying a stimulant myself. I feel fine on the medications i'm currently taking with regards to anxiety and highs and lows ~ its just motivation and what could possibly be decribed as mild ADD symptoms or more so my thinking is that possibly my lack of motivation and the symptoms with it may respond well to a stimulant. Possibly, but I don't know for sure, everything else is okay but I cannot maintain interest in anything long enough lol It is mild though and I think the stimulant if it worked, would be off setting lack of motivation from the side effects of me currently taking 2 anticonvulsants, drowsyness causing lack of motivation etc..
I have bipolar mainly inherited from my mother, but to complicate things even more my older brother was diagnosed with ADD as a child back in the 80's. I believe my brother got the ADD from my dad ~ where I seem to have got bipolar from my mum. What a mix LOL
I think if i looked at the bipolar and ADD elements separately, I tend to follow suit more with bipolar, but the ADD element could still be in there somewhere...
What was it you didn't like with Provigil?...and in your opinion with the stimulants on the market today what do you think is the safest, most effective and considered first-line?
Many thanks Tom and I hope you're well.
Kind regardsNick
Posted by Meri-Tuuli on September 3, 2005, at 13:07:05
In reply to Re: executive functioning etc..... » Meri-Tuuli, posted by Nickengland on September 2, 2005, at 14:04:47
Hi!!
Thanks for your lovely post! It is much apprecaited.
> Are you currently under a psychiatrist?
No, I see a GP at a health centre.....I have been though most of them there, and the one i have at the moment, is the one that is pretty amenable and has let me try reboxetine. I wanted to try it because I think I am ADD (and I also suffer from depression) although I have never had a proper diagnosis made by a psychiatrist. I am realising that I should see one. At least if I have a proper diagnosis, then I could get the right meds and also begin to try and get myself better.....
Anyway I was thinking of trying wellbutrin. Or one of the TCAs. Celexa sort of worked for me, like lifted the depression (sort of), but I was soooo tired all the time and had zero motivation I have got sick of it. I just about weaned off it last week. And my theory about celexa and the tirdness is that it affects your 'sleep architecture' and actually the sleep you get on it, isn't as refreshing. Now I really notice the difference - my sleep quality is much better. Anyway, yeah so, I think I might try wellbutrin on its own. I'm meant to be taking reboxetine, which I found really calming but I don't like the fact that its made me develop acne and my periods have stopped. Plus my little heart was racing away! And it pooped out.
I was reading somewhere else about reward deficiney - which neurotransmitter is involved with that - dopamine? Would therefore wellbutrin help with that??
Posted by Meri-Tuuli on September 3, 2005, at 13:17:46
In reply to Re: executive functioning etc....., posted by linkadge on September 3, 2005, at 7:03:33
> Many of the TCA's including nortryptaline have been used in the treatment of ADD.
Would this also help with depression?
> If an SSRI is working but making you apathetic, I think your best bet is lower it slightly and add some nortryptaline. Failing this, add some remeron, or wellbutrin.
I am quite keen to try wellbutrin next (on its own). And I think my GP would be okay with this. I live in the UK, and GPs won't prescribe much, plus wellbutrin isn't actually available, he would have to do it 'off label' and therefore it would be Zyban. It was a toss up between reboxetine and wellbutrin when I saw him last and I went for the rebox. He was really okay with it - I went to him and was like 'look, its not working with ciprmail, but maybe wellbutin or rebox would be good' and I showed him printed stuff out and he was like 'it looks like you've done all the hard work!' Perhaps if I went in and was like.....'lets try the ritalin!' he wouldn't bat an eyelid.......my flatmates are primary teachers and they say that some of the kids are on ritalin.....if kids can be prescribed it, then surely me! LOL!!!!!!!
Or maybe I can buy Provigil or something online..
Thanks Linkage afor all your helpful advice and support....!
Warm regards
Meri
Posted by Meri-Tuuli on September 3, 2005, at 13:28:38
In reply to Executive functioning.....For Meri-Tuuli and Nick!, posted by Tom Twilight on September 3, 2005, at 8:23:08
Hey Tom!!
Thanks for the reply - it wasn't ropey at all. And anyway its not as if most of my posts are works of art anyway!! LOL!!
Em, I will defo try to get to see a private psych doc. Whats the best way of getting to find one?? And, roughly how much do they cost???
Hahaha I actually almost nearly dated a pysch JUST to get to know more about my disorders etc etc, but then I didn't think it was ethical. But imagine, he'd be able to get you all the meds you needed!! But then he might know how to manipulate me!! EEeeek.Where was I, I have depression as well, so the med you mentioned wouldn't be a good idea I don't think.
Going to America - well darn it, by boyfriend lives in Boston, a stones throw from Harvard, I should have gone to see a psych when I was over there visiting him.....he's coming back now (to the UK)for good now, a chance lost. But he might go back for conferences and to use their machines and stuff (he's a science geek/researcher).
Hmmm...I'm all so confused at the moment, and I just wish that the UK had a slightly more comprehensive mental health care!! GRrrrrrrr and what do we pay for in taxes????
So I'm thinking wellbutrin for the moment.
Posted by crazy teresa on September 3, 2005, at 14:46:07
In reply to Re: describe executive functioning for me again, posted by linkadge on September 3, 2005, at 7:08:48
> People with executive function (ADD ADHD etc) often experience reward deficiancy. Basically even if they finish a task, it is hard for them to take pleasure in what they have accomplished.
>
> Sometimes stimulant treatment can reverse this effect, whereby a patent treated succesfully can take more pleasure in completing tasks.
>
> Linkadge
Okay, please anylize this for me:At home, I don't care if anything gets done or not. There just seems to be no point in doing it. I've been thinking it's some kind of rebellion against my family for being so ungrateul all these years, that I'd just given up on being Suzy Homemaker.
I'm not angry or disapointed, I really don't care one way or another. It seems to me a great burden has been lifted as I no longer struggle to have everything perfect or stress over what needs to be done or what doesn't get done. My family, however, is pretty upset with me. Maybe they really did appreciate what I once did--or are they just spoiled? No difference, I should still do some of it; there is no joy in doing it, but I don't seem to have a problem about not doing it either.
This attitude is surfacing about other things I used to do. I was always busy doing work in the church, baking for the neighbors, blah, blah, blah. Now I do nothing. I always enjoyed all of that and I'm not sure why I've stopped. I just did. I've not replaced these tasks with other tasks. I still think about doing them, I just don't.
I don't this notice too much at work, but I'm really busy there with customers, so I probably don't have time to be this way. I did think the other day perhaps the new is wearing off the job... it's not as much fun. But wouldn't I have felt like that before being there for 2 yrs. if this was the case? I adore my job and what I do.
Effexor seems to work fine for me, I am not even close to being as depressed as I was, but was wondering if it was mellowing me a little too much when I began noticing all of this.
BTW, linkadge, what is your profession? I hope what you charge me for your analysis is reasonable! ;~} Will you work for homemade fudge?
crazy teresa
Posted by zeugma on September 3, 2005, at 16:12:53
In reply to Re: executive functioning etc..... » linkadge, posted by Meri-Tuuli on September 3, 2005, at 13:17:46
> > Many of the TCA's including nortryptaline have been used in the treatment of ADD.
>
> Would this also help with depression?Yes, it would. Nortriptyline is a very effective antidepressant.
>
> Or maybe I can buy Provigil or something online..
>Provigil is better for many aspects of executive functioning for me. I can organize my desk a little better (although it's still a frightful mess). Ritalin did nothing for organization. I have more of a 'sense of the future', ability to plan, on Provigil. It's not a dramatic effect however, but it's better than nothing.
Ritalin works a lot more dramatically to improve 'reward deficiency.' The dysphoria I would feel after completing any task was alleviated by Ritalin at 60 mg/day, but not at lower dosages. Provigil helps a little with this, but it's a slower, smaller effect. but when being organized enough to get out the door in one piece is a challenge, every little bit counts.
-z
>
>
Posted by linkadge on September 3, 2005, at 16:52:52
In reply to Re: executive functioning etc..... » linkadge, posted by Meri-Tuuli on September 3, 2005, at 13:17:46
The TCA's are effective antidepressants and effective for attention related disorders.
Wellbutrin is worth a try.
I personally have had bad experience with stimulants. Any improvement I attain I experience the equal and exact opposite too when the dose wears off.
I have had more success with the TCA's. But it a stimulant may be worth a try
Linkadge
Posted by Phillipa on September 3, 2005, at 18:33:56
In reply to Re: executive functioning etc..... » Meri-Tuuli, posted by zeugma on September 3, 2005, at 16:12:53
Okay as usual I'm getting confused. As you know I'm starting tonight on a dose of l0mg of nortriptaline. I'll be taking this with l0mgof valium. I've been getting a lot of nightmares and one of side effects is this and also says notify doctor of thyroid disorder and I'm hypo. So if my main symptom is extreme anxiety resulting in panic attacks at times how will a med that is stimulating help me sleep and be calmer. Fondly, Phillipa
Posted by zeugma on September 3, 2005, at 20:04:18
In reply to Re: executive functioning etc..... » zeugma, posted by Phillipa on September 3, 2005, at 18:33:56
> Okay as usual I'm getting confused. As you know I'm starting tonight on a dose of l0mg of nortriptaline. I'll be taking this with l0mgof valium. I've been getting a lot of nightmares and one of side effects is this and also says notify doctor of thyroid disorder and I'm hypo. So if my main symptom is extreme anxiety resulting in panic attacks at times how will a med that is stimulating help me sleep and be calmer. Fondly, Phillipa
presumably your doctor knows of your thyroid disorder. Nortriptyline is a good antipanic medication; naturally this is not a guarantee of its efficacy in every case but it does have a known effect in panic disorder.
As to whether nortriptyline is 'stimulating', it is not a 'stimulant.' I did not find low dosages sedating, but this varies among people too. The only way to find out what effect it will have, of course, is to try it, and 10 mg is a very low dose. I found that its analgesic and antipanic effects set in at lower dosages than sedating or antidepressant effects.
-z
Posted by Meri-Tuuli on September 4, 2005, at 8:15:04
In reply to Re: executive functioning etc..... » zeugma, posted by Phillipa on September 3, 2005, at 18:33:56
Hi Phillipa!
> if my main symptom is extreme anxiety resulting in panic attacks at times how will a med that is stimulating help me sleep and be calmer. Fondly, Phillipa
I have found that when I was on reboxetine (a potent noradrenaline reuptake inhibitor) it was the best thing ever for panic and anixety. I had no panic whatsoever, but it wasn't so good for depressional thinking.
Let us know how it goes!
Meri
Posted by Meri-Tuuli on September 4, 2005, at 8:24:22
In reply to Re: executive functioning etc....., posted by linkadge on September 3, 2005, at 16:52:52
> Wellbutrin is worth a try.
I think I will give this a go next.....
Not sure my british GP is going to let be try a TCA. Although some of my friends are on them. I have atypical depression which doesn't respond so well to TCAs (or so I've heard).
Meri
x
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.