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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by G-man885858 on March 4, 2010, at 22:49:07
I have had a severe depression for 15 years. I've tried Effexor, Paxil, Celexa, Lexapro which all made me more tired, and more depressed.
I am so sick of these *ssh*l* doctors being so reluctant to prescribe a stimulant to a 27-year old adult male like me, while at the same time feeding them to little kids like candy. What the f*ck?
I am so F*cking angry that every time I ask to try a stimulant I get blown off. What can I possibly do to convince these prick doctors to let me try a stimulant?
Posted by JohnnyBLinux on March 5, 2010, at 1:01:09
In reply to How can I convince doctor to Prescribe Stimulant?, posted by G-man885858 on March 4, 2010, at 22:49:07
It's going to be hard to get a doctor to prescribe a stimulant because you don't have a history of ADHD / ADD. However, if you state your case plainly, that you've tried all these X, Y, and Z antidepressants without success, then you may have better luck. I understand your frustration because pdocs hand them out to "hyperactive" kids without a second thought. Anyway, I don't know what else to suggest other than to keep trying until you find a willing doctor, which you should eventually find because I do believe pdocs prescribe them for TX resistant cases of depression.
Good luck.
Posted by bleauberry on March 5, 2010, at 5:33:46
In reply to How can I convince doctor to Prescribe Stimulant?, posted by G-man885858 on March 4, 2010, at 22:49:07
>
> I am so F*cking angry that every time I ask to try a stimulant I get blown off. What can I possibly do to convince these prick doctors to let me try a stimulant?Study up on the symptoms of ADD and ADHD. Go into the doctor's office with all of those symptoms as your complaints. Stimulants are the mainstay in treating those. So basically, instead of going to a doctor to get treated for depression, turn it into ADD/ADHD instead. Maybe a little fudging involved, but ya know. Sometimes we gotta do what we gotta do because no one else is going to do it for us.
Posted by Phillipa on March 5, 2010, at 11:03:02
In reply to Re: How can I convince doctor to Prescribe Stimulant?, posted by bleauberry on March 5, 2010, at 5:33:46
I don't feel you should not tell the whole truth. sometimes honesty works. Same as the tramadol and the pdoc she said yes she's heard from other patient that opiods work but said the higher ups monitor their prescriptions and they could lose their license for off lable prescribing. She suggested trying to find a pain clinic but they also don't use pain killers. I feel add is kind of the same. What about providgil or nuvidgil? Phillipa
Posted by emme on March 5, 2010, at 16:44:55
In reply to How can I convince doctor to Prescribe Stimulant?, posted by G-man885858 on March 4, 2010, at 22:49:07
> I have had a severe depression for 15 years. I've tried Effexor, Paxil, Celexa, Lexapro which all made me more tired, and more depressed.
>
> I am so sick of these *ssh*l* doctors being so reluctant to prescribe a stimulant to a 27-year old adult male like me, while at the same time feeding them to little kids like candy. What the f*ck?
>
> I am so F*cking angry that every time I ask to try a stimulant I get blown off. What can I possibly do to convince these prick doctors to let me try a stimulant?Both my previous and current pdocs use stimulants as an add-on to other drugs to help with fatigue in treatment resistant depression. You might not get one prescribed as monotherapy, but you may very well find a pdoc who will use them as part of the arsenal.
But let me ask you, why are you zeroing in on stimulants? Is it for the fatigue? There are an awful lot of medications you have not yet tried, and they do not all induce fatigue. Wellbutrin might be worth trying. Many people on this board do well with the MAOIs. There are the tricyclics, a couple of which are not so sedating. Lamictal can work for unipolar depression, as can some of the antipsychotics.
What has worked for me was to find medications that treated most of the depression and adding a low dose of a stimulant to help with remaining fatigue. I don't think the stimulant alone would help my mood and anxiety.
Good luck.
Posted by gibbons482 on March 5, 2010, at 17:22:35
In reply to Re: How can I convince doctor to Prescribe Stimulant?, posted by bleauberry on March 5, 2010, at 5:33:46
Study up on the symptoms of ADD and ADHD. Go into the doctor's office with all of those symptoms as your complaints. Stimulants are the mainstay in treating those. So basically, instead of going to a doctor to get treated for depression, turn it into ADD/ADHD instead. Maybe a little fudging involved, but ya know. Sometimes we gotta do what we gotta do because no one else is going to do it for us.
This is the EXACT reason why it's so difficult for me to get treated for ADHD--people lying (and it is LYING not FUDGING). This really irks me off that you even suggested this. That's abuse.
Posted by gibbons482 on March 5, 2010, at 17:28:15
In reply to How can I convince doctor to Prescribe Stimulant?, posted by G-man885858 on March 4, 2010, at 22:49:07
I agree with what some others have posted. I don't agree with lying to a doctor. First of all, you can get outed doing this by a TOVA test (test of variable attention). So please don't ruin it for those of who legitamately neeed stimulants. So, I agree with just being honest about what you've tried and then asking for a stimulant trial. Perhaps go in with some references to studies in their indication for treatment resistant depression. Honesty will get you everywhere, lying will get you nowhere. Doctors aren't stupid.
Posted by bleauberry on March 5, 2010, at 19:24:53
In reply to How can I convince doctor to Prescribe Stimulant?, posted by G-man885858 on March 4, 2010, at 22:49:07
Alrighty then. I hear ya all. Nobody here ever lies or fudges.
So forget I ever said anything. Strike it from the records. With the benefit of hindsight, I agree it was a bad idea.
So that leaves two options:
1. Talk to the doctor honestly about the desires to try stimulants. Support your case with literature and pubmed studies.
2. If he still refuses, fire him, get another doctor who is more cooperative. Or, instead of firing him, just get a second opinion another doctor.
As to the comment of doctors not prescribing ADD meds because too many people fake it, I just don't buy that. Sorry.
Posted by Justherself54 on March 5, 2010, at 19:31:11
In reply to Re: How can I convince doctor to Prescribe Stimulant? » G-man885858, posted by gibbons482 on March 5, 2010, at 17:28:15
I have had stimulants prescribed by my pdoc and I don't have ADHD. Stimulants are often used in conjunction with an AD. Ritalin stopped working but Alertec works great. I don't think you should have to lie to your pdoc. Just simply ask him/her if a stimulant would be worth trying. No harm in discussing it with your doctor.
Posted by linkadge on March 5, 2010, at 19:35:10
In reply to Re: How can I convince doctor to Prescribe Stimulant? » G-man885858, posted by gibbons482 on March 5, 2010, at 17:28:15
The more you try to convince your doctor, the more you look like a drug seeker - the less likely he/she is to prescribe one.
Linkadge
Posted by G-man885858 on March 5, 2010, at 21:21:26
In reply to Re: How can I convince doctor to Prescribe Stimulant? » G-man885858, posted by emme on March 5, 2010, at 16:44:55
> But let me ask you, why are you zeroing in on stimulants? Is it for the fatigue? There are an awful lot of medications you have not yet tried, and they do not all induce fatigue. Wellbutrin might be worth trying. Many people on this board do well with the MAOIs. There are the tricyclics, a couple of which are not so sedating. Lamictal can work for unipolar depression, as can some of the antipsychotics.
>
> What has worked for me was to find medications that treated most of the depression and adding a low dose of a stimulant to help with remaining fatigue. I don't think the stimulant alone would help my mood and anxiety.
>
> Good luck.
>
>
>
>Emme,
I have been given Wellbutrin at 75, 150 and 300 mg SR doses. All these doses do the same problem: I fall right asleep after taking them. I thought that Wellbutrin was supposed to be a "stimulating" antidepressant, but not for me.
I have read that many folks on this board have tried MAOIs like u said. I am well aware of the MAOIs side effects like the ultra-strict tyramine-avoidance diet which I can't do right now because my current gluten free & casein-free diet is too restrictive as it is.
I've tried 2 tricyclics- Doxepin and Norpramin - these were BRUTALLY fatiguing - I literally couldn't move out of my bed at all.
My sister takes Adderall, and she once gave me one. It felt literally PERFECT. No side effects, no anxiety, no fatigue - just a smooth, mellow state of incredible mental energy. I was able to read HUGE pieces of text that I would normally lose focus on. I was able to talk to my parents without the anger and rancor that we usually engage in. I felt so empathetic, and insightful. It just gave me everything that I was missing emotionally.
Posted by emme on March 5, 2010, at 22:11:48
In reply to Re: How can I convince doctor to Prescribe Stimulant? » emme, posted by G-man885858 on March 5, 2010, at 21:21:26
> I have been given Wellbutrin at 75, 150 and 300 mg SR doses. All these doses do the same problem: I fall right asleep after taking them. I thought that Wellbutrin was supposed to be a "stimulating" antidepressant, but not for me.Bizarre. It's apparently not good for you.
> I've tried 2 tricyclics- Doxepin and Norpramin - these were BRUTALLY fatiguing - I literally couldn't move out of my bed at all.I know doxepin can knock people out. I think it's desipramine that is more stimulating.
> My sister takes Adderall, and she once gave me one. It felt literally PERFECT. No side effects, no anxiety, no fatigue - just a smooth, mellow state of incredible mental energy. I was able to read HUGE pieces of text that I would normally lose focus on. I was able to talk to my parents without the anger and rancor that we usually engage in. I felt so empathetic, and insightful. It just gave me everything that I was missing emotionally.
I see why you want to go the stimulant route. Actually, if it helped you feel mellow and concentrate, do you think there's any indication that you actually do have ADD? I would never advocate inventing symptoms, but if you do actually have ADD symptoms, then your new doc will need to know.
I do think you need to be careful how you bring up wanting a stimulant with a new pdoc. You'll be giving a new pdoc the list of things you've tried, so that will get the conversation started. Also, I've seen a number of anecdotal reports (can't remember where exactly) where people have found Provigil to be hugely helpful for depression. So that might be another option.
Good luck.
emme
Posted by G-man885858 on March 7, 2010, at 8:50:47
In reply to Re: How can I convince doctor to Prescribe Stimulant? » G-man885858, posted by emme on March 5, 2010, at 16:44:55
I don't understand how Stimulants can be used to augment antidepressant therapy. I read that combining these 2 can cause Serotonin syndrome.
Posted by emme on March 7, 2010, at 14:13:00
In reply to Re: How can I convince doctor to Prescribe Stimulant? » emme, posted by G-man885858 on March 7, 2010, at 8:50:47
> I don't understand how Stimulants can be used to augment antidepressant therapy. I read that combining these 2 can cause Serotonin syndrome.
Where did you read that? I have never heard this, nor can I imagine what mechanism might be involved. As I understand it, stimulant augmentation is a pretty well-known strategy. Look through the article below. The author has a pretty common-sense approach and uses stimulants to augment antidepressants when a patient is low on energy.
http://www.thecarlatreport.com/expertqa/choosing-antidepressants
emme
Posted by G-man885858 on March 8, 2010, at 20:56:23
In reply to Re: How can I convince doctor to Prescribe Stimulant? » G-man885858, posted by emme on March 7, 2010, at 14:13:00
>
> Where did you read that?Emme,
I read this at Wikipedia.org. Is this a reliable website or is Wikipedia unreliable?
I got the link right here:
Posted by emme on March 8, 2010, at 21:41:47
In reply to Re: How can I convince doctor to Prescribe Stimulant?, posted by G-man885858 on March 8, 2010, at 20:56:23
>
> >
> > Where did you read that?
>
> Emme,
>
> I read this at Wikipedia.org. Is this a reliable website or is Wikipedia unreliable?
> I got the link right here:
>
> http://en.wikipedia.org/wiki/Serotonin_syndrome#CauseCan you point me to the specific sentence in the article? I just perused it and I don't see anywhere where it actually says that combining an AD with a stimulant causes serotonin syndrome. The table lists a large number of drugs, but doesn't say *which* combinations are problematic.
People can have problems using stimulants with Parnate, but I believe that's through another mechanism than serotonin syndrome. There may be other ADs that shouldn't be mixed with stimulants (someone chime in here). But I think that if combining stimulants with AD's was categorically contraindicated for all stimulants and ADs, then the 3 top-notch psychopharmacologists I've seen would not use that strategy.
I actually take a low dose of a stimulant with Lamictal and Abilify (which are not classified as ADs) and it works well.
Anyway, stimulants alone might be great for you, and that may be end of story. But if a pdoc ends up wanting to combine a stimulant with something else, I'd trust her/his expertise.
Good luck,
emmeP.S., I may not post on this thread again as I realized you have the facebook and twitter buttons on your posts, which means someone could effectively add my posts to twitter or facebook because they're included in your posts. I'm a little shy about that. But my babblemail is turned on.
Posted by paulbwell on March 12, 2010, at 15:41:25
In reply to Re: How can I convince doctor to Prescribe Stimulant?, posted by bleauberry on March 5, 2010, at 5:33:46
"Sometimes we gotta do what we gotta do because no one else is going to do it for us."
If you have suffered thru many ADS a stimulant may well help. I tried 6 and only one was usefull, but was eventually Dx ADD and given Ritalin-best AD i have taken, in combo with prozac.
If you don't ask-you don't get.
Posted by Phillipa on March 12, 2010, at 21:21:17
In reply to Re: How can I convince doctor to Prescribe Stimulant? » bleauberry, posted by paulbwell on March 12, 2010, at 15:41:25
Hey stranger doing well I take it? Love Phillipa
Posted by G-man885858 on March 13, 2010, at 0:56:09
In reply to Re: How can I convince doctor to Prescribe Stimulant? » bleauberry, posted by paulbwell on March 12, 2010, at 15:41:25
> If you have suffered thru many ADS a stimulant may well help. I tried 6 and only one was usefull, but was eventually Dx ADD and given Ritalin-best AD i have taken, in combo with prozac.
>
> If you don't ask-you don't get.When I told my psychiatrist that I had severe brain fog, inability to concentrate, inability to read long text passages without always zoning out, and I mostly "zone out" when speaking to people... He said that "if you weren't diagnosed with ADD in childhood, then its extremely unlikely that you have it now (I'm 27 years old now)". The doctor's wrong about this, right?
Posted by minniebabe_2000 on March 18, 2010, at 13:37:10
In reply to How can I convince doctor to Prescribe Stimulant?, posted by G-man885858 on March 4, 2010, at 22:49:07
> I have had a severe depression for 15 years. I've tried Effexor, Paxil, Celexa, Lexapro which all made me more tired, and more depressed.
>
> I am so sick of these *ssh*l* doctors being so reluctant to prescribe a stimulant to a 27-year old adult male like me, while at the same time feeding them to little kids like candy. What the f*ck?
>
> I am so F*cking angry that every time I ask to try a stimulant I get blown off. What can I possibly do to convince these prick doctors to let me try a stimulant?---->Reply<------
I went through years of being misdiagnosed with anxiety, depression, and bipolar. My brother has been diagnosed ADD/ADHD since 6yrs old and I thought that you had to be dumb and extremely hyper like him. Hence, I never made the conncection that I could even be ADD because I feel I'm an inteligent and non-hyper person. I stumbled across my discovery by mistake when I was having an extreme "episode" and looked up my brother's medication to see what it is used to treat. Then I was directed to the symptoms and I had ALL of them. When I went to the doctor (whom had never seen me before, and is the only one my insurance covers near me), he didn't believe me and accused me of trying to get pills for illegal uses. I told him to look at my medical history and the medications prescribed and he would see that I've had a long history of problems and I believe I was misdiagnosed. First he informed me that only 3% of adults have ADD (boy is he way off) and the symtptoms don't appear overnight. He finally agreed to give me a 1 month prescription and I'm supposed to go back and report my progress. I feel confident and my mood has increased and I almost always feel happy. And when I do feel sad, it's a short-lived experience. My sex drive has increased dramatically and I believe it was due to psychological reasons which Vyvanse has helped me with. I feel normal for the first time in my life. It was like puting glasses on for the first time and seeing clearly. I only hope that the doctor will see that this has helped my situation dramatically and let me continue taking it.
My symptoms included:
*Struggle w/anger,frustration,irritable w/moodswings, depression, anxiety, tension
*Overreacting to critcism, low-self esteem
*History of problems that medication didn't help
such as depression, anxiety, and told I may be bipolar due to moodswings & irritability
*Trouble w/motivation, procrastination,organization
*Insomnia,constant leg shaking where people always asked me if I was nervous/anxious about something
*Low sex-drive,no energy
*Impulsiveness-(risky behavior), 7 car accidents which over 1/2 were my fault (this symptom was one that made me realize whoa..it was my a ha moment), roadrage
*Forgetful, clumsy, running into things, dropping things
*Hyperfocus(that was the 2nd a ha moment)
*Constant daydreaming and wandering all day and during conversations, problems remembering conversations, dates, and appointments
*Being withdrawn and drowning myself in quiet activities and wanting to be left alone.
*Genetics-my brother previously diagnosed
My Side Effects:
*Diarehha in the morning, in the evening it returns to normal-only when medicine kicks into my intestinal tract do I get the diarehha
*Headache
*Loss of appetite but returns at night when comming down from medicine and if I'm hungry I am able to eat, for instance if I didn't eat much the day before. I also sometimes forget to eat until the medicine wears off and I feel hungry b/c I'm not compulsively thinking about food like before
*Dry-mouth
*The rest of the side-effects are positive and definetly outweigh the few minor ones
Posted by G-man885858 on March 18, 2010, at 22:22:04
In reply to Re: How can I convince doctor to Prescribe Stimulant?, posted by minniebabe_2000 on March 18, 2010, at 13:37:10
I am Extremely frustrated. I've truly tried my hardest .. I feel like giving up.
Posted by minniebabe_2000 on March 19, 2010, at 10:23:26
In reply to I want to give up » minniebabe_2000, posted by G-man885858 on March 18, 2010, at 22:22:04
> I am Extremely frustrated. I've truly tried my hardest .. I feel like giving up.
---------------
Someone suggested to me that if the doctor was going to be a jerk and not believe me that I could try the Bowen Center. Luckily he at least gave me a trial-run on it. Try someplace like that. They can evaluate you and help you really figure out what you need. I was lucky and stumbled on my issues at age 25 (but my old physician missed it completely and I had to figure it out for myself. The ironic thing is that she helped diagnose my brother, so it baffles me how she missed my diagnosis). I can't believe how many people in their 40's and 50's went thru their entire life not being diagnosed and treated. I'm so happy on my medication and I enjoy life now. I wish you the best and keep us posted on your progress.
Posted by evenintherain on March 19, 2010, at 17:13:50
In reply to Re: I want to give up, posted by minniebabe_2000 on March 19, 2010, at 10:23:26
i think girls are underdiagnosed because we show symptoms differently, and all medicine basically uses males as the standard.
i went to a new doctor yesterday and he suggested maybe i had add, he didn't prescribe anything yet, but i am hopeful that stimulants will help my situation.
my brother was diagnosed w/add recently even though i don't think he has it. i definitely show more symptoms than he does.
Posted by minniebabe_2000 on March 21, 2010, at 9:24:16
In reply to Re: I want to give up » minniebabe_2000, posted by evenintherain on March 19, 2010, at 17:13:50
> i think girls are underdiagnosed because we show symptoms differently, and all medicine basically uses males as the standard.
> i went to a new doctor yesterday and he suggested maybe i had add, he didn't prescribe anything yet, but i am hopeful that stimulants will help my situation.
> my brother was diagnosed w/add recently even though i don't think he has it. i definitely show more symptoms than he does.--->Yeah.I've been finding out that girls have it tougher than boys b/c docs and teachers are so quick to prescribe meds to hyperactive boys and completely passover anyone who doesn't stand out. I was very withdrawn in school. There were a couple moments in highschool where I felt unstoppable and friendly but mostly stuck to myself. I fit the ADD symptoms to a T and I just never realized it b/c even I thought you had to have a learning disability and be super hyper like my brother who was diagnosed. It's very discouraging b/c the doctors don't wanna believe you when you do finally figure out what's going on.
This is the end of the thread.
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