Posted by JohnL on June 12, 2000, at 5:25:58
In reply to Thank you--armed with new info for pdoc, posted by shellie on June 11, 2000, at 20:08:52
> I am changing back once again to my old pdoc, even though she doesn't accept my insurance. I've had one mean and two uninformed pdocs since, so I am going to spend the bucks. Tomorrow is my appointment. I am taking nardil (which I have for years). Now, thanks to you guys on the board, I have a list of options for augmentation. She had talked about topomax as a possible next option (lacimtal worked well for me, but I gained a lot of weight). The side effects of topamax scare me. Now I have buprenorphine, naltrexone, and provigil to talk about, besides my original idea of ridlin. She'll be able to tell me the pros and cons; she's very good, but it feels better to come in really prepared since I have just a 1/2 hour with her. I don't even know how she'll feel about my choices. I'll write soon with the final decision ("so that's your final answer?") shellie
Shellie,
Even though it's pricey, I think it's a good thing you'll be seeing someone you're comfortable with. That's half the battle won right there.As for suggesting your augmentation choices to the physician, I would strongly urge printing out your research to lay on the doctor's desk. Your ideas will have the appearance of being much more credible when they are backed up with supporting documents from credible sources. If you print out everything, that might be too much. Just print out the most important points. Keep it concise and focused. Even if the physician doesn't read what you've brought in, you have accomplished making the impression that you take your illness seriously, you are educating yourself about it, taking personal responsibility and involvement with it, and seeking knowledge from professional sources around the country.
The medications you mentioned sound like decent choices. I think personally I would start with the Ritalin, since it is so fast-acting. In the old days it wasn't uncommon to mix it with MAOIs, so I hope your physician is open enough to realize it's not as wild a combination as it might seem.
Anyway, with Ritalin you will know within 24 to 72 hours whether you like it, hate it, or it's neutral. Other equal choices might be Adderall or Provigil. You could even sell your doc on the arrangement to try Ritalin for 5 days, Adderall for 5 days, and Provigil for 5 days, with a one day washout inbetween. Get a small 5-day prescription for all three. The purpose would be to compare the whole class before committing to any particular drug. Their fast onset makes this a realistic test. In your trials I would go for the quickest onset meds first, save the longer ones for last. And hopefully you'll stumble onto a good one before getting very far. That would be cool. Stimulants certainly possess that potential.
Naltrexone in the hands of my pdoc hasn't worked yet with anyone. N=6 patients who've tried it, including me. When it works, it's remarkable. But the odds of it working aren't any better than the odds of anything else.
Anyway, I'm wishing you success in all that you do.
JohnL
poster:JohnL
thread:36967
URL: http://www.dr-bob.org/babble/20000610/msgs/36997.html