Posted by Cairo on July 15, 2004, at 23:25:57
In reply to Re: Should she be off psychostims and cortisol levels » Cairo, posted by Sad Panda on July 15, 2004, at 19:28:58
Here's the psychostim rundown:
Ritalin - I think she's a fast metabolizer and gets too choppy an effect; Ritalin SR (older long acting form) - not very good for attention; Dexedrine - drug from hell,the daily come down was awful, make her aggressive; Adderall - flattened affect way too much, which was a problem with her anxiety and social phobia; Concerta >18mg - annihilates appetite; never tried pemoline - docs won't prescribe it.As for the summer "I'm bored" line, I saw an increase in this and attention, even during the school year when on Concerta. I wondered if we were getting psychostim poop out; maybe just due to an increase in anxiety and depression. We took her off Concerta this summer due to the social withdrawal causing real problems at school, such as school refusal and contributing to anxiety.
When I say boredom is a problem during the summer, I mean that in one morning we go to the movies, to the bookstore, she's been on the computer, done chores, etc. and she's still looking for a kick every 30 seconds. And her anxiety prevents her from calling friends and her fatigue prevents her from doing physical exercise. This is not the usual teenager's summer ennui.
I know boredom is partly due to her ADHD, but my question really pertains to what effect giving the stims will have on her dysthymia? Strattera induced melancholic depression (believe me it did and it abated as we weaned her off of it). As Strattera is an NERI, I'm concerned that increasing NE with psychostims will increase anxiety and too much of that will cause another episode of depression. The Chrousos article about dysregulation of the stress system and high CRH/NE causing major depression is what I'm talking about (actually I suspect she's got atypical symptoms, too; the article says you can have mixed types).
The consultant we just saw in Philadelphia at UPenn said to try Seroquel to augment the partial response she's getting to Lexapro for depression. What we're now facing with Lexapro is extreme fatigue. She's been on it for 5 months and the fatigue and short term memory seem worse, and it wasn't good to begin with. It breaks my heart to have her wake up tired in the morning, yawn all day, and avoid all activity except for the computer because she's too tired.
We just took her off Desyrel (for sleep as a sleep study showed she doesn't go into stage 3) because the doc said the Desyrel might be contributing to the memory issues (I'm thinking it's the Lex). Too soon to see if we see a change.
In my gut, I know she's a candidate for a cocktail of meds, but we simply haven't yet found a local doc to prescribe this. We're waiting for an appointment in August with a new local doc. Until then I just wanted to know if we could combat the inattention/boredom with Concerta or are we making things worse??? I'm totally confused.
Cairo
poster:Cairo
thread:365984
URL: http://www.dr-bob.org/babble/20040714/msgs/366720.html