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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 Shirley1 on March 6, 2001, at 5:43:18
I know I'm sounding like a broken record but I need some more help regarding my med situation. You all have been so helpful and that's why I keep asking as I am so darned tired of this situation.
A brief recap - I am being treated for depression, anxiety, and ADD and am currently taking 30mg Adderall, 15 Remeron, and 30mg Prozac. While the Prozac has been helpful in many ways, I can't seem to find the right dose as I feel like 30mg is not enough and 35 is too high (being on edge, emotions totally blunted, heart racing). I have also tried taking 2.4mg in liquid form in addition to the regular 30mg to no avail.
My psychiatrist has suggested adding 25mg Wellbutrin SR to the mix. But I am leary of that suggestion for these reasons:
Cam - Your posts seems to indicate it wouldn't be effective at such a low dose. I would be concerned about taking more because of already being on adderall and having anxiety as a secondary condition.
My thoughts after searching posts on this board:
1. Increase the adderall dose in the am from 10mg to 12mg. My reasoning is yesterday, when I took 32.4 mg Prozac and 10mg Adderall, I did fine but fizzled out about an hour before my mid time Adderall dose. Maybe the 12mg would jump start the Prozac better in the morning. Also, yesterday, when I had another cup of coffee, I felt much better.
2. Ritalin - Maybe another stimulant would work better with the Prozac.
3. Buspar - Instead of increasing the stimulants, add Buspar because it would take the edge off of Prozac. Also, it has good PMS Properties and I suffer through that. Has been shown to be effective as augmentation in some cases.
4. Lithium - Don't have as many good reasons for it but still wonder whether it would be a good option.
In the past, I have gotten slightly manic on antidepressants which makes me think about Lithium. Also, it's been shown to be effective.Finally, I am getting to the point where I feel confident to ask my psychiatrist if I could sample these various options. If I were to go that route, it seems like I should try the stimulants first and then the Buspar. Am I thinking logically?
Sorry to burden you all with such a long post. Due to having LD and ADD, I get overwhelmed easily with all this information. It also doesn't help me in communicating with my psychiatrist even though I always think I am prepared with questions.
Thanks in advance for your help.
Shirley
Posted by Cam W. on March 6, 2001, at 6:50:46
In reply to Sounding like a broken record (Help), posted by Shirley1 on March 6, 2001, at 5:43:18
Shirley - Write these questions down or print them out for the psychiatrist and hand them to him; either at the start of the appointment or the end (so that he has a chance to go over the options before your next appointment). The stress of sitting in the office is enough to make one forget. Let you doctor know of the options that you are considering. He/she knows your history better than us and will be able to tell you which of these options has a better chance of working. It will show that you are also doing your homework in your treatment.
As for the 25mg of Wellbutrin, it can't really hurt and is an alternative to raising the Adderall dose. By itself Wellbutrin may not be effective at low doses, but when added to a regimen, it may work.
Hope this helps - Cam
Posted by Shirley1 on March 6, 2001, at 7:08:34
In reply to Re: Sounding like a broken record (Help) » Shirley1, posted by Cam W. on March 6, 2001, at 6:50:46
Cam,
As always, excellent advice. What happened is when I saw my psychiatrist yesterday, I fully expected to be talking to him about fine tuning the liquid prozac dose.
But I unexpectantly at work started having problems and of course, I didn't want be surfing this site while at work So of course, I was unprepared and frustrated. What I might do is push up my next appointment to two weeks from yesterday and of course, send in my post as you suggested. I still would appreciate though hearing other suggestions.
By the way, I tried the 12mg Adderall and that doesn't seem to be the answer so on to the next step. But back to your point Cam, when something unexpected happens, because of LD, if I'm not prepared with questions, I leave appointments frustrated and end up having to schedule another one real quickly.
In the past, because LD affects my auditory problems and I process things slower, I have asked for a longer appointment. But I always seem to have to wait forever for one. To be honest, I have gotten to the point where I am thinking of looking for someone else
That's why if I had my druthers, my ideal psychiatrist in addition to knowing about meds would be experienced with adult LD issues. I try to be prepared but there are going to be times when I don't word my questions perfectly everytime. LD isn't just about writing questions down, it's have professional explain things in terms that I can understand.
I know I am dreaming and I don't mean to go off on you Cam. Just alot of frustration that's brewing.
Thanks for responding so quickly. It is much appreciated.
Shirley
Posted by Pandora on March 7, 2001, at 22:00:46
In reply to Re: Sounding like a broken record (Help), posted by Shirley1 on March 6, 2001, at 7:08:34
Shirley,
I'm relatively new to this board and haven't read any of your earlier postings (outside this thread), so this may be a redundant suggestion. Have you thought of taking someone along on your doctor visits who knows you well and is familiar with your treatment and your history? This person could serve as an advocate for you if you aren't able, for whatever reason, to express your ideas or concerns clearly. This person could also "translate" the doctor's recommendations or rationale if he is not making himself clear. (trust me, you don't have to have LD to have difficulty understanding doctors sometimes!) If this is not a good option for you, have the doctor write down his recommendations for you so you have something concrete to refer to later. Finally, many times, if there is a point you forgot to make or a question that comes up after you leave the doctor's office, you can contact his nurse and relay the info to her (sorry, folks, I've got the gender stereotypes going today!). The nurse often can answer your questions herself, and if not, can consult with the doctor and call you back... all without an additional visit or additional charges : )Anyway, sorry for the long-winded post. I hope you find a good combination soon.
P.S. Have you tried Effexor or Serzone? They are both known to work on anxiety and Effexor seems to work in some ADD cases as well.
Posted by Shirley1 on March 9, 2001, at 19:11:08
In reply to Re: Sounding like a broken record (Help) » Shirley1, posted by Pandora on March 7, 2001, at 22:00:46
Pandora,
Thank you for a very thoughtful and helpful post.
I have thought about asking my psychiatrist to write things down so your advice is an excellent reminder for me. Can't think if who I would ask to come with me but your idea of an advocate is a good one and I'll certainly give it some thought.
I have come to realize that the Prozac is actually pretty effective for my depression and anxiety but the Adderall is causing the problems. I have been experimenting with the Adderall dose and timing (with my psychiatrist's approval) and if I can't figure it out by Monday, I will call him to see if he would prescribe Concerta.
My reasoning is the first dose of Adderall I take works perfectly but the subsequent doses do not. Since Concerta is suppose to be smoother, that's why I wanted to try it.
Regarding calling his nurse, he doesn't have one but there is nothing preventing me from calling him for clarification. Thanks for that suggestion.
Finally, I'm keeping a drug chart of my reactions to meds and plan on sending them to my psychiatrist on a weekly basis. If I still have problems and he continues to be stumped, then I have done everything I can do as a patient and need to find someone else or seek a second opinion.
Thanks again Pandora, you have been extremely helpful.
Shirley
Posted by pandora on March 9, 2001, at 22:53:19
In reply to Re: Sounding like a broken record (Help), posted by Shirley1 on March 9, 2001, at 19:11:08
Shirley,
Keeping a record of how you feel each day is a great idea... not only can it help pinpoint drug effectiveness/problems, it can help you notice other factors that may be affecting your mood that you may not have thought of. Since you're already keeping a chart about your meds, why not keep track of what you ate, how you slept, etc... you never know what coorelations you might discover.Also, while you're looking into Concerta, ask your doc. about extended release (or sustained release) formulas of stimulants. I know Ritilan has one, but I'm not sure about any others.
Good luck, and let us know how it goes when you talk to the doctor.
This is the end of the thread.
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