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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 azurebay on May 28, 2002, at 19:58:40
Hi All,
Serious subject, yet I think a lot of us experience it. This is where I definitely would appreciate some expert (as in "experienced") advice from those of you who have posted here much longer than I.
Here is my in-a-nutshell-bio/history:
1. Diagnosed with ADD/ADHD as an adult in my 30's. Neurostimulant meds helped tremendously as did therapy. Honestly guys, there's no question about this Dx cause it's saved my life with neurostimulant meds!
2. As I became more in touch with the more inner things, feelings, and the whole of what had transpired over the years, I realized (over the course of 3 years with a good pdoc) that comorbid disorders were also a part of ME - just the biochemical, flesh and bones package, so to speak.
3. It became self-evident that a deeply rooted anxiety disorder, then subsequent depression was a distinct characteristic of my life since... OMG...say 9 years old! Which came first, the chicken or the egg, who knows lol.
4. The psychiatrist began exploring various medical/therapeutic alteratives to these newly emerging discoveries. At first we tried SSRI's, that were by in large a huge disappointment for the depressive aspect... with the exeption of Celexa and Effexor. Having done my research on both, it's not difficult to see why these, particularly Effexor, would work in an ADD/ADHD case.
5. For the past six months, however, I've felt as if I'm dying inside again (sigh)... panic, anxiety, sincerely working through life's crazy stuff, long story. We have literally exhausted the benzo's including Klonopin, Atavan, Valium, Librium, Serax (blah blah blah)... oh, and let's not forget the beloved Xanax *smiles*. The best of these were Klonopin and Xanax, with best results using Xanax at higher doses.
6. Despite all this bio-chemistry crap, I have been mostly functional, yet still off my game - a freelance writer, into good nutrition, solid research, yoga, mediation, etc. - doing pretty well overall, just still not exactly whole or healing.
7. Today the doc (an older doc with an open mind and lots of experience) suggests we try something different: Zyprexa. He bases this upon results with patients who have a chronic, low-level anxiety, and research supporting this class of drugs use for at least a trial at low doses.
So, does this sort of scenerio ring a bell for any of you? Any thoughts, advice, alternatives, ideas?
I'll certainly try the Zyprexa beginning tonight because frankly I have nothing to lose, and I rarely have serious side-effects from medications.
Your thoughts and posts are deeply appreciated!!!
Azure
Posted by katekite on May 28, 2002, at 21:58:46
In reply to ADD and Comorbid Disorders; Expert Advice PLZ!, posted by azurebay on May 28, 2002, at 19:58:40
I found neurontin incredibly good for my anxiety. I got side effects and had to stop, but now and then I still take it despite that... it was great. It seems to reduce input a little, helping my ADD for me, and at the same time helps anxiety. I became all focussed on improving my life and getting social things done, etc.
There are a few reports, case anecdotes, of using it in kids with ADD and comorbid anxiety or behavior problems. They like it in kids because so few side effects. A typical starting dose would be 100 mg three times a day. I started at 200 three times a day with no problems and I'm quite med sensitive. And had good anxiety relief in a couple days.
My one experience with an atypical antipsychotic was yucky, xyprexa made me more anxious and unable to think straight. Similar experience with buspar. Both are anti-dopamine in normal doses, and us ADD people need more dopamine, not less, usually.
So my advice would be try neurontin next if xyprexa doesn't work out. Few ADD people can tolerate any xyprexa. Maybe if you increased your stimulant.
There is some evidence that the atypical antipsychotics in very small doses only hit some 'inhibitory' dopamine receptors (I mean autoreceptors) so that it can actually enhance some dopamine action -- so if you do try an antipsychotic you would want to go real low on the dose. They also work on serotonin receptors. My take on low dose xyprexa is that its not much different than high dose buspar.
If you try it tonight and it screws you up, try cutting the pill in half and take half as much. If you felt stupid or more anxious it would mean you were hitting the thinking dopamine receptors and not the ones I mentioned above. Its something like a tenfold difference in dose (with the micro dose hitting the receptors implicated in anxiety and the bigger dose hitting the ones important in cognitive processing). Absorbtion and metabolism will vary so what dose might work for you will vary.
I actually found if I took about 1/5th of the smallest available pill I felt a slight anxiety relief, not as good as benzos though, at least for me. That was the last day of the trial and I got fed up with it.
kate
Posted by Ritch on May 29, 2002, at 0:09:51
In reply to ADD and Comorbid Disorders; Expert Advice PLZ!, posted by azurebay on May 28, 2002, at 19:58:40
> Hi All,
>
> Serious subject, yet I think a lot of us experience it. This is where I definitely would appreciate some expert (as in "experienced") advice from those of you who have posted here much longer than I.
>
> Here is my in-a-nutshell-bio/history:
>
> 1. Diagnosed with ADD/ADHD as an adult in my 30's. Neurostimulant meds helped tremendously as did therapy. Honestly guys, there's no question about this Dx cause it's saved my life with neurostimulant meds!
>
> 2. As I became more in touch with the more inner things, feelings, and the whole of what had transpired over the years, I realized (over the course of 3 years with a good pdoc) that comorbid disorders were also a part of ME - just the biochemical, flesh and bones package, so to speak.
>
> 3. It became self-evident that a deeply rooted anxiety disorder, then subsequent depression was a distinct characteristic of my life since... OMG...say 9 years old! Which came first, the chicken or the egg, who knows lol.
>
> 4. The psychiatrist began exploring various medical/therapeutic alteratives to these newly emerging discoveries. At first we tried SSRI's, that were by in large a huge disappointment for the depressive aspect... with the exeption of Celexa and Effexor. Having done my research on both, it's not difficult to see why these, particularly Effexor, would work in an ADD/ADHD case.
>
> 5. For the past six months, however, I've felt as if I'm dying inside again (sigh)... panic, anxiety, sincerely working through life's crazy stuff, long story. We have literally exhausted the benzo's including Klonopin, Atavan, Valium, Librium, Serax (blah blah blah)... oh, and let's not forget the beloved Xanax *smiles*. The best of these were Klonopin and Xanax, with best results using Xanax at higher doses.
>
> 6. Despite all this bio-chemistry crap, I have been mostly functional, yet still off my game - a freelance writer, into good nutrition, solid research, yoga, mediation, etc. - doing pretty well overall, just still not exactly whole or healing.
>
> 7. Today the doc (an older doc with an open mind and lots of experience) suggests we try something different: Zyprexa. He bases this upon results with patients who have a chronic, low-level anxiety, and research supporting this class of drugs use for at least a trial at low doses.
>
> So, does this sort of scenerio ring a bell for any of you? Any thoughts, advice, alternatives, ideas?
>
> I'll certainly try the Zyprexa beginning tonight because frankly I have nothing to lose, and I rarely have serious side-effects from medications.
>
> Your thoughts and posts are deeply appreciated!!!
>
> Azure
Hello,Got a question: Just what meds are you currently taking right now? That is very important when you are asking us about experiences with med combinations (vis a vis your current symptoms). It *sounds* like you tried stimulants for ADHD and they helped you focus and pay attention to your environment and other people. BUT, after a time you had unresolved mixed anxiety/depression problems? Then you tried Celexa and Effexor and they helped your depression? Then your docs have added benzos to help with residual anxiety problems/panic? So, you are now at this place where you could see an "all-in-one" medication like Zyprexa taking the place of all of your other meds? Atypical (newer) antipsychotics are very helpful for many (and for multiple symptoms like you mention), but if you don't have *psychosis* you may be taking unnecessary risks that you may not need to take, such as irreversible movement disorders like tardive dystonia and tardive dyskinesia. Many will pooh-pooh that risk, but it is definitely there and very real. Not only that, if you have a primary mood disorder (anxiety, depression, bipolar) those risks are greater than for the general population. I got dystonic reactions from Risperdal and Seroquel that took several *months* to fade, and that was at very tiny doses. Zyprexa and *all* medications that block dopamine receptors also effect various hormone levels resulting in weight gain, sleep changes, blood sugar changes, etc. You may easily wind up with the side effects of several meds in one pill as well! Zyprexa is the most sedative of the newer antipsychotics and has a very long half-life of elimination. It will tend to reduce the effectiveness of any psychostimulant you may be taking for ADD. Antipsychotics generally are poor antipanic agents as well. It sounds like you might be better off with an antidepressant that helps your ADD (like the Celexa or Effexor you mentioned), and reduces panic as well. Maybe the psychostimulants you are taking could be reduced or eliminated as a result-possibly reducing anxiety further.
Mitch
Posted by azurebay on May 29, 2002, at 12:14:41
In reply to Re: ADD and Comorbid Disorders; Expert Advice PLZ! » azurebay, posted by Ritch on May 29, 2002, at 0:09:51
Thanks Mitch & Kate,
Ya, guess it might help if you knew my current meds. (And, btw, first dose of Zyprexa totally blew me out of the water, as in I feel like a total zombie, have no memory of events after about 9:00 pm last night. This, of course freaked, my wife out and me as well.)
At any rate, I'm taking the following:
Medidate CD (sr of methylphenidate) 40 mg total
Atenolol (for the shakiness of ADD drug)
Effexor XR 75 mg
Celexa 10 mgThe last benzo we used was Serax, and it tended to have an almost opposite reaction (as in created more of an agitated state). The best benzos I've used for the almost intolerable anxiety and panic attacks were Klonopin and Xanax.
Geesh, I appreciate the info on Zyprexa... no wonder I feel so out of it concentration wise this morning; it's as if the neurostimulant's not even working.
Smiles and TY,
Azure
Posted by azurebay on May 30, 2002, at 19:32:17
In reply to Re: ADD and Comorbid Disorders; Expert Advice PLZ!, posted by azurebay on May 29, 2002, at 12:14:41
Evening All,
I had to add to my last medication detail since visiting with the doc this afternoon... quite interesting and informative, at least in my situation.
The Zyprexa reaction was frankly, the WORST experience I've ever had with ANY drug, bar none, out of literally hundreds taken over a certain person's lifetime. This was extremely uncommon, since taking everything from (honestly) almost EVERY AD, trying ALL the ADD drugs, having lived with chronic pain earlier in life, and also (generally speaking) being rather street-wise with every drug known to man, addictive or otherwise lol. I kid you not, I could take 300mg of Effexor (and have), go off it with no side-effects after 4 months (and have); take benzos for extended periods of time (and, yes I have), go off of them with NO withdrawal... but this was HORRIFIC!
Zyprexa PUT ME ON THE GROUND, literally, with memory loss (total amnesia, which I've never experienced even after drinking lethal limits of alcohol for months, and massive doses of various meds in my pre-diagnosed-ADD-crazy-past-life, so-to-speak *smiles*), zombie-like for 2 damn days, unable to so much as walk normally, and SEVERE pain from twitching in my legs and feet!!! JESUS H! That's some questionable "orphan" in-the-middle psychotropic drug reactions, as my doc would say!
I don't doubt its use in severe cases, but at the lowest dose of 2.5mg... I wouldn't give this to my worst enemy... worse than any GHB or Rohypnol or anything I, personally, have ever experienced.
Chances are it's just my bio-chemistry, particularly the ADD component being most predominant.
At any rate, I'm completely back to normal today on an effective dose of ADD med, small anti-depressant doses, and a gentle benzodiazapine, also at small doses. It's like night and day, as if I'm back to normal, feeling better than ever.
I do appreciate your responses, but for research sake (as in Dr. Bob's information) -- I would never consider this medication for someone with predominant ADD/ADHD symptoms and co-existing GAD with depression.
Smiles Always (and again, TY all),
Azure
Posted by katekite on May 31, 2002, at 12:21:13
In reply to Re: About that ADD and Co-existing Disorders, posted by azurebay on May 30, 2002, at 19:32:17
Yep! That was my experience, though it only lasted for about 8 hrs after each 2.5 mg pill (lengthening each time of course due to rising blood levels)....literally could not sit up at the peak of it. Felt like a complete nut, unable to think, although no twitching for me, yuck that sounds bad.
I felt pretty darn good for about 2 days after it all wore off just because I wasn't dead.
I had a similar experience with depakote 150 mg -- could not speak, couldn't sleep, but couldn't raise my eyelids to tell anyone I was awake -- you might not want to try that either.
Remeron was also terrible. Retrograde amnesia. Not normal for days after one dose.
Since we have similar responses to xyprexa, let me know what turns out to work for you.
kate
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