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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Slugbrain on July 10, 2015, at 8:46:37
Hi all. I've read posts and "researched" meds here many times. Finally reaching out. Hoping for constructive suggestions.
I'm a lifelong Inattentive ADD sufferer. Slug: because like Robert Deniro and friends in the movie "Awakenings", I come to an almost complete stop without a stimulant in my system. My parents said I was sedentary. I was. But they were impatient with my spacy--ness and became angry and hurtful. Other family members began to see me as the Angry One when I objected to my narcissistic father's cruel prognostications re: my subpar academic performance, impulsivity, inattention.
Fast forward: Dx ADD 1992. Stimulants that help are the amphetamines, specifically Dexedrine and Adderall, Vyvanse, etc. I need a tiny bit only or I have trouble sleeping and my already very anxious and obsessive brain lights up and keeps me awake with a torrent of negative and self loathing thoughts. The impact and value of this tiny amount of stim med is immeasurable. I look at a pile of papers and see what should be done, I get up, I organize that and anything else incredibly well in a steady state of concentration (as opposed to an overly "up" response, or hypo or full mania) -- but have to rush to get it all done before the effect wears off and I slip back into catatonia.
I do take the full 450 Wellbutrin for uni depression that seems to be getting worse over time. Comes either in its own, espec in dark months, or as a result of the intrusive, ruminative negative thkinking. I've tried to cut down in the brighter months, as I have in other years, but can't right now. For the OCD-like (not Dx) thinking PDoc prescribed 10-20 mg Prozac in addition. It hasn't really helped so far, but The usual side effects have already appeared. And the self loathing torrents continue.
Sometimes it feels like an electrical storm in there. Along with the nasty thoughts are snippets of songs, many other pieces of events and conversations, seemingly simultaneously. Not hallucations, just a cross circuiting brain. I wonder whether it's an inflammatory problem. Sometimes things calm down after I take an ibuprofen.
Recently tried desoxyn in hopes or alleviating some of the additional anxiety we think due to dex. I've always had success - for 6 hours at a time - with 10 mg spansule. A 5mg IR tab will ramp me up too much but I'll try 1/4 late afternoon to try to jump start things, otherwise I sink into the couch and cannot organize or execute with work or family demands. So far I like the Desoxyn. 5mg at a time seems to be ok; 10 too much (must avoid other stims, espec. caffeine). One time I took my 10 mg Dex spansule in the am and a single desoxyn in the afternoon and was up most of the night. (Another time I took half of 150mg nuvigil - constantly experimenting to get to more hours of concentration - and 1 desoxyn in the afternoon and was awake for 36+'hours, and "extremely productive".)
I hate but accept the role of medication in my life. I worry about the effect on my brain. My short term memory is awful and getting worse. I try to miminize meds as possible. I have no problems at all starting or stopping any amphetamines or Benzos. At times the insomnia + night time anxiety is so awful that I use a sleep or anxyolitc. Will leave out detail about what of those I've tried for now - and patting self on back for beating back impulse to share way more detail than already have. Suffice to say that I've had success with tiny amounts of clonidine to break the neg thought Torrent. But even that means zero productivity the next day unless I do bigger amounts of stim, which I don't want to do, and that doesn't even help that much anyway. Apart from the sedation I love how I feel on trazezodone. Anxiety nearly completely relieved, sleep better, helps depression all the way down to the existential level that Wellbutrin doesn't get to. And that's with only 1/4 of 25 mg tab!!! But extreme sludge brain the next morning, even into the day after.
ALL that to say - and thank you for reading up to here - I am in search of a way to alleviate the neg thought torrent without sedation, and to maintain focus and execution into the evening, without insomnia. Sedation counters ANY anti-ADD benefit from stims and I am not going to do the old "doggy downers, puppy uppers" approach (ancient SNL reference). But i definitely need more hours of productivity, FAR less anxiety, and a powerful enough antidepressant to get all the way to that "I don't bring any added value to my family, to the world, etc." level.
Will stop for now. Will so, so appreciate any thoughts and input that's constructive and not about whether or not one should take any medication at all. Thank you for reading. (And if I have accidentally said something that hurts someone's feelings here, I apologize in advance, please let me know)
Posted by bleauberry on July 11, 2015, at 16:01:33
In reply to Hello + request for assistance with ADD, anx., dep. meds etc., posted by Slugbrain on July 10, 2015, at 8:46:37
Hi. Just thinking out loud...
I can relate. Been there. Or similar. I think the antipsychotic class is helpful for that stuff. Zyprexa is my favorite because it often just works good enough. Abilify is a decent one too. Seroquel is basically just a super potent antihistamine and sleep med but some people like it the most.
I often introduce people to the potential their complicated chronic resistant psychiatric stuff is actually a stealth unsuspected infection. Lyme is the most common, only 1 in 10 is properly diagnosed, and nearly all of them have complicated psychiatric presentations and the majority of these folks improve greatly or remission on antibiotic and anti-inflammatory strategies. The meds stay on board just for symptoms, but the goal is to get better so they aren't needed.
Could be other bacteria, or a yeast/fungus/mold thing, candida, or a virus. All of these produce powerful neurotoxins which have affinity for neurotransmitter sites and synapses such as serotonin, dopamine, and opioids. Hormones are messed up. There are other symptoms besides just psychiatric....fatigue, brain fog, pains, weird unexplained things, any or all, etc....most times, we'll never know what the actual bug was, the symptoms are all so similar being toxins, but it doesn't matter that much because the treatments hit them all in blanket coverage.
So anyway I don't know what to suggest for meds other than zyprexa. It is usually difficult to get an MD to go along with an antibiotic trial (great way to make a diagnose) but LLMDs do this stuff. My own journey was 25 years psychiatric but I got way better, almost remission, with antibiotics and their cousin herbs.
To test the waters easily, to see if this risk might be worth exploring deeper, these substances most likely will cause a significant improvement and a significant worsening, all in a very short time period of just days...and if that doesn't happen then the infection risk has less credibility at that point.
Berberine by Phytobiotic or Thorne Research. Lyme books suggest 3 to 4 three times per day. My fav because it is just so good for so many things. Research it if you want. Vitamin D...had it checked lately? If it is low, the infection risk is strong. Anyway, take lots of it and vitamin c. Fish oils might make you feel worse or more bizarre if infection, but otherwise are very helpful and desirable...if hurtful, wait until after some antibiotic treatment, then the oils should work properly again...
Ya know? There is stuff you can do to get yourself much better, with other MDs and additional herbal support . I believe that anyway. That is my story and many others.
anyway I hope maybe something is a little helpful...just sharing experiences and stuff...
Posted by Christ_empowered on July 12, 2015, at 2:22:25
In reply to Hello + request for assistance with ADD, anx., dep. meds etc., posted by Slugbrain on July 10, 2015, at 8:46:37
I dunno...maybe some kinda amphetamine AM and some Remeron PM?
Posted by phidippus on July 15, 2015, at 7:34:01
In reply to Hello + request for assistance with ADD, anx., dep. meds etc., posted by Slugbrain on July 10, 2015, at 8:46:37
>I come to an almost complete stop without a stimulant in my system.
Catatonia, as you described it, is more of a depressive symptom.
>intrusive, ruminative negative thkinking.
If you do have OCD, 20 mg of Prozac isn't going to cut it. To treat OCD you need to be taking 60-80 mg. And if your intrusive thoughts don't respond to that, I'd recommend you add an atypical antipsychotic.
I find it strange that stimulants ramp you up. I have ADHD and I slow down when I take my Vyvanse.
>i definitely need more hours of productivity, FAR less anxiety, and a powerful enough antidepressant
Increase your Prozac and add an atypical antipsychotic...Try Buspirone for the anxiety.
Eric
Posted by Slugbrain on July 17, 2015, at 17:18:30
In reply to Re: Hello + request for assistance with ADD, anx., dep. meds etc., posted by bleauberry on July 11, 2015, at 16:01:33
Thanks, Bleau. Yes, I've had help thinking out of the box so really appreciate all your suggestions. There were a couple ideas I hadn't thought of so will mention to my pdoc. Also wanted to mention a positive for blastocystis hominis and also, more recently, SIBO (by hydrogen breath test). I agree that it's essential to cover all possible explanatory factories.
Posted by Slugbrain on July 17, 2015, at 17:42:12
In reply to Re: Hello + request for assistance with ADD, anx., dep. meds etc., posted by Christ_empowered on July 12, 2015, at 2:22:25
C_E: thanks, will look into Remeron. Whatever can accomplish the most with the fewest side effects....I'm sure that's what we are all after!
Phippidus: sorry, I wasn't at all clear - by "ramp up" I meant that IR Dex tabs ramp up my anxiety, not my physical state. I generally do much better with immediate release formulations, though some (like Dex IR), make me awfully anxious, even while highly productive. Dex spansules, on the other hand, sometimes lead to hyper-focus and almost always disturb my sleep in subtle but pervasive ways. Vyvanse, too, unfortunately.
Catatonia - also too hyperbolic for the meaning I was actually trying to convey. I meant that when the stimulant wears off, what goes first for me is initiative and motivation. When the effect wears off, I can still be mentally alert and organized but the power to act, to accomplish anything slips away. Then I'm stuck to the couch again (not really catatonic! Just mentally stopped and stuck) with great ideas for productivity but little power to get 'er done. Hard to explain, really feels like excuse-making and I often doubt myself...until I hit it right with med and dose, and then plan and execute exceedingly well. I'm more impressed than anybody at the difference in my activity level. And Then I believe the power of the med for me all over again.
I've been fascinated by the research into inattentive ADD vs h- and c- types, how they differ in symptom display, how they respond differently to methylphenidate vs amphetamine treatment.
You're right, 20 mg Prozac has done nothing for the intrusive thoughts I'm plagued with, usually at 3:30am! (And Prozac sexual side effects are a beast.) I'm still searching for an answer, for the right combo. And have been working with therapist(s) for years to try to get control over the intrusive thoughts. I hate that I can't control them but I often truly cannot, and they (my negative introject) make me absolutely and utterly miserable.
Posted by phidippus on July 19, 2015, at 20:20:15
In reply to Re: Hello + request for assistance with ADD, anx., dep. meds etc., posted by Slugbrain on July 17, 2015, at 17:42:12
Interesting you become anxious on stimulants. I never have. Why not pair it with a small amount of ativan or xanax. Or you could take KEppra, which will help with the anxiety and the OCD.
First things first, you need to take a higher dose of whatever SSRI you want to take.
You can't get control over your intrusive thoughts. The only thing you can control is how you react to those thoughts. Fight them and you will lose. Agree with them and they will eventually fade or come to mean nothing.
What are your intrusive thoughts?
Eric
Posted by Slugbrain on July 20, 2015, at 9:05:37
In reply to Re: Hello + request for assistance with ADD, anx., dep. meds etc. » Slugbrain, posted by phidippus on July 19, 2015, at 20:20:15
Thanks, Eric. I think the anxiety comes when I take too much of stim - even tiny increases are difficult.. For example, the IR 5mg Dex I use when necessary (extremely effective) can sometimes be a problem - breaking it in half helps but remembering to dose is much more difficult for a disorganized brain. The SR Dex works much better for that reason but no matter how early I take it, interrupts sleep or lessens quality. Poor sleep = poor mood, more anxiety...
I have had rx for klonopin, Xanax and other anti anxiety meds but they're typically far too sedating even in minuscule amounts (I need very very little of anything except antidepressant). I'm also very concerned about links to dementia. Trazodone, though horribly sedating, gave me a glimpse of a truly happy, anxiety free existence (and then I fell back to sleep!). Just got an rx from pdoc for serzone...a gentler trazodone? Hope so.
I've always run on the anxious side... Ether my natural inclination or a result of much cruel criticism of my dreamy/spacey-ness in adolescent/teen/young adult years. Over time I guess Ive incorporated that into an extremely powerful negative introject (or maybe the added anxiety at a particular age wrecked my brain circuitry, led to inattention, etc. I would not be surprised if ADD is some day linked directly to early trauma.
My neg thoughts are always about how little value I bring, especially due to ADD, that I won't ever find employment that fits and won't bore me to tears, that the financial impact of my underemployment is devastating to me and my family, that even when I find something that works initially it ends because of something I've done wrong or not well enough due to poor organization etc. , that everyone else knows what they can and want to do with their lives and are enjoying success because of their clarity.
That's it in a nutshell... ;)
I do take your point about fighting vs accepting those negative messages and I find solace and even a kind of spiritual beauty in that thought, so thank you.
Posted by SLS on July 20, 2015, at 12:52:37
In reply to Re: Hello + request for assistance with ADD, anx., dep. meds etc., posted by Slugbrain on July 17, 2015, at 17:42:12
Have you tried antipsychotics for the intrusive thoughts? I haven't read all of your posts, so I apologize if you have already covered this issue. While the content of your intrusive thoughts can be addressed through psychotherapy, it would be nice to have them stop altogether. I'm wondering if a relatively low dose (0.5 - 2.0 mg/day) of Risperdal might help. I have had trouble with intrusive thoughts in the past. I don't recall having any episodes since I began taking Abilify over 10 years ago. That might be an unrelated coincidence, though. I wasn't charting my treatment experiences.
Any PTSD?
- Scott
Posted by phidippus on July 20, 2015, at 16:39:37
In reply to Re: Hello + request for assistance with ADD, anx., dep. meds etc., posted by Slugbrain on July 20, 2015, at 9:05:37
>My neg thoughts are always about how little value I bring, especially due to ADD,
Before you start working on this snowball, consider what might happen to these worries if you have a sense of humor about it. Buy a mop and start practicing to be a janitor!
Do you know how many CEOs have ADHD?
http://www.forbes.com/sites/dalearcher/2014/05/14/adhd-the-entrepreneurs-superpower/
Read this article.
>that I won't ever find employment that fits and won't bore me to tears,
I have the same fear myself, that's why I'm in school studying something that challenges me so I can work in a field that challenges me.
How do you challenge yourself?
>that the financial impact of my underemployment is devastating to me and my family,
I see your worry starts to snowball. Do you stop yourself when you begin to worry like this?
>that even when I find something that works initially it ends because of something I've done wrong or not well enough due to poor organization etc.
The snowball gets bigger. You're catastrophizing.
>that everyone else knows what they can and want to do with their lives and are enjoying success because of their clarity.
Why does this bother you?
Posted by Slugbrain on July 21, 2015, at 6:40:22
In reply to Re: Hello + request for assistance with ADD, anx., dep. meds etc. » Slugbrain, posted by phidippus on July 20, 2015, at 16:39:37
Dear Eric,
It's too early for Valentine's Day but.... Would you be my positive introject!?
Thank you... Means a lot.
Posted by phidippus on July 21, 2015, at 11:11:08
In reply to Re: Hello + request for assistance with ADD, anx., dep. meds etc., posted by Slugbrain on July 21, 2015, at 6:40:22
I've never been a positive introject! :)
Eric
Posted by Slugbrain on July 26, 2015, at 17:58:49
In reply to Re: Hello + request for assistance with ADD, anx., dep. meds etc. » Slugbrain, posted by SLS on July 20, 2015, at 12:52:37
Hi - I think there's PTSD as a result of longterm identity subjugation by a narcissistic parent. So, yes...
I've been trying to better understand *identity* over the past year or two...how such a childhood made me more susceptible to manipulations by bullying types, why "I" so quickly disappear in these circumstances. Troubling. Horrible experience with a work environment recently - narcissistic supevisor - it's taken me about two years to get back to where I was before; the intrusive thoughts continue to hold me back, keep me from retuning to that more resilient place.
Have never been on a antipsichotic. Tried all the "-als" and they didn't help much. Am about to start on 50 mg Serzone, as the intrusiveness and abusive nature of these negative thoughts (that ole negative introject) becomes unbearable at times, which leads to depression. At least I think that's what's happening.
Any suggestions for working into Serzone would be appreciated! Meanwhile, I continue to exercise, get outside, and do all the other self soothing things I can to get some strength back and deal with the intrusive thoughts.
Posted by SLS on July 26, 2015, at 21:33:51
In reply to Re: Hello + request for assistance with ADD, anx., dep. meds etc., posted by Slugbrain on July 26, 2015, at 17:58:49
> Hi - I think there's PTSD as a result of longterm identity subjugation by a narcissistic parent. So, yes...
There is some suggestion that a "developmental PTSD" results from repeated childhood abuse (physical or emotional) and neglect. Neglect might be particularly disabling. Bullying can also take a toll. I experienced all of these. I know this sounds a bit nutty, but a drug known as prazosin (Minipress) helps me quite a bit. It was discovered that prazosin given at night can help prevent nightmares and enhance sleep in people with acute event PTSD. It was later discovered that when taken at higher dosages during the day, daytime depression and anxiety is reduced. My doctor thought it was worth a try. I felt significantly better once I began taking it. I currently take 30 mg/day. For me, it acts like an antidepressant. The only major drawback is that it can reduce sex-drive significantly. I experience very little, if any, dizziness. If you decide to try prazosin, you must take your first dose of 1 mg at bedtime to prevent the syncope that can occur. You can then move up to 2 - 3 mg/day. My guess is that 6 - 12 mg/day will help. Some doctors researching prazosin are going up to 40 mg/day.
Developmental PTSD:
http://www.positivehumandevelopment.com/developmental-ptsd.html
High-dose prazosin in PTSD:
http://www.ncbi.nlm.nih.gov/pubmed/24490030
I really cannot comment on nefazodone (Serzone). I have never taken it. Have you tried fluvoxamine (Luvox)? If so, how did it affect you? It is different from other SSRIs in that it is a potent agonist of sigma-1 receptors - something that seems to make it effective for psychotic depression. Perhaps it would help with intrusive thoughts along with any obsessions you may have. I really don't know.
http://www.ncbi.nlm.nih.gov/pubmed/20373470
The content of your thoughts might be addressed in psychotherapy, but they don't necessarily have to plague you so intrusively. I believe the intrusiveness is probably the product of abnormal brain function. I hope you find a biological treatment that helps.
I think CBT would help when the intrusive thoughts appear. It might be the quickest way to extinguish them.
These are just a few things to think about. I am not a health care professional, so you should research these things yourself and work with your doctors.
- Scott
Posted by phidippus on July 27, 2015, at 12:39:48
In reply to Re: Hello + request for assistance with ADD, anx., dep. meds etc., posted by Slugbrain on July 26, 2015, at 17:58:49
Nefazodone acts primarily as a potent antagonist at the 5-HT2A receptors. By doing this, it causes: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC446220/
Nefazodone gets high marks for the treatment of PTSD, but not so much for the treatment of OCD
Eric
Posted by Slugbrain on September 15, 2015, at 0:05:59
In reply to Re: Hello + request for assistance with ADD, anx., dep. meds etc. » Slugbrain, posted by SLS on July 26, 2015, at 21:33:51
Hi - sorry for the space between replies after your and others' thoughtful suggestions.
I'm feeling miserable, much thought of death (and tears, shutdown of most activity). Can't take action because of loving husband and daughters but ... I'm feeling less sensitive to how awful it would be for them if I were gone, and considering the possibilitybthat it would help them move on in their lives with more happiness instead of my deadweight.
I'm still on 450'wellbutrin but it seems to cause terrible tinnitus, and isn't covering depressive responses to particular triggers In this instance, paranoid/delusional sister insists I talk with her only through a mediator. I refuse to do so, as participating in a circumstance where i am viewed as a danger to someone,even if they're delusional, would be- is - extremely unhealthy for me. my brain will not let up on me about this, hasn't yet from the first suggestion of her fears about me, it "makes me" think i have caused this situation (CBT not controlling my thoughts, negative introject is just way too fierce, and I'm too weak).i truly wonder sometimes whether I have another identity within me at war with...me. Or is it just anxiety +++.
Thank you for suggestion of prazosin. And I would never consider someone's experience or genuine suggestion to be "nutty". I know you have all good intentions.
Im trying Serzone 25mg again though last time I felt very disoriented the next morning, lost track of where I was briefly 2 times, but I'm desperate. So low, so discouraged. Completely at mercy of what brain wishes to mull. Trazodone worked best for my brain control but too too sedating. I'm a lightweight. Pdoc thought Serzone would be a good next step but I'm wondering if there's a cleaner drug. Liver issues...scary.
When I have energy back I will look up prazosin and mention to pdoc. I am lucky that he supports my trying different things with some frequency. I am afraid, though, that I will push him over the edge at some point because no combination can get this attacking brain to stop.
One weird thing I experience sometimes when I'm obsessing is that an ibuprofen seems to help. I wonder whether Ive got too much inflammation going. But that's a tangent...
I'm not sure it is actually obsession,more like wires crossed so that I'm absolutely - neurologically - unable to go to another topic, I'm just constantly having to endure all the hateful things "I" am saying to myself. It's making me so sad and discouraged, and I feel out of control.
Not sure there are other options. Transcranial magnet? I am open to anything,
Thanks for reading.
Posted by phidippus on September 15, 2015, at 21:06:42
In reply to Re: Hello + request for assistance with ADD, anx., dep. meds etc., posted by Slugbrain on September 15, 2015, at 0:05:59
I would add something to the Wellbutrin. Another antideporessant that is serotogenic.
Or I would recommend an MAOI.
Eric
Posted by Hugh on September 16, 2015, at 18:22:54
In reply to Re: Hello + request for assistance with ADD, anx., dep. meds etc., posted by Slugbrain on September 15, 2015, at 0:05:59
> Not sure there are other options. Transcranial magnet? I am open to anything,
You might check to see if there is a Deep TMS provider near you.
http://www.brainsway.com/patients-portal
JohnLA wrote this detailed thread about his experiences with Deep TMS:
Posted by Hugh on September 18, 2015, at 1:45:34
In reply to Re: Hello + request for assistance with ADD, anx., dep. meds etc., posted by Slugbrain on September 15, 2015, at 0:05:59
And check out these treatments:
This is the end of the thread.
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