Posted by Clayton on November 8, 2003, at 5:48:15
In reply to Thinking - Attention Deficet Problems-Cognitive, posted by deloris on November 6, 2003, at 3:09:15
I cannot think straigt anymore, started 6 yrs ago, since then various rx's, currently on Lithium-Elavil-Ritalin-Aricept-Klonipin-Estrongen I am 51 and once had a brain, any others experienceing this? Ritalin helps best but get irritable when it wears off, this is a living hell, in the past took provigil, lamitcal, adderall etc, At worse when I awake have to take ritalin to function like to do anything!!!I live in hell, I was never ADHD in past, whats wrong? HELP HELP DR BOB someone........
__________________________________________________
Hi Deloris,You were very concise and yet have given me so much to respound to. I am fifty-two and just got back to work after three months of enforced medical leave brought about by cognitive impairment. No memory. No intuition, highly compromised analytical ability. I am a software engineer whose main HOBBIES were Physics, Math and Philosophy. I am NOT gifted but I used to have a brain and I know how it feels to loose it.
And I have lived in hell, unrelenting misery and suffering, just as you have, with the worst time coming every morning when I tried to get out of bed.
I self-diagnose myself as borderline AD but not HD. I am have an overwhelming amotivatioal syndrome. My main problems are Social Phobia in the extreme (though I love people and need their company), mood depression and insomnia.
How did I get this way? Best GUESSES: 1. genes, 2. extremeley violent dysfunctioal childhood home with 6' 3" mean alcoholic father and a mom who was verbally demeaning to her children and took my father's abuse, setting an example of weakness, 3. Illegal Drugs - about two years of swallowing meth tabs on and off in my twenties causing permanent damage to my dopamine and norephinephrine systems and therefore, my "reward system". I can't set goals, plan or follow through. Maybe it's ADHD but I tend to think that I can't conceptualize the reward at he end of the rainbow. Anyway, this history rules Ritalin out for me. So does 30 years of marijuana use that I have finally stoped. I KNOW pot makes you lazy in the short run and compromises short term memory. Maybe these effects are permanent And so I make no plans and take no actions to influence my future for the beter, 4. Habitual laziness (a little old fahioned thinking there) and, 5. Psycotropic drugs.
Your ADHD is, I think, probably the result of your psychotropics. I think you are taking too many drugs. And the wrong ones. Remember this FACT. NOBODY understands the mechanism of action of a single psychotropic, especially antidepressants - that is, how they achieve their intended result. And that's when one drug is used in isolation. Mix a bunch together and you have a Synergistic Psychotropic Soup that no one can hope to begin to understand. Not a prayer. Maybe in two hundred years but not now. Here's some guesses. 1. I've taken Elavil (to help my insomnia - but NEVER AGAIN). It impairs my mind for days. It's well known a a "dumb drug". It clouds my mind and destroys my ability to reason. I can't sustain a rational train of thought. Why aren't you using a more modern antidepressant? 2. Klonapin: My pdoc put me on Klonapin. For me it is extremely sedating. I can't think. It gives me total amnesia for the entire six hour period it lasts. It is well known that benzos impair memory. This one, Klonapin, I find extremely brutal. It also makes me feel depressed (unlike Xanax). If you are taking Klonapin to help sleep, it is disrupting your brain's normal sleep cycles and impairing the quality of you sleep. Poor sleep equals poor memory and poor reasoning plus bad judgement, 3. Why does yur doc prescribe Aricept? I hope it's not to "compensate" for the memory loss caused by Klonapin and Elavil. That would be CLASSIC BAD PSYCHIATRY. 4. Ritalin: You are blessed not to have an addictive personality but the stuff will still eventually make anyone dependant. Maybe you can't get going without it because you are habituated to it (it may has depleted your dopamine and you need it to squeeze out whatever dopamine is left). 5. I was misdiagnosed with ADHD a couple years back and was given lithium. It did nothing for me except remove my emotions (and that's DEPRESSING) and SEDATE me. More sedation means more impaired cognitive function. 5. Estrogen: No comment. I'm a man and can't understand menopause. If your best judgement is that the benefits of HRT outweigh the risks, I guess you should go for it. You ARE using your Best Judgement, aren't you?
You should be on a modern antidepressant (if any at all). They all have their flaws but Elavil is "dirty" as hell. It affects you brain in literally hundreds of unknown ways.
Are you SURE you have ADHD? You are taking drugs fully capable of explaining the AD symptoms they are prescribed to treat. The ritalin, in theory, could explain manic phases. Here's a suggestion - take it or leave it. Ask you pdoc to explain the purpose of every single drug you take. You should get a clear answer in plain English - no psycho-babble. Ask him/her how they selected the specific drugs that comprise the mixture you take. Again, you should get a clear answer in plain English. The answer should at least demonstate that the doctor was concerned with and mindful of the interaction of every single drug with all the others. Ask the doctor what the synergistic effect is of taking all these drugs in combination. If he/she admit that they are not sure and are going partly on past experience and largely on intuition, that's a GOOD thing! If they pretend, obfuscate or actually believe they know, in my amateur opinion, it is time to find a new doctor.
I am not a healthcare professional. I'm just a guy who has done some reading and thinking. I am bound to be wrong about some things. Use GREAT caution if you decide to heed my advice. But remember to use great caution and your best judgement when heeding a professional's advice, too. They too rely on intuition and educated guesses. It is your responsibility to use your best judgement about whether to accept their best judgement!
Here's one scenario. It's hypothetical and heuristic because I am definetely NOT qualified to plan such a coarse of action: Use every resource at your disposal to find the best pdoc you can. Learn everything you possinly can about your problems and the effect of psychotropics on them. Then go to that doctor. Here's where your self-education comes in. Ask questions. Ask ones you know the answers to from your research. I'm not advising you to ask trick quesstions or be really devious. Just be in a position to assess their knowledge. If they don't know, do they bluff or obfuscate? Does this doctor have a state-of-the-art comprehension of your conditions, the drugs you take and psychotropics in general? Does the doctor admit that in this era in history, there is much we do not know, that their tools are limited, all have negative side-effects and that any treatment they suggest will be based in large measure on past experience and gut level intuition?
THEN use YOUR best judgement and intuition on whether you are willing to give this doctor a try. If so, ask them to skillfully wean you off that soup you are swallowing. I think the Elavil should go first and, at least initially, be replaced by a modern antidepressant. You want to quit or drastically reduce the Klonapin next. This should eventually get you to a state where the doctor can begin to assess whether the ADHD is real or was induced or exacerbated by the medicine. Start to wean off the lithium. If bipolar symptoms don't manifest themselves, try to quit the lithium entirely. If you ARE bipolar, ask about the modern antipsychotic mood stabalizers seeking those that impair your cognition and normal emotions the least.(By this time you WILL feel your cognitive skills returning, either way. Be patient...it will take time). And if your improved skills start allowing you to stay on task, start to get rid of the Ritalin. Use Provigil if it helps (it helps me - what did it do for you when you tried it??? - I'm really curious). I'm not sure of the purpose of the Aricept, but if it was to offset memory loss, you won't need it after you recover from the Klonipin and Elavil.
So where does that leave you? Well, on a single moden antidepressant. It will likely be Stratera (an SNRI) because that is approved for ADHD and will help you stay on task, vigilant and focused. Your Pdoc may want to use bupropion because it has a small dopaminergic effect and weakly blocks reuptake of Seratonin and Norepineohrine, too. It's real mechanism of action is completely unknown and, personally (don't forget...I'm just a guy, NOT a doctor), I think Stratera is your best option. And here's one more suggestion, based only on a personal bias. Add Remaron as a second antidepressant. I'm very enthusiastic about it because it worked for me. It gave me my life back. I CREDIT REMARON WITH RESTORING MY MEMORY AND COGNITIVE FACALTIES. Remaron is unique. It enhances both seratonin and norepinephrine levels by increasing the supply produced in you brain, not by blockung reuptake. It has no sexual side-effects. And it starts working in about three days.(Effexor would also support the same two neurotranmitters but it would do so by reuptake blocking. Read about it in this forum. There are a lot of scary stories about side effects and terrible withdrawl symptoms).
With this combo, you would have synergistic support for norepinephrine levels based on the dual action: increased supply and diminished reuptake. Good for mood, concentration, focus, drive and staying on task. The Remaron will also suport your seratonin levels. Some reputable research studies show that Remaron improves memory (I can send the links if you want them) I won't bore you with the details but Remaron plus an SSRI (Paxil) saved my life. I was amazed! I had given up hope on drugs. In my case, we're talking about putting the synergistic emphasis on the seratonin side. In your case,with Stratera, the norepinephrine side. (Because of my amotivational syndrome, my doc and I are considering swapping out the Paxil for Stratera. The decision is yet to be made. He says it may improve my mood substantially as well as help with motivation and completing tasks. I broached the idea and he said he had already been considering it. Although Paxil had little efficacy until Remaron was added, it is still the "Social Anxiety" drug and I'm a little afraid to abandon it or mess with success.
Please forgive such detailed advice from an amateur. My honest guess is that you are on too many meds and probably some that are wrong for you.
If you find the right doctor and work together with him/her you WILL FREE YOURSELF FROM HELL and get your MIND BACK!
This happened for me and I know it can happen for you. I have not had a single SAD attack since I got with the right doc on the right TWO meds - I can't take credit; it was partly good luck. (Maybe some day, I'll manage with fewer. That's certainly what Solo seems to have done). My mood depression has lifted. Most mornings I awaken happy and get up early. I still have my bad days, but not nearly as bleak and black and conflicted and rending as before. There has been one recent setback, really a major tragedy in my life, that I've discussed in other posts. It actually was precipitated by too high a dose of Remaron acting in concert with Paxil resulting in seratonin levels that were way to high.
Just like your ADHD seemed to appear out of nowhere, I woke up one day and began to discover that something entirely new was happening to me - I was manic depressive. I walked around crying and wailing, then seitched to excited, animated ceaseless talking and ranting. Both behaviors are entirely out of character and without precedent for me. One of the classic behaviors of bipolar disorder is spending money you don't have. I sat here at the computer all night one fine evening buying things and overdrawing my checking account by $1000.00. It sure was fun! So the Remaron dose has been dialed down and I am taking a modern antipsychotic mood stabalizer, zyprexa, temporarily until we are comfortable that the seratonin levels are proper. This is one reason why my doc and I are thinking of substituting Strattera for Paxil.
If I'm way off target with my suggestions here, I apologize.
If you ever want to discuss these issues privately, email to TheoryQuery@aol.com.
Take Good Care of Yourself!
OTHER: Provigil is very helpful to me as an occassional adjunct to the SSRI and Remaron. You mentioned that you've tried it. I'm very interested in what you experience with it was like and why you discontinued use. It improves my memory, reduces anxiety, sharpens my mental focus and allows me to quickly direct focus to a variety of disparate tasks that may all be hitting me at once. That sound like hyperbole so perhaps I should just say my brain seems to function like when I was in college again.
poster:Clayton
thread:277052
URL: http://www.dr-bob.org/babble/20031105/msgs/277685.html