Posted by blueberry1 on January 17, 2007, at 18:59:48
Of the 2 GPS and 4 Pdocs I have seen in the last 12 years, who blows them in the weeds? A nurse practioner. Go figure. She has a license in psychiatry and naturopathy. Unlike the pdocs I've seen, she is constantly doing research and keeping up. Anyway, I went back to her today after a long wait. Thought I would review it for anyone interested.
She was excited to see me. Said she had learned a lot of psychiatry from me, from research I shared with her and from our own failures.
The general agreement was that I have a confused mix of depression, ADD, and anxiety. I have never been considered to have ADD until now. She says no matter what you call it, the primary symptom cluster is 'Reward Deficiency Syndrome'. She said that is primarily a dopamine thing, but that in reality it involves all the neuros.
I wanted to try Adderall. I expected she would resist. I wanted to try Trazodone for sleep. I expected she would have no prob with that. It went just the opposite. She wrote a script for AdderallXR immediately, claiming it made perfect sense for me and that she has more success with the XR version even though it is so costly. But she would not write a script for Traz. She insisted I use my stockpiled Remeron from old days for sleep. I told her I had been on it with prozac for a couple years and never liked it. She said it is different with Adderall and that she has a number of patients doing extremely well with the Adderall+Remeron combo. I will try 5mg AdderallXR tonight at work (night shift). I am hesitant on the Remeron though. By itself it makes me more depressed.
She said an ssri of my choice is likely, but that she wanted me to sample adderall first.
Being a naturopath also, she is strong on nutritional strategies and such. She says based on my presentation she believes I have low serotonin, low dopamine, low norepinephrine, low gaba, but high glutamate. She says when we begin targeted nutritional strategies to knock down glutamate that the feedback mechanisms will kick into gear and automatically help all the others recover, so as to keep medication doses at a minimum. Fish oil of course is one of her favorites. She drew diagrams and showed me all about phopholipids and the coating around receptors and all that. When was the last time a psychiatrist ever talked in such detail? Never in my life.
So, my last pdoc wanted me to increase zyprexa back to 5mg (where I had been for 8 years already!) and then we'll go from there. Geez, $200 for that lame advice? Nothing more talented or creative than that? And this guy is supposedly real good? And he would rather shock me to hell with ECT than try a week of Adderall and then Provigil augmentation? $200? Anyway, over an hour today with this very impressive caring knowledgable nurse practitioner cost me $45. Cool.
I hope the AdderallXR goes good. I am fearful of increased anxiety, agitation, irritation, meanness, grinding teeth, and worsened depression. I want my fears to be wrong.
poster:blueberry1
thread:723386
URL: http://www.dr-bob.org/babble/20070113/msgs/723386.html