Posted by tom2228 on May 21, 2014, at 7:24:21
In reply to Re: Been Seeking Adult ADHD 20mnths. Success! One prob, posted by LouisianaSportsman on May 21, 2014, at 1:07:19
Wow Louisiana, a lawsuit? I don't see what is so wrong about this combination, especially if the client is as satisfied dixieland seems to be.. Regarding the cardiovascular risk, if the pulse is fine, there shouldn't be a problem. Having multiple medications that can affect pulse is kind of like one that's dosed particularly high (unless they affect the QTc interval which isn't the case for this combo). I don't think it's fair to scare someone who's reporting that they're doing fairly well. But that's my opinion.
While 11 (I count the Focalin IR and XR as 1) is an "abnormally" high number of medications, I'd say as long as you're feeling well, functioning in several domains of your life, doing better than before, not experiencing too much sedation/ cognitive impairment or too much numbing, not feeling too detached from life, its wonders, or relationships... that this is okay. Like you said, you are dealing with a refractory case of your illness, and refractory cases often need an innovative approach. It is difficult to find good care when your needs are high; I am glad you have found a doctor who sounds like he has the expertise, out-of-the-box approach, and willingness to take on your case. Other doctors, including other psychiatrists, may have their opinions, but if you are being treated well under someone else's care and not having medical complications under that regimen, it's none of their business to tell you what's right especially if they don't have extensive knowledge of psychiatry.
I take 8 medications myself, but I have several diagnoses and my depression is agonizingly difficult to treat. I DO have major drug interactions, but they are well monitored/ managed. Unlike the dixie, I'm not doing wholly well, but am on the right track/ getting close. I am hoping to downsize my combination because I was feeling a bit numb/ having difficulty with cognition, but that might not be feasible in terms of the number of medications due to how refractory my case is, and might be better achieved by switching and modifying doses.
I too have ADHD and understand that it can be difficult to treat. While Desoxyn works well for me, Mirapex, notriptyline, and Marplan have brought me closer to optimal control that I cannot achieve with a stimulant alone. I feel my cognition is moot without the Mirapex although the sedation is hard to deal with. And while mood stabilizers are not really indicated for ADHD, they can slow down hyperactive thoughts and behaviors leading to better focus, but in my case I suspect that this is because I'm bipolar.
Just so you know I am taking the following for refractory depression/ bipolar/ ADHD/ anxiety (generalized and social), and personality issues.
Marplan 40mg
Nortriptyline 25mg (tapered down to switch due to sedation/ cognitive impairment)
Deplin 30mg
Desoxyn 22.5mg
Mirapex ER 0.375mg (hoping to switch due to sedation/ sleepiness)
lithium 900mg (0.4-.5 blood level)
Lamictal 100mg (lowered due to cognitive impairment/ numbing)
Abilify 10mg (hoping to switch due to tiredness/ flatness/ hunger/ lack of interest/ motivation)was also on Wellbutrin 75mg (supposed to be in place of the nortriptyline) for a week but that didn't work out. Stopped as of yesterday.
I would also suggest that in taking so much medication you have therapy to supplement it/ help you understand and sort through how your medications affect the way you relate to yourself, others, and the world. It is easy to get lost in your own head when you are taking so much.
Best to you,
Tom
poster:tom2228
thread:1065850
URL: http://www.dr-bob.org/babble/20140512/msgs/1065898.html