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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 Buster on July 25, 2001, at 19:13:38
This is my first post to Psychobabble.
I have tried over 20 different medications for depression, several in each class. I have developed adverse reactions (usually migraine headaches) to all of them.
When I asked my internist if he would consider a trial of Adderall for my depression, he told me that Adderall (a Schedule II medication) (1) can only be prescribed by a psychiatrist, and (2) can only be prescribed for people who have been diagnosed with attention deficit-hyperactivity disorder.
Is this true?
If what he told me is not correct, but he still will not prescribe this medication (or another psychostimulant) for me, do you have any suggestions about how I can find a doctor who will at least *consider* prescribing psychostimultants for someone with refractory depression?
Thanks for your help,
Buster
Posted by Zo on July 25, 2001, at 19:32:22
In reply to Schedule II Prescription Restrictions?, posted by Buster on July 25, 2001, at 19:13:38
> This is my first post to Psychobabble.
>
> I have tried over 20 different medications for depression, several in each class. I have developed adverse reactions (usually migraine headaches) to all of them.
>
> When I asked my internist if he would consider a trial of Adderall for my depression, he told me that Adderall (a Schedule II medication) (1) can only be prescribed by a psychiatrist, and (2) can only be prescribed for people who have been diagnosed with attention deficit-hyperactivity disorder.
>
> Is this true?
>
> If what he told me is not correct, but he still will not prescribe this medication (or another psychostimulant) for me, do you have any suggestions about how I can find a doctor who will at least *consider* prescribing psychostimultants for someone with refractory depression?
>
> Thanks for your help,
>
> BusterWell, one way is to see an MD or pdoc who specializes in ADD. . .Most depressed people would have no trouble qualifying. Complain of inattention. Read up on ADD in adults.
Doctors can be remarkably biased against stimulants, meaning they also have very poor understanding of their action and effects. . .even wholly innacurate. Don't settle for bias. Any behavioral med pdoc worth his salt won't have a problem with stimulants.
Zo - ADD & depression
Posted by Else on July 25, 2001, at 20:07:29
In reply to Re: Schedule II Prescription Restrictions?, posted by Zo on July 25, 2001, at 19:32:22
If you have a refractory depression I suggest you DO get a psychiatrist quickly. I'm surprised you don't have one.
> > This is my first post to Psychobabble.
> >
> > I have tried over 20 different medications for depression, several in each class. I have developed adverse reactions (usually migraine headaches) to all of them.
> >
> > When I asked my internist if he would consider a trial of Adderall for my depression, he told me that Adderall (a Schedule II medication) (1) can only be prescribed by a psychiatrist, and (2) can only be prescribed for people who have been diagnosed with attention deficit-hyperactivity disorder.
> >
> > Is this true?
> >
> > If what he told me is not correct, but he still will not prescribe this medication (or another psychostimulant) for me, do you have any suggestions about how I can find a doctor who will at least *consider* prescribing psychostimultants for someone with refractory depression?
> >
> > Thanks for your help,
> >
> > Buster
>
> Well, one way is to see an MD or pdoc who specializes in ADD. . .Most depressed people would have no trouble qualifying. Complain of inattention. Read up on ADD in adults.
>
> Doctors can be remarkably biased against stimulants, meaning they also have very poor understanding of their action and effects. . .even wholly innacurate. Don't settle for bias. Any behavioral med pdoc worth his salt won't have a problem with stimulants.
>
> Zo - ADD & depression
Posted by Andy123 on July 25, 2001, at 20:15:05
In reply to Schedule II Prescription Restrictions?, posted by Buster on July 25, 2001, at 19:13:38
> When I asked my internist if he would consider a trial of Adderall for my depression, he told me that Adderall (a Schedule II medication) (1) can only be prescribed by a psychiatrist, and (2) can only be prescribed for people who have been diagnosed with attention deficit-hyperactivity disorder.
>
> Is this true?1. This is false.
2. This is false.
Your doctor is reluctant to prescribe stimulants for two reasons: 1. the DEA counts the number of times he prescribes them and will persecute him if he does prescribe them regularly 2. some people do have negative reactions to stimulants, especially people with mood lability.
Posted by kazoo on July 25, 2001, at 21:09:57
In reply to Re: Schedule II Prescription Restrictions?, posted by Zo on July 25, 2001, at 19:32:22
> ... Most depressed people would have no trouble qualifying. Complain of inattention. Read up on ADD in adults.
^^^^^^^^^^^^^^^
Advising someone to "fake" an ailment to get drugs is the best way to get labeled as one with "drug-seeking behavior" ... not a very sound, or judicious approach to get help ... and also a very good way to be denied treatment.> Doctors can be remarkably biased against stimulants ...
^^^^^^^^^^^^
You're right ... since the 1920's, stimulant drugs have had a checkered career.To get a historical handle on why this is so, go here: http://www.geocities.com/zoots90210/index.htm
Though this article is dated 1972, the basic tenents re. stimulant abuse are extant.
kazoo
Posted by Zo on July 25, 2001, at 22:29:56
In reply to Re: Schedule II Prescription Restrictions?, posted by kazoo on July 25, 2001, at 21:09:57
> Advising someone to "fake" an ailment to get drugs is the best way to get labeled as one with "drug-seeking behavior" ... not a very sound, or judicious approach to get help ... and also a very good way to be denied treatment.
I object to your characterization of my post and judgemental attitude. Since you know nothing of me, of my experience or education, leaping to negative conclusions seems injudicious at best.
Zo
Posted by Buster on July 25, 2001, at 22:43:47
In reply to Re: Schedule II Prescription Restrictions? » Zo, posted by Else on July 25, 2001, at 20:07:29
> If you have a refractory depression I suggest you DO get a psychiatrist quickly. I'm surprised you don't have one.
Else,I've had some *major* (and by *major* I mean MAJOR) problems in the past with mental health professionals, including psychiatrists, who have abused their position of power. I can't trust any of them and have vowed that I will never see another psychiatrist as long as I live.
Also, the psychiatrists I have seen invariably become extremely frustrated with my problems in tolerating medications, although I have not been able to tolerate *any* medication other than hormones - not just psychotropics - on a long-term basis.
Several of my psychiatrists have told me they believe my inability to tolerate medications has a psychological rather than a physiological basis. The rest just made comments that insinuated that that was what they believed.
That attitude does wonders for the treatment relationship.I also find it interesting that I need antihistamines and a number of other medications to help me get over these "psychological" reactions.
Buster
Posted by Willow on July 25, 2001, at 23:01:37
In reply to Re: Schedule II Prescription Restrictions? » Else, posted by Buster on July 25, 2001, at 22:43:47
> Several of my psychiatrists have told me they believe my inability to tolerate medications has a psychological rather than a physiological basis. The rest just made comments that insinuated that that was what they believed.
You are not alone in this. Monday I went to yet another doctor who started me on yet another medication, discounting what the other doctors have said. The only encouraging thing about this new one is that he said to start at a really small dosage because of side-effects. Don't take it personally. I too will not go near a psychiatrist. Though my options here are limited to only one.
> That attitude does wonders for the treatment relationship.
And they've had schooling? I agree with you. I guess no amount of education can teach empathy, unless they've really walked a mile in our shoes, though I wouldn't wish that on anyone but maybe a psychiatrist!
Whispering Willow
Posted by Zo on July 26, 2001, at 0:11:33
In reply to Re: Schedule II Prescription Restrictions?, posted by Willow on July 25, 2001, at 23:01:37
Probably the best idea is to see only psychiatrists who specialize in Behavioral Medicine or whom you otherwise know - in advance - are into drugs/meds.
The rest of the bunch are [Dr. Bob, ignore rest of post] a really screwed up, shaming bunch. Which is indeed the exact opposite of what you would suppose they are in business for. But shrinks are looked down upon by "real" doctors - I think they are even lower on the ladder than dermatologists (!) - and tend to act out that shaming on those who imagine themselves to be in these psychiatrists' "care."
Zo
Posted by kazoo on July 26, 2001, at 0:45:46
In reply to Re: Schedule II Prescription Restrictions? » kazoo, posted by Zo on July 25, 2001, at 22:29:56
> > Advising someone to "fake" an ailment to get drugs is the best way to get labeled as one with "drug-seeking behavior" ... not a very sound, or judicious approach to get help ... and also a very good way to be denied treatment.
>
> I object to your characterization of my post and judgemental attitude. Since you know nothing of me, of my experience or education, leaping to negative conclusions seems injudicious at best.Objection sustained, Zo, and I apologize.
kazoo
Posted by jojo on July 26, 2001, at 1:37:22
In reply to Schedule II Prescription Restrictions?, posted by Buster on July 25, 2001, at 19:13:38
> This is my first post to Psychobabble.
>
> I have tried over 20 different medications for depression, several in each class. I have developed adverse reactions (usually migraine headaches) to all of them.
>
> When I asked my internist if he would consider a trial of Adderall for my depression, he told me that Adderall (a Schedule II medication) (1) can only be prescribed by a psychiatrist, and (2) can only be prescribed for people who have been diagnosed with attention deficit-hyperactivity disorder.
>
> Is this true?
>
> If what he told me is not correct, but he still will not prescribe this medication (or another psychostimulant) for me, do you have any suggestions about how I can find a doctor who will at least *consider* prescribing psychostimultants for someone with refractory depression?
>
> Thanks for your help,
>
> BusterThe good doctor is mistaken. Possibly the
FDA has only approved the Patient Insert for ADD,
but a doctor, even one who is not a psychiatrist,
can prescribe off lable use unless it is specifically prohibited. Adderall can be prescribed as an adjunct for depression, as can Buprenex, a Schedule 5 mu agonist-antagonist, which can not be prescribed in a doctor's office for opiate withdrawl (only at an opiate withdrawl clinic), but can be prescribed as an off lable use for depression. 80% of prescriptions for Neurontin, I have read, are for off lable use.
Possibly your Congressman, especially if he was one of those who determined that
marijuana had no medical use, could suggest
another drug, based on the same training that allowed
him to determine that Marijuana had no medical value.
Or perhaps I am being unfair. Possibly he prefered
to leave that up to the patients and their physicians
to determine.
jojo
Posted by Noa on July 26, 2001, at 10:25:01
In reply to Re: Schedule II Prescription Restrictions? » Buster, posted by jojo on July 26, 2001, at 1:37:22
I wonder if, as an internist, he feels this is beyond the scope of his expertise. Stimulants can be prescribed for reasons other than ADHD, but as others have advised, in the case of hard-to-treat depression, where one needs to go beyond a single antidepressant approach, I feel it is advisable to consult a psychopharmocologist, rather than work with the internist on this matter.
BTW, many insurance companies will balk at covering stimulants for reasons other than narcolepsy or ADHD. My previous insurance had a rule that if not prescribed for narcolepsy, anyone over the age of 19 needs special pre-authorization for coverage. Essentially it meant my pdoc and I had to go through a hassle every 6 months to get it covered. Fortunately, my current insurance makes no such restrictions. The idea that the age of 19 is somehow a legitimate diagnostic boundary is ludicrous, of course.
It is a tricky issue--a pain in the butt to have to get an actual paper scrip every month due to the restrictions. On the other hand, stims are being abused, especially among college students.
Bottom line for you (IMHO): see a good psychiatrist who specializes in psychopharmocology. It is worth it.
Posted by Else on July 26, 2001, at 22:09:20
In reply to Re: Schedule II Prescription Restrictions? » Else, posted by Buster on July 25, 2001, at 22:43:47
> > If you have a refractory depression I suggest you DO get a psychiatrist quickly. I'm surprised you don't have one.
>
>
> Else,
>
> I've had some *major* (and by *major* I mean MAJOR) problems in the past with mental health professionals, including psychiatrists, who have abused their position of power. I can't trust any of them and have vowed that I will never see another psychiatrist as long as I live.
>
> Also, the psychiatrists I have seen invariably become extremely frustrated with my problems in tolerating medications, although I have not been able to tolerate *any* medication other than hormones - not just psychotropics - on a long-term basis.
>
> Several of my psychiatrists have told me they believe my inability to tolerate medications has a psychological rather than a physiological basis. The rest just made comments that insinuated that that was what they believed.
> That attitude does wonders for the treatment relationship.
>
> I also find it interesting that I need antihistamines and a number of other medications to help me get over these "psychological" reactions.
>
> BusterFunny you should mention that. I recently started Nasonex for rhinitis and I sleep much better. Maybe it's just a coincidence, I don't know. Maybe you should see a neurologist, a neuropsychiatrist or maybe an endocrinologist. I just personnally think GPs are good for prescribing penicilin and not much else. Once I saw a GP at a clinic and asked if I could get Ativan for a night to two. He said he wasn't sure he could give me those since I was on Depakote. I said yes, I've combined the two before and it's in the PDR anyway, look it up. He went through my whole file and ended up giving me two pills after waisting a lot of time. Another GP I see never knows what my problem is no matter what. Her answer to everything is: "I don't see what that could be". Look, maybe you've been unlucky with psychiatrists but maybe you could shop around, talk to some people here who live in your area, go to university hospitals or see younger doctors who are less likely to have been brainwashed by freudian ideology.
Posted by stjames on July 26, 2001, at 22:25:08
In reply to Schedule II Prescription Restrictions?, posted by Buster on July 25, 2001, at 19:13:38
> This is my first post to Psychobabble.
>
> I have tried over 20 different medications for depression, several in each class. I have developed adverse reactions (usually migraine headaches) to all of them.
>
> When I asked my internist if he would consider a trial of Adderall for my depression, he told me that Adderall (a Schedule II medication) (1) can only be prescribed by a psychiatrist, and (2) can only be prescribed for people who have been diagnosed with attention deficit-hyperactivity disorder.
>
> Is this true?james here....
yes and no. He can, but the DEA will be on him like white on rice.
It better that a Pdoc prescribe Sch II.james
Posted by Elizabeth on July 26, 2001, at 23:04:18
In reply to Schedule II Prescription Restrictions?, posted by Buster on July 25, 2001, at 19:13:38
> When I asked my internist if he would consider a trial of Adderall for my depression, he told me that Adderall (a Schedule II medication) (1) can only be prescribed by a psychiatrist, and (2) can only be prescribed for people who have been diagnosed with attention deficit-hyperactivity disorder.
These laws can vary somewhat from state to state, but my guess is that he's claiming that he "can't" prescribe Adderall when in fact he *won't* do it. Schedule II drugs certainly can be used for off-label indications. Stimulant augmentation is a well-accepted approach when depression is only partially responsive to ADs.
-elizabeth
Posted by Wendy B. on July 27, 2001, at 13:02:12
In reply to Re: Schedule II Prescription Restrictions? » Zo, posted by kazoo on July 26, 2001, at 0:45:46
> > > Advising someone to "fake" an ailment to get drugs is the best way to get labeled as one with "drug-seeking behavior" ... not a very sound, or judicious approach to get help ... and also a very good way to be denied treatment.
> >
> > I object to your characterization of my post and judgemental attitude. Since you know nothing of me, of my experience or education, leaping to negative conclusions seems injudicious at best.
>
> Objection sustained, Zo, and I apologize.
> kazooKazoo,
(I'm sorry, I can't let this one go -)
Don't be so hasty to apologize... I thought
the same thing you did when I read the post
you're referring to.
What exactly did you say to Zo that was
judgemental? You said that advising Buster
to fake symptoms was going to get Buster
labeled as exhibiting "drug-seeking behavior."
I absolutely agree.
You said it was not "sound or judicious" behavior.
Right again! This is not a judgement of anyone,
just a statement of opinion.Stick to your guns, man! A spade is a spade!
Buster, your animosity toward psychiatrists may
be based on real things that happened to you,
and you may have sworn to yourself that you
would never see one ever again. I have sworn
up and down so many times myself, that I would
NEVER do such and such (see my mother again,
talk to whomever it was that I was mad at at the time,
etc.) All I learned from that was to never
say never. It doesn't do you any good, and will
just make getting better more difficult. If your
p-docs said maybe the drug reactions you had were
a part of your illness, refractory depression,
would you NEVER listen to what they had to say?
I think it's all part of the big picture.Ever hear the Shakespeare line: "Methinks he doth
protest too much"? It means that the things we
most object to, and deny can be true for or about
us, are actually the crux, the kernel, the real
reason we're not getting better. I've had to face
that. I am BP II, and I know how it feels to be in the
grips of a depression that just won't go away. So I don't
say these things lightly, or want to be critical. I hope it
doesn't come off that way. I don't believe in the 'Pull Yourself Up By Your Bootstraps' mentality. I believe our problems are caused by a lot of factors: our parenting, our brain chemistry, and our repetitions, which may be
a function of both.As for prescriptions and psycho-pharmaco-issues:
My regular family medicine dr could prescribe
anything; you just have to have MD after your
name. Also, in NY state, a nurse practitioner
(what I have for therapy and meds) can sign off
on any med, as long as they're being monitored
by an MD. Your internist may just be saying,
I don't have the expertise. But why lie to your
patient? He should have just told you the truth.I wish you the best, and good luck finding the
right doctor,Wendy
Posted by Zo on July 27, 2001, at 22:53:43
In reply to Re: Schedule II Prescription Restrictions? » kazoo, posted by Wendy B. on July 27, 2001, at 13:02:12
Wendy,
I did not adivse Buster to "fake" symptoms, if you will give my post more than a shallow reading. I know, for example, that many CFS/FM patients suffer needlessly. . . when they do indeed qualify as ADD, and if that is what is needed to get a Dex Rx, some FM patients are getting smart enough to demand it. Dex is a key, *key* med. The "stimulants" are pure sources of dopamine, and dopamine is crucial to pain reduction, muscle activity, alertness, pleasure, focus, satisfaction.
If one cannot tolerate or get relief from Wellbutrin, there is no choice but to get into stims. . .and deal with all the nonsense horse puckey surrounding the issue of getting an Rx for -- gasp, naughty naughty, meth addict -- Dexadrine. Or Adderall.Use of these agents deserves and warrants no shame or judgement, and they are vastly underutilized for emotionally bogus and factually incorrect reasons. Period.
Zo
Posted by Wendy B. on July 28, 2001, at 15:05:25
In reply to Re: Schedule II Prescription Restrictions? » Wendy B., posted by Zo on July 27, 2001, at 22:53:43
> Wendy,
>
> I did not adivse Buster to "fake" symptoms, if you will give my post more than a shallow reading. I know, for example, that many CFS/FM patients suffer needlessly. . . when they do indeed qualify as ADD, and if that is what is needed to get a Dex Rx, some FM patients are getting smart enough to demand it. Dex is a key, *key* med. The "stimulants" are pure sources of dopamine, and dopamine is crucial to pain reduction, muscle activity, alertness, pleasure, focus, satisfaction.
> If one cannot tolerate or get relief from Wellbutrin, there is no choice but to get into stims. . .and deal with all the nonsense horse puckey surrounding the issue of getting an Rx for -- gasp, naughty naughty, meth addict -- Dexadrine. Or Adderall.
>
> Use of these agents deserves and warrants no shame or judgement, and they are vastly underutilized for emotionally bogus and factually incorrect reasons. Period.
>
> Zo
Zo,Uh-oh, I'm being accused of giving something a shallow reading! The shame of it all...
You said, and I think it could be mis-read even by intelligent persons:
"Well, one way is to see an MD or pdoc who specializes in ADD. . .Most depressed people would have no trouble qualifying. Complain of inattention. Read up on ADD in adults."
I took this to mean, as did Kazoo, that you were advising Buster to complain of symptoms he didn't actually have. He didn't say he couldn't concentrate in his post. And I took it to mean that you thought he should read up on ADD in adults so that he could have more of those symptoms on his list of complaints, in order to get the drug that *you* think he should have. Any reasonable person *might* read your post the way I did. Sorry...
You're probably right that a trial of a psycho-stims would be worthwhile, and I hope he can get to see a specialist. And I absolutely agree that the way these drugs are underutilized because of ignorance and the FDA's narrow views is a shame, so you're preaching to the converted on that one.
Many thanks for the discussion,
Wendy
Posted by Zo on July 30, 2001, at 16:39:09
In reply to Re: Schedule II Prescription Restrictions? » Zo, posted by Wendy B. on July 28, 2001, at 15:05:25
Wendy, I think I meant to say was not to accuse anyone of being shallow. . .It was more like, Hey, person the benefit of the doubt!. Lord knows we're not always in the best of shape when we post, here!
Thanks,
Zo
This is the end of the thread.
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