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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 17 to 41 of 55. Go back in thread:
Posted by katekite on April 14, 2002, at 10:48:16
In reply to Re: ADD diagnosis 1 week ago, completely calm now » katekite, posted by mike21 on April 14, 2002, at 10:04:54
Well that's an interesting question. My newest therapist (last six months) was just about to call my psychiatrist to discuss how much more like OCD he felt my thinking was than like pure anxiety. I say just about because I was being evaluated for ADD by a specialist, and then last week I walked into his office on ritalin and that theory went right out the window.
I used to pull my hair out as well, a 'soft' ocd trait. When I was working at the computer or reading or on the phone, but not while watching tv or while doing something 'fun'. I can not explain why I did it, but as of the day I started ritalin I have stopped. I started when I was 13 and have battled it ever since. Now its just gone.
I do not have traits like checking or washing etc. I did 'ruminate' or think repeatedly about the same subject. My mom seems to check things a lot, like whether the curling iron is on, and worry about those things and I suspect she has ADD (since my father does not, and my brother and I both do and it is so heritable).
I also found, and still find, the internet soothing. I think because its a manageable little world where distractions are predictable. I used to have a very very hard time stopping emailing, if I needed to do something or go somewhere. To the point my husband would ask if I needed the computer physically taken away and I would reluctantly say yes. Then he would, and I would feel very upset about it for some minutes until I switched tasks. Having trouble switching tasks can be a sign of ocd.
So I definitely have/had some ocd traits. I don't know how common that is in ADD, I don't know what purpose it served. It does seem to be much much different and better on ritalin in the course of a week. I feel much more relaxed.
I'm not sure to what extent these traits exist in general in untreated ADDers. Its possible that it simply is something unique to me, like I have a threshold for ocd behavior and when stressed by my untreated ADD it comes out.
Hope this helps.
kate
Posted by Ritch on April 14, 2002, at 11:16:11
In reply to Re: ADD diagnosis 1 week ago, completely calm now » katekite, posted by mike21 on April 14, 2002, at 10:04:54
> Kate,
>
> I've read a couple of your posts regarding the stimulants helping to calm you. One of them in anther thread mentioned obsessive-type anxiety. Your description of thinking several thoughts at once sounds like me, too. Also, I have had relief of some symptoms from valium.
>
> I am curious if any of your now-diagnosed "ADD" symptoms could fall under OCD, obsessive-compulsive disorder. I am starting to think there might be some similarities between these two disorders.
>
> Have obsessions or compulsions ever helped you to cope with anxiety? I am asking because I am considering stimulants in the treatment of my anxiety, which I believe is OCD-mediated. Or perhaps I should reconsider my own diagnosis to be ADD.
>
> Anyone else have any thoughts?
>
> Mike
>
Hi Mike,OCD is the most common comorbid psychiatric illness in families that have members with ADHD (from what I remember). OCD and ADHD are similar in some ways. If you think about it-both are "attentional dysfunctions" of different flavors. In OCD, people get "stuck" on a particular thought/ritual, whereas in ADHD your attention can't seem to stick to anything. Pschostimulants used for ADHD increase your ability to stay on a single task-whereas they can *diminish* your ability to rapidly "multi-task". SSRI meds that tend to help OCD, help to get your thoughts "unstuck" (in OCD), to relieve the anxiety. Psychostimulants (of the ones I have tried thus far anyhow) have mixed positive effects in relation to focus and single/multitasking. ADHD people have a tendency to "hyper-focus" on things they are interested in (without medication help), but can't stay on track with ordinary things. When I am involved in a task that I typically will "hyper-focus" on and I take a psychostimulant, sometimes it will make me *inefficient* with the task because I burn too much energy and time on it than the task requires. Stimulants improve efficiency with focus on tasks that come up that are everyday or routine (ordinarily quite boring) in nature (reading your mail-writing a check-filling out your taxes, listening and following directions, etc.) I have adapted to ADHD quite well. I looked at all of the "tips" and "tricks" on living with ADHD you can get from the NIMH, etc. and all of the things they suggest are methods I have already already adopted to keep myself on track (lists, notes to self, color-coding, etc.) Taking psychostimulants work quite well for my recurrent major depressions, but for everyday help with ADHD they actually impair my ability to rapidly multi-task on several things at once. Some things don't get done best all at one time.
Mitch
Posted by pharmer on April 14, 2002, at 22:45:37
In reply to Re: ADD diagnosis... OCD? » mike21, posted by Ritch on April 14, 2002, at 11:16:11
I was told by my pdoc that I have ocb - not full blown ocd. Asked what he ment by that and he said many patients have symptons that are clinicaly reconized as obsesive-compulsive"Behavior". Ocd is much more debilitating and a disorder in itself where as ocb is attributed to deppressive-gad.
Posted by jonh kimble on April 15, 2002, at 21:06:38
In reply to Re: ANYONE'S ANXIETY HELPED BY A STIMULANT? » dennison, posted by paxvox2000 on April 8, 2002, at 18:18:57
Hi, I know in my experience with social anxiety with some g.a.d, i have not responded to other anxiety agents. although anxiety is considered to be mediated through serotonin or gaba dysfunction, i believe that dopamine also plays a large yet unknown part, as it does in depression and social anxiety as well. this may explain why you do well on stims. i dont have any expereince with amisulpride, but it is totally a dopamine drug that benefits anxiety, social anxiety and depression. you may want to find out more about amisulpride, i know i sure do.
jon
Posted by mike21 on April 15, 2002, at 21:12:38
In reply to Re: ADD diagnosis... OCD?, posted by pharmer on April 14, 2002, at 22:45:37
Hi guys,
I find this discussion of OCD/OCB/ADD fascinating. I wish I had more time to give a proper response. Maybe in another day or so. Please stay tuned.
Mike
Posted by d miller on April 15, 2002, at 23:23:18
In reply to Re: ANYONE'S ANXIETY HELPED BY A STIMULANT? » dennison, posted by paxvox2000 on April 8, 2002, at 18:18:57
I have been reading things in this site for a few weeks.
The idea of stimulants working to help anxiety really interest me because I suffer from severe anxiety. I was told I have OCD 8 years ago and for the most part effexor had worked for me. It really helped with my anxiety and the OCD and depression in the past. I weaned myself off a year ago and this Janurary had a horribe relapse. Effexor is not working like it did before, and I have lots of axienty still.
Something I had kinda noticed was that on days that a drank a caffeine beverage like coke or moundtain dew I would start to feel better. For the most part I stayed away for caffiene because of everthing I read about it causing anxiety. But I wonder. I did mention this to my pdoc jokingly that I was oppisite girl and that maybe stimulants would work for me. She of course just looked at me stupidly, and prescribed clozapam for the anxiety which doesn't relieve it totally for me. It just makes so groggy all I want to do is take cat naps all day long. Who can do that?
d.miller
Posted by JohnX2 on April 16, 2002, at 16:56:58
In reply to Didn't Make Myself Clear » sid, posted by IsoM on April 9, 2002, at 22:43:26
> Sid, I reread my post to you & realised I didn't make something clear. When I say I wake up groggy, it's not a result of the stims - it's me naturally & taking something like Dexedrine doesn't counter it as when I wake up there's no Dexedrine left in my system, of course. But when I wake up from regular use of adrafinil, I don't wake up groggy. It seems to make my brain normal & I wake up like a normal person - groggy for about 5 minutes then properly awake. Hope I'm clear now.
Hi IsoM,
How does the Adrafinil compare to the Modafinil?
I tried Modafinil, but like every other stim or AD it crapped out on me in like 1 hr (followed by a crushing myofacial pain headache, just like Wellbutrin and Zoloft). Adderall would hold out if I took enough Klonopin with it; the Klonopin seemed to have an ability to prevent the development of tolerance.
John
Posted by JohnX2 on April 16, 2002, at 16:58:34
In reply to Re: Didn't Make Myself Clear » IsoM, posted by JohnX2 on April 16, 2002, at 16:56:58
> > Sid, I reread my post to you & realised I didn't make something clear. When I say I wake up groggy, it's not a result of the stims - it's me naturally & taking something like Dexedrine doesn't counter it as when I wake up there's no Dexedrine left in my system, of course. But when I wake up from regular use of adrafinil, I don't wake up groggy. It seems to make my brain normal & I wake up like a normal person - groggy for about 5 minutes then properly awake. Hope I'm clear now.
>
> Hi IsoM,
>
> How does the Adrafinil compare to the Modafinil?
>
> I tried Modafinil, but like every other stim or AD it crapped out on me in like 1 hr (followed by a crushing myofacial pain headache, just like Wellbutrin and Zoloft). Adderall would hold out if I took enough Klonopin with it; the Klonopin seemed to have an ability to prevent the development of tolerance.
>
> JohnOh, for the hour modafinil worked, it had a nice property of not driving me manic like adderall.
John
Posted by mike21 on April 16, 2002, at 19:24:07
In reply to mild ocd maybe yes » mike21, posted by katekite on April 14, 2002, at 10:48:16
For starters, I had OCD when I was about 8 years old. I've heard that when it occurs at such a young age it generally does not go away with behavioural/cognitive therapy, but that a med is probably required. The two symptoms I remember were washing and showering repeatedly, and choosing not to speak for periods of time.
I think the mutism was due to the anxiety from talking, and I think the washing helped to take away the anxiety. After a shower I would not talk for as long as possible. Sometimes I would even go to extent of using hand gestures alone to try to communicate.
I saw a psychologist which did nothing for me except to convince me that this behaviour was not really acceptable. So I remember one day deciding that if I ever hoped to stop seeing this guy, I would have to convince him I was cured. So I did, but I'd say that much of the anxiety I felt then is still present.
My current thinking is that OCD is based on a deficit in the pleasure centers of the brain. I seem to derive some sort of relief from my own general state of discomfort by repetitive thoughts, so much so that it is more uncomfortable to discontinue them. Maybe getting a circuit in the brain going generates more endogenous opioids, I don't know. But that kind of theory explains why some compulsions involve self-inflicted pain like hair-pulling or cutting. I've read about how treatment-resistant OCD'ers have had complete relief from their symptoms from just one weekly dose of morphine. Conversely, an opioid antagonist like naltrexone also works.
In the same respect, maybe a lack of attention could be due to a lack of positive feedback from certain dopaminergic pleasure centers of the brain. For example, social interactions are too variable to give a predictable reward, and the brain disengages itself. Like you, I find comfort in dealing with things in my own little contained world, like working on the computer. But after awhile, I get so locked in that groove, that getting out and interacting with others is difficult. I also get burned out and depressed- I think my brain just gets too tired from working at the same thing.
On the other hand, maybe OCD is an adaptation to ADD. It would make sense for someone with ADD to repeatedly check the curling iron to make sure it is turned off- it's probably been left on on more than one occasion! And obsessing could be the brains attempt at disciplining itself when it starts to wander. Perhaps people just have two opposing tendencies to react to the same basic brain chemistry- some people become AD/HD-manic while others go the route of OCD with comorbid depression, while others alternate between the two.
Given your success with ritalin and others success with opioids, it's suprising that I haven't heard more about a dopaminergic med for OCD. I've tried SSRI/SSNIs, they seem to make me even more capable of ocd behaviour.
Guess a stimulant would be worth a try.
Mike
> Well that's an interesting question. My newest therapist (last six months) was just about to call my psychiatrist to discuss how much more like OCD he felt my thinking was than like pure anxiety. I say just about because I was being evaluated for ADD by a specialist, and then last week I walked into his office on ritalin and that theory went right out the window.
>
> I used to pull my hair out as well, a 'soft' ocd trait. When I was working at the computer or reading or on the phone, but not while watching tv or while doing something 'fun'. I can not explain why I did it, but as of the day I started ritalin I have stopped. I started when I was 13 and have battled it ever since. Now its just gone.
>
> I do not have traits like checking or washing etc. I did 'ruminate' or think repeatedly about the same subject. My mom seems to check things a lot, like whether the curling iron is on, and worry about those things and I suspect she has ADD (since my father does not, and my brother and I both do and it is so heritable).
>
> I also found, and still find, the internet soothing. I think because its a manageable little world where distractions are predictable. I used to have a very very hard time stopping emailing, if I needed to do something or go somewhere. To the point my husband would ask if I needed the computer physically taken away and I would reluctantly say yes. Then he would, and I would feel very upset about it for some minutes until I switched tasks. Having trouble switching tasks can be a sign of ocd.
>
> So I definitely have/had some ocd traits. I don't know how common that is in ADD, I don't know what purpose it served. It does seem to be much much different and better on ritalin in the course of a week. I feel much more relaxed.
>
> I'm not sure to what extent these traits exist in general in untreated ADDers. Its possible that it simply is something unique to me, like I have a threshold for ocd behavior and when stressed by my untreated ADD it comes out.
>
> Hope this helps.
>
> kate
Posted by mike21 on April 16, 2002, at 19:50:39
In reply to Re: ADD diagnosis... OCD? » mike21, posted by Ritch on April 14, 2002, at 11:16:11
> > Kate,
> >
> > I've read a couple of your posts regarding the stimulants helping to calm you. One of them in anther thread mentioned obsessive-type anxiety. Your description of thinking several thoughts at once sounds like me, too. Also, I have had relief of some symptoms from valium.
> >
> > I am curious if any of your now-diagnosed "ADD" symptoms could fall under OCD, obsessive-compulsive disorder. I am starting to think there might be some similarities between these two disorders.
> >
> > Have obsessions or compulsions ever helped you to cope with anxiety? I am asking because I am considering stimulants in the treatment of my anxiety, which I believe is OCD-mediated. Or perhaps I should reconsider my own diagnosis to be ADD.
> >
> > Anyone else have any thoughts?
> >
> > Mike
> >
>
>
> Hi Mike,
>
> OCD is the most common comorbid psychiatric illness in families that have members with ADHD (from what I remember). OCD and ADHD are similar in some ways. If you think about it-both are "attentional dysfunctions" of different flavors. In OCD, people get "stuck" on a particular thought/ritual, whereas in ADHD your attention can't seem to stick to anything. Pschostimulants used for ADHD increase your ability to stay on a single task-whereas they can *diminish* your ability to rapidly "multi-task". SSRI meds that tend to help OCD, help to get your thoughts "unstuck" (in OCD), to relieve the anxiety. Psychostimulants (of the ones I have tried thus far anyhow) have mixed positive effects in relation to focus and single/multitasking. ADHD people have a tendency to "hyper-focus" on things they are interested in (without medication help), but can't stay on track with ordinary things. When I am involved in a task that I typically will "hyper-focus" on and I take a psychostimulant, sometimes it will make me *inefficient* with the task because I burn too much energy and time on it than the task requires. Stimulants improve efficiency with focus on tasks that come up that are everyday or routine (ordinarily quite boring) in nature (reading your mail-writing a check-filling out your taxes, listening and following directions, etc.) I have adapted to ADHD quite well. I looked at all of the "tips" and "tricks" on living with ADHD you can get from the NIMH, etc. and all of the things they suggest are methods I have already already adopted to keep myself on track (lists, notes to self, color-coding, etc.) Taking psychostimulants work quite well for my recurrent major depressions, but for everyday help with ADHD they actually impair my ability to rapidly multi-task on several things at once. Some things don't get done best all at one time.
>
> MitchI'm glad you pointed out that they were comorbid- it had never occured to me that they could be so closely related, just because they seem at opposite ends of the psychological spectrum. But after obsessing, I mean thinking, about it I've come up with some theories (see above post).
From what you say about burning up too much energy on a task, I'd have to say that I do that already. It is more due to perfectionism than anything. Sometimes with a boring task, getting it as perfect as possible gives me a feeling of accomplishment and reward.
I do have a hard time multi-tasking in terms of getting things done in the physical world- I tend to seek out things I am interested in, at the expense of other "boring" things that really *need* to get done.
When you say you burn up too much energy than the task requires, does that mean you become perfectionistic?
Mike
Posted by IsoM on April 16, 2002, at 22:48:04
In reply to Re: Didn't Make Myself Clear--IsoM, posted by JohnX2 on April 16, 2002, at 16:58:34
If you can't take modafinil (Provigil), John, you probably wouldn't be able to tolerate adrafinil either. Remember that one of adrafinil's metabolites is modafinil. Unless there's something helpful or protective of the other main metabolite of adrafinil, the fact part of it changes to modafinil would probably count it out for you.
You said you had an hour of it working before you got a massive headache. What dose had you taken? I find it surprising when people say they notice an immediate affect with Provigil or adrafinil. It took fully a week for me to notice a difference & then it continued improving over the next month. I'm wondering if you started with a lower dose (perhaps even 1/4 of normal) & worked it up to 1/2 the next week, then 3/4 the following week before reaching the full dose, if it might work better.
Zo mentioned that she found Provigil has a fairly narrow therapeutical window & beyond it, side-effects show & negate the benefits. Less than that, it didn't seem to work. Your therapeutical window might be much lower than what's 'normal'. Seeing you probably have Provigil still kicking about, why not give it a try again at 1/4 normal dose on a weekend when you can crash from the pain, if it happens.
Remember how it doesn't seem to have any strong affinity for any neurotransmitter but seems to increase over-all brain metabolism? Perhaps too much increases someplace in your brain that affects your perception of pain?
Muscle relaxation & the mental calmness I feel with adrafinil was one of the last benefits to kick in. For me, it was very noticable when it did. I realised that I could be alert & bright without being tense with muscles like coiled springs. My shoulders were no longer slightly hunched, no furrowed brow, tightly held jaw, or madly tapping toes & swinging legs. My body was still & relaxed but I was alert & ready. The only other time I ever felt so relaxed was when I'd awake in the morning & then slip back into sleep. I never equated calm with alert before.
Anyway, if you can tolerate it in a lowered dose, be patient about feeling the full benefits of it. Most reports I've read said it takes a while for them to happen.
Posted by IsoM on April 16, 2002, at 22:49:24
In reply to Re: Didn't Make Myself Clear--IsoM, posted by JohnX2 on April 16, 2002, at 16:58:34
If you can't take modafinil (Provigil), John, you probably wouldn't be able to tolerate adrafinil either. Remember that one of adrafinil's metabolites is modafinil. Unless there's something helpful or protective of the other main metabolite of adrafinil, the fact part of it changes to modafinil would probably count it out for you.
You said you had an hour of it working before you got a massive headache. What dose had you taken? I find it surprising when people say they notice an immediate affect with Provigil or adrafinil. It took fully a week for me to notice a difference & then it continued improving over the next month. I'm wondering if you started with a lower dose (perhaps even 1/4 of normal) & worked it up to 1/2 the next week, then 3/4 the following week before reaching the full dose, if it might work better. I started slow with the adrafinil just to be safe - maybe that might account for the fact I had no problems too.
Zo mentioned that she found Provigil has a fairly narrow therapeutical window & beyond it, side-effects show & negate the benefits. Less than that, it didn't seem to work. Your therapeutical window might be much lower than what's 'normal'. Seeing you probably have Provigil still kicking about, why not give it a try again at 1/4 normal dose on a weekend when you can crash from the pain, if it happens?
Remember how it doesn't seem to have any strong affinity for any neurotransmitter but seems to increase over-all brain metabolism? Perhaps too much increases some area in your brain that affects your perception of pain? Or after an hour or so, the blood plasma level has risen to the maximum & it's higher than your window is?
Muscle relaxation & the mental calmness I feel with adrafinil was one of the last benefits to kick in (after 3-4 weeks). For me, it was very noticable when it did. I realised that I could be alert & bright without being tense with muscles like coiled springs. My shoulders were no longer slightly hunched, no furrowed brow, tightly held jaw, or madly tapping toes & swinging legs. My body was still & relaxed but I was alert & ready. The only other time I ever felt so relaxed was when I'd awake in the morning & then slip back into sleep. I never equated calm with alert before.
Anyway, if you can tolerate it in a lowered dose, be patient about feeling the full benefits of it. Most reports I've read said it takes a while for them to happen.
Posted by JohnX2 on April 16, 2002, at 23:42:01
In reply to Modafinil vs Adrafinil » JohnX2, posted by IsoM on April 16, 2002, at 22:48:04
> If you can't take modafinil (Provigil), John, you probably wouldn't be able to tolerate adrafinil either. Remember that one of adrafinil's metabolites is modafinil. Unless there's something helpful or protective of the other main metabolite of adrafinil, the fact part of it changes to modafinil would probably count it out for you.
>
> You said you had an hour of it working before you got a massive headache. What dose had you taken? I find it surprising when people say they notice an immediate affect with Provigil or adrafinil. It took fully a week for me to notice a difference & then it continued improving over the next month. I'm wondering if you started with a lower dose (perhaps even 1/4 of normal) & worked it up to 1/2 the next week, then 3/4 the following week before reaching the full dose, if it might work better.
>
> Zo mentioned that she found Provigil has a fairly narrow therapeutical window & beyond it, side-effects show & negate the benefits. Less than that, it didn't seem to work. Your therapeutical window might be much lower than what's 'normal'. Seeing you probably have Provigil still kicking about, why not give it a try again at 1/4 normal dose on a weekend when you can crash from the pain, if it happens.
>
> Remember how it doesn't seem to have any strong affinity for any neurotransmitter but seems to increase over-all brain metabolism? Perhaps too much increases someplace in your brain that affects your perception of pain?
>
> Muscle relaxation & the mental calmness I feel with adrafinil was one of the last benefits to kick in. For me, it was very noticable when it did. I realised that I could be alert & bright without being tense with muscles like coiled springs. My shoulders were no longer slightly hunched, no furrowed brow, tightly held jaw, or madly tapping toes & swinging legs. My body was still & relaxed but I was alert & ready. The only other time I ever felt so relaxed was when I'd awake in the morning & then slip back into sleep. I never equated calm with alert before.
>
> Anyway, if you can tolerate it in a lowered dose, be patient about feeling the full benefits of it. Most reports I've read said it takes a while for them to happen.I don't remember the dose, but I'm sure it was strong. Unfortunately my insurance didn't cover it so i just got a few pills to try it out because it was so expensive and I wanted to make sure it was for me 1st. I threw out the rest (a few pills) after it bombed. I brought it up once with my new pdoc, but he is not a big fan of the med for some reason.
Thanks for the info on the therapeutic window and Adrafinil.
John
Posted by Ritch on April 17, 2002, at 0:03:46
In reply to Re: ADD diagnosis... OCD?, posted by mike21 on April 16, 2002, at 19:50:39
> I'm glad you pointed out that they were comorbid- it had never occured to me that they could be so closely related, just because they seem at opposite ends of the psychological spectrum. But after obsessing, I mean thinking, about it I've come up with some theories (see above post).
(snip from above post....) ....In the same respect, maybe a lack of attention could be due to a lack of positive feedback from certain dopaminergic pleasure centers of the brain. For example, social interactions are too variable to give a predictable reward, and the brain disengages itself. Like you, I find comfort in dealing with things in my own little contained world, like working on the computer. But after awhile, I get so locked in that groove, that getting out and interacting with others is difficult. I also get burned out and depressed- I think my brain just gets too tired from working at the same thing.
> From what you say about burning up too much energy on a task, I'd have to say that I do that already. It is more due to perfectionism than anything. Sometimes with a boring task, getting it as perfect as possible gives me a feeling of accomplishment and reward.
>
> I do have a hard time multi-tasking in terms of getting things done in the physical world- I tend to seek out things I am interested in, at the expense of other "boring" things that really *need* to get done.
>
> When you say you burn up too much energy than the task requires, does that mean you become perfectionistic?
>
> Mike
Fascinating post up there Mike. I have this awful mix of bipolar, ADHD, social anxiety/perfectionism, mild neuro probs. with mild LD (CAPD/dyslexia), and they are all intertwined together. It is interesting that amongst the symptoms of ADHD, perfectionism and shyness is commonly listed. My pdoc tells me that my social anxiety/perfectionism is the result of abnormally hypercritical parents that I could never please, and I have over-generalized my responses to them to everybody else in my environment-the trick is to understand that most folks are not as *perfectionistic* as my parents and generally don't give my achievements/behaviour that much scrutiny-so why not just chill out? Of course, genetic predispositions are there making it tough for me as it was made tough for my parents.Enough of that-what about the multitasking thing? SSRI's enhance my ability to multitask. Stimulants tend to hinder it. I think the "locked in a groove thing" is a good place to be if you are trying to study-read-listen-comprehend something new. When it bites you in the ass is when you are doing something that you are already very familiar with. When I get hyperfocused on something I am familiar with and I am taking a stimulant..I start seeing a lot of subtle permutations that I didn't seem to be aware of that somehow need to get "worked out". This is usually work-related logical minutiae (sp?), that really requires only a glossy summary at best-and I wind up burning double the time on it that it really warrants.
I think where the ADHD and OCD differ is the sense of "reward" that you speak about. With my ADHD problems I never seem to reach the *end* of anything. *Time* doesn't seem to have distinct start/stop points. I don't *feel* any kind of *reward* for *anything* that is task oriented. Everything tends to seem like a work in progress. If you give me too much to work on I freak out because I don't know where/what to start and what to finish first!
I think with the OCD there is a "reward" thing like you say that gets released when the "loop" is successful. And reward is related to dopaminergic transmission. I guess it could be possible that in OCD you may be "self-rewarding" yourself for something that doesn't *deserve* a reward: counting all your crayons, i.e.. SO... do you try to snip that circuit in two electro-chemically or find a way to *not* experience the REWARD reinforcement by not *feeling* the sense of reward for something that doesn't deserve that feeling? Sorry, if this is a little improvised.
Mitch
Posted by omega man on April 17, 2002, at 10:18:04
In reply to Re: ANYONE'S ANXIETY HELPED BY A STIMULANT?, posted by jonh kimble on April 15, 2002, at 21:06:38
I have had chronic anxiety 12 years...eight spent hooked on benzo's..after withdrawal hell I tried all types of stimulant approaches
i.e. effexor ..prozac type lots of stuff...which seems to make the mind and body so highly strung that the anxiety becomes excitement and positive energy..
but the quality of thinking or perception mmnnn seemed sort of like continual train ..because your drug regime has little to do with the dynamic of real life...I mean if you have your head continually buzzed with stimulants it can piss people off..when in fact you may need to listen to what life is telling you...
omega 3 oil which is the food of intelligence (fish) helped with my thinking and seemed to give my mind space..and this makes sense when you think of the brain as a volume of electricity and the high quality fat of omega 3 stops the neural feedback that results in brain regions overloading and blocking the whole organ acting en masse..
I would say that after a year that omega 3 is my choice for anxiety..the anxiety I had was not being able to think..to be overloaded by events ..along with particular neurotransmitter adjustments..which I believe should be done as needed to shock the brain back into producing its own and then stopping to let the body lead you to the foods and drugs which you really need..
NOT to take the drugs every day..but to stop and start ..during stopping you take a break ..go food shopping play with lots of drugs ..and let your mind and body lead you to the key..and in a drug crazed society you may find that biggest shock is that after a while you are just fine with nothing..I would never have believed ten years or even three months ago that oil tablets would stop my anxiety..but with all these drugs filling my drawers including benzos..I choose the chemical Omega 3 ...and occasionally I reach for whatever else to jump start the transmitter deficit but omega 3 allows me to think..and to be in situations of extreme stimulation complexity aND PRESSURE (Social) ....when one cannot be social one loses what it is to be human and the isolation creates more need to take drugs..
like the saying goes do not adjust your mind the fault is in reality is not true of course..but on this forum people need to be reminded that this is a huge part of the process of getting well..
Omega 3 gives me the space to take in reality..the space to see how my hurt from the past clouds my judgement of social situations...but most importantly omega 3 is the intelligence chemical and to have the space to be laid back with your own transmitter profileand not zonked or spangled or hyperenergetic is a step from a very complicated process to gain the mental space to deal with the competitive and social situtations ..
Sorry to ramble..
> Hi, I know in my experience with social anxiety with some g.a.d, i have not responded to other anxiety agents. although anxiety is considered to be mediated through serotonin or gaba dysfunction, i believe that dopamine also plays a large yet unknown part, as it does in depression and social anxiety as well. this may explain why you do well on stims. i dont have any expereince with amisulpride, but it is totally a dopamine drug that benefits anxiety, social anxiety and depression. you may want to find out more about amisulpride, i know i sure do.
>
> jon
Posted by Spongemomsquarepants on April 17, 2002, at 12:20:12
In reply to Re: ANYONE'S ANXIETY HELPED BY A STIMULANT?, posted by jonh kimble on April 15, 2002, at 21:06:38
Hi,
I am helped a great deal with Adderall XR. I started taking it for ADHD 3 weeks ago, and I can't believe the difference. I have been taking 1.5 mg of klonopin for about the past 8 years for generalized anxiety.
Viki
Posted by JohnX2 on April 18, 2002, at 2:34:28
In reply to Re: ANYONE'S ANXIETY HELPED BY A STIMULANT?, posted by omega man on April 17, 2002, at 10:18:04
> omega 3 oil which is the food of intelligence (fish) helped with my thinking and seemed to give my mind space..and this makes sense when you think of the brain as a volume of electricity and the high quality fat of omega 3 stops the neural feedback that results in brain regions overloading and blocking the whole organ acting en masse..
>
....>
> Sorry to ramble..
>Thanks for the tip!
John
Posted by mike21 on April 18, 2002, at 18:49:59
In reply to Re: ADD diagnosis... OCD? » mike21, posted by Ritch on April 17, 2002, at 0:03:46
> > I'm glad you pointed out that they were comorbid- it had never occured to me that they could be so closely related, just because they seem at opposite ends of the psychological spectrum. But after obsessing, I mean thinking, about it I've come up with some theories (see above post).
>
> (snip from above post....) ....In the same respect, maybe a lack of attention could be due to a lack of positive feedback from certain dopaminergic pleasure centers of the brain. For example, social interactions are too variable to give a predictable reward, and the brain disengages itself. Like you, I find comfort in dealing with things in my own little contained world, like working on the computer. But after awhile, I get so locked in that groove, that getting out and interacting with others is difficult. I also get burned out and depressed- I think my brain just gets too tired from working at the same thing.
>
> > From what you say about burning up too much energy on a task, I'd have to say that I do that already. It is more due to perfectionism than anything. Sometimes with a boring task, getting it as perfect as possible gives me a feeling of accomplishment and reward.
> >
> > I do have a hard time multi-tasking in terms of getting things done in the physical world- I tend to seek out things I am interested in, at the expense of other "boring" things that really *need* to get done.
> >
> > When you say you burn up too much energy than the task requires, does that mean you become perfectionistic?
> >
> > Mike
>
>
> Fascinating post up there Mike. I have this awful mix of bipolar, ADHD, social anxiety/perfectionism, mild neuro probs. with mild LD (CAPD/dyslexia), and they are all intertwined together. It is interesting that amongst the symptoms of ADHD, perfectionism and shyness is commonly listed. My pdoc tells me that my social anxiety/perfectionism is the result of abnormally hypercritical parents that I could never please, and I have over-generalized my responses to them to everybody else in my environment-the trick is to understand that most folks are not as *perfectionistic* as my parents and generally don't give my achievements/behaviour that much scrutiny-so why not just chill out? Of course, genetic predispositions are there making it tough for me as it was made tough for my parents.
>
> Enough of that-what about the multitasking thing? SSRI's enhance my ability to multitask. Stimulants tend to hinder it. I think the "locked in a groove thing" is a good place to be if you are trying to study-read-listen-comprehend something new. When it bites you in the ass is when you are doing something that you are already very familiar with. When I get hyperfocused on something I am familiar with and I am taking a stimulant..I start seeing a lot of subtle permutations that I didn't seem to be aware of that somehow need to get "worked out". This is usually work-related logical minutiae (sp?), that really requires only a glossy summary at best-and I wind up burning double the time on it that it really warrants.
>
> I think where the ADHD and OCD differ is the sense of "reward" that you speak about. With my ADHD problems I never seem to reach the *end* of anything. *Time* doesn't seem to have distinct start/stop points. I don't *feel* any kind of *reward* for *anything* that is task oriented. Everything tends to seem like a work in progress. If you give me too much to work on I freak out because I don't know where/what to start and what to finish first!
>
> I think with the OCD there is a "reward" thing like you say that gets released when the "loop" is successful. And reward is related to dopaminergic transmission. I guess it could be possible that in OCD you may be "self-rewarding" yourself for something that doesn't *deserve* a reward: counting all your crayons, i.e.. SO... do you try to snip that circuit in two electro-chemically or find a way to *not* experience the REWARD reinforcement by not *feeling* the sense of reward for something that doesn't deserve that feeling? Sorry, if this is a little improvised.
>
> MitchI have the same problem getting caught up in work-related minutia that is pointless. I have to keep asking myself- is this value added? Frequently I find that it's not.
As far as the question of snipping the circuit in two or stopping the feeling of reward from occuring goes... Well, I guess you mean an SSRI would help to keep the circuit from going on indefinitely, and that some sort of dopamine antagonist-type drug would stop the feeling of reward. I don't know.
I think the answer is to tickle the pleasure centers enough so you don't have to look for b.s. ways of getting reward.
My longest trial on an SSRI was 6 months- prozac. My recollection of it was that it didn't help my general dysphoric outlook on life- but it did seem to help my social life. On the other hand, I behaved much more compulsively and in some ways recklessly on that drug. My opinion of the whole thing was that it didn't get to the root of the problem, but made coping easier.
As far as stopping the reward goes, I can't speak from a med standpoint. I don't think I'd want to try naltrexone, an opioid antagonist. Seems like that would maybe take away one's only feeling of pleasure in the world, both OCD and just normal good feeling.
And to me, that's the same idea behind stopping compulsions in favor of exposing oneself to anxiety-provoking situations. It may take away the fear, but for me it doesn't tend to give me any greater enjoyment of that situation. For example, I could talk to people non-stop all day long- I would end up stressed out and would have been acting the whole time.
That's why I believe in some sort of deficient pleasure system, not serotonergic, definitely not norepinephrine. But that's just my theory today. It tends to change a lot lately.
In the meantime, I'm trying not to get wrapped around the axle trying to figure out my situation. Sometimes I get the feeling I'm looking for something that's not there- or at least is not available yet.
Mike
Posted by katekite on April 18, 2002, at 22:58:35
In reply to Re: ADD diagnosis... OCD? » Ritch, posted by mike21 on April 18, 2002, at 18:49:59
Yeah sometimes I feel like we are all here 10 years too early. Think of how many ssris and mood stabilizers have been developed in the last ten years, the pace has picked up really quickly. I just hope the market isn't satisfied with what's available. Since I haven't quite found something perfect for me.
To update you on how ritalin is going, I think it was you who posted to me a few days back, I had to decrease it because of chest pain. boo hoo. I actually stopped it altogether but was back to pulling my hair again. And I'm up late now because I was trying not to need it to go to sleep. I will try some other stimulants and see if they like me better.
kate
Posted by Ritch on April 18, 2002, at 23:26:01
In reply to Re: ADD diagnosis... OCD? » Ritch, posted by mike21 on April 18, 2002, at 18:49:59
> > > I'm glad you pointed out that they were comorbid- it had never occured to me that they could be so closely related, just because they seem at opposite ends of the psychological spectrum. But after obsessing, I mean thinking, about it I've come up with some theories (see above post).
> >
> > (snip from above post....) ....In the same respect, maybe a lack of attention could be due to a lack of positive feedback from certain dopaminergic pleasure centers of the brain. For example, social interactions are too variable to give a predictable reward, and the brain disengages itself. Like you, I find comfort in dealing with things in my own little contained world, like working on the computer. But after awhile, I get so locked in that groove, that getting out and interacting with others is difficult. I also get burned out and depressed- I think my brain just gets too tired from working at the same thing.
> >
> > > From what you say about burning up too much energy on a task, I'd have to say that I do that already. It is more due to perfectionism than anything. Sometimes with a boring task, getting it as perfect as possible gives me a feeling of accomplishment and reward.
> > >
> > > I do have a hard time multi-tasking in terms of getting things done in the physical world- I tend to seek out things I am interested in, at the expense of other "boring" things that really *need* to get done.
> > >
> > > When you say you burn up too much energy than the task requires, does that mean you become perfectionistic?
> > >
> > > Mike
> >
> >
> > Fascinating post up there Mike. I have this awful mix of bipolar, ADHD, social anxiety/perfectionism, mild neuro probs. with mild LD (CAPD/dyslexia), and they are all intertwined together. It is interesting that amongst the symptoms of ADHD, perfectionism and shyness is commonly listed. My pdoc tells me that my social anxiety/perfectionism is the result of abnormally hypercritical parents that I could never please, and I have over-generalized my responses to them to everybody else in my environment-the trick is to understand that most folks are not as *perfectionistic* as my parents and generally don't give my achievements/behaviour that much scrutiny-so why not just chill out? Of course, genetic predispositions are there making it tough for me as it was made tough for my parents.
> >
> > Enough of that-what about the multitasking thing? SSRI's enhance my ability to multitask. Stimulants tend to hinder it. I think the "locked in a groove thing" is a good place to be if you are trying to study-read-listen-comprehend something new. When it bites you in the ass is when you are doing something that you are already very familiar with. When I get hyperfocused on something I am familiar with and I am taking a stimulant..I start seeing a lot of subtle permutations that I didn't seem to be aware of that somehow need to get "worked out". This is usually work-related logical minutiae (sp?), that really requires only a glossy summary at best-and I wind up burning double the time on it that it really warrants.
> >
> > I think where the ADHD and OCD differ is the sense of "reward" that you speak about. With my ADHD problems I never seem to reach the *end* of anything. *Time* doesn't seem to have distinct start/stop points. I don't *feel* any kind of *reward* for *anything* that is task oriented. Everything tends to seem like a work in progress. If you give me too much to work on I freak out because I don't know where/what to start and what to finish first!
> >
> > I think with the OCD there is a "reward" thing like you say that gets released when the "loop" is successful. And reward is related to dopaminergic transmission. I guess it could be possible that in OCD you may be "self-rewarding" yourself for something that doesn't *deserve* a reward: counting all your crayons, i.e.. SO... do you try to snip that circuit in two electro-chemically or find a way to *not* experience the REWARD reinforcement by not *feeling* the sense of reward for something that doesn't deserve that feeling? Sorry, if this is a little improvised.
> >
> > Mitch
>
> I have the same problem getting caught up in work-related minutia that is pointless. I have to keep asking myself- is this value added? Frequently I find that it's not.
>
> As far as the question of snipping the circuit in two or stopping the feeling of reward from occuring goes... Well, I guess you mean an SSRI would help to keep the circuit from going on indefinitely, and that some sort of dopamine antagonist-type drug would stop the feeling of reward. I don't know.
>
> I think the answer is to tickle the pleasure centers enough so you don't have to look for b.s. ways of getting reward.
>
> My longest trial on an SSRI was 6 months- prozac. My recollection of it was that it didn't help my general dysphoric outlook on life- but it did seem to help my social life. On the other hand, I behaved much more compulsively and in some ways recklessly on that drug. My opinion of the whole thing was that it didn't get to the root of the problem, but made coping easier.
>
> As far as stopping the reward goes, I can't speak from a med standpoint. I don't think I'd want to try naltrexone, an opioid antagonist. Seems like that would maybe take away one's only feeling of pleasure in the world, both OCD and just normal good feeling.
>
> And to me, that's the same idea behind stopping compulsions in favor of exposing oneself to anxiety-provoking situations. It may take away the fear, but for me it doesn't tend to give me any greater enjoyment of that situation. For example, I could talk to people non-stop all day long- I would end up stressed out and would have been acting the whole time.
>
> That's why I believe in some sort of deficient pleasure system, not serotonergic, definitely not norepinephrine. But that's just my theory today. It tends to change a lot lately.
>
> In the meantime, I'm trying not to get wrapped around the axle trying to figure out my situation. Sometimes I get the feeling I'm looking for something that's not there- or at least is not available yet.
>
> Mike
Mike,Basically what I want to say is that SSRI meds are not all the same. Just curious, but have you tried others besides Prozac? What was your experience with the others? It is interesting that with OCD you are *looking* for things to *do* to feel better, whereas with ADHD symptoms I just want to *eliminate* all the unnecessary "noise" so I can *reduce* what I feel that I need to get done! A good analogy is wearing bad eyeglasses and sitting in the front row at a movie theatre and trying to figure out what is going on over here and over there, and only hearing the dialogue between the characters at the places you are looking at (which is changing rapidly). The good thing about behavioural therapy (exposure/CBT) is that it does have some *structure*. When I was taking Wellbutrin for my latest seasonal depressive thingie I got wired up and panicky on it a few times and found myself using some cognitive skills to quell the panicky feelings, and it was moderately successful.
Mitch
Posted by mike21 on April 19, 2002, at 8:52:43
In reply to Re: ADD diagnosis... OCD? » mike21, posted by Ritch on April 18, 2002, at 23:26:01
> > > > I'm glad you pointed out that they were comorbid- it had never occured to me that they could be so closely related, just because they seem at opposite ends of the psychological spectrum. But after obsessing, I mean thinking, about it I've come up with some theories (see above post).
> > >
> > > (snip from above post....) ....In the same respect, maybe a lack of attention could be due to a lack of positive feedback from certain dopaminergic pleasure centers of the brain. For example, social interactions are too variable to give a predictable reward, and the brain disengages itself. Like you, I find comfort in dealing with things in my own little contained world, like working on the computer. But after awhile, I get so locked in that groove, that getting out and interacting with others is difficult. I also get burned out and depressed- I think my brain just gets too tired from working at the same thing.
> > >
> > > > From what you say about burning up too much energy on a task, I'd have to say that I do that already. It is more due to perfectionism than anything. Sometimes with a boring task, getting it as perfect as possible gives me a feeling of accomplishment and reward.
> > > >
> > > > I do have a hard time multi-tasking in terms of getting things done in the physical world- I tend to seek out things I am interested in, at the expense of other "boring" things that really *need* to get done.
> > > >
> > > > When you say you burn up too much energy than the task requires, does that mean you become perfectionistic?
> > > >
> > > > Mike
> > >
> > >
> > > Fascinating post up there Mike. I have this awful mix of bipolar, ADHD, social anxiety/perfectionism, mild neuro probs. with mild LD (CAPD/dyslexia), and they are all intertwined together. It is interesting that amongst the symptoms of ADHD, perfectionism and shyness is commonly listed. My pdoc tells me that my social anxiety/perfectionism is the result of abnormally hypercritical parents that I could never please, and I have over-generalized my responses to them to everybody else in my environment-the trick is to understand that most folks are not as *perfectionistic* as my parents and generally don't give my achievements/behaviour that much scrutiny-so why not just chill out? Of course, genetic predispositions are there making it tough for me as it was made tough for my parents.
> > >
> > > Enough of that-what about the multitasking thing? SSRI's enhance my ability to multitask. Stimulants tend to hinder it. I think the "locked in a groove thing" is a good place to be if you are trying to study-read-listen-comprehend something new. When it bites you in the ass is when you are doing something that you are already very familiar with. When I get hyperfocused on something I am familiar with and I am taking a stimulant..I start seeing a lot of subtle permutations that I didn't seem to be aware of that somehow need to get "worked out". This is usually work-related logical minutiae (sp?), that really requires only a glossy summary at best-and I wind up burning double the time on it that it really warrants.
> > >
> > > I think where the ADHD and OCD differ is the sense of "reward" that you speak about. With my ADHD problems I never seem to reach the *end* of anything. *Time* doesn't seem to have distinct start/stop points. I don't *feel* any kind of *reward* for *anything* that is task oriented. Everything tends to seem like a work in progress. If you give me too much to work on I freak out because I don't know where/what to start and what to finish first!
> > >
> > > I think with the OCD there is a "reward" thing like you say that gets released when the "loop" is successful. And reward is related to dopaminergic transmission. I guess it could be possible that in OCD you may be "self-rewarding" yourself for something that doesn't *deserve* a reward: counting all your crayons, i.e.. SO... do you try to snip that circuit in two electro-chemically or find a way to *not* experience the REWARD reinforcement by not *feeling* the sense of reward for something that doesn't deserve that feeling? Sorry, if this is a little improvised.
> > >
> > > Mitch
> >
> > I have the same problem getting caught up in work-related minutia that is pointless. I have to keep asking myself- is this value added? Frequently I find that it's not.
> >
> > As far as the question of snipping the circuit in two or stopping the feeling of reward from occuring goes... Well, I guess you mean an SSRI would help to keep the circuit from going on indefinitely, and that some sort of dopamine antagonist-type drug would stop the feeling of reward. I don't know.
> >
> > I think the answer is to tickle the pleasure centers enough so you don't have to look for b.s. ways of getting reward.
> >
> > My longest trial on an SSRI was 6 months- prozac. My recollection of it was that it didn't help my general dysphoric outlook on life- but it did seem to help my social life. On the other hand, I behaved much more compulsively and in some ways recklessly on that drug. My opinion of the whole thing was that it didn't get to the root of the problem, but made coping easier.
> >
> > As far as stopping the reward goes, I can't speak from a med standpoint. I don't think I'd want to try naltrexone, an opioid antagonist. Seems like that would maybe take away one's only feeling of pleasure in the world, both OCD and just normal good feeling.
> >
> > And to me, that's the same idea behind stopping compulsions in favor of exposing oneself to anxiety-provoking situations. It may take away the fear, but for me it doesn't tend to give me any greater enjoyment of that situation. For example, I could talk to people non-stop all day long- I would end up stressed out and would have been acting the whole time.
> >
> > That's why I believe in some sort of deficient pleasure system, not serotonergic, definitely not norepinephrine. But that's just my theory today. It tends to change a lot lately.
> >
> > In the meantime, I'm trying not to get wrapped around the axle trying to figure out my situation. Sometimes I get the feeling I'm looking for something that's not there- or at least is not available yet.
> >
> > Mike
>
>
> Mike,
>
> Basically what I want to say is that SSRI meds are not all the same. Just curious, but have you tried others besides Prozac? What was your experience with the others? It is interesting that with OCD you are *looking* for things to *do* to feel better, whereas with ADHD symptoms I just want to *eliminate* all the unnecessary "noise" so I can *reduce* what I feel that I need to get done! A good analogy is wearing bad eyeglasses and sitting in the front row at a movie theatre and trying to figure out what is going on over here and over there, and only hearing the dialogue between the characters at the places you are looking at (which is changing rapidly). The good thing about behavioural therapy (exposure/CBT) is that it does have some *structure*. When I was taking Wellbutrin for my latest seasonal depressive thingie I got wired up and panicky on it a few times and found myself using some cognitive skills to quell the panicky feelings, and it was moderately successful.
>
> MitchHey Mitch,
Yeah, I've tried paxil, effexor, wellbutrin, and johns wort. Most of the trials (proz,pax,effex,wb) were about 6-7 years ago. I was in college, living a much different lifestyle, self-medicating to a significant degree with alcohol. I remember hoping that these meds would be the magic bullet for me, but thinking pretty quickly that they weren't doing it for me.
You could argue they deserve a better trial now, given my change of lifestyle and brain chemistry: I work a 9to5 type job, 1 or 2 drinks seems to make me depressed for a couple days, and I recently tried both effexor and wellbutrin- not strictly ssri's but the interesting thing was that I couldn't tolerate either one, whereas my past trials a few years ago seemed to give me little or no benefit at all. I tried wb for a month a few years ago and went off it cause of no benefit. I tried it for 2 weeks a few weeks ago and it made me extremely anxious (same reaction as you) and sleep deprived.
Here's my real problem with the reuptake inhibitors. I just don't buy it as a reliable form of treatment- Long term side effects seem to be unknown, their method of actually working seems to be unknown (do they slow down the firing of OR do they "prune" neurons when transmitter levels become elevated- a scary thought for me). It might be awhile before we know answers to these questions.
But for me (in my albeit *limited* exposures)it was just like I was treating a symptom and not the cause of my condition. That was awhile back, but I feel like the older I get, the more my brain adapts the best way it can, the harder it is to pinpoint what's really going on with me, what's really the deficiency here, etc. And I'm back to treating symptoms.
Anyway, maybe they deserve another shot. I guess I want to try a couple of different classes before I resort to that.
WRT to OCD/ADD- I feel like there is a movie going on in front of me, but I can't tear myself away from what's going on inside my head. Not that it's really more interesting, just that I'm enthralled by it. So I try to cope with being moderately engaged in what's in front of me while giving the rest of my attention to my thoughts.
As far as the therapy issue goes, yeah, I agree that it can provide valuable skills for coping. I was in individual therapy for 3 years and group for 1 year. It really helps me now to take an impartial look at my thoughts, and correct for any times I can get carried away with unrealistic ideas.
MIke
Posted by mike21 on April 19, 2002, at 9:14:50
In reply to the drugs 10 years from now » mike21, posted by katekite on April 18, 2002, at 22:58:35
> Yeah sometimes I feel like we are all here 10 years too early. Think of how many ssris and mood stabilizers have been developed in the last ten years, the pace has picked up really quickly. I just hope the market isn't satisfied with what's available. Since I haven't quite found something perfect for me.
>
> To update you on how ritalin is going, I think it was you who posted to me a few days back, I had to decrease it because of chest pain. boo hoo. I actually stopped it altogether but was back to pulling my hair again. And I'm up late now because I was trying not to need it to go to sleep. I will try some other stimulants and see if they like me better.
>
> kateKate,
I'm betting the drug companies have only begun to tap the market for their products. I also hope they develop better ways for diagnosing people. Maybe after 10 years of reading message boards like this one, they'll figure things out better ; )
Is chest pain a common side effect? Did your heart feel racy on it? Interesting that a stimulant helps you sleep. That's like when sedatives like valium make me more alert in social interactions. They seem like paradoxes.
I'm definitely suggesting this class of meds when I see my new doctor next week. I'll be interested to follow your trials of other stims. Please keep us posted. (Maybe you could follow-up to this thread, so I will be notified?)
Best of luck with your meds,
Mike
Posted by mike21 on April 20, 2002, at 9:36:50
In reply to Re: ADD diagnosis... OCD?, posted by mike21 on April 19, 2002, at 8:52:43
> > > > > I'm glad you pointed out that they were comorbid- it had never occured to me that they could be so closely related, just because they seem at opposite ends of the psychological spectrum. But after obsessing, I mean thinking, about it I've come up with some theories (see above post).
> > > >
> > > > (snip from above post....) ....In the same respect, maybe a lack of attention could be due to a lack of positive feedback from certain dopaminergic pleasure centers of the brain. For example, social interactions are too variable to give a predictable reward, and the brain disengages itself. Like you, I find comfort in dealing with things in my own little contained world, like working on the computer. But after awhile, I get so locked in that groove, that getting out and interacting with others is difficult. I also get burned out and depressed- I think my brain just gets too tired from working at the same thing.
> > > >
> > > > > From what you say about burning up too much energy on a task, I'd have to say that I do that already. It is more due to perfectionism than anything. Sometimes with a boring task, getting it as perfect as possible gives me a feeling of accomplishment and reward.
> > > > >
> > > > > I do have a hard time multi-tasking in terms of getting things done in the physical world- I tend to seek out things I am interested in, at the expense of other "boring" things that really *need* to get done.
> > > > >
> > > > > When you say you burn up too much energy than the task requires, does that mean you become perfectionistic?
> > > > >
> > > > > Mike
> > > >
> > > >
> > > > Fascinating post up there Mike. I have this awful mix of bipolar, ADHD, social anxiety/perfectionism, mild neuro probs. with mild LD (CAPD/dyslexia), and they are all intertwined together. It is interesting that amongst the symptoms of ADHD, perfectionism and shyness is commonly listed. My pdoc tells me that my social anxiety/perfectionism is the result of abnormally hypercritical parents that I could never please, and I have over-generalized my responses to them to everybody else in my environment-the trick is to understand that most folks are not as *perfectionistic* as my parents and generally don't give my achievements/behaviour that much scrutiny-so why not just chill out? Of course, genetic predispositions are there making it tough for me as it was made tough for my parents.
> > > >
> > > > Enough of that-what about the multitasking thing? SSRI's enhance my ability to multitask. Stimulants tend to hinder it. I think the "locked in a groove thing" is a good place to be if you are trying to study-read-listen-comprehend something new. When it bites you in the ass is when you are doing something that you are already very familiar with. When I get hyperfocused on something I am familiar with and I am taking a stimulant..I start seeing a lot of subtle permutations that I didn't seem to be aware of that somehow need to get "worked out". This is usually work-related logical minutiae (sp?), that really requires only a glossy summary at best-and I wind up burning double the time on it that it really warrants.
> > > >
> > > > I think where the ADHD and OCD differ is the sense of "reward" that you speak about. With my ADHD problems I never seem to reach the *end* of anything. *Time* doesn't seem to have distinct start/stop points. I don't *feel* any kind of *reward* for *anything* that is task oriented. Everything tends to seem like a work in progress. If you give me too much to work on I freak out because I don't know where/what to start and what to finish first!
> > > >
> > > > I think with the OCD there is a "reward" thing like you say that gets released when the "loop" is successful. And reward is related to dopaminergic transmission. I guess it could be possible that in OCD you may be "self-rewarding" yourself for something that doesn't *deserve* a reward: counting all your crayons, i.e.. SO... do you try to snip that circuit in two electro-chemically or find a way to *not* experience the REWARD reinforcement by not *feeling* the sense of reward for something that doesn't deserve that feeling? Sorry, if this is a little improvised.
> > > >
> > > > Mitch
> > >
> > > I have the same problem getting caught up in work-related minutia that is pointless. I have to keep asking myself- is this value added? Frequently I find that it's not.
> > >
> > > As far as the question of snipping the circuit in two or stopping the feeling of reward from occuring goes... Well, I guess you mean an SSRI would help to keep the circuit from going on indefinitely, and that some sort of dopamine antagonist-type drug would stop the feeling of reward. I don't know.
> > >
> > > I think the answer is to tickle the pleasure centers enough so you don't have to look for b.s. ways of getting reward.
> > >
> > > My longest trial on an SSRI was 6 months- prozac. My recollection of it was that it didn't help my general dysphoric outlook on life- but it did seem to help my social life. On the other hand, I behaved much more compulsively and in some ways recklessly on that drug. My opinion of the whole thing was that it didn't get to the root of the problem, but made coping easier.
> > >
> > > As far as stopping the reward goes, I can't speak from a med standpoint. I don't think I'd want to try naltrexone, an opioid antagonist. Seems like that would maybe take away one's only feeling of pleasure in the world, both OCD and just normal good feeling.
> > >
> > > And to me, that's the same idea behind stopping compulsions in favor of exposing oneself to anxiety-provoking situations. It may take away the fear, but for me it doesn't tend to give me any greater enjoyment of that situation. For example, I could talk to people non-stop all day long- I would end up stressed out and would have been acting the whole time.
> > >
> > > That's why I believe in some sort of deficient pleasure system, not serotonergic, definitely not norepinephrine. But that's just my theory today. It tends to change a lot lately.
> > >
> > > In the meantime, I'm trying not to get wrapped around the axle trying to figure out my situation. Sometimes I get the feeling I'm looking for something that's not there- or at least is not available yet.
> > >
> > > Mike
> >
> >
> > Mike,
> >
> > Basically what I want to say is that SSRI meds are not all the same. Just curious, but have you tried others besides Prozac? What was your experience with the others? It is interesting that with OCD you are *looking* for things to *do* to feel better, whereas with ADHD symptoms I just want to *eliminate* all the unnecessary "noise" so I can *reduce* what I feel that I need to get done! A good analogy is wearing bad eyeglasses and sitting in the front row at a movie theatre and trying to figure out what is going on over here and over there, and only hearing the dialogue between the characters at the places you are looking at (which is changing rapidly). The good thing about behavioural therapy (exposure/CBT) is that it does have some *structure*. When I was taking Wellbutrin for my latest seasonal depressive thingie I got wired up and panicky on it a few times and found myself using some cognitive skills to quell the panicky feelings, and it was moderately successful.
> >
> > Mitch
>
> Hey Mitch,
>
> Yeah, I've tried paxil, effexor, wellbutrin, and johns wort. Most of the trials (proz,pax,effex,wb) were about 6-7 years ago. I was in college, living a much different lifestyle, self-medicating to a significant degree with alcohol. I remember hoping that these meds would be the magic bullet for me, but thinking pretty quickly that they weren't doing it for me.
>
> You could argue they deserve a better trial now, given my change of lifestyle and brain chemistry: I work a 9to5 type job, 1 or 2 drinks seems to make me depressed for a couple days, and I recently tried both effexor and wellbutrin- not strictly ssri's but the interesting thing was that I couldn't tolerate either one, whereas my past trials a few years ago seemed to give me little or no benefit at all. I tried wb for a month a few years ago and went off it cause of no benefit. I tried it for 2 weeks a few weeks ago and it made me extremely anxious (same reaction as you) and sleep deprived.
>
> Here's my real problem with the reuptake inhibitors. I just don't buy it as a reliable form of treatment- Long term side effects seem to be unknown, their method of actually working seems to be unknown (do they slow down the firing of OR do they "prune" neurons when transmitter levels become elevated- a scary thought for me). It might be awhile before we know answers to these questions.
>
> But for me (in my albeit *limited* exposures)it was just like I was treating a symptom and not the cause of my condition. That was awhile back, but I feel like the older I get, the more my brain adapts the best way it can, the harder it is to pinpoint what's really going on with me, what's really the deficiency here, etc. And I'm back to treating symptoms.
>
> Anyway, maybe they deserve another shot. I guess I want to try a couple of different classes before I resort to that.
>
> WRT to OCD/ADD- I feel like there is a movie going on in front of me, but I can't tear myself away from what's going on inside my head. Not that it's really more interesting, just that I'm enthralled by it. So I try to cope with being moderately engaged in what's in front of me while giving the rest of my attention to my thoughts.
>
> As far as the therapy issue goes, yeah, I agree that it can provide valuable skills for coping. I was in individual therapy for 3 years and group for 1 year. It really helps me now to take an impartial look at my thoughts, and correct for any times I can get carried away with unrealistic ideas.
>
> MIkeOh yeah, Mitch, I guess I should include a lot of other meds in that class of "method of action not well understood and long-term effects unknown." I just think in the current ssri-craze, some other possibilities for me have been overlooked. These others have their own risks, and I guess the potential for benefit is starting to outweigh the risk.
Anyway, thanks for your descriptions on what it's like living with ADD. You've given me a lot to think about.
Good luck with your meds and take care,
Mike
Posted by IsoM on April 20, 2002, at 11:34:01
In reply to Re: ADD diagnosis... OCD? » mike21, posted by Ritch on April 18, 2002, at 23:26:01
Mitch, when you mentioned that you wanted to eliminate all the "noise", that's how I describe what I see (plus hear - I think of it as sensory overload). So I'm wondering if you fit Irlen syndrome too. I was tested for it by a certified tester & rated 'very high'. Perhaps you have it too. It's considered a real (not New Age) condition by the American govenment as they're funding money for more research into this condition.
http://www.readingandwriting.ab.ca/judypool/irlen.htm
The low contrast version on the above home page is SO much easier on my eyes. I didn't buy a bonafide pair of lenses (testing will indicate which colour works best for you) but still the sun glasses (not really sun glasses but those 'trendy' coloured nonprescription ones you see about) I bought are more soothing than regular sight.
Now, if there was only something that I could use to elminate all the external (& internal) background noises I hear that interfere with hearing & concentration.
I seriously think (from what I've read in all the science journals over many years) that the large & constant amount of DDT & other pesticides that I was exposed to in utero & through my growing years has contributed strongly to my ADD & sensory sensitivity. It seems to be something that runs in my family, but my sons & I seem far more affected than my parents & relatives. My sons are probably affected from the pesticides being passed on in the fatty content of my milk. I nursed them for a long time each.
Posted by Ritch on April 20, 2002, at 16:49:13
In reply to ADD, Irlen Syndrome, and sensory sensitivity too? » Ritch, posted by IsoM on April 20, 2002, at 11:34:01
> Mitch, when you mentioned that you wanted to eliminate all the "noise", that's how I describe what I see (plus hear - I think of it as sensory overload). So I'm wondering if you fit Irlen syndrome too. I was tested for it by a certified tester & rated 'very high'. Perhaps you have it too. It's considered a real (not New Age) condition by the American govenment as they're funding money for more research into this condition.
>
> http://www.readingandwriting.ab.ca/judypool/irlen.htm
>
> The low contrast version on the above home page is SO much easier on my eyes. I didn't buy a bonafide pair of lenses (testing will indicate which colour works best for you) but still the sun glasses (not really sun glasses but those 'trendy' coloured nonprescription ones you see about) I bought are more soothing than regular sight.
>
> Now, if there was only something that I could use to elminate all the external (& internal) background noises I hear that interfere with hearing & concentration.
>
> I seriously think (from what I've read in all the science journals over many years) that the large & constant amount of DDT & other pesticides that I was exposed to in utero & through my growing years has contributed strongly to my ADD & sensory sensitivity. It seems to be something that runs in my family, but my sons & I seem far more affected than my parents & relatives. My sons are probably affected from the pesticides being passed on in the fatty content of my milk. I nursed them for a long time each.
Hi IsoM,Thanks for that link. I don't think that is my trouble though. I am beginning to think it isn't even ADHD really. I think it is a combo of bipolar *and* an auditory processing disorder with some dyslexia. Here are some links that I found quick (I haven't read all of it-there is just too much). The first link has to do with CAPD.
http://216.239.35.100/search?q=cache:xSTmtUiMzwsC:journals.asha.org/1059-0089/v5n2/041.pdf+Central+Auditory+Processing+temporal+lobes&hl=en
http://nba19.med.uth.tmc.edu/faculty/faculty.htm
http://thalamus.wustl.edu/course/
I was surprised to find out that dyslexia is a phonemic decoding problem not necessarily a problem with flipped letters/numbers and such. Different meds affect my ability to understand what people are saying to a great degree. My attentional deficits are the most pronounced when it comes to listening to someone else talk and needing to follow along with what they are saying. I do have trouble with reading, too, but nothing like human speech. The worst case scenario would be someone telling me directions on how to get somewhere or how to do something that I have never done before. I am always asking questions over and over and have awful problems keeping all of it in order. Central auditory processing is done by the temporal lobes and that is where some of the weird phenomena I experience seems to exist. When I tried dexedrine back over a few weeks I noticed that when the medication was peaking I would smell something burning for a few moments here and there. I already have music playing in there off and on sometimes quite intrusively. Neurontin and Depakote quiet it down. Of course SSRI tends to intensify it. With Prozac I could read something that someone else had written (and if I knew the author) I could hear their voice in my head reading it as clear as day. (I could read "aloud" in my head in the voice of the writer if I knew that person well). I chalk it all up to just odd wiring-there seems to be a lot of "jumpers" that have been created to "work around" the problems (whatever they are). I can do fantastic at tasks I understand well, and I can listen to people I know well fairly OK. When someone I haven't heard speak before that is when I can get really lost-Hmmm.. maybe that has something to do with the social anxiety?? OF course, I do nothing but create more questions rather than answers.Mitch
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