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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by sudhira on August 26, 2002, at 17:40:46
hello,
My prescriber makes me feel like using a stimulant to improve my quality of life is "cheating"--my current med combo is:
celexa 40mg
lamictal 50mg
anafranil 50mg
ritalin 5mg 2x's p dayWe recently added the ritalin at my request (it was like pulling teeth) in order to address my symptoms of apathy and lethargy. it really seems to be the missing ingredient. I have recurrent major depression--the atypical sort--as well as symptoms of inattentive add and social anxiety.
My prescriber warns that it's risky to use stims long term and that research has shown that it is not useful for apathy or lethargy. From what I've seen and read this is not always true, but when I offered my own research she said "I'm the doctor here".
What do you think about stimulant augmentation in the short and long term? And what do you think of docs with God complexes?
Posted by JonW on August 26, 2002, at 17:46:08
In reply to doctors and stimulants, posted by sudhira on August 26, 2002, at 17:40:46
Posted by wendy b. on August 26, 2002, at 21:21:13
In reply to doctors and stimulants, posted by sudhira on August 26, 2002, at 17:40:46
My nurse-practioner/therapist is also suspicious of me wanting stims. What is the basis for this? She seems to be implying that the apathy and lethargy are failings on my part, and that I should just buck up and get off my lazy butt. Or at least that's how I'm reading it, and I do admit: I'm prone to exaggeration and sensitive to criticism (bipolar stuff).
Anyway, just wanted to commiserate and say I know what you're going through...
Best,
Wendy
Posted by fachad on August 26, 2002, at 21:35:24
In reply to doctors and stimulants, posted by sudhira on August 26, 2002, at 17:40:46
I'm feeling too lazy to type it again, but take a look at these prior posts, which discuss the issues of stimulant efficacy and the weird catch22 involved with asking for them:
Ritalin is not marketed as AD (long detailed expl)
http://www.dr-bob.org/babble/20020307/msgs/97442.html
The Controlled Substance Catch-22
http://www.dr-bob.org/babble/20020416/msgs/103521.html
Re: Dexedrine Tolerance? A Theory
http://www.dr-bob.org/babble/20020215/msgs/94906.html
Ritalin for SSRI Induced Apathy Anergia
http://www.dr-bob.org/babble/20020307/msgs/97130.html
> hello,
>
> My prescriber makes me feel like using a stimulant to improve my quality of life is "cheating"--my current med combo is:
>
> celexa 40mg
> lamictal 50mg
> anafranil 50mg
> ritalin 5mg 2x's p day
>
> We recently added the ritalin at my request (it was like pulling teeth) in order to address my symptoms of apathy and lethargy. it really seems to be the missing ingredient. I have recurrent major depression--the atypical sort--as well as symptoms of inattentive add and social anxiety.
>
> My prescriber warns that it's risky to use stims long term and that research has shown that it is not useful for apathy or lethargy. From what I've seen and read this is not always true, but when I offered my own research she said "I'm the doctor here".
>
> What do you think about stimulant augmentation in the short and long term? And what do you think of docs with God complexes?
>
>
>
>
>
Posted by Jerrympls on August 26, 2002, at 22:02:26
In reply to Find a new doc... (nm), posted by JonW on August 26, 2002, at 17:46:08
I say the same: Find a new doc NOW! Don't even get me started about Dr.'s and God complexes and their" I'm the doctor - you are the stupid uninformed patient" attitudes. Run far from this beast of a person and find a doc who doesn't sit on a throne or worship dusty old textbooks.
You have the power
Posted by awake at last on August 27, 2002, at 9:42:46
In reply to doctors and stimulants, posted by sudhira on August 26, 2002, at 17:40:46
I'm a true believer in finding one's true illness and curing that when possible, and not using meds to just cover the symptoms, if a root problems exists that isn't treated, it will only get worse and more meds will be required over time. But sometimes there are no cures and treating the symptoms is all that is available.
I would be curious as to why this doctor doesn't want to give you stimulants, especially if you've been diagnosed with ADD. ADD can definitely be causing the apathy and lethargy. If you doctor is holding back on these meds in order to allow for further dianosing - that's one thing. But if your doctor is making you feel as if you are just being lazy or that this is all in your head - it's time to move on to another doc.
I can give you a suggestion of another med to try - especially if you stay with this doctor. If you are looking for a med to help increase motivation and alertness - request to try Provigil (Modafinil) instead of the Ritalin. Provigil is the new replacement drug for Ritalin and other stimulants in the treatment of Narcolepsy. They are currently testing it for ADD with positive results so far. This may give you the lift you need without the worry (or your Dr's worry) of stimulant side-effects.
*************************************************
> hello,
>
> My prescriber makes me feel like using a stimulant to improve my quality of life is "cheating"--my current med combo is:
>
> celexa 40mg
> lamictal 50mg
> anafranil 50mg
> ritalin 5mg 2x's p day
>
> We recently added the ritalin at my request (it was like pulling teeth) in order to address my symptoms of apathy and lethargy. it really seems to be the missing ingredient. I have recurrent major depression--the atypical sort--as well as symptoms of inattentive add and social anxiety.
>
> My prescriber warns that it's risky to use stims long term and that research has shown that it is not useful for apathy or lethargy. From what I've seen and read this is not always true, but when I offered my own research she said "I'm the doctor here".
>
> What do you think about stimulant augmentation in the short and long term? And what do you think of docs with God complexes?
>
>
>
>
>
Posted by fachad on August 27, 2002, at 14:30:46
In reply to Re: doctors and stimulants, posted by awake at last on August 27, 2002, at 9:42:46
I don't know for sure, but I'd bet that this person's doc is not holding out because he thinks he is lazy, or it's all in his head.
He's holding out because stimulants are Schedule II Controlled Substances, and asking for them could be construed as "drug seeking behavior".
Docs are specifically trained not to give stimulants for fatigue or apathy, and they are under pressure from the DEA not to over prescribe controlled substances or prescribe them "off label".
I really hate this situation, but it is very common with all controlled substances (e.g., stimulants, benzodiazepines, narcotic pain killers, etc.)
People with legimate need get excluded from treatment to avoid prescribing for a potential abuser.
See this prior post on this situation:
The Controlled Substance Catch-22
http://www.dr-bob.org/babble/20020416/msgs/103521.html
-fachad
> I'm a true believer in finding one's true illness and curing that when possible, and not using meds to just cover the symptoms, if a root problems exists that isn't treated, it will only get worse and more meds will be required over time. But sometimes there are no cures and treating the symptoms is all that is available.
> I would be curious as to why this doctor doesn't want to give you stimulants, especially if you've been diagnosed with ADD. ADD can definitely be causing the apathy and lethargy. If you doctor is holding back on these meds in order to allow for further dianosing - that's one thing. But if your doctor is making you feel as if you are just being lazy or that this is all in your head - it's time to move on to another doc.
> I can give you a suggestion of another med to try - especially if you stay with this doctor. If you are looking for a med to help increase motivation and alertness - request to try Provigil (Modafinil) instead of the Ritalin. Provigil is the new replacement drug for Ritalin and other stimulants in the treatment of Narcolepsy. They are currently testing it for ADD with positive results so far. This may give you the lift you need without the worry (or your Dr's worry) of stimulant side-effects.
>
>
>
> *************************************************
>
>
> > hello,
> >
> > My prescriber makes me feel like using a stimulant to improve my quality of life is "cheating"--my current med combo is:
> >
> > celexa 40mg
> > lamictal 50mg
> > anafranil 50mg
> > ritalin 5mg 2x's p day
> >
> > We recently added the ritalin at my request (it was like pulling teeth) in order to address my symptoms of apathy and lethargy. it really seems to be the missing ingredient. I have recurrent major depression--the atypical sort--as well as symptoms of inattentive add and social anxiety.
> >
> > My prescriber warns that it's risky to use stims long term and that research has shown that it is not useful for apathy or lethargy. From what I've seen and read this is not always true, but when I offered my own research she said "I'm the doctor here".
> >
> > What do you think about stimulant augmentation in the short and long term? And what do you think of docs with God complexes?
> >
> >
> >
> >
> >
>
>
Posted by sudhira on August 27, 2002, at 17:44:11
In reply to Re: doctors and stimulants » awake at last, posted by fachad on August 27, 2002, at 14:30:46
fachad,
First off, thank you for the information describing the dreaded catch-22, I relate completely. I've had such anxiety these past few months once I decided I wanted to ask for a prescription for a pstim. I knew it would be a tough discussion. I also felt sure that in my particular case it was a reasonable and logical next step.
Years ago I experienced a complete remission while on Parnate but it lost its effectiveness so I've been an antidepressant guinea pig this past year--which I know many of you can relate to. It's been hellish and surreal.
I experienced some mood improvement with the combo of celexa, lamictal, and anafranil however I was also sleeping 12-14 hours and had little desire to do much besides watch tv. Wellbutrin and Provigil were surprisingly ineffective. It just became obvious to me that a pstim may prove helpful. I've read that stimulants are often the next step if activating AD's fail.
It might have been easier to get a prescription if I had officially been diagnosed with ADD but this doctor has decided I don't have it based on the fact that I did okay in school. I sense she is suspicious of anyone who wants an ADD eval because drug seekers may use it to get stimulants. Anyhow, this is the feeling I got from her--that since I was curious about possible ADD I must want to get high, even though my history proves otherwise.
Ultimately, I got the prescription for ritalin but what a pain trying.
Oh, that vicious catch-22..
Posted by sudhira on August 27, 2002, at 17:53:13
In reply to Re: Find a new doc... » JonW, posted by Jerrympls on August 26, 2002, at 22:02:26
Thank you for the encouragement. I definitely need to remind myself that I "have the power". Sometimes I forget, especially when depressed. I'm pleased to say I have an appointment with someone new this week. Yes! Life is too short to endure bad care when there are other doctors to choose from.
Posted by IsoM on August 27, 2002, at 18:48:01
In reply to Re: doctors and stimulants, posted by sudhira on August 27, 2002, at 17:44:11
I'm curious if you've used Ritalin before & if you haven't, what you think of its effects, with this new prescription, if you don't mind saying.
Doctors have it constantly drummed into them 'don't prescribe stims unless as a last resort & only with all sorts of safeguards in the way'. One doctor I had before he moved was given nothing but trouble from the hospital board & the 'good old boys club' of doctors that controlled it due to a number of factors. (He was E. Indian in an area mostly comprised of white doctors, many from S. Africa.) For every controlled medication he prescribed, they raked him over the coals for it. He was an excellent doctor & one with a great deal of empathy & sympathy for the poor in his area, but others made life hell for him till he moved out.
Too many doctors do think of stims as ready to be abused by anybody that ever uses them. I'm curious as to why your doctor gave you Ritalin as opposed to another stim. I've heard that Ritalin has a greater potential for abuse as it can be mixed with Talwin for a street high. Don't know how true that is.
Posted by sudhira on August 28, 2002, at 1:59:40
In reply to Re: Ritalin prescription... » sudhira, posted by IsoM on August 27, 2002, at 18:48:01
Hi IsoM,
Thanks for writing. I have used Ritalin before. In Washington last year it was prescribed to address the symptoms of ADD that accompany my depression. It helped me to focus a bit and tend to tasks that I'd avoided but I was also deeply depressed and it did little to help my mood on its own.
I have a different doc now that I've moved to Oregon, a rather anti-stimulant doc. I talked her into trying a stimulant as an augment after wellbutrin and provigil failed to help my symptoms of fatigue and apathy.
Currently I am using ritalin (for 2 weeks now) to augment celexa, lamictal and anafranil. It helps to get me out of bed and do more than watch t.v. I'm a little more productive and a little less fearful socially. However, when it wears off after about 3 hours I feel soooo tired. others on this board have experienced this with ritalin.
It's interesting that you have heard ritalin has the most potential for abuse. My prescriber told me just the opposite. I had wanted to try adderall and she said something about adderall being the most amphetamine-like and therefore the more risky option. She seems to pull "facts" out of the air though.
In any case the ups and downs in energy I experience on ritalin are really terrible. If there is another better option it makes sense to try and find it.
This is the end of the thread.
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