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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by g_g_g_unit on January 10, 2010, at 0:47:15
i've been doing my best to commit to therapy lately, and have been astounded to discover how much of a deblitating effect perfectionism has had on my life - to the point that's it's pretty much made me rethink my entire approach to medication. up until now, it seems like i have been trying to use medication as agents to meet perfectionistic requirements, grown despondent when i 'sense' that they've interfered with my functioning somehow, and then quickly abanonded them. so me and my therapist have agreed that until i can let go of that (self-destructive) intuition, i will never really make any progress. sometimes bullying yourself can help to an extent - i know it helped me push myself creatively, socially, academically etc., but the problem is you can destroy yourself trying to maintain those standards permanently. i can cry thinking about how much time, money and components of my sanity i've wasted unnecessarily.
what's most difficult is trying to ascertain why the perfectionism was aroused in the first place; in my case, the perfectionism has graduated to full-borne OCD - no doubt about that - but the underlying condition feels more vague.
i was wondering if anyone can maybe quantify whether any of this sounds familiar, and might be more an outgrowth of OCD or ADD. prior to the OCD fully taking root at around 18, in high school i demonstrated the following problems:
- great ease in 'hands on' subjects like mathematics, where my attention was constantly occupied. i was excellent with detail, but often unable to see the 'bigger picture' - for example, i could memorize large passages of information with ease, but often failed to intuit the core ideas behind them.
- feeling extremely lost when instructions on how to perform a task weren't clearly delineated. if i didn't know what was 'wanted from me', i found it hard to take initiative and act. this also exists in concert with a certain cognitive inflexbility, where i felt like once i had learned how to do something, it was frustrating to find it could be done other ways. it's really hard to tell if that lack of initiative/free thinking is just a confidence issue, or the result of something else.
unfortunately, i've become so reliant on that perfectionistic 'inner voice', that i often feel lost acting without it.
my therapist and i have tried to work out more logical goals for me to attempt to undertake. my family is moving to a new country soon, which means that i need to prioritize. at this point, my former line of work as a freelance writer is causing too much grief (due to too much freedom afforded) for me to really pursue it as a realistic career. so in that sense, i think it might be better to return to university in order to undertake an honor's/masters in an area that might allow me to get a normal job. i also suffer from pretty crippling social anxiety, so feel like that side of things needs to be taken care of.
SSRI's i guess helped by suppressing the need to perform things perfectly, but they don't indirectly improve concentration as a result, and also make socializing even more difficult. the exception might be prozac, which helped brain fog at first, but which i was taken off due to initial insomnia.
Nardil i liked a lot. unfortunately, i kept upping the dose in order to pursue the euphoria. at 75mg+, i couldn't deal with the cognitive and neurological side-effects (RLS, leg-twitching, etc.) which i get on all SSRI's. my anxiety also got a lot worse. i've been thinking maybe a lower dose (60mg) of Nardil might be suitable. i know it can effect short-term memory though. is this more of a temporary or last side-effect? and as for the neurological (and memory) problems, could something like memantine, which might increase dopamine concentrations? improve the problem?
finally, my doctor has arranged for a Dexedrine script, which i get in two weeks. i can see how in the hands of a perfectionist, it might be a disaster, but i guess if there is an ADD component at work, i'll know because hopefully it might correct an underlying imbalance.
so, Nardil seems to cover most of my bases, and thereotically memantine seems like it might be a good augmentation for brain fog issues etc.?
otherwise, i wonder about a more targeted approach like Prozac +dex or an NRI, though am a little concerned about long-term SRI use. all i know is that this time if i find something that works, i really need to try sticking with it, so i'm doing my best to think this through semi-logically.
thanks for anyone who had the patience to read this.
Posted by mtdewcmu on January 10, 2010, at 11:12:00
In reply to ADD/OCD+perfectionism+med choices-plz help(long), posted by g_g_g_unit on January 10, 2010, at 0:47:15
> i've been doing my best to commit to therapy lately, and have been astounded to discover how much of a deblitating effect perfectionism has had on my life - to the point that's it's pretty much made me rethink my entire approach to medication.
If therapy is helping you, then you ought to stick with it. That is, unless the cost is more than you can afford. (There's no way I could afford it.)
>
> what's most difficult is trying to ascertain why the perfectionism was aroused in the first place; in my case, the perfectionism has graduated to full-borne OCD - no doubt about that - but the underlying condition feels more vague.
>
> i was wondering if anyone can maybe quantify whether any of this sounds familiar, and might be more an outgrowth of OCD or ADD. prior to the OCD fully taking root at around 18, in high school i demonstrated the following problems:
>
> - great ease in 'hands on' subjects like mathematics, where my attention was constantly occupied. i was excellent with detail, but often unable to see the 'bigger picture' - for example, i could memorize large passages of information with ease, but often failed to intuit the core ideas behind them.
>
> - feeling extremely lost when instructions on how to perform a task weren't clearly delineated. if i didn't know what was 'wanted from me', i found it hard to take initiative and act.I have had this problem at my jobs. I have come to see it as a combination of an inability to concentrate fully on a task due to anxiety and depression, and the lack of energy and enthusiasm for the task due to depression. I used to be employed as a computer programmer, but it required too much concentration. I ended up having to quit, because it was clear that the issues weren't going away.
>
> unfortunately, i've become so reliant on that perfectionistic 'inner voice', that i often feel lost acting without it.I think I know what you mean. In myself, I see this as being preoccupied with my inner state due to depression. When I am less depressed, I can focus on something outside myself.
>
> my therapist and i have tried to work out more logical goals for me to attempt to undertake. my family is moving to a new country soon, which means that i need to prioritize. at this point, my former line of work as a freelance writer is causing too much grief (due to too much freedom afforded) for me to really pursue it as a realistic career. so in that sense, i think it might be better to return to university in order to undertake an honor's/masters in an area that might allow me to get a normal job. i also suffer from pretty crippling social anxiety, so feel like that side of things needs to be taken care of.
>You may want to look for something that requires less decision-making and personal initiative, unless you are hopeful that you can conquer your anxiety and depression.
> SSRI's i guess helped by suppressing the need to perform things perfectly, but they don't indirectly improve concentration as a result, and also make socializing even more difficult. the exception might be prozac, which helped brain fog at first, but which i was taken off due to initial insomnia.
>
> Nardil i liked a lot. unfortunately, i kept upping the dose in order to pursue the euphoria. at 75mg+, i couldn't deal with the cognitive and neurological side-effects (RLS, leg-twitching, etc.) which i get on all SSRI's. my anxiety also got a lot worse. i've been thinking maybe a lower dose (60mg) of Nardil might be suitable. i know it can effect short-term memory though. is this more of a temporary or last side-effect? and as for the neurological (and memory) problems, could something like memantine, which might increase dopamine concentrations? improve the problem?
>
> finally, my doctor has arranged for a Dexedrine script, which i get in two weeks. i can see how in the hands of a perfectionist, it might be a disaster, but i guess if there is an ADD component at work, i'll know because hopefully it might correct an underlying imbalance.
>
> so, Nardil seems to cover most of my bases, and thereotically memantine seems like it might be a good augmentation for brain fog issues etc.?
>
> otherwise, i wonder about a more targeted approach like Prozac +dex or an NRI, though am a little concerned about long-term SRI use. all i know is that this time if i find something that works, i really need to try sticking with it, so i'm doing my best to think this through semi-logically.
>
> thanks for anyone who had the patience to read this.
>
>
I think you are trying to slice up your problem into excessively small pieces and trying to treat each one individually. I think that you could re-envision all of your symptoms as manifestations of depression and anxiety, and treat them all with antidepressants. From what you have written on this board, I don't think you have given SSRIs a fair chance to work.
Posted by Phillipa on January 10, 2010, at 12:15:16
In reply to Re: ADD/OCD+perfectionism+med choices-plz help(long), posted by mtdewcmu on January 10, 2010, at 11:12:00
Didn't you say you could get lost in a project as you were fully occupied if that's the case I'd doubt ADD. You seem to have a tendancy to do what I too do and that is to want to be perfect in an unperfect world with unperfect people. I know the feeling. And it definitely hard. Yes I think some is a form of OCD as the ruminating is Ocd to me. I agree if you have a therapist that's good work with them. I also agree that anxiety especially is something to try to control. I say try as I try hard even with meds and don't succeed except to wear myself emotionally out. Worry is my definition. Sounds benign but it's not. I also know when working I was fine as occupied. Phillipa
Posted by g_g_g_unit on January 10, 2010, at 16:30:43
In reply to Re: ADD/OCD+perfectionism+med choices-plz help(long), posted by mtdewcmu on January 10, 2010, at 11:12:00
>
> If therapy is helping you, then you ought to stick with it. That is, unless the cost is more than you can afford. (There's no way I could afford it.)sorry to hear that. i wouldn't normally be able to afford it, but i receive assistance from the government. i also use a service which has a sliding-scale arrangement.
>
> >
> > what's most difficult is trying to ascertain why the perfectionism was aroused in the first place; in my case, the perfectionism has graduated to full-borne OCD - no doubt about that - but the underlying condition feels more vague.
> >
> > i was wondering if anyone can maybe quantify whether any of this sounds familiar, and might be more an outgrowth of OCD or ADD. prior to the OCD fully taking root at around 18, in high school i demonstrated the following problems:
> >
> > - great ease in 'hands on' subjects like mathematics, where my attention was constantly occupied. i was excellent with detail, but often unable to see the 'bigger picture' - for example, i could memorize large passages of information with ease, but often failed to intuit the core ideas behind them.
> >
> > - feeling extremely lost when instructions on how to perform a task weren't clearly delineated. if i didn't know what was 'wanted from me', i found it hard to take initiative and act.
>
> I have had this problem at my jobs. I have come to see it as a combination of an inability to concentrate fully on a task due to anxiety and depression, and the lack of energy and enthusiasm for the task due to depression. I used to be employed as a computer programmer, but it required too much concentration. I ended up having to quit, because it was clear that the issues weren't going away.
these problems existed prior to the onset of any anxiety/depression issues; they were occurring in high school, so i consider them innate problems.
>
> >
> > unfortunately, i've become so reliant on that perfectionistic 'inner voice', that i often feel lost acting without it.
>
> I think I know what you mean. In myself, I see this as being preoccupied with my inner state due to depression. When I am less depressed, I can focus on something outside myself.i've always felt that way, though - the feeling that i'm constantly monitoring myself in everything i do. certain medications erase that critical voice (for the first time in my life), and disinhibit me to an extent, which can be really disorientating
>
>
> >
> > my therapist and i have tried to work out more logical goals for me to attempt to undertake. my family is moving to a new country soon, which means that i need to prioritize. at this point, my former line of work as a freelance writer is causing too much grief (due to too much freedom afforded) for me to really pursue it as a realistic career. so in that sense, i think it might be better to return to university in order to undertake an honor's/masters in an area that might allow me to get a normal job. i also suffer from pretty crippling social anxiety, so feel like that side of things needs to be taken care of.
> >
>
> You may want to look for something that requires less decision-making and personal initiative, unless you are hopeful that you can conquer your anxiety and depression.i suffer from dysthymia with bouts of atypical depression, though i feel like the depression etc. takes a backseat to OCD overall. i don't think getting the depression under control should be too difficult overall; it's a matter of whether i can stick with a treatment. and i'm still relatively young, so i'd like to capitalize on what i have now.
>
>> >
> >
>
>
> I think you are trying to slice up your problem into excessively small pieces and trying to treat each one individually. I think that you could re-envision all of your symptoms as manifestations of depression and anxiety, and treat them all with antidepressants. From what you have written on this board, I don't think you have given SSRIs a fair chance to work.social anxiety is a concrete problem for me, and something that i feel requires attention. i did give Luvox a full 8-week trial, and found myself more depressed than i began with. it made social interaction incredibly difficult for me. Prozac seemed better, and i don't really understand why i was taken off it - doesn't the initial insomnia pass?
Posted by floatingbridge on January 10, 2010, at 18:07:48
In reply to Re: ADD/OCD+perfectionism+med choices-plz help(lon, posted by g_g_g_unit on January 10, 2010, at 16:30:43
Oh dear, ggg. Well, I think the insight regarding perfection is vital however upsetting. Therapy sounds good for you.
Dexadrine sounds like a sensible trial. I'm not sure why you say it could be a disaster in the hands of a perfectionist. Hope it provides you with some relief.
I'll be following this thread.
fb (dx'd w/ add and crippling perfectionism and social anxiety--the dexadrine works for the social anxiety for me!)
Posted by mtdewcmu on January 10, 2010, at 19:30:15
In reply to Re: ADD/OCD+perfectionism+med choices-plz help(lon, posted by g_g_g_unit on January 10, 2010, at 16:30:43
> > I have had this problem at my jobs. I have come to see it as a combination of an inability to concentrate fully on a task due to anxiety and depression, and the lack of energy and enthusiasm for the task due to depression. I used to be employed as a computer programmer, but it required too much concentration. I ended up having to quit, because it was clear that the issues weren't going away.
>
>
> these problems existed prior to the onset of any anxiety/depression issues; they were occurring in high school, so i consider them innate problems.Is it possible that you were depressed in high school and didn't know it?
> >
> > >
> > > unfortunately, i've become so reliant on that perfectionistic 'inner voice', that i often feel lost acting without it.
> >
> > I think I know what you mean. In myself, I see this as being preoccupied with my inner state due to depression. When I am less depressed, I can focus on something outside myself.
>
> i've always felt that way, though - the feeling that i'm constantly monitoring myself in everything i do. certain medications erase that critical voice (for the first time in my life), and disinhibit me to an extent, which can be really disorientating
> >
> >
> > >
> > > my therapist and i have tried to work out more logical goals for me to attempt to undertake. my family is moving to a new country soon, which means that i need to prioritize. at this point, my former line of work as a freelance writer is causing too much grief (due to too much freedom afforded) for me to really pursue it as a realistic career. so in that sense, i think it might be better to return to university in order to undertake an honor's/masters in an area that might allow me to get a normal job. i also suffer from pretty crippling social anxiety, so feel like that side of things needs to be taken care of.
> > >
> >
> > You may want to look for something that requires less decision-making and personal initiative, unless you are hopeful that you can conquer your anxiety and depression.
>
> i suffer from dysthymia with bouts of atypical depression, though i feel like the depression etc. takes a backseat to OCD overall. i don't think getting the depression under control should be too difficult overall; it's a matter of whether i can stick with a treatment. and i'm still relatively young, so i'd like to capitalize on what i have now.
> >
> >
>
> > >
> > >
> >
> >
> > I think you are trying to slice up your problem into excessively small pieces and trying to treat each one individually. I think that you could re-envision all of your symptoms as manifestations of depression and anxiety, and treat them all with antidepressants. From what you have written on this board, I don't think you have given SSRIs a fair chance to work.
>
> social anxiety is a concrete problem for me, and something that i feel requires attention. i did give Luvox a full 8-week trial, and found myself more depressed than i began with. it made social interaction incredibly difficult for me. Prozac seemed better, and i don't really understand why i was taken off it - doesn't the initial insomnia pass?If you have anxiety and OCD, those are treated basically the same way as depression.
The insomnia may or may not pass. There are no guarantees.
Posted by g_g_g_unit on January 10, 2010, at 20:52:20
In reply to Re: ADD/OCD+perfectionism+med choices-plz help(lon, posted by floatingbridge on January 10, 2010, at 18:07:48
> Oh dear, ggg. Well, I think the insight regarding perfection is vital however upsetting. Therapy sounds good for you.
yeah - like i say, it's not all as dismal as it sounds. i'm proud of some of the things i accomplished in that myopic state. but overall it's pretty torturous. the most frustrating thing is finding out that letting go of your standards still doesn't ensure success. it just accustoms you to failure (in certain areas of life, anyway).
>
> Dexadrine sounds like a sensible trial. I'm not sure why you say it could be a disaster in the hands of a perfectionist. Hope it provides you with some relief.i just thought that increased mental energy might afford more incentive to carry out perfectionist rituals. which i guess is where therapy comes in.
>
> I'll be following this thread.
>
> fb (dx'd w/ add and crippling perfectionism and social anxiety--the dexadrine works for the social anxiety for me!)
>
oh well, it's nice to know i'm not alone in this. i have a sneaking suspicion that most of my closest friends, and women i find myself attracted, suffer from a similar affliction. then again, i'm sure every human being on the planet does to some extent.how did you manage to come to terms with yours?
thanks for your enduring support, and hope you're doing okay.
Posted by g_g_g_unit on January 11, 2010, at 4:37:26
In reply to Re: ADD/OCD+perfectionism+med choices-plz help(lon, posted by mtdewcmu on January 10, 2010, at 19:30:15
>
> Is it possible that you were depressed in high school and didn't know it?not that i know of. everything was pretty great up until i turned 17. i did however suffer from dysthmic symptoms since around the age of 10, which caused me to self-stimulate with video games, etc. behaviourally, i present with all the inattentive ADD symptoms, but i was placed in a gifted class at high school which forced me to regulate my behaviour to an extent, and covered up some of my academic shortcomings. i wonder how close the relationship between dysthymia and inattentive add might be.
>
>
>
> If you have anxiety and OCD, those are treated basically the same way as depression.
>
> The insomnia may or may not pass. There are no guarantees.well i guess i'm wondering if insomnia is a pretty common start-up side-effect with Prozac that's know to usually pass (in the same way SSRI start-up anxiety does), or if i was some kind of anomaly. i have a feeling my pdoc was just trying not to overload me with drugs (by adding a sleeping agent), since meditation was actually his first suggestion for me. if the prozac insomnia is transient, settling once the drug reaches a steady blood concentration, then it would be the drug i would return to first at this point.
Posted by floatingbridge on January 13, 2010, at 11:24:35
In reply to Re: ADD/OCD+perfectionism+med choices-plz help(lon, posted by g_g_g_unit on January 10, 2010, at 20:52:20
Ummmm, I don't think I've quite come to terms with it :-/ Awareness of the perfectionist trait, leading to some elp acceptance has helped modify behavior and provides some humor. And therapy.
Add and perfectionism are perverse, ironic companions.
Not sure dex helps perfectionist issues--does, though increasingly less effectively, help w/ social anxiety.
fb
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