Psycho-Babble Medication Thread 1065850

Shown: posts 1 to 13 of 13. This is the beginning of the thread.

 

Been Seeking Adult ADHD 20mnths. Success! One prob

Posted by dixieland on May 20, 2014, at 16:59:32

I do not have a family doctor. I generally go to clinics and today I went to seek treatment for a cough I've been having that was diagnosed as allergic. Normally I've never had to fill out "what meds are you taking" but I went ahead and put every single med the PDOC I've been seeing for about 20 months has put be on for a rather hard to treat case of adult ADHD only.

Never been much of a depression guy or anything but I have a bad sort of focus at this office job I have now since I got promoted from a blue collar position and I have a little bit of stress from it. Work pays for my visits to this man a 2 hour round trip away. All I know is that it's free and it would be a $280 bill each time otherwise.

Now this doctor is complaining about my meds and work was already complaining about them since they pay to fill every single one that this doctor has put me on. This general doctor says I'm on too many; do you guys think this is true? The doctor I go to says it is normal for many of his patients to be on the number of meds I'm on and looking on this board it seems to be true.

I trust this top-of-the-field doctor over this general doctor I found in the phonebook but I want the opinions on safety or if I should cut or do anything. this is what I take and I'm very very happy with it. Doctor says while it is a lot there aren't any interactions there are worrisome.

Doctor calls these "Maintenance Remedies" :

Straterra 100 mg
Namenda XR 28 mg
Fetzima 120 mg
Aptiom 800 mg

Doctor Calls these "Dopamine" Remedies since I have a dopamine problem:

Daytrana 15 mg (1.6mg/hr)
Focalin 7.5 mg
Focalin XR 15 mg X 2
Nuvigil 50 mg X 3
Mirapex ER 3.75 mg

Stress Remedies:

Lyrica 150 mg X 3
Klonopin Wafers 1 mg X 3
Intuniv 3 mg

Example Work-day Drug Schedule my doctor made that I try to stick with:

7:45 A.M.:
Fetzima 120 mg
Mirapex ER 3.75 mg
Daytrana 15mg
Focalin XR 15 mg
Focalin 7.5 mg
Nuvigil 50mg. X 1
Lyrica 150mg.

8:30 A.M.:
Klonopin 1mg under tongue until I'm in car driving


1:45 P.M.:
Focalin XR 15 mg
Nuvigil 50 mg X 2 to beat that 2 o' clock groggy feeling
Klonopin 1mg
Lyrica 150 mg

8:15 P.M.:
Lyrica 150 mg takes longer to kick in

10:00 P.M.:
Klonopin 1 mg
Namenda XR 28 mg
Aptiom 800 mg
Intuniv 3 mg
Straterra 100 mg
--------------


Straterra 100 mg -- seems to do more for my focus than the focalin does but the focalin is more important somehow

Namenda XR 28 mg -- not sure what this does for me to be honest but I feel sharper and doctor says I may not get used to the Focalin as fast as it seems I need a lot of it

Fetzima 120 mg -- while I said I wasn't a depressed type of person, this has bettered my mood, not sure about ADHD, but I want to keep it for positive mood effect. thanks, doc.

Aptiom 800 mg -- same thing, better mood, more calm, I guess I would say more focused on this. good medicine.

Daytrana 15 mg (1.6mg/hr) -- beats the pills out, really smooth than just relying on XR pills, big fan, like it better than the Vyvanse we tried first

Focalin 7.5 mg -- this is to kickstart the morning. my doctor says the daytrana patch and the XR pill need to get in my system but this puts it in my system at once to get me ready for the day

Focalin XR 15 mg X 2 -- needed

Nuvigil 50 mg X 3 -- helps with that after lunch tiredness and the one in the morning helps me wake up a bit too. big fan

Mirapex ER 3.75 mg -- subtle is all I can say. I could give it up. I think I noticed an improvement however, seems to go good with the fetzima with synergy

Lyrica 150 mg X 3 -- at first, it was too euphoric perhaps, now it smooths out my day and has brightened my outlook on life. sometimes i think that people that get antidepressants should just get this stuff. prefer it to klonopin for stress but takes awhile to kick in and not as noticeable, also seems to cause some cognitive dulling.

Klonopin Wafers 1 mg X 3 -- no longer let little things bother me, not edgy, easygoing attitude has made an inspirational leader at work, little development of tolerance, ensures great sleep. vital.

Intuniv 3 mg -- synergistic with focalin for blood pressure concerns and I think it may teeny-tiny contribute to relief of ADHD symptoms

I rate my medicine "cocktail", wow can't believe Im useing this word, a 10/10 and my doctor a 10/10. I have made tremendous life changes with these medicines. I'd say my life was a 5.6/10 before medicine and now it is a 8.4/10.

Psychiatric medicine is astonishing I had no idea it cold do so much.

Is my doctor right in the fact that there aren't any rough interactions and my other doctor wrong however and how long can I keep this up? Is this normal?

thanks for replies to my long winded comment I just have so much to learn

do you think I have the right doctor? as in my treatment is proper?

 

Re: Been Seeking Adult ADHD 20mnths. Success! One prob

Posted by LouisianaSportsman on May 20, 2014, at 17:59:14

In reply to Been Seeking Adult ADHD 20mnths. Success! One prob, posted by dixieland on May 20, 2014, at 16:59:32

Hey, buddy! Where are you from? I notice you're from "dixieland"? You couldn't have come to a better place to get your questions answered! And, hmm, you also remind me of myself a little bit, must be a southern thing or I'm not sure. I can't put my finger on it, just your mannerisms are like mine. So stay around after your questions have been answered! You made one of the most interesting threads on here, actually and It doesn't sound like you have too much to learn because you were able to transcribe down those medicines rather craftily for someone who is completely "inexperienced". I'm sure you have some idea of rather what you're taking is safe or not.

Let's get to "business".

Is your doctor a he or a she because you were gender neutral the entire time, it just sounds a bit like my doctor lol, especially considering your name (geographic location) and the number of medications as well as that price. I'll Babblemail you something. Don't give any details until you read that haha.

No, it is NOT NORMAL to be on what I see to be TWELVE MEDICATIONS! I used to on EIGHT and I thought that too many, but in your case, I did a Lexicomp (it's what doctors actually use to check interactions) and Micromedex (a pay-to-use interactions checker) check and you come up clean. There are no contraindications or major interactions between any of your medications; therefore, if all twelve of this medications are essential to your quality of life at this moment, then I suggest that you listen to your healthcare provider and not discontinue any of them unless directed to do so under their guidelines. Usually, when someone is prescribed TWELVE medications, there are major interactions to be wary of, but I simply do not see anything malicious about your cocktail that would advise discontinuation of anything that would jeopardize therapeutic benefit so my personal suggestion is to remain on all of your medications as directed.


 

Re: Been Seeking Adult ADHD 20mnths. Success! One prob

Posted by LouisianaSportsman on May 20, 2014, at 18:37:26

In reply to Been Seeking Adult ADHD 20mnths. Success! One prob, posted by dixieland on May 20, 2014, at 16:59:32

(Note: I think your doctor is brilliant and should post here. I don't think I've been more impressed by a cocktail on this forum and I find it hard to believe that you're so much, but there are no malicious interactions. It's a bit hard to believe this is even real, good medicine like this is hard to come by these days.)

This is the skeleton I'd work around here:

Daytrana 15 mg (1.6mg/hr)
Focalin 7.5 mg
Focalin XR 15 mg X 2

I do not think this overdosing at all; in fact, many patients have skiddish doctors when it comes to correctly dosing schedule II drugs. I also like how your keeps your blood plasma level stable with the Daytrana, gives you an immediate boost in the morning with the IR, and then supplements with the XRs. This is one of the best methylphenidate strategies I've seen utilized on the internet to date.

Nuvigil 50mg. X 3: I've always advocated the use of this with stimulants and I'm glad your doctor does too. I'm also glad that you use it strategically at that after-lunch portion of the day to reduce fatigue. Very smart use of this nootropic.

Adding the Namenda XR 28 mg ^^^ is a good augmentation to stimulant therapy, has good results in ADHD trials (as a D2 agonist) and can theoretically prevent tolerance buildup via NMDA receptors and glutamate. I'd say it's good to keep since you can afford it.

Fetzima 120 mg: Been around for awhile now as Savella. This akin to using Wellbutrin, but probably better since it has more a NE impact. I assume that the doctor thought that if responded well to Straterra, which you claimed gave you more focus that Focalin which is no small claim (also brings into play a minor drug interaction) that maybe this would benefit you as well. In that light, I see it being a good pick. You also mentioned stress being a factor in your life and this might help mitigate that a bit. Pretty good pick.

Aptiom 800 mg: I could see standing to lose this one although these is some evidence that carbamazepine had some limited effectiveness for ADHD. This version, an metabolite of Trileptal, came out just in time for use in your cocktail or otherwise, there would be some drug-drug interactions. It does reduce your seizure risk but so does the Lyrica and Klonopin. Your doctor likely didn't want your moods to be up and down by the use of all of these stimulants, benzos, antidepressants, etc. and wanted to use a mood stabilizer with ADHD benefits. I'll trust his intuition and say that this is an appropriate medication for you. Might be somewhat stress-relieving. It's brand new.

Lyrica 150 mg x 3: Finally! A doctor that knows how to appropriately dose pregabalin for anxiolytic response. This truly is an amazing medication for a number of reasons as you mentioned and you may not need the Klonopin. Good pick.

Klonopin Wafers 1 mg X 3: Best maintenance benzo for generalized anxiety there is. May not need both Lyrica and Klonopin, but I see synergy here especially since you said you get good sleep with it.

Intuniv 3 mg: With the BP concerns arising from your other medications, this is likely a good pick with ADHD benefits as well. Solid choice.

One caveat: Mirapex ER 3.75 mg: I don't see much benefit with this one. Are you taking it before bed? That's when you should be taking it or I think that's when your doctor intended for you to take it. Perhaps you made a mistake here? Was it for sexual side effects? I think you were unclear here. Was it for Fetzima's sexual side effects? It is neurotrophic and promotes the growth a new neurons and could relax you to fall asleep via the DA pathway. I think you meant to put this in the night category. If not, you could stand to lose it.

I think you're on one of the best advanced treatments for Adult ADHD currently offered in psychiatry to be honest. I think you have an extremely intelligent doctor who knows what he is doing-- not the doctor in the phonebook.

I think you know who to trust.

 

Re: Been Seeking Adult ADHD 20mnths. Success! One prob

Posted by Babbler20 on May 20, 2014, at 20:23:10

In reply to Been Seeking Adult ADHD 20mnths. Success! One prob, posted by dixieland on May 20, 2014, at 16:59:32

Holy crap! Are you on all these meds? Inused to think I had ADD and then I started sleeping better. Do you sleep for at least 7 hrs a night. If not, try sleeping at least 7 with the help of medication as needed, and see how you feel.

 

Re: Been Seeking Adult ADHD 20mnths. Success! One prob

Posted by Phillipa on May 20, 2014, at 21:33:47

In reply to Re: Been Seeking Adult ADHD 20mnths. Success! One prob, posted by Babbler20 on May 20, 2014, at 20:23:10

I feel that's a lot of meds to be on. And driving while taking them all? Phillipa

 

Re: Been Seeking Adult ADHD 20mnths. Success! One prob

Posted by LouisianaSportsman on May 20, 2014, at 23:14:42

In reply to Re: Been Seeking Adult ADHD 20mnths. Success! One prob, posted by Phillipa on May 20, 2014, at 21:33:47

> I feel that's a lot of meds to be on. And driving while taking them all? Phillipa

Yes, I feel there is an extreme cardiovascular risk that dixie's doctor is downplaying to him. I'm surprised he's not worried about a malpractice lawsuit. Or if dixie is not pulling our leg.... yet it does work out via my analysis.

I'm just not sure what to think about it.

 

to Phillipa

Posted by LouisianaSportsman on May 20, 2014, at 23:17:52

In reply to Re: Been Seeking Adult ADHD 20mnths. Success! One prob, posted by LouisianaSportsman on May 20, 2014, at 23:14:42

> > I feel that's a lot of meds to be on. And driving while taking them all? Phillipa

I'm not sure why he can't drive? Oh, I'll get back with your email, Phillipa. I don't ever check that email I signed up for babble with and I just remembered I never got back with you.

 

Re: Been Seeking Adult ADHD 20mnths. Success! One prob

Posted by dixieland on May 20, 2014, at 23:46:46

In reply to Re: Been Seeking Adult ADHD 20mnths. Success! One prob, posted by LouisianaSportsman on May 20, 2014, at 18:37:26

I never received any email from you Louisiana; over here In the same state, it should be here by now. I was waiting on that response before saying anything, but you just commented again. You may have been the one from the waiting room who told me about this sight. mla? ddd? Email me at: dixielandtw@gmail.com

And, my doctor is actually a female as well. think I used wrong gender reference noun. another mistake I made is that i do that Mirapax XR pramiprexole at night.

if it's true you said she did right you eight meds and almost did you more, reassured me about things for awhlile; she aint really worried almost a suit, but this needs to be deleted. How do I delete a post on this webforum page? I did not think you would respond like that.

Thanks Dr. Bob!

 

Re: Been Seeking Adult ADHD 20mnths. Success! One prob

Posted by LouisianaSportsman on May 21, 2014, at 1:07:19

In reply to Re: Been Seeking Adult ADHD 20mnths. Success! One prob, posted by dixieland on May 20, 2014, at 23:46:46

> I never received any email from you Louisiana; over here In the same state, it should be here by now. I was waiting on that response before saying anything, but you just commented again. You may have been the one from the waiting room who told me about this sight. mla? ddd? Email me at: dixielandtw@gmail.com
>
> And, my doctor is actually a female as well. think I used wrong gender reference noun. another mistake I made is that i do that Mirapax XR pramiprexole at night.
>
> if it's true you said she did right you eight meds and almost did you more, reassured me about things for awhlile; she aint really worried almost a suit, but this needs to be deleted. How do I delete a post on this webforum page? I did not think you would respond like that.
>
> Thanks Dr. Bob!
>

I emailed you. Not sure if we got the same person.

 

Re: Been Seeking Adult ADHD 20mnths. Success! One prob

Posted by tom2228 on May 21, 2014, at 7:24:21

In reply to Re: Been Seeking Adult ADHD 20mnths. Success! One prob, posted by LouisianaSportsman on May 21, 2014, at 1:07:19

Wow Louisiana, a lawsuit? I don't see what is so wrong about this combination, especially if the client is as satisfied dixieland seems to be.. Regarding the cardiovascular risk, if the pulse is fine, there shouldn't be a problem. Having multiple medications that can affect pulse is kind of like one that's dosed particularly high (unless they affect the QTc interval which isn't the case for this combo). I don't think it's fair to scare someone who's reporting that they're doing fairly well. But that's my opinion.

While 11 (I count the Focalin IR and XR as 1) is an "abnormally" high number of medications, I'd say as long as you're feeling well, functioning in several domains of your life, doing better than before, not experiencing too much sedation/ cognitive impairment or too much numbing, not feeling too detached from life, its wonders, or relationships... that this is okay. Like you said, you are dealing with a refractory case of your illness, and refractory cases often need an innovative approach. It is difficult to find good care when your needs are high; I am glad you have found a doctor who sounds like he has the expertise, out-of-the-box approach, and willingness to take on your case. Other doctors, including other psychiatrists, may have their opinions, but if you are being treated well under someone else's care and not having medical complications under that regimen, it's none of their business to tell you what's right especially if they don't have extensive knowledge of psychiatry.

I take 8 medications myself, but I have several diagnoses and my depression is agonizingly difficult to treat. I DO have major drug interactions, but they are well monitored/ managed. Unlike the dixie, I'm not doing wholly well, but am on the right track/ getting close. I am hoping to downsize my combination because I was feeling a bit numb/ having difficulty with cognition, but that might not be feasible in terms of the number of medications due to how refractory my case is, and might be better achieved by switching and modifying doses.

I too have ADHD and understand that it can be difficult to treat. While Desoxyn works well for me, Mirapex, notriptyline, and Marplan have brought me closer to optimal control that I cannot achieve with a stimulant alone. I feel my cognition is moot without the Mirapex although the sedation is hard to deal with. And while mood stabilizers are not really indicated for ADHD, they can slow down hyperactive thoughts and behaviors leading to better focus, but in my case I suspect that this is because I'm bipolar.

Just so you know I am taking the following for refractory depression/ bipolar/ ADHD/ anxiety (generalized and social), and personality issues.

Marplan 40mg
Nortriptyline 25mg (tapered down to switch due to sedation/ cognitive impairment)
Deplin 30mg
Desoxyn 22.5mg
Mirapex ER 0.375mg (hoping to switch due to sedation/ sleepiness)
lithium 900mg (0.4-.5 blood level)
Lamictal 100mg (lowered due to cognitive impairment/ numbing)
Abilify 10mg (hoping to switch due to tiredness/ flatness/ hunger/ lack of interest/ motivation)

was also on Wellbutrin 75mg (supposed to be in place of the nortriptyline) for a week but that didn't work out. Stopped as of yesterday.

I would also suggest that in taking so much medication you have therapy to supplement it/ help you understand and sort through how your medications affect the way you relate to yourself, others, and the world. It is easy to get lost in your own head when you are taking so much.

Best to you,
Tom


 

Re: Been Seeking Adult ADHD 20mnths. Success! One prob

Posted by LouisianaSportsman on May 21, 2014, at 7:33:12

In reply to Re: Been Seeking Adult ADHD 20mnths. Success! One prob, posted by tom2228 on May 21, 2014, at 7:24:21

You must read a email I sent you, Tom.

 

Re: Been Seeking Adult ADHD 20mnths. Success! One prob

Posted by tom2228 on May 21, 2014, at 8:34:43

In reply to Re: Been Seeking Adult ADHD 20mnths. Success! One prob, posted by LouisianaSportsman on May 21, 2014, at 7:33:12

Oh, and I can drive fine on all my meds. Could drive fine when was on Ativan too. The Wellbutrin I was on for the last week actually made it it more difficult but that's no more.

 

Re: names dixieland

Posted by Dr. Bob on May 23, 2014, at 2:02:24

In reply to Re: Been Seeking Adult ADHD 20mnths. Success! One prob, posted by dixieland on May 20, 2014, at 23:46:46

> I never received any email from you Louisiana; over here In the same state, it should be here by now.

Please don't post under more than one name at the same time or change your posting name without following these steps:

http://www.dr-bob.org/babble/faq.html#names

Thanks,

Bob


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