![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by Peter on March 1, 2002, at 11:39:15
Hi all:
My pdoc has me on a regime now that he insists is right for me, but I can't help but have this really uneasy feeling about it. I was going to get a second opinion from another pdoc, but I know alot of you are extremely knowledgeable and can help me as much if not more than a doc with my concerns.
I used to be a cocaine and herion abuser in the mid 90's. I then went to rehabs for a year and entered AA. That was until about '97, when I left and, with the help of friends, therapy, and my 'higher power', I have been sober since (except for the ocassional drink).
I've been seeing my pdoc since '97, when I completely came off of illicit drugs, and he put me on depakote, believing I had dysphoric hypomania which fueled my drug abuse. Over the last five years, he's added a slew of other meds to target other problems that arose-depression, anxiety (SP), etc.. I tried just about every single SSRI, and they all had the same effect on me-they would help for a few weeks, and then the increase of seratonin would produce a decrease in dopamine, and I would get very impulsive and crave drugs, and end up relapsing almost every time. He also tried me on dopamine-agonists, beta-blockers, benzos (I'm still on klonopin 1.5mg daily), moclobemide, effexor, wellbutrin, and different mood-stabilizers, all in different combinations.
After attempthing, with his help, to come off of all medication twice unsuccesfully, he decided that we start a new regime of neurontin (for mood stability and anxiety), sticking with the klonopin, and adderall XR. His theory is that the stimulant would help me more than an anti-depressant, as he believes the depressive episodes I fall into are due to dopamine deficiency, not seratonin. He also told me that, as we have been meeting for years, and he knows alot about my history, he believes I have adult ADHD, so the adderall can have a dual benefit.
This sounds like it makes sense, theoretically. But I'm disturbed by 3 things:
1) I'm an ex-addict; he knows that, but I can't seem to get the lingering thought out of my head that I am 'active' in my addiction again since I am taking 'speed.' This is what my rehab experience has ingrained in my psyche, and, though, I have not abused the adderall, I'm upset at the very principle of this thought. My pdoc has said there is no more chance of relapse (perhaps even less of chance) with me on a stimulant. The 'rehab mentality' would consider this replacing one vice with another.
2) I can see his notion of targeting the dopamine to alleviate depressive cycles, but I have not found one article across the entire web justifying the use of stimulants alone for depression (except in terminally-ill patients). This lack of documentation makes me think my pdoc is just speculating about the possibility of this working, basing it on some anecdotal evidence. I feel this might be insufficient.
3) I'm also uncomfortable with the fact that I've been diagnosed with ADD, although there hasn't been any real tesing. But my doc does not believe that diagnostic psychiatric testing is any more reliable for an ADD diagnosis than an office visit with a professional pdoc. I would, of course, feel better knowing that I definitely have adult ADD. ANYTHING TO JUSTIFY IN MY MIND MY USING ADDERALL-SUCH JUSTIFICATION WOULD REALLY LIFT THESE INCESSANT WORRIES.
Sorry for the length, but I'd REALLY appreciate any help. Thanks,
Peter
Posted by cmcdougall on March 1, 2002, at 20:28:50
In reply to stims for ex-addict w/ treatment-resistant depr., posted by Peter on March 1, 2002, at 11:39:15
Hi Peter,
Just a small FYI - stimulants (mostly dexedrine)were the first antidepressants used... For some people they are the only thing that does work. For depression, I think they are mostly used to augment other ADs.
Really, your pdoc is correct. A "formal" test might not be any better at diagnosing ADD than an hour spent w/ a good pdoc.
Don't think of the Adderal as "speed". It is a prescribed medicine - a treatment for serious and potentially debilitating illness. And as for trading one addiction for another.... Thats just rubbish. If you had to take insulin injections that thought would never enter your mind!
Love and luck,
Carly
Posted by rxcuriousity on March 2, 2002, at 0:03:09
In reply to stims for ex-addict w/ treatment-resistant depr., posted by Peter on March 1, 2002, at 11:39:15
I hear you, Peter. I, too, am an "ex-addict". I am part of the AA fellowship and often question my motivation in trying new combinations of drugs to treat my depression. I recently had my doctor prescribe me Provigil. Provigil is a psychostimulant with a low abuse potential. Nevertheless, I question why I sought the drug out, and was excited to try it (Even though I would be extremely tired without it, as I take 262.5mg of Effexor XR/day).
I agree with Carly. I don't believe the drug itself jeopardizes your sobriety. The drug seems to be enhancing your quality of life. Go easy on yourself.
As addicts, it is important for us to remain vigilant about our use of anything mind-altering. My recomendation is to use what works, but remain vigilant. You also might want to check in with a 12-Step group from time to time to share your concerns. You might find that there's someone else like you (for instance, me) dealing with the same issue.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.